Analysis Of Lymph Node Metastasis Research Articles

Analysis of lymph node metastasis and survival prognosis in early gastric cancer patients: A retrospective study.

Early gastric cancer (EGC) is a common malignant tumor of the digestive system, and its lymph node metastasis and survival prognosis have been concerning. By retrospectively analyzing the clinical data of EGC patients, we can better understand the status of lymph node metastasis and its impact on survival and prognosis. To evaluate the prognosis of EGC patients and the factors that affect lymph node metastasis. The clinicopathological data of 1011 patients with EGC admitted to our hospital between January 2015 and December 2023 were collected in a retrospective cohort study. There were 561 males and 450 females. The mean age was 58 ± 11 years. The patient underwent radical gastrectomy. The status of lymph node metastasis in each group was determined according to the pathological examination results of surgical specimens. The outcomes were as follows: (1) Lymph node metastasis in EGC patients; (2) Analysis of influencing factors of lymph node metastasis in EGC; and (3) Analysis of prognostic factors in patients with EGC. Normally distributed measurement data are expressed as mean ± SD, and a t test was used for comparisons between groups. The data are expressed as absolute numbers or percentages, and the chi-square test was used for comparisons between groups. Rank data were compared using a nonparametric rank sum test. A log-rank test and a logistic regression model were used for univariate analysis. A logistic stepwise regression model and a Cox stepwise regression model were used for multivariate analysis. The Kaplan-Meier method was used to calculate the survival rate and construct survival curves. A log-rank test was used for survival analysis. Analysis of influencing factors of lymph node metastasis in EGC. The results of the multifactor analysis showed that tumor length and diameter, tumor site, tumor invasion depth, vascular thrombus, and tumor differentiation degree were independent influencing factors for lymph node metastasis in patients with EGC (odds ratios = 1.80, 1.49, 2.65, 5.76, and 0.60; 95%CI: 1.29-2.50, 1.11-2.00, 1.81-3.88, 3.87-8.59, and 0.48-0.76, respectively; P < 0.05). Analysis of prognostic factors in patients with EGC. All 1011 patients with EGC were followed up for 43 (0-13) months. The 3-year overall survival rate was 97.32%. Multivariate analysis revealed that age > 60 years and lymph node metastasis were independent risk factors for prognosis in patients with EGC (hazard ratio = 9.50, 2.20; 95%CI: 3.31-27.29, 1.00-4.87; P < 0.05). Further analysis revealed that the 3-year overall survival rates of gastric cancer patients aged > 60 years and ≤ 60 years were 99.37% and 94.66%, respectively, and the difference was statistically significant (P < 0.05). The 3-year overall survival rates of patients with and without lymph node metastasis were 95.42% and 97.92%, respectively, and the difference was statistically significant (P < 0.05). The lymph node metastasis rate of EGC patients was 23.64%. Tumor length, tumor site, tumor infiltration depth, vascular cancer thrombin, and tumor differentiation degree were found to be independent factors affecting lymph node metastasis in EGC patients. Age > 60 years and lymph node metastasis are independent risk factors for EGC prognosis.

Risk factor analysis of lymph node metastasis in endometrial carcinoma combined with molecular types

Objective: To investigate the relationships between molecular types of the cancer genome atlas (TCGA) of patients with endometrial carcinoma (EC) and lymph node metastasis and other clinicopathological features. Methods: The clinical pathological information of 295 patients with EC who underwent initial inpatient surgical treatment and accepted the detection of the molecular types of TCGA with next-generation sequencing technology at Peking University People's Hospital were collected during April 2016 and May 2022. The TCGA molecular typing of EC was divided into four types: POLE-ultramutated (15 cases), high microsatellite instability (MSI-H; 50 cases), copy-number low (CNL; 175 cases), and copy-number high (CNH; 55 cases). The differences of clinical pathological features among different molecular types and the risk factors of lymph node metastasis were analyzed retrospectively. Results: Among 295 patients with EC, the average age was (56.9±0.6) years. (1) There was a statistically significant difference in lymph node metastasis (0, 8.0%, 10.3% and 25.5%) among the four molecular types (χ2=12.524, P=0.006). There were significant differences in age, stage, pathological type, grade (only endometrioid carcinoma), myometrium invasion, lymphatic vascular space infiltration, and estrogen receptor among the EC patients of four molecular types (all P<0.05). Among them, while in the patients with CNH type, the pathological grade was G3, the pathological type was non-endometrioid carcinoma, and the proportion of myographic infiltration depth ≥1/2 were higher (all P<0.05). (2) Univariate analysis suggested that pathological type, grade, myometrium infiltration depth, cervical interstitial infiltration, lymphatic vascular space infiltration, and progesterone receptor were all factors which significantly influence lymph node metastasis (all P<0.01); multivariate analysis suggested that the lymphatic vascular space infiltration was an independent risk factor for lymph node metastasis (OR=5.884, 95%CI: 1.633-21.211; P=0.007). (3) The factors related to lymph node metastasis were different in patients with different molecular types. In the patients with MSI-H, the non-endometrioid carcinoma of pathological type was independent risk factor for lymph node metastasis (OR=29.010, 95%CI: 2.067-407.173; P=0.012). In the patients with CNL, myometrium infiltration depth≥1/2 (OR=4.995, 95%CI: 1.225-20.376; P=0.025), lymphatic vascular space infiltration (OR=14.577, 95%CI: 3.603-58.968; P<0.001) were the independent risk factors for lymph node metastasis. While in the CNH type patients pathological type of non-endometrioid carcinoma (OR=7.451, 95%CI: 1.127-49.281; P=0.037), cervical interstitial infiltration (OR=22.938, 95%CI: 1.207-436.012; P=0.037), lymphatic vascular space infiltration (OR=9.404, 95%CI: 1.609-54.969; P=0.013), were the independent risk factors for lymph node metastasis. Conclusions: POLE-ultramutated EC patients have the lowest risk of lymph node metastasis, and CNH patients have the highest risk of lymph node metastasis. The risk factors of lymph node metastasis of different molecular types are different. According to preoperative pathological and imaging data, lymph node metastasis is more likely to occur in patients with non-endometrioid carcinoma in MSI-H and CNH type patients, and lymph node metastasis is more likely to occur in patients with myometrium infiltration depth ≥1/2 in CNL type patients.

