Lymph Node Metastasis In Adenocarcinoma Research Articles

A deep learning-based radiomics model for predicting lymph node status from lung adenocarcinoma

ObjectivesAt present, there are many limitations in the evaluation of lymph node metastasis of lung adenocarcinoma. Currently, there is a demand for a safe and accurate method to predict lymph node metastasis of lung cancer. In this study, radiomics was used to accurately predict the lymph node status of lung adenocarcinoma patients based on contrast-enhanced CT.MethodsA total of 503 cases that fulfilled the analysis requirements were gathered from two distinct hospitals. Among these, 287 patients exhibited lymph node metastasis (LNM +) while 216 patients were confirmed to be without lymph node metastasis (LNM-). Using both traditional and deep learning methods, 22,318 features were extracted from the segmented images of each patient's enhanced CT. Then, the spearman test and the least absolute shrinkage and selection operator were used to effectively reduce the dimension of the feature data, enabling us to focus on the most pertinent features and enhance the overall analysis. Finally, the classification model of lung adenocarcinoma lymph node metastasis was constructed by machine learning algorithm. The Accuracy, AUC, Specificity, Precision, Recall and F1 were used to evaluate the efficiency of the model.ResultsBy incorporating a comprehensively selected set of features, the extreme gradient boosting method (XGBoost) effectively distinguished the status of lymph nodes in patients with lung adenocarcinoma. The Accuracy, AUC, Specificity, Precision, Recall and F1 of the prediction model performance on the external test set were 0.765, 0.845, 0.705, 0.784, 0.811 and 0.797, respectively. Moreover, the decision curve analysis, calibration curve and confusion matrix of the model on the external test set all indicated the stability and accuracy of the model.ConclusionsLeveraging enhanced CT images, our study introduces a noninvasive classification prediction model based on the extreme gradient boosting method. This approach exhibits remarkable precision in identifying the lymph node status of lung adenocarcinoma patients, offering a safe and accurate alternative to invasive procedures. By providing clinicians with a reliable tool for diagnosing and assessing disease progression, our method holds the potential to significantly improve patient outcomes and enhance the overall quality of clinical practice.

Identification of the Characteristic Genes and their Roles in Lung Adenocarcinoma Lymph Node Metastasis through Machine Learning Algorithm.

Background Lymph node metastasis is an important route of lung cancer metastasis and can significantly affect the survival of lung cancer. Methods All the analysis was conducted out in the R software. Expression profile and clinical information of lung adenocarcinoma (LUAD) patients were downloaded from The Cancer Genome Atlas database. Results In our study, we firstly identified the characteristic genes of lymph node metastasis in LUAD through two machine learning algorithms, least absolute shrinkage and selection operator (LASSO) logistic regression, and SVM-RFE algorithms. Ten characteristic genes were finally identified, including CRHR2, ITIH1, PRSS48, MAS1L, CYP4Z1, LMO1, TCP10L2, KRT78, IGFBP1, and PITX3. Next, we performed univariate Cox regression, LASSO regression, and multivariate Cox regression sequentially to construct a prognosis model based on MAS1L, TCP10L2, and CRHR2, which had a good prognosis prediction efficiency in both training and validation cohorts. Univariate and multivariate analysis indicated that our model is a risk factor independent of other clinical features. Pathway enrichment analysis showed that in the high-risk patients, the pathway of MYC target, unfolded protein response, interferon alpha response, DNA repair, reactive oxygen species pathway, and glycolysis were significantly enriched. Among three model genes, MAS1L aroused our interest and therefore was selected for further analysis. KM survival curves showed that the patients with higher MAS1L might have better disease-free survival and progression-free survival. Further, pathway enrichment, genomic instability, immune infiltration, and drug sensitivity analysis were performed to in-deep explore the role of MAS1L in LUAD. Conclusions Results showed that the signature based on MAS1L, TCP10L2, and CRHR2 is a useful tool to predict prognosis and lung cancer lymph node metastasis.

Alantolactone exerts anti-proliferative and apoptotic effects on BGC823 and SGC7901 cells via activation of p38MAPK and inhibition of NF-κB signaling pathway

Purpose: To investigate the anti-proliferative and apoptotic influences of alantolactone on gastric carcinoma (GC) cell lines, and the mechanism(s) involved.
 Methods: Human gastric cancer cell line (BGC823) and gastric adenocarcinoma lymph node metastasis cell line (SGC7901) were maintained in Ham’s F12 medium supplemented with 10 % heatinactivated fetal bovine serum (FBS). In each group of cancer cell line, 5 groups of cells were used: control and four alantolactone groups which were treated with increasing concentrations of alantolactone (5 - 30 μM) for varying periods. Proliferation was determined using MTT assay, while realtime quantitative polymerase chain reaction (qRT-PCR) was used to assay the expressions of apoptosis- and metastasis-related genes. The expressions of p38MAPK and nuclear transcription factor-κB (NF-κB) in BGC823 and SGC7901 cells were measured with Western blotting.
 Results: Phosphorylated protein (p-p38 protein) expression was significantly higher in both groups of GC cells, relative to control (p < 0.05). The expressions of NF-κB in plasma protein were markedly higher in both groups of GC cells than in control group, but the corresponding expressions in nuclear protein were significantly lower in both groups of GC cells, relative to control (p < 0.05).
 Conclusion: Alantolactone exerts anti-proliferative and apoptotic effects on BGC823 and SGC7901 cells via mechanisms involving activation of the p38MAPK, and inhibition of the NF-κB signaling pathways. Thus, alantolactone may be a new and effective anti-gastric cancer drug.

PRIMARY LUNG ADENOCARCINOMA PRESENTING AS INGUINAL MASS

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Metastases to inguinal lymph nodes are common from malignant lesions arising on or in the lower extremity, lower one-half of the trunk, perineum, and male and female reproductive tracts. Inguinal lymph nodes are an unusual site for distant metastasis of adenocarcinoma of the lung. We report a rare case of primary adenocarcinoma of the lung presenting as inguinal mass. CASE PRESENTATION: A 73-year-old Caucasian female with a past medical history significant for hypertension, Chronic obstructive pulmonary disease (COPD), everyday smoker was seen in the primary care clinic for ongoing shortness of breath, worsening cough, and wheezing. She was prescribed a short course of steroids and antibiotics for possible COPD exacerbation. Despite these measures, the patient had worsening pulmonary symptoms and got evaluated in the emergency room. A CAT scan of the chest was done that showed right upper lobe bilobed masses and smaller satellite lesions seen measuring 3.4 and 2.8 cm in the greatest dimension. She got admitted to the hospital for further evaluation, and pulmonary service was consulted for possible endobronchial ultrasound-guided biopsy (EBUS) of the mediastinal nodes. During the physical exam, she was found to have a large fungating mass in the right groin. Upon further questioning, she reported that the mass began as small swelling in the groin three months ago and was evaluated by the primary care and received antibiotics for two weeks. During this time, she did not have any worsening pulmonary symptoms. She underwent bedside excisional biopsy of the lymph node, and the pathology came back positive for metastatic adenocarcinoma of pulmonary origin. A CAT scan of the abdomen revealed Hypoattenuating mass posterior aspect right lobe of the liver and second lesion in the spleen. Unfortunately, the patient had a significant worsening of her respiratory distress and was transitioned to comfort measures and passed away after three days. DISCUSSION: Extra thoracic nodal metastasis to the brain, bone, liver, and adrenal glands were the most common sites from adenocarcinoma of the lung at presentation1. Inguinal lymph nodes are an unusual site for distant metastasis. There have been only two other case reports of the Inguinal lymph node metastasis in adenocarcinoma and both were a sign of disease relapse2. we present the first case of inguinal metastasis from lung adenocarcinoma at presentation. In a retrospective study of 1486 cases of surgically removed NSCLC by Riquet et al., extrathoracic nodal metastases to inguinal lymph node was seen in one case3. Groin metastases are exceptional and no lymphatic vessel continuity can explain their incidence. Therefore, these metastases are systemic in origin. CONCLUSIONS: In conclusion, although extremely rare, metastatic disease to the inguinal region from lung cancer should be considered in the differential diagnosis of any lesion in the groin. Reference #1: Quint LE, Tummala S, Brisson LJ, Francis IR, Krup- nick AS, Kazerooni EA, et al. Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg 1996; 62:246-50. Reference #2: Tasci, Canturk & Dogan, Deniz & çiçek, Ali & Uçar, Ergün & özkan, Metin & Bilgic, Hayati. (2011). A case of lung cancer which presented with saphenous vein thrombosis and inguinal lymph node metastasis. Anatolian Journal of Clinical Investigation. Reference #3: Riquet M, Le Pimpec-Barthes F, Danel C. Axillary lymph node metastases from bronchogenic carcinoma. Ann Thorac Surg 1998; 66:920-2. DISCLOSURES: No relevant relationships by Venkatkiran Kanchustambham, source=Web Response No relevant relationships by Swetha Saladi, source=Web Response

A case of endosalpingiosis in the lymph nodes of the mesocolon

BackgroundEndosalpingiosis in the lymph nodes of the mesocolon is very rare. We reported a case with appendiceal endometriosis who had endosalpingiosis in the lymph nodes of the mesocolon that was found during laparoscopic ileocecal resection.Case presentationThe patient was a 44-year-old woman who had visited a physician for fever, bloody stool, and abdominal pain 1 year earlier. She was diagnosed with ulcerative colitis on colonoscopy, and symptoms improved with oral treatment. A colonoscopy performed 2 months after diagnosis detected a hard, 20-mm submucosal tumor (SMT) in the cecum. On abdominal contrast CT, an intensely stained mass, including a low-density region, was observed in the cecum. A boring biopsy was performed after mucosal resection of the cecal SMT at our hospital, but diagnosis could not be made. Since the possibility of a malignant lesion could not be ruled out, laparoscopic ileocecal resection was performed. In the resected specimen, a 29 × 27 × 21-mm mass was present in the appendicular root. On histopathological examination, appendiceal endometriosis and endosalpingiosis in the lymph nodes around the ileocolic artery were observed. The postoperative course was favorable, and the patient was discharged 7 days after surgery.ConclusionDifferentiation of endosalpingiosis in lymph nodes in the mesocolon from lymph node metastasis of adenocarcinoma is important in patients with an abdominal mass.

Identification of GSN and LAMC2 as Key Prognostic Genes of Bladder Cancer by Integrated Bioinformatics Analysis.

Bladder cancer is a common malignancy with mechanisms of pathogenesis and progression. This study aimed to identify the prognostic hub genes, which are the central modulators to regulate the progression and proliferation in the specific subtype of bladder cancer. The identification of the candidate hub gene was performed by weighted gene co-expression network analysis to construct a free-scale gene co-expression network. The gene expression profile of GSE97768 from the Gene Expression Omnibus database was used. The association between prognosis and hub gene was evaluated by The Cancer Genome Atlas database. Four gene-expression modules were significantly related to bladder cancer disease: the red module (human adenocarcinoma lymph node metastasis), the darkturquioise module (grade 2 carcinoma), the lightgreen module (grade 3 carcinoma), and the royalblue module (transitional cell carcinoma lymphatic metastasis). Based on betweenness centrality and survival analysis, we identified laminin subunit gamma-2 (LAMC2) in the grade 2 carcinoma, gelsolin (GSN) in the grade 3 carcinoma, and homeodomain-interacting protein kinase 2 (HIPK2) in the transitional cell carcinoma lymphatic metastasis. Subsequently, the protein levels of LAMC2 and GSN were respectively down-regulated and up-regulated in tumor tissue with the Human Protein Atlas (HPA) database. Our results suggested that LAMC2 and GSN are the central modulators to transfer information in the specific subtype of the disease.

Recurrence Pattern and Lymph Node Metastasis of Adenocarcinoma at the Esophagogastric Junction.

The surgical approach for adenocarcinoma of the esophagogastric junction (AEJ) still is controversial despite revised tumor-node-metastasis (TNM) classification. This study aimed to evaluate the oncologic outcome of a routine transhiatal approach for AEJ in terms of recurrence and lymph node (LN) metastasis of AEJ. Recurrence patterns and LN metastasis of a single, primary AEJ (n=463) treated by a surgical resection using a transhiatal approach without routine complete mediastinal LN dissection or routine splenectomy were analyzed respectively. To validate current treatment for recurrence, a validation index of recurrence (ViR; overall survival/incidence of solitary recurrence factor) was developed. The overall recurrence rate for AEJ was 20.3%, which did not differ significantly between AEJ II (20.8%; n=125) and AEJ III (20.1%; n=338). Mediastinal recurrence did not differ significantly among the subtypes of AEJ, irrespective of gastroesophageal junction involvement. Splenic hilar LN recurrence-free survival did not differ significantly between the gastrectomy-only group, the gastrectomy-plus-splenectomy group, and the gastrectomy plus distal pancreatectomy group. The solitary recurrence rate for the mediastinal LN was 0.7% for AEJ, and the overall median survival with that recurrence was 30.5months. The ViR for mediastinal LN recurrence (43.6) was higher than for regional LN (20.9) or distant LN (14.6) metastasis. In terms of LN metastasis and recurrence, a transhiatal approach without complete mediastinal LN dissection can be acceptable, and routine splenectomy is not necessary for AEJ II or AEJ III arising within the stomach.

Predictors of Lymph Node Metastasis and Prognosis in pT1 Colorectal Cancer Patients with Signet-Ring Cell and Mucinous Adenocarcinomas

Background/Aims: The local excision of early colorectal cancer is limited by the presence of lymph node metastasis (LNM). Signet-ring cell carcinomas (SRC) and mucinous adenocarcinomas (MAC) are two relatively infrequent histological subtypes. However, little is known about the predictors of LNM and prognosis to support the feasibility of local excision in early-stage SRC and MAC. Methods: The Surveillance Epidemiology and End Results Database were used to identify all patients with pT1 adenocarcinomas, including conventional adenocarcinoma (AC), MAC, and SRC. The prevalence of LNM was assessed, and the long-term survival rate in the above three types of colorectal cancer was calculated. Results: SRC accounted for 0.3% and MAC accounted for 4.4% of the entire cohort of colorectal adenocarcinomas. Compared to AC, MRC and SRC were more often located in the proximal colon, and exhibited a higher grade. The incidence of LNM in AC, MAC, and SRC was 10.6%, 17.2%, and 33.3% for colon cