High Risk Of Lymph Node Metastasis Research Articles

MRI-based radiomics analysis to predict preoperative lymph node metastasis in papillary thyroid carcinoma.

The aim of the present study was to develop a magnetic resonance imaging (MRI) radiomics model and evaluate its clinical value in predicting preoperative lymph node metastasis (LNM) in patients with papillary thyroid carcinoma (PTC). Data of 129 patients with histopathologically confirmed PTC were retrospectively reviewed in our study (90 in training group and 39 in testing group). 395 radiomics features were extracted from T2 weighted imaging (T2WI), diffusion weighted imaging (DWI) and T1 weighted multiphase contrast enhancement imaging (T1C+) respectively. Minimum redundancy maximum relevance (mRMR) was used to eliminate irrelevant and redundant features and least absolute shrinkage and selection operator (LASSO), to additionally select an optimized features' subset to construct the radiomics signature. Predictive performance was validated using receiver operating characteristic curve (ROC) analysis, while decision curve analyses (DCA) were conducted to evaluate the clinical worth of the four models according to different sequences. A radiomics nomogram was built using multivariate logistic regression model. The nomogram's performance was assessed and validated in the training and validation cohorts, respectively. Seven key features were selected from T2WI, five from DWI, ten from T1C+ and seven from the combined images. The scores (Rad-scores) of patients with LNM were significantly higher than patients with non-LNM in both the training cohort and the validation cohort. The combined model performed better than the T2WI, DWI, and T1C+ models alone in both cohorts. In the training cohort, the area under the ROC (AUC) values of T2WI, DWI, T1C+ and combined features were 0.819, 0.826, 0.808, and 0.835, respectively; corresponding values in the validation cohort were 0.798, 0.798, 0.789, and 0.830. The clinical utility of the combined model was confirmed using the radiomics nomogram and DCA. MRI radiomic model based on anatomical and functional MRI images could be used as a non-invasive biomarker to identify PTC patients at high risk of LNM, which could help to develop individualized treatment strategies in clinical practice.

Large population-based study using the SEER database: is endoscopic resection appropriate for early gastric cancer patients in the United States?

AimTo investigate whether endoscopic treatment is applicable to American patients and explores the predictors of lymph node metastasis (LNM) in early gastric cancer (EGC).MethodsPatients with EGC confined to either mucosa (T1a, n = 1799) and submucosa (T1b, n = 1689) were identified from the Surveillance, Epidemiology, and End Result database. Multivariate logistic regression, Kaplan–Meier method, and univariate/multivariate Cox regression were used to assess the correlation between invasion depth and LNM or prognosis. A nomogram for predicting LNM was constructed and internally validated.ResultsEGC limited to T1a exhibited a 2.4% incidence of LNM, which increased to 11.1% when the depth invaded T1b.LNM was present at 1.4%, 5.2%, and 5.0% for sizes ≤2, 2–5, and >5cm of low-grade T1a EGC, respectively, (p = .019) and at 4.8%, 12.4%, and 28.6% of T1b EGC, respectively (p < .001).The multivariate logistic model revealed that older age, T1b invasion, larger tumor size, and high-grade lesions were associated with a higher risk of LNM. Moreover, the T1a EGC patients had better cancer-specific survival (OS) and overall survival(CSS) compared with the T1b EGC patients (5-year OS: 77.2% versus 67.4%, p < .001; 5-year CSS: 90.6% versus 81.4%, p < .001). The discrimination of the prediction model was 0.745.ConclusionsEndoscopic treatment may only be suitable for patients in the US population who have low-grade T1a lesions of less than 2 cm in size. Patients with T1a lesions of greater than 2 cm in size, lesions with high-grade, and all T1b lesions may benefit from radical surgical resection with lymphadenectomy.

MicroRNA Expression Profiling on Paired Primary and Lymph Node Metastatic Breast Cancer Revealed Distinct microRNA Profile Associated With LNM.

Breast cancer (BC) is the foremost cause of cancer-related deaths in women. BC patients are oftentimes presented with lymph node metastasis (LNM), which increases their risk of recurrence. Compelling data have recently implicated microRNAs in promoting BC metastasis. Therefore, the identification of microRNA (miRNA)-based molecular signature associated with LNM could provide an opportunity for a more personalized treatment for BC patients with high risk of LNM. In current study, we performed comprehensive miRNA profiling in matched primary breast and LNM and identified 40 miRNAs, which were differentially expressed in LNM compared to primary tumors. The expression of 14 miRNAs (Up: hsa-miR-155-5p, hsa-miR-150-5p, hsa-miR-146a-5p, hsa-miR-142-5p and down: hsa-miR-200a-3p, hsa-miR-200b-3p, hsa-miR-200c-3p, hsa-miR-205-5p, hsa-miR-210-3p, hsa-miR-214-3p, hsa-miR-141-3p, hsa-miR-127-3p, hsa-miR-125a-5p, and hsa-let-7c-5p) was subsequently validated in a second cohort of 32 breast and 32 matched LNM tumor tissues. Mechanistically, forced expression of hsa-miR-205-5p, or hsa-miR-214-3p epigenetically inhibited MDA-MB-231 cell proliferation, colony formation, and cell migration. Global gene expression profiling on MDA-MB-231 cells overexpressing hsa-miR-205-5p, or hsa-miR-214-3p in combination with in silico target prediction and ingenuity pathway analyses identified multiple bona fide targets for hsa-miR-205-5p, hsa-miR-214-3p affecting cellular proliferation and migration. Interestingly, interrogation of the expression levels of hsa-miR-205 and hsa-miR-214 in the METABRIC breast cancer dataset revealed significantly poor overall survival in patients with downregulated expression of miR-205 [HR = 0.75 (0.61–0.91)], p = 0.003 and hsa-miR-214 [HR = 0.74 (0.59–0.93) p = 0.008]. Our data unraveled the miRNA-transcriptional landscape associated with LNM and provide novel insight on the role of several miRNAs in promoting BC LNM, and suggest their potential utilization in the clinical management of BC patients.

Inverse Association of Age with Risk of Lymph Node Metastasis in Superficial Colorectal Cancer: A Large Population-Based Study.

Superficial colorectal cancer (SCRC) is defined as colorectal cancer (CRC) confined to the mucosa or submucosa. Endoscopic resection (ER) is widely used to resect differentiated SCRC from patients without lymph node metastasis (LNM). However, it is unclear whether ER is suitable for use with patients with differentiated early-onset SCRC because early-onset CRC is more aggressive. Therefore, we aimed to investigate the association between age of CRC onset and LNM. We retrieved data for patients with surgically resected differentiated-type SCRCs from the Surveillance, Epidemiology, and End Results (SEER) database. Rate of LNM was compared among patients aged 18-39, 40-49, 50-59, 60-69, and ≥70 years. The association between age and LNM was further examined using multivariate logistic regression. We retrieved 34,506 records of differentiated SCRCs from the SEER database, including 667 patients aged 18-39 years, 2,385 aged 40-49, 8,075 aged 50-59 years, 9,577 aged 60-69 years, and 13,802 aged ≥70 years. Rates of LNM were 15.74%, 14.13%, 10.67%, 8.07%, and 6.76% for patients aged 18-39, 40-49, 50-59, 60-69, and ≥70 years, respectively. We found an inverse correlation between age at diagnosis and risk of LNM from the univariate analysis (p < .001). Compared with patients aged 18-39, the odds ratios with 95% confidence interval (CI) for patients aged 40-49, 50-59, 60-69, and ≥70 years were 0.90 (0.71-1.15, p = .376), 0.69 (0.56-0.87, p = .001), 0.54 (0.43-0.68, p < .001), and 0.47 (0.38-0.60, p < .001), respectively. In differentiated SCRCs, younger age at diagnosis was associated with higher risk of LNM. Endoscopic resection (ER) is widely used to resect differentiated superficial colorectal cancer (SCRC) without lymph node metastasis (LNM). However, no study has ever investigated risk of LNM of early-onset SCRC compared with average onset SCRC to explore whether ER is suitable for early-onset SCRC. To the authors' knowledge, this population-based study is the first study to find inverse correlation between age at diagnosis and risk of LNM in differentiated SCRCs. This finding indicates that ER may not be suitable for young patients with differentiated SCRC. Because the 30-day operative mortality after surgery is higher but the risk of LNM is lower in older patients compared with younger patients, ER for differentiated SCRCs may be advantageous over surgery for older patients.

A Novel Circulating MiRNA-Based Signature for the Diagnosis and Prognosis Prediction of Early-Stage Cervical Cancer.

Background:MicroRNAs (miRNAs) have been shown to play a key role in regulating the progression of cervical cancer (CC). This study aimed to develop a circulating miRNA-based molecular signature for the diagnosis and prognosis prediction of early-stage CC.Methods:This study included 112 patients diagnosed with early-stage CC, 45 patients confirmed with cervical intraepithelial neoplasia (CIN) and 90 healthy subjects. Compared to the normal controls, the expression level of miR-21 was increased, while the levels of miR-125b and miR-370 were decreased in CC in both GSE30656 and The Cancer Genome Atlas (TCGA) cohort. The expression levels and diagnostic value of these candidate miRNAs were then validated through qRT-PCR. Their diagnostic and prognostic values for early-stage CC were further explored.Results:Compared to the patients with CIN and healthy subjects, serum miR-21 was increased, while serum miR-125b and serum miR-370 were reduced in early-stage CC. In addition, combining these molecules yielded good performance for differentiating early-stage CC from CIN or healthy subjects. Moreover, strong association was found between serum miR-21 and lymph node metastasis (LNM) as well as recurrence-free survival of early-stage CC. Similar observations were found for serum miR-125b and serum miR-370. Patients with simultaneously high serum miR-21 + low serum miR-125b + low serum miR-370 suffered a high risk of LNM and recurrence, while those with low serum miR-21 + high serum miR-125b + high serum miR-370 had little risk for LNM and recurrence.Conclusions:Combining serum miR-21, miR-125b and miR-370 as a miRNA-based signature is promising for the detection and prognosis prediction of early-stage CC.

History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer.

Japanese guidelines for gastric cancer treatment were first published in 2001 for the purpose of showing the appropriate indication for each treatment method, thereby reducing differences in the therapeutic approach among institutions, and so on. With the accumulation of evidence and the development and prevalence of endoscopic submucosal dissection (ESD), the criteria for the indication and curability of endoscopic resection (ER) for early gastric cancer (EGC) have expanded. However, several problems still remain. Although a risk-scoring system (eCura system) for predicting lymph node metastasis (LNM) may help treatment decision in patients who do not meet the curative criteria for ER of EGC, which is referred to as eCura C-2 in the latest guidelines, additional gastrectomy with lymphadenectomy may be excessive for many patients, even those at high risk for LNM. Less-invasive function-preserving surgery, such as non-exposed endoscopic wall-inversion surgery with laparoscopic sentinel node sampling, may overcome this problem. In addition, further less-invasive treatment, such as ER with chemotherapy, should be established for patients who prefer not to undergo additional gastrectomy.

Determining the current indications for endoscopic submucosal dissection in patients with Lauren mixed-type early gastric cancer.

Recent study showed that early gastric cancer (EGC) with Lauren mixed-type (MT) histology is associated with worse prognosis. We aimed to evaluate the clinicopathologic features and prognostic significance of Lauren MT-EGCs that meets the criteria for endoscopic submucosal dissection (ESD). We reviewed 2665 patients with EGC who underwent surgery between 2010 and 2015. The clinicopathologic features and invasiveness including lymph node metastasis (LNM) and lymphovascular invasion (LVI) of MT-EGC were compared with those of intestinal type and diffuse type by Lauren histology. Among 2665 patients, EGCs in 241 (9%) patients were classified as MT. Tumor size was larger and depth of invasion was greater than other histology. Among patients with MT-EGC, 16.6% (40/241) showed LNM and 22.8% (55/241) showed lymphatic invasion, which were significantly higher than that of patients with other Lauren types (8.2% and 15.3% in intestinal type and 9.1% and 8.7% in diffuse type, P<0.001). This finding remained significant even after adjusting for depth of invasion. However, when we analyzed the patient groups who met the absolute or expanded criteria of ESD, no significant difference was observed in the rates of LNM or LVI or cancer mortality by Lauren classification. Mixed-type early gastric cancer (MT-EGC) exhibited larger tumor size, greater depth of invasion, and higher risk of LNM and LVI. However, among the patients who met the absolute or expanded criteria of ESD, no significant difference was observed in LNM, LVI, and gastric cancer mortality risk.

Efficacy and safety of endoscopic submucosal dissection for papillary adenocarcinoma-type early gastric cancer.

Endoscopic submucosal dissection (ESD) has increasingly been used to treat early gastric cancer (EGC); however, its efficacy in treating papillary adenocarcinoma-type EGC remains unknown.We sought to identify risk factors for lymph node (LN) metastasis in papillary adenocarcinoma-type EGC and evaluate the clinical outcome after ESD.This study retrospectively reviewed the medical records of patients who were diagnosed with EGC in our hospital from January 2009 to December 2016. In total, 85 patients had papillary adenocarcinoma-type EGC, of whom 52 and 33 underwent surgical treatment and ESD, respectively. This study analyzed the LN metastasis risk factors and clinical outcomes between these 2 groups and with those of an existing ESD indication group.LN metastasis occurred in 13 (25.0%) of 52 patients who underwent surgery. Multivariate analysis indicated that lymphovascular invasion was an independent risk factor (odds ratio: 20.624; 95% confidence interval: 19.628–21.497; P = .001). Of 33 patients who underwent ESD, 21 (63.6%) had an absolute indication and 12 (36.4%) had an expanded indication. All 3 (9.1%) patients with non-curative resection underwent additional surgery. The clinical outcomes were compared to those of 926 patients who underwent ESD of non-papillary adenocarcinoma-type EGC. There were no significant differences in curative resection rate (P = .327), procedure-related complication (P = .853), local recurrence (P = 1.000), or overall survival (P = 1.000).ESD of papillary adenocarcinoma-type EGC showed an acceptable outcome in comparison to an existing ESD indication group. However, these patients exhibit a relatively higher risk of LN metastasis.

Pancreatic neuroendocrine tumors: MR imaging features preoperatively predict lymph node metastasis.

Predictive factors of lymph node metastasis (LNM) in pancreatic neuroendocrine tumors (pNETs) are not well established. We sought to identify the value of MR imaging features in preoperatively predicting the lymph node metastasis of pNETs. In this study, we enrolled 108 consecutive patients with pNETs between January 2009 and June 2018. MR morphologic features and quantitative data were evaluated. Predictors of LNM were evaluated using univariate and multivariate logistic regression models. A total of 108 patients with pNETs were finally enrolled, including 82 LNM-negative and 26 LNM-positive patients. Features significantly related to the LNM of pNETs at univariate analysis were tumor size > 2cm (P = 0.003), Ki-67 > 5% (P = 0.002), non-enhancement pattern (P < 0.001), apparent diffusion coefficient value (P < 0.001), main pancreatic duct dilation (P < 0.001) and pancreatic atrophy (P = 0.032) and extrapancreatic tumor spread (P = 0.001), CNRs during arterial, portal and delay phase (P = 0.005, 0.047, and 0.045, respectively), and histological classification (P = 0.006). At multivariate analysis, non-enhancement pattern (P = 0.019; odds ratio, 6.652; 95% CI 1.369, 32.321) and main pancreatic duct dilation (P = 0.018; odds ratio, 6.745; 95% CI 1.379, 32.991) were independent risk factors for predicting the LNM of pNETs. The non-enhancement characteristic and main pancreatic duct dilation appear to be linked with LNM in pNETs. These radiological predictors can be easily obtained preoperatively, and may help to avoid missing pNETs with a high risk of LNM.

Lung Adenocarcinoma has a Higher Risk of Lymph Node Metastasis than Squamous Cell Carcinoma: A Propensity Score-Matched Analysis.

Controversy still exists in which subtype of non-small-cell lung cancer [squamous cell carcinoma (SCC) or adenocarcinoma] is more likely to have lymph node (LN) metastasis. The aim of this study is to compare the pattern of LN metastasis in two cohorts of matched patients surgically treated for SCC or adenocarcinoma. A retrospective analysis of patients undergoing lobectomy or segmentectomy with systematic lymphadenectomy without preoperative treatment for lung SCC or adenocarcinoma was conducted in this study. Data for analysis consisted of age, gender, tumor size, lobe-specific tumor location, tumor location (peripheral or central), and pathologic findings. We conducted the propensity score-matched (PSM) analysis to eliminate potential bias effects of possible confounding factors. From January 2015 to December 2016 in our department, we finally included a total of 387 patients (including 63 patients with SCC and 324 patients with adenocarcinoma) for analysis. For the unmatched cohort, there was no sufficient evidence of significantly different number of positive LNs (P = 0.90) and rate of LN metastasis (P = 0.23) between SCC patients and adenocarcinoma patients. However, potential confounding factors, for example gender, tumor size, tumor location, tumor differentiation, and total number of dissected LNs, were significantly different between patients with SCC and those with adenocarcinoma. In the analysis of matched cohort after PSM analysis, those above confounding factors were comparable between the two groups. However, patients with adenocarcinoma had significantly more mean positive LNs (2.2 and 0.7; P = 0.008) and a higher rate of LN metastasis (53% and 29%; P = 0.016) than those with SCC. Lung adenocarcinoma had a higher risk of LN metastasis than SCC, suggesting that different therapeutic modalities may be indicated for the two different subtypes of lung cancer.

Biliary Tract Cancer at CT: A Radiomics-based Model to Predict Lymph Node Metastasis and Survival Outcomes.

Purpose To evaluate a radiomics model for predicting lymph node (LN) metastasis in biliary tract cancers (BTCs) and to determine its prognostic value for disease-specific and recurrence-free survival. Materials and Methods For this retrospective study, a radiomics model was developed on the basis of a primary cohort of 177 patients with BTC who underwent resection and LN dissection between June 2010 and December 2016. Radiomic features were extracted from portal venous CT scans. A radiomics signature was built on the basis of reproducible features by using the least absolute shrinkage and selection operator method. Multivariable logistic regression model was adopted to establish a radiomics nomogram. Nomogram performance was determined by its discrimination, calibration, and clinical usefulness. The model was internally validated in 70 consecutive patients with BTC between January 2017 and February 2018. Results The radiomics signature, composed of three LN-status-related features, was associated with LN metastasis in primary and validation cohorts (P < .001). The radiomics nomogram that incorporated radiomics signature and CT-reported LN status showed good calibration and discrimination in primary cohort (area under the curve, 0.81) and validation cohort (area under the curve, 0.80). Patients at high risk of LN metastasis portended lower disease-specific and recurrence-free survival than did those at low risk after surgery (both P < .001). High-risk LN metastasis was an independent preoperative predictor of disease-specific survival (hazard ratio, 3.37; P < .001) and recurrence-free survival (hazard ratio, 1.98; P = .003). Conclusion A radiomics model derived from portal phase CT of the liver has good performance for predicting lymph node metastasis in biliary tract cancer and may help to improve clinical decision making. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Laghi and Voena in this issue.

RA08.06: ONGOING CHALLENGES IN CLINICAL ASSESSMENT OF NODAL STATUS IN T1 ESOPHAGEAL ADENOCARCINOMA

Abstract Background Endoscopic resection has emerged as an esophageal-preserving treatment for T1 esophageal adenocarcinoma (EAC); however, only patients with negligible risk of nodal metastasis should receive this option. Since preoperative reliable diagnostic tools are lacking, scoring systems have been developed to assess risk of lymph node metastasis (LNM). The purpose of this study was to provide external validation of two previously published scoring systems for clinical prediction of nodal status in patients with T1 EAC. Methods In adherence with patient selection criteria in the two previously published scoring systems (figure 1), we identified patients with T1 EAC (n = 230) who underwent esophagectomy without neoadjuvant treatment from a prospective database between 1995 and 2017. Clinicopathologic characteristics were compared between patients with LNM and without. Risk scores were tabulated in accordance with the two scoring systems. Predictive accuracy of the scores were evaluated by c-index and calibration plots, and compared using Venkatraman's test for paired receiver operating characteristics curves. Results Groups were similar in age, location and nodes harvested. There were 38 (17%) patients with positive LNM; 3/66 (5%) T1a and 35/164 (21%) T1b. LNM was associated with poor differentiation (25% vs 42; P = 0.001), positive LVI (16.1% vs 71.1; P &lt; 0.001) and longer tumors (1.6 cm vs 2.2; P = 0.004). Median score A was 6.2 (IQR 4.2–7.6) for patients without LNM versus 12.5 (8–13.5) with LNM. Median score B was 2 for T1a and 3 for T1b patients without LNM versus 5 for T1a and T1b with LNM. AUCs of the two scoring systems were similar (score A 0.86, [95% CI 0.81–0.91] vs B 0.83 [0.77–0.89], P = 0.89). For patients with LNM (n = 38), all were high risk for LNM according to score A and 37 (97%) met criteria for esophagectomy according to B. In those without LNM (n = 192), 138 (72%) were high risk for LNM and 102 (53%) met criteria for esophagectomy. Conclusion Both scoring systems demonstrated good predictive accuracy for LNM; however, B may be simpler to implement. Most patients classified as high risk or for esophagectomy did not have nodal metastasis on pathology. Future scoring systems must better identify which patients are candidates for organ preservation on the basis of LNM. Disclosure All authors have declared no conflicts of interest.

Risk factor analysis and prediction model establishment of lymph node metastasis in remnant gastric cancer

To explore the risk factors and establish an effective model to predict lymph node metastasis (LNM) for remnant gastric cancer (RGC). Clinicopathological characteristics of 91 RGC patients undergoing radical gastrectomy at Sun Yat-sen University Cancer Center from January 2000 to December 2017 were retrospectively analyzed. RGC was defined as cancer detected in the remnant stomach >5 years for primary benign diseases or >10 years for malignant diseases following distal gastrectomy. Risk factors of LNM in RGC were identified using logistic regression (P<0.1). Covariates were then scored according to the β regression coefficient in the multivariate analysis, and a score model was established, in which higher score indicated higher risk of LNM. Finally, receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy of risk factors and the score model. Among the 91 RGC patients, 84 were male and 7 were female with the age ranging from 47 to 82 years (63.7±8.5) years. Mean harvested lymph node (LN) was 16.0±11.8, including ≥15 LNs in 42(46.2%) patients and <15 LNs in 49(53.8%) patients. Forty-six (50.5%) patients were identified as LNM. Univariate analysis showed that tumor size ≥4 cm (χ2=8.106, P=0.004), Borrmann III(-IIII( gross type (χ2=6.129, P=0.013), increased CEA level (χ2=4.041, P=0.044) and T3-4 stage (χ2=17.321, P=0.000) were associated with LNM in RGC. In Logistic multivariate analysis, tumor size ≥4 cm (OR: 2.362, 95%CI: 0.829-6.730, P=0.100, β regression coefficient: 0.859) and T3-4 stage (OR: 7.914, 95%CI: 1.956-32.017, P=0.004, β regression coefficient: 2.069) remained as the independent risk factors for LNM, and were scored as 1 and 2 point in the final prediction model. In the final score model, LNM of patients with 0, 1, 2, 3 point were 11.1%(2/18), 1/5, 51.6%(16/31) and 73.0%(27/37), respectively. The AUC of the prediction model was 0.756 (P=0.000). Increased CEA level, tumor size ≥4 cm, Borrmann III(-IIII( gross type, and deeper T stage are associated with LNM in RGC. Moreover, the score model combining with tumor size and T stage can effectively predict the LNM in RGC.

A new approach to predict lymph node metastasis in solid lung adenocarcinoma: a radiomics nomogram

Lymph node metastasis (LNM) of lung cancer is an important factor related to survival and recurrence. The association between radiomics features of lung cancer and LNM remains unclear. We developed and validated a radiomics nomogram to predict LNM in solid lung adenocarcinoma. A total of 159 eligible patients with solid lung adenocarcinoma were divided into training (n=106) and validation cohorts (n=53). Radiomics features were extracted from venous-phase CT images. We built a radiomics nomogram using a multivariate logistic regression model combined with CT-reported lymph node (LN) status. The performance of the radiomics nomogram was evaluated using the area under curve (AUC) of receiver operating characteristic curve. We performed decision curve analysis (DCA) within training and validation cohorts to assess the clinical usefulness of the nomogram. Fourteen radiomics features were chosen from 94 candidate features to build a radiomics signature that significantly correlated with LNM. The model showed good calibration and discrimination in the training cohort, with an AUC of 0.871 (95% CI: 0.804-0.937), sensitivity of 85.71% and specificity of 77.19%. In the validation cohort, AUC was 0.856 (95% CI: 0.745-0.966), sensitivity was 91.66%, and specificity was 82.14%. DCA demonstrated that the nomogram was clinically useful. The nomogram also showed good predictive ability in patients at high risk for LNM in the CT-reported LN negative (cN0) subgroup. The radiomics nomogram, based on preoperative CT images, can be used as a noninvasive method to predict LNM in patients with solid lung adenocarcinoma.

Clinical outcomes of minimally invasive treatment for early gastric cancer in patients beyond the indications of endoscopic submucosal dissection.

Endoscopic submucosal dissection (ESD) with laparoscopic sentinel lymph node dissection (ESN) and endoscopic full-thickness gastric resection with laparoscopic sentinel lymph node dissection (Hybrid-natural orifice transluminal endoscopic surgery, Hybrid-NOTES) are minimally invasive treatment options for early gastric cancer (EGC) beyond the indications of ESD. This study aimed to evaluate the short- and long-term clinical outcomes of ESN and Hybrid-NOTES. We retrospectively analyzed patients who had undergone ESN or Hybrid-NOTES for EGC from January 2009 to March 2013. A total of 48 patients, including 21 undergoing ESN and 27 undergoing Hybrid-NOTES, were enrolled. All patients had cancer stage T1N0M0, EGC less than 5cm in size, and suspected submucosal invasion according to imaging or biopsy-proven diffuse-type histology. In ESN and Hybrid-NOTES, the curative resection rates were 76.5% and 90.9% of patients, respectively. In the ESN group, 5 patients underwent an additional gastrectomy (1 for lymph node metastasis (LNM), 3 for surgical complications, and 1 for noncurative resection). In the Hybrid-NOTES group, 6 patients underwent additional gastrectomy, (1 for LNM, 3 for surgical complications, and 2 for noncurative resection). Of the 37 patients who were followed up in the long-term (a median follow-up of 59.8months), one was found to have liver metastasis after ESN and received palliative chemotherapy. ESN and Hybrid-NOTES have shown favorable long-term outcomes despite their technical limitations. These methods may be utilized as a bridge between ESD and gastrectomy in cases of EGC with a high risk of LNM beyond the ESD indications.

Role of CXCR7 as a Common Predictor for Prognosis in Solid Tumors: a Meta-Analysis.

Background: Accumulating evidence indicated that the CXC chemokine receptor (CXCR) 7 (CXCR7) was overexpressed in a variety of tumors. However, the value of the CXCR7 expression in predicting prognosis in solid tumors remains controversial. Therefore, we performed this meta-analysis to evaluate the correlation between CXCR7 expression and lymph node metastasis (LNM), tumor pathological grade and survival, including overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS).Methods: Eligible studies were searched in PubMed, Web of Science, and PMC up to April 2018. A total of 27 studies were included in this meta-analysis. Odds ratio (OR), hazard ratio (HR) and 95 % confidence intervals (CI) were used as effect measures.Results: The meta-analysis showed that high expression of CXCR7 predicted a high risk of LNM (pooled OR = 2.22, 95%CI: 1.41-3.50), high tumor grade (pooled OR = 1.94, 95%CI: 1.20-3.13), poor OS (pooled HR = 1.66, 95%CI: 1.30-2.03), and poor DFS/RFS (pooled HR = 1.82, 95%CI: 1.21-2.43). Subgroup analysis showed that CXCR7 expression had a positive correlation with LNM in pan-adenocarcinoma subgroup (pooled OR = 3.73, 95%CI: 2.21-6.30), while no correlation was found in pan-squamous cancer subgroup (pooled OR = 1.29, 95%CI: 0.56-2.96). Subgroup analysis of tumor grade revealed that high expression of CXCR7 predicted high tumor grade both in pan-squamous cancer and pan-adenocarcinoma (pooled OR = 3.58, 95%CI: 1.39-9.22, pooled OR = 2.25, 95%CI: 1.20-4.20). As in OS group, we divided the data based on analysis method and it turned out that overexpressed CXCR7 predicted worse OS both in multivariate analysis (pooled HR =1.57, 95%CI: 1.12-2.01) and univariate analysis subgroup (pooled HR =1.86, 95%CI: 1.23-2.49).Conclusions: Our meta-analysis revealed that high expression of CXCR7 predicted unfavorable prognosis and may serve as potential targets of cancer therapy.

Clinical significance of CCBE1 expression in lung cancer.

Lymph node metastasis (LNM) is one of the major causes of cancer-associated morbidity and mortality in patients with lung cancer following radical pulmonary carcinoma resection. The present study aimed to investigate the relationship between the expression of collagen and calcium-binding epidermal growth factor domain-containing protein 1 (CCBE1) and lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) in tumor tissue with the clinical prognosis of lung cancer. The present study included 40 patients with lung cancer that underwent pulmonary carcinoma resection, including 10 patients with LNM, and 10 control patients who underwent pulmonary bullae resection. CCBE1 and LYVE1 expression was assessed in samples from normal and tumor tissue using polymerase chain reaction, western blot analysis and immunohistochemistry. CCBE1 expression appeared to be decreased in lung tumor tissue and further downregulated in samples from patients with LNM, and was revealed to be correlated with poor clinical outcome. Conversely, LYVE1 expression appeared to be upregulated in lung cancer tissue. In conclusion, the present results suggested that CCBE1 and LYVE1 may have potential as biomarkers for the identification of lung cancer patients at a high risk of LNM.

Clinical predictors of histologic type of gastric cancer

Gastric cancer is classified into differentiated and undifferentiated types according to the degree of glandular differentiation. Undifferentiated-type early gastric cancer (EGC) carries a higher risk of lymph-node metastasis than differentiated type, and therefore the indication criteria for endoscopic resection differ. This study aimed to clarify the ability of clinical predictors to distinguish between differentiated-type and undifferentiated-type EGCs. This was a post hoc study of a multicenter prospective trial carried out in 5 Japanese hospitals, including 343 patients with cT1 EGC of≥10mm. According to the protocol, age, sex, and endoscopic findings of cancer (diameter, location, macroscopic type, and invasion depth) were evaluated, and the final diagnosis was confirmed from resected specimens. We evaluated the associations between these clinical factors and the histologic type of cancer and calculated the ability of the factors to diagnose differentiated-type EGC. The diagnostic ability of forceps biopsy was also calculated as a reference. Multivariate analysis identified older age (≥72 years), male sex, larger tumor size (>30mm), elevated type, and shallower invasion depth (cT1a) as independent significant predictors for differentiated-type EGC, with elevated type showing the highest positive likelihood ratio. The sensitivity, specificity, accuracy, and positive and negative likelihood ratios of elevated type for differentiated-type EGC were 24%, 99%, 38%, 15.7, and 0.77, respectively, compared with 96%, 86%, 95%, 7.0, and 0.04 for forceps biopsy. Endoscopic elevated type is a significant predictor for differentiated-type EGC and may exclude undifferentiated-type EGC without the need for forceps biopsy.

Contrast-enhanced ultrasonography features of papillary thyroid carcinoma for predicting cervical lymph node metastasis.

The present study was performed to evaluate the predictive value of contrast-enhanced ultrasonography (CEUS) for the risk of cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). Between May 2014 and November 2016, 42 patients who received surgery for suspicious PTCs were enrolled in the present study. Each individual underwent CEUS with conventional ultrasound (US), preoperative US-guided fine needle aspiration and personalized surgery. Subsequently, the microvascular density (MVD) of all surgical specimens was measured. According to the results of surgical histopathology, individuals were divided into two groups: LNM+ (PTCs with LNM), and LNM− (PTCs without LNM). Clinicopathological characteristics, CEUS enhancement patterns, perfusion parameters and measurements of MVD were compared. The correlation between quantitative variables and LNM was analyzed using Spearman's correlation analysis. Compared with that in the LNM− group, patients in the LNM+ group were younger (P<0.05) and had a larger mean tumor size (P<0.05). The incidence ratio of patients who were ≤45 years old (P<0.05), tumors >10 mm in size (P<0.05) and capsular infiltration (P<0.05) were statistically higher in the LNM+ group. Following the use of a novel classification system, the ratio of PTCs with early partial hyper-enhancement was identified to be significantly higher in the LNM+ group (P<0.01). The mean intensity, intensity increase velocity, MVD ratio and mean intensity ratio of intratumoral/peripheral thyroid parenchyma (MIR) were statistically higher in the LNM+ group compared with that in the LNM− group (all P<0.05). MIR was identified to be positive correlated with LNM (P<0.05). A MIR value of 0.86 was the optimal threshold of LNM in PTCs. In conclusion, LNM may rely on the local rich blood supply of PTC lesions. Partial hyper-enhancements of CEUS and higher values of MIR may suggest a high risk for LNM in PTC.

Lymph Node Retrieval is Inferior in the Modified Merendino Resection for Early Barrett's Carcinoma: A Matched-Pair Comparison with Ivor Lewis Resection.

A matched-pair comparison between the modified Merendino resection (MER) and Ivor Lewis resection (ILR) for early Barrett's carcinoma. Early adenocarcinoma of the esophagus (eACE) with positive risk factors for lymph node metastasis (LNM) needs surgery for cure. MER appeared to be an alternative to ILR. Between July 2000 and July 2012, 156 patients with high-grade dysplasia or eACE received ILR, whereas in 30 cases MER was performed in a tertiary care center for GI Surgery. A matched-pair analysis was performed on the basis of sex, age, BMI, ASA classification and tumor stage. Thirty patients were assigned to each group. The data were analyzed regarding perioperative aspects (e.g., operating time, hospital stay, complications, number of lymph nodes) and survival analysis. The mean operating time was 301.7min for ILR, compared to 255.4min for MER (p=0.044). The hospital stay following ILR was significantly longer than for MER (22.4days ILR vs. 16.4days MER, p=0.023). There was no statistically significant difference regarding complications between the two groups (p=0.463). The number of resected lymph nodes was significantly lower in the MER group (median 21) compared to the ILR group, where a median of 31 lymph nodes could be removed (p<0.001). There was no statistically significant difference in overall (p=0.145) or tumor-specific survival (p=0.353). Lymph node retrieval is significantly inferior in the MER. Postoperative complication rates were comparable between the two operating techniques, although the operation time for ILR took longer and these patients required a longer hospital stay. MER should not be applied in cases with high risk of LNM.