SMAD4 and KCNQ3 alterations are associated with lymph node metastases in oesophageal adenocarcinoma

Metastasis in oesophageal adenocarcinoma (OAC) is an important predictor of survival. Radiological staging is used to stage metastases in patients, and guide treatment selection, but is limited by the accuracy of the approach. Improvements in staging will lead to improved clinical decision making and patient outcomes. Sequencing studies on primary tumours and pre-cancerous tissue have revealed the mutational landscape of OAC, and increasingly cheap and widespread sequencing approaches offer the potential to improve staging assessment. In this work we present an analysis of lymph node metastases found by radiological and pathological sampling, identifying new roles of the genes SMAD4 and KCNQ3 in metastasis. Through transcriptomic analysis we find that both genes are associated with canonical Wnt pathway activity, but KCNQ3 is uniquely associated with changes in planar cell polaritiy associated with non-canonical Wnt signalling. We go on to validate our observations in KCNQ3 in cell line and xenograph systems, showing that overexpression of KCNQ3 reduces wound closure and the number of metastases observed. Our results suggest both genes as novel biomarkers of metastatic risk and offer new potential routes to drug targeting.

Correlation of Diffusion-weighted MR imaging and FDG PET/CT in the Diagnosis of Metastatic Lymph Nodes of Head and Neck Malignant Tumors

Objectives: The aim of this study was to investigate the efficacy of DW-MRI as a reliable imaging modality for detecting metastatic neck lymph nodes of head and neck SCC.&#x0D; Methods: 32 patients underwent FDG PET/CT and diffusion-weighted MRI were evaluated. Histopathologic analysis of lymph node metastases was used as the gold standard for assessment. We analyzed differences in sensitivity, specificity, accuracy, positive predictive value and negative predictive value among the imaging modalities using the Chi-square test. Their discriminative power evaluated using the Receiver-Operating Characteristic curve and calculation of the area under the curve. The correlation between ADCmin and SUVmax was calculated using the Spearman test. SPSS 24 was used for statistical analyses. P value of 0.05 indicates a statistically significant difference.&#x0D; Results: A total of 32 patients with 50 neck dissections with head and neck SCC included. Sensitivity, specificity, accuracy, positive and negative predictive value of neck palpation was %72, %60, %70, %62 and %80 respectively. Sensitivity, specificity, accuracy, positive and negative predictive value of DW-MRI was %87,5, %96,2, %92, %95,5 and %89,3 respectively, according to ADCmin cutoff value 0.82×10-3s/mm2 . Sensitivity, specificity, accuracy, positive and negative predictive value of FDG-PET/CT was %91,7, %100, %96, %100 and %92,9 , respectively ,according to SUVmax cutoff value 3.4. For all neck dissections, there was a statistically significant inverse correlation between ADCmin and SUVmax (P&lt;001).&#x0D; Conclusion: DW-MRI is reliable as detecting cervical lymph node metastases as FDG-PET/CT. DWI and FDG PET/CT could play a complementary role in clinical assessment.

Risk Factors for Lymph Node Metastasis and Recurrence in T1 Colorectal Cancer: Analysis of 801 Patients in a Single Institute.

To identify risk factors for lymph node metastasis and postoperative recurrence of pT1 colorectal cancer by clinicopathological study of surgically resected cases. In 801 patients with pT1 colorectal cancer who underwent surgical resection with lymph node dissection between April 2007 and January 2021, we evaluated clinicopathological factors (age, gender, BMI, serum CEA level, tumor localization, additional resection after endoscopic treatment, operation time, blood loss, histological type, tumor size, vascular invasion, and central lymph node dissection). We performed univariate and multivariate analyses to examine risk factors for lymph node metastasis. We also examined risk factors for recurrence in 583 patients up to December 2017. Lymph node metastasis was observed in 100/801 patients (12.5%). Multivariate analysis of lymph node metastasis showed that patients with positive lymphatic invasion (odds ratio 2.57, 95% CI 1.62-4.04, P < .0001), positive venous invasion (odds ratio 2.31, 95% CI 1.48-3.61, P = .0002), and histologically poorly differentiated type (odds ratio 4.54, 95% CI 1.35-15.2, P = .014) were identified as risk factors. Postoperative recurrence was observed in 18/580 patients (3.1%). Risk factors for postoperative recurrence were also examined, including preoperative endoscopic treatment (odds ratio 3.59, 95% CI 1.18-10.9, P = .024), positive venous invasion (odds ratio 3.63, 95% CI 1.22-10.8, P = .021), positive lymph node metastasis (odds ratio 4.91, 95% CI 1.10-21.8, P = .037) were extracted as risk factors. In this study, venous invasion, lymphatic invasion, and histologically poorly differentiated type were identified as risk factors for lymph node metastasis in T1 colorectal cancer, and positive venous invasion, positive lymph node metastasis, and preoperative endoscopic treatment were identified as risk factors for recurrence. We hope that large prospective study will lead to the development of a more specific treatment strategy, including endoscopic treatment and additional surgical resection.

Analysis of Lymph Node Metastasis and Risk Factors in 975 Patients with FIGO 2009 Stage IA–IIA Cervical Cancer

Objectives: The objective of this study was to summarize the rate of lymph node metastasis (LNM) of patients with stage IA–IIA cervical cancer and further analyze its distribution characteristics and related risk factors. Design: This study is a retrospective analysis of clinical data about cervical cancer. Participants: According to the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging standard, 975 patients with stage IA–IIA cervical cancer treated in our hospital from January 2010 to December 2018. Setting: This is a single-center study. Methods: The incidence and distribution of LNM were analyzed, and the influencing factors of cervical cancer LNM were analyzed using univariate and multivariate logistic regression. Results: In this study, the LNM rate was 14.8% (144/975), and a total of 20,288 lymph nodes were removed, among which 359 lymph nodes had metastasis. According to the number and frequency of metastatic lymph nodes in different regions, the metastatic rate was the highest in the external iliac regions. Univariate analysis showed that more than three pregnancies, tumor size >4 cm, gross type, FIGO stage, pathological type, positive lymphovascular space invasion (LVSI), deep cervical stromal invasion (outer half invasion), parametrial involvement, and uterine corpus invasion (UCI) were correlated with LNM (p < 0.05). Multivariate analysis showed that tumor lesion of >4 cm (odds ratio (OR) = 2.253, 95% confidence interval (CI): 1.486–3.416, p < 0.001), positive LVSI (OR = 5.353, 95% CI: 3.303–8.676, p < 0.001), deep cervical stromal invasion (OR = 3.461, 95% CI: 2.106–5.688, p < 0.001), and deep UCI (myometrial invasion ≥50%) (OR = 3.529, 95% CI: 1.321–9.427, p = 0.012) were independent risk factors for LNM. Limitations: Retrospective nature of the study and limitation to a single-center study are the limitations of the study. Conclusions: Patients with cervical cancer are more likely to have LNM with a tumor size of >4 cm, positive LVSI, deep cervical stromal invasion, or deep UCI. When these risk factors are present, the presence of LNM is possible, and attention should be paid. This study provides a certain reference value for predicting LNM risk for patients with early cervical cancer and for the stratified management of early cervical cancer treatment.

7P Predicting lymph node metastasis and molecular subtype from pathology united with genomics in breast cancer with multitask deep learning

In early-stage of breast cancer, the analysis of lymph node metastasis(LNM) and molecular subtypes is conductive to clinical diagnosis and treatment decision-making. Here we proposed a new Deep learning network architecture, called DeepCALM, Conducted with Attention mechanism to united genomics and pathology, that can simultaneously predict LNM and Molecular subtypes.

Abstract 980: Genomic characterization of lymph node metastases in papillary thyroid carcinoma following the Chernobyl accident reveals an expression profile specific to metastatic process

Abstract Following the Chernobyl nuclear power plant explosion in Ukraine in 1986, increased childhood exposure to radioactive iodine (131I), which occurred primarily through contaminated food sources, has been consistently associated with increased risk of developing papillary thyroid carcinoma (PTC). Increased frequency of cervical lymph node metastases (LNM) is well recognized in pediatric PTC, including pediatric cases following the Chernobyl accident. We recently leveraged the collection of fresh-frozen tumor tissues from the Chernobyl Tissue Bank to conduct a genomic landscape analysis of 440 cases of PTC that provided new insights into radiation-related molecular characteristics of PTC occurring after the accident (Morton et al., Science 2021). Here, we extend that study to conduct a genomic landscape analysis of LNMs for a subset of 48 PTC cases to investigate the specific genomic alterations occurring in LNM. The analysis set comprised 144 samples, including fresh-frozen treatment-naïve primary and LNM PTC tumor samples as well as matched normal tissue or blood. Overall, the mutational load was highly concordant between primary and metastatic PTC. On average, 50% of somatic single nucleotide variants and 97% structural variants were shared between primary and metastatic PTCs. In contrast, the burden of somatic copy number alterations (SCNA) between primary tumor and LNM pairs was less concordant, particularly for copy number gains, whereas most of the copy number loss was found to be shared between matched pairs. PTC is usually driven by one driver mutation, most often involving the mitogen-activated protein kinase (MAPK) pathway. All driver mutations were shared between primary and metastatic PTC and were clonal; thus, no additional driver mutations were detected in metastatic PTC. Notably, however, the matched pairs in this study disproportionately had fusion drivers (77%), whereas only 23% of the drivers were BRAF V600E and none were RAS mutations. Transcriptome analysis revealed differentially expressed genes (DEGs) in metastatic PTC compared to primary PTC; three-quarters of the DEGs were overexpressed in metastatic PTC. Half of the LNM overexpressed DEGs were members of the HOXC family, which has been linked with epithelial-mesenchymal transition in cancer progression. There was also reduced expression in LNM for the DLX family, which relates to TGF-beta signaling. Our findings did not reveal a relationship between radiation dose and expression profiles in the LNM, comparable to our findings for the primary PTCs. We still observe that the efficiency of the radiation-induced PTC is paramount and subsequent events are directly related to the drivers in the MAPK pathway. For the cervical LNMs, we observed expression profiles not observed in the primary PTC that could give new insights into PTC local metastases. Citation Format: Olivia W. Lee, Danielle M. Karyadi, Chip Stewart, Tetiana I. Bogdanova, Jieqiong Dai, Stephen W. Hartley, Sara J. Schonfeld, Vidushi Kapoor, Marko Krznaric, Meredith Yeager, Amy Hutchinson, Belynda D. Hicks, Casey L. Dagnall, Julie M. Gastier-Foster, Jay Bowen, Mitchell J. Machiela, Elizabeth K. Cahoon, Kiyohiko Mabuchi, Vladimir Drozdovitch, Sergii Masiuk, Mykola Chepurny, Liudmyla Y. Zurnadzhy, Amy Berrington de González, Gad Getz, Gerry A. Thomas, Mykola D. Tronko, Lindsay M. Morton, Stephen J. Chanock. Genomic characterization of lymph node metastases in papillary thyroid carcinoma following the Chernobyl accident reveals an expression profile specific to metastatic process [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 980.

Occult nodal metastasis in major salivary gland malignancy: An update from the National Cancer Database

ObjectivesMalignant salivary gland tumors are rare neoplasms that are vastly heterogenous in their histological patterns and clinical behaviors. As a consequence, studies have lacked the robust sample sizes needed to define treatment strategies. In this study, we used the National Cancer Database to identify the incidence of occult nodal metastasis and effect on overall survival for the most common malignant salivary gland subtypes. A retrospective review of patients in the National Cancer Database with primary site malignancies of major salivary glands between 2004 and 2016 was performed. Subjects included in the study underwent surgical treatment with and without adjuvant radiation and had complete information on TNM pathological stage. Materials and methods8,689 patients with primary malignant salivary gland cancer were analyzed. The sample was stratified by histologic subtype. Univariate analysis of lymph node metastasis of the whole cohort showed a higher risk of death (p < 0.001), when compared to those without. Also when comparing occult vs evident metastasis, the risk of death was higher for the latter (p < 0.001). Results and conclusionOccult cervical lymph node metastasis ranged from 14.9% to 35.8% in malignant salivary gland cancers, depending on histological subtype. Occult nodal metastasis was a poor prognostic factor with significantly worse overall survival.

Correlation between molecular prognostic factors and magnetic resonance imaging intravoxel incoherent motion histogram parameters in breast cancer

ObjectiveTo explore the efficacy of the quantitative parameter histogram analysis of intravoxel incoherent motion (IVIM) for different molecular prognostic factors of breast cancer. Materials and methodsA total of 72 patients with breast cancer who were confirmed by surgical pathology and underwent preoperative magnetic resonance imaging (MRI) were analyzed retrospectively. A region of interest (ROI) was drawn in each slice of the IVIM images. Whole-tumor histogram parameters were obtained with Firevoxel's software by accumulating all ROIs. Next, Kolmogorov-Smirnov test, Student's t-test, Mann-Whitney U test, receiver operating characteristic curve analysis and spearman rank correlation analysis were used to assess the relationship between histogram parameters and molecular prognostic factors of breast cancer. ResultsAmong estrogen receptor (ER)-negative ROCs, the apparent diffusion coefficient (ADC) 10th percentile had the highest ROC of 0.792, with a cut-off value of 0.788 × 10−3 mm2/s, and sensitivity and specificity of 0.714 and 0.867, respectively. The negative correlation between lymph node metastasis status and ADC standard deviation was significant (ρ = −0.44, the correlation coefficients was represented by ρ). Positive correlations were observed between hormonal expression of ER and progesterone receptor (PR) with heterogeneity metrics of ADC or perfusion fraction (f), such as ADC inhomogeneity (ρ = 0.37, ρ = 0.29) and f skewness (ρ = 0.32, ρ = 0.28). Negative correlations were observed with numerical metrics, such as the ADC median (ρ = −0.31, ρ = −0.34) and f 45th percentile (ρ = −0.35, ρ = −0.28). The positive correlations between human epidermal receptor factor-2 (HER2) and pseudo-diffusivity (Dp) numerical metrics, Ki-67 expression, and heterogeneity metrics of Dp were high. ConclusionsThe ADC 10th percentile had the largest area under the curve in the ER-negative ROC analysis, and the ADC standard deviation was the most valuable in the correlation analysis of lymph node metastasis. Whole-lesion quantitative histogram parameters of IVIM could, therefore, provide a scientific basis for radiomics to further guide clinical practice in the prognosis of breast cancer.

A Population-based Analysis of Lymph Node Metastasis in Extremity Soft Tissue Sarcoma: An Update

BackgroundSoft tissue sarcomas (STSs) are mesenchymal tumors that may rarely metastasize to lymph nodes. This investigation sought to evaluate regional lymph node metastasis (RLNM) in extremity STS using a national cohort. Materials and methodsThis study was a retrospective review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016. A Cox proportional hazards model was used to identify prognostic factors associated with disease-specific survival (DSS). ResultsRLNM was present in 3.7% (n = 547) of extremity STS. The rate of RLNM was highest in rhabdomyosarcoma (26.7%), clear cell sarcoma (18.8%), epithelioid sarcoma (14.5%), angiosarcoma (8.1%), spindle cell sarcoma (5.0%), and synovial sarcoma (3.2%). The 5-year DSS probability without RLNM was 69% (standard error: 1.3%) compared to 26% (standard error: 3.6%) with RLNM (P < 0.001). For the historically high-risk extremity STS, advanced age (hazard ratio (HR), 1.036; 95% confidence interval (CI), 1.0-1.04; P < 0.001), higher grade tumors (HR, 1.979; 95% CI, 1.3-3.0; P < 0.001), tumor size greater than 10 cm (HR, 1.892; 95% CI, 1.3-2.7; P < 0.001), primary site surgery (HR, 0.529; 95% CI, 0.3-0.8; P = 0.006), distant metastasis (HR, 4.585; 95% CI, 3.0-6.8; P < 0.001), and RLNM (HR, 2.153; 95% CI, 1.3-3.5; P = 0.003) were each independent disease-specific prognostic factors. ConclusionsThe prognosis of RLNM in historically high-risk extremity STS is poor with a 5-year DSS of 26%. These data support a staging system of STS inclusive of nodal involvement and contribute to the growing body of evidence that characterizes the rates of RLNM in STS.

Clinicopathological features and risk factors analysis of lymph node metastasis and long-term prognosis in patients with synchronous multiple gastric cancer

BackgroundAs a common malignancy, gastric cancer (GC) remains an important threat to human’s health. The incidence of synchronous multiple gastric cancer (SMGC) has increased obviously with technical advances of endoscopic and pathological examinations. Several studies have investigated the relationship between SMGC and solitary gastric cancer (SGC). However, little is known about the relationship between early and advanced SMGCs, and the independent risk factors of lymph node metastasis and prognosis in SMGC patients remain unclear.MethodsWe retrospectively collected 57 patients diagnosed as SMGC and underwent radical gastrectomies from December 2011 to September 2019. Epidemiological data and clinicopathological characteristics of all patients were recorded. Postoperative follow-up was performed by telephone or outpatient service. Chi-squared test or Fisher’s exact test was adopted in analysis of categorical data. Continuous data were analyzed by using unpaired t test. Univariate and multivariate analyses were performed to investigate the independent risk factors of lymph node metastasis and tumor recurrence of SMGC.ResultsThere were 45 males and 12 females. The average age was 62.1 years old. There were 20 patients with early SMGC and 37 patients with advanced SMGC. Most of patients (91.2%) had two malignant lesions. Tumor recurrence occurred in 8 patients, among which 7 patients died from recurrence. The rates of total gastrectomy, tumor size ≥ 2 cm, poorly differentiated type, lymph node metastasis, ulcer and nerve invasion, and preoperative CEA level were significantly higher in advanced SMGC patients compared to those with early SMGC. Lymphovascular cancer plug and preoperative CA125 were the independent risk factors of lymph node metastasis in patients with SMGC. Lymph node metastasis, nerve invasion, and preoperative AFP might be the risk factors of tumor recurrence of SMGC, but need further validation.ConclusionsIn patients with SMGC, the presence of tumor size ≥ 2 cm, poorly differentiated type, lymph node metastasis, ulcer, nerve invasion, and relatively high preoperative CEA level might indicate the advanced SMGC. More attention should be paid to lymph node metastasis in SMGC patients with lymphovascular cancer plug and high preoperative CA125. Lymph node metastasis, nerve invasion, and preoperative AFP might be associated with recurrence of SMGC, needing further validation.

Variants in multiple genes are associated with esophageal cancer risk in a Chinese Han population: A case-control study.

The present study investigated whether 16 single nucleotide polymorphisms (SNPs), selected based on minor allele frequencies, Hardy-Weinberg equilibrium and reported SNPs related to the susceptibility of certain gastrointestinal cancer, were associated with esophageal cancer (EC) risk in a Chinese Han population. We genotyped 16 SNPs among 506 cases and 507 controls using Agena MassARRAY (Agena, San Diego, CA, USA). The association between 16 SNPs and EC risk was analyzed by a chi-squared test and genetic model analysis. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). rs1050631 and the rs6214 were associated with a decreased EC risk (OR = 0.75, p = 0.038; OR = 0.74, p = 0.045, respectively). In stratification analysis, the rs9868873 was associated with an increased EC risk (age < 64 years) (OR = 5.03, p = 0.005). The rs6214 was associated with a decreased EC risk (age < 64 years) (OR = 0.59, p = 0.025). The rs861530 was significantly associated with a decreased EC risk (age ≥ 64 years) (OR = 0.67, p = 0.046). rs1050631 was associated with a decreased EC risk in males (OR = 0.71, p = 0.034). In the stratified analysis of clinical stage III/IV, the rs1800566 was associated with a decreased EC risk (OR = 0.49, p = 0.024). Finally, the rs1052133 was associated with an elevated EC risk in the stratified analysis of lymph node metastasis (OR = 1.73, p = 0.025). The findings of the present study demonstrate that SLC39A6, IGF1, SEMA5B, XRCC3, NQO1 and OGG1 polymorphisms were associated with EC risk under multiple models.

MiR-143HG Gene Polymorphisms as Risk Factors for Gastric Cancer in Chinese Han Population.

MicroRNA (miRNA) is a pivotal regulator of the occurrence and development of various cancers. And gastric cancer (GC) is one of the most common and deadly cancers in the world. The aim of this study is to explore whether the microRNA-143 host gene (miR-143HG) polymorphisms are correlated with the risk of GC. 5 single-nucleotide polymorphisms (SNPs) were genotyped among 506 patients and 500 healthy controls in Han Chinese population. Multiple genetic models, stratification analysis and haplotype analysis were used to evaluate the association between miR-143HG polymorphisms and GC risk by calculating odds ratios (ORs), 95% confidence intervals (CIs). Our results indicated that rs11168100 was associated with decreased risk of GC under the Codominant model (OR = 0.67, 95%CI = 0.52-0.88, p = 0.003), and under the Dominant model (OR = 0.72, 95%CI = 0.56-0.92, p = 0.009). Rs353300 was associated with increased risk of GC under the Recessive model (OR = 1.41, 95%CI = 1.06-1.87, p = 0.017). Further, rs11168100 and rs353300 were correlated with the susceptibility of GC (age > 60 years), and three SNPs (rs12654195, rs353303, and rs353300) were related with the risk of GC (age ≤ 60 years). In addition, two SNPs (rs12654195 and rs11168100) were found to be associated with decrease in the susceptibility of GC in the female subgroup. Rs353300 represented two-sided roles in the occurrence and development of GC in female. Finally, rs3533003 was associated with decreased risk of GC in stratified analysis of lymph node metastasis. For the first time, our results provide some evidence on the polymorphisms of miR-143HG associated with GC risk in the Chinese Han population.

Analysis of lymph node metastasis in early gastric cancer: a single institutional experience from China

BackgroundLymph node metastasis (LNM) has a strong influence on the prognosis of patients with early gastric cancer (EGC). The aim of this study was to reveal the incidence of LNM and evaluate risk factors for LNM to determine the appropriate treatment for EGC in a Chinese population.MethodsPatients who underwent radical gastrectomy with lymph node dissection for EGC between 2012 and 2017 were retrospectively analyzed. Univariate and multivariate analyses were conducted to identify clinicopathological features that were risk factors for LNM.ResultsA total of 1033 patients with EGC were enrolled. Of these patients, 668 (64.7%) were men, and 365 (35.3%) were women, ranging in age from 19 to 82 years (mean 56.9 ± 10.9 years). LNM was detected in 173(16.7%) patients with EGC. Among 508 patients with mucosal cancer, 44 (8.7%) patients had LNM. In 525 patients with submucosal cancer, the incidence of LNM was 24.6% (129/525). The age, gender, tumor size, type of differentiation, Lauren classification, and lymphovascular and perineural invasion showed a significant correlation with the rate of LNM in EGC by univariate and multivariate analyses. Patients with submucosal gastric cancer had an older age, a higher proportion of proximal lesion, larger tumor size, more frequent lymphovascular invasion, perineural invasion, and more LNM than patients with mucosal gastric cancer.ConclusionsOur study revealed a relatively high incidence of LNM in EGC, compared with Japanese and Korean cohorts. Female sex, large tumor size, undifferentiated-type, and lymphovascular invasion were independent risk factors for LNM in EGC. Radical gastrectomy with lymphadenectomy should be performed in EGC patients with a high risk of LNM.

Analysis of lymph node metastasis in 200 patients with non-small cell lung cancer.

BackgroundLymph node metastasis occurs although clinical stage IA is a relatively early stage for patients with non-small cell lung cancer (NSCLC). This study aimed to explore the influencing factors of lymph node metastasis.MethodsA total of 200 patients diagnosed with clinical stage IA NSCLC preoperatively from July 2014 to July 2016 were examined. Every patient underwent lobectomy and systematic lymph node dissection. Their clinicopathological characteristics and status of lymph node metastasis are analyzed.ResultsThe rates of both N1 and N2 lymph node metastasis increase with the increase in the tumor diameter. The N1 lymph node metastasis rate is 0%, 2.82%, and 9.52%, while the N2 lymph node metastasis rate is 0%, 4.23%, and 25.40% for pure ground-glass nodules, mixed ground-glass nodules (solid component <50%), and mixed ground-glass nodules (solid component >50%), respectively. The difference is statistically significant (P=0.000). Patients with squamous cell carcinoma have a relatively higher N1 lymph node metastasis rate comparing with patients with adenocarcinoma (P<0.05). Tumors locate in the inner half lobe (close to hilus) are prone to metastasize to lymph nodes (P=0.018). Multiple regression analysis shows that tumor diameter, solid component rate, and tumor location are relevant factors for lymph node metastasis.ConclusionsIn patients with NSCLC, who have tumors smaller than 1 cm, pure ground-glass nodules, or tumors locate in the lateral half lobe, lymph node metastasis is rare and selective lymphadenectomy is considerable.

The association between lymph node metastases and long-term survival in patients with epithelial ovarian cancer.

IntroductionA key survival prognosis factor for patients treated for ovarian cancer is complete cytoreductive surgery where all macroscopic neoplastic implants, including enlarged metastatic lymph nodes, are removed. We presume that investigating the involvement of the lymphatic system can result in a more individualized approach to the treatment of ovarian cancer patients. The main aim of our study was to analyze the relationship between the presence, number and types of lymph node metastases and ovarian cancer patient prognosis.Material and methodsWe carried out a retrospective analysis of patients who underwent cytoreduction due to primary ovarian cancer, between 2010 and 2015. We analyzed the number of metastatic lymph nodes, the lymph node ratio defined as the ratio of the number of metastatic lymph nodes to the total number of lymph nodes removed, extracapsular involvement, and the histopathological pattern of metastases.ResultsThe study group included 651 patients. Of these, 377 had lymphadenectomy, 144 presented with lymph node metastases, and 233 had no lymph node metastases. We also included a group of 274 patients who did not have lymphadenectomy. Patients with more than 4 metastatic lymph nodes and a lymph node ratio of ≥ 0.1 had significantly poorer overall survival. Extracapsular involvement had no relation to patient overall survival. Multivariant survival analysis indicated that a lymph node ratio of ≥ 0.1 was an independent predictor of poor survival.ConclusionsThe analysis of lymph node metastases in ovarian cancer patients can have predictive value for patient overall survival.

Analysis of lymph node metastasis for hypopharyngeal carcinoma based on computed tomography

Objective To explore the pattern of lymph node metastasis and provide guidance for the delineation of clinical target volume for patients diagnosed with hypopharyngeal squamous cell carcinoma (HSCC). Methods A total of 123 patients who were initially diagnosed with HSCC by electrolaryngoscope and computed tomography (CT) of the head and neck in Shandong Tumor Hospital between 2014 and 2017 were recruited in this study. The lymph node metastasis was evaluated based on the diagnostic criteria of CT scan. The lymphatic metastasis ratio (LMR) at each node level was calculated. Analysis of variance (ANOVA) and χ2 test were used to analyze the relationship between LMR and primary tumors. Results Among 123 patients, primary tumors were originated from the pyriform sinus (PS) in 101 cases (82.1%), posterior pharyngeal wall (PPW) in 15(12.2%) and postcricoid (PC) in 7(5.7%), respectively. The overall LMR was calculated as 84.6%(n=104), in detail, 84.2% for patients with primary tumors originating from PS, 93.3% for those from PPW and 71.4% for patients from PC, respectively. For PS-derived tumors, the ipsilateral neck LMR at the level Ⅰa, Ⅰb, Ⅱa, Ⅱb, Ⅲ, Ⅳ, Ⅴ, Ⅵa, Ⅵb, and Ⅶ was 0, 3.0%, 66.3%, 42.6%, 46.5%, 10.9%, 5.0%, 2.0%, 7.9%, and 11.9%, respectively, and 0, 0, 14.9%, 5.0%, 3.0%, 2.0%, 0, 0, 3.0%, and 2.0% for the contralateral neck. For PPW tumors, the ipsilateral neck LMR at the level Ⅰa, Ⅰb, Ⅱa, Ⅱb, Ⅲ, Ⅳ, Ⅴ, Ⅵa, Ⅵb, and Ⅶ was 6.7%, 6.7%, 66.7%, 46.7%, 46.7%, 20.0%, 0, 13.3%, 33.3%, and 60.0%, respectively, and 6.7%, 6.7%, 33.3%, 26.7%, 20.0%, 20.0%, 0, 0, 13.3%, and 33.3% for the contralateral neck. For PC tumors, the ipsilateral neck LMR at the level Ⅱa, Ⅱb, Ⅲ, Ⅳ, Ⅴ and Ⅵb was 71.4%, 28.6%, 14.3%, 14.0%, 14.0%, and 14.3%, respectively, and the LMR at the level Ⅱa was 14.3% for the contralateral neck. No lymph node metastasis occurred in other lymph node levels. The mean levels of lymph node metastasis for the T1-T4 stage tumors were 2.4, 1.9, 2.2, 3.3 with statistical significance (P=0.023), and 2.2, 4.5 and 1.6 for patients with the tumors originated from PS, PPW and PC (P=0.000). The PPW invasion was significantly correlated with the level Ⅶ metastasis (P=0.000), and PC or esophageal invasion was intimately correlated with the level Ⅵ metastasis (P=0.002 and 0.001). Conclusions The most common lymphatic metastasis includes ipsilateral neck Ⅱa, Ⅲ, and Ⅱb, whereas the level Ⅰ and Ⅴ are rarely observed. For PPW-derived tumors, the LMR at the level Ⅶ is up to 60.0%. The incidence of PC or esophageal invasion enhances the risk of level Ⅵ lymph node metastasis. Key words: Hypopharyngeal carcinoma; Lymph node; Clinical target volume

Differential analysis of lymph node metastasis in histological mixed-type early gastric carcinoma in the mucosa and submucosa.

AIMTo investigate the relationship between histological mixed-type of early gastric cancer (EGC) in the mucosa and submucosa and lymph node metastasis (LNM).METHODSThis study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated (pure D), pure undifferentiated (pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. Furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.RESULTSOf the 298 patients, 165 (55.4%) had mucosa-confined EGC and 133 (44.6%) had submucosa-invasive EGC. Only 13 (7.9%) cases of mucosa-confined EGC and 30 (22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion (OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type (OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixed-type (OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixed-type group (P = 0.012) and pure U group (P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group (P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixed-type (P = 0.012) and pure U group (P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group (P = 0.375). Multivariate logistic analysis showed that only female sex (OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion (OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC (P = 0.106).CONCLUSIONFor mucosal EGC, histological mixed-type is not an independent risk factor for LNM and could be managed in the same way as the undifferentiated type.

Correlation Between Squamous Cell Carcinoma Antigen Level and the Clinicopathological Features of Early-Stage Cervical Squamous Cell Carcinoma and the Predictive Value of Squamous Cell Carcinoma Antigen Combined With Computed Tomography Scan for Lymph Node Metastasis.

The aim of this study was to analyze the relationship between serum squamous cell carcinoma antigen (SCC-Ag) and the clinicopathological features of cervical squamous cell carcinoma. The value of SCC-Ag and computed tomography (CT) for predicting lymph node metastasis (LNM) was evaluated. A total of 197 patients with International Federation of Gynecology and Obstetrics stages IB to IIA cervical squamous cell carcinoma who underwent radical surgery were enrolled in this study. The SCC-Ag was measured, and CT scans were used for the preoperative assessment of lymph node status. Increased preoperative SCC-Ag levels were associated with International Federation of Gynecology and Obstetrics stage (P = 0.001), tumor diameter of greater than 4 cm (P < 0.001), lymphovascular invasion (P = 0.001), LNM (P < 0.001), and greater than one half stromal infiltration (P < 0.001). Multivariate analysis identified LNM (P < 0.001, odds ratio [OR] = 4.399), tumor diameter of greater than >4 cm (P = 0.001, OR = 4.019), and greater than one half stromal infiltration (P = 0.002, OR = 3.680) as independent factors affecting SCC-Ag greater than or equal to 2.35 ng/mL. In the analysis of LNM, SCC-Ag greater than or equal to 2.35 ng/mL (P < 0.001, OR = 4.825) was an independent factor for LNM. The area under the receiver operator characteristic curve (AUC) of SCC-Ag was 0.763 for all patients, and 0.805 and 0.530 for IB1 + IIA1 and IB2 + IIA2 patients, respectively; 2.35 ng/mL was the optimum cutoff for predicting LNM. The combination of CT and SCC-Ag showed a sensitivity and specificity of 82.9% and 66% in parallel tests, and 29.8% and 93.3% in serial tests, respectively. The increase of SCC-Ag level in the preoperative phase means that there may be a pathological risk factor for postoperative outcomes. The SCC-Ag (≥2.35 ng/mL) may be a useful marker for predicting LNM of cervical cancer, especially in stages IB1 and IIA1, and the combination of SCC-Ag and CT may help identify patients with LNM to provide them with the most appropriate therapeutic approach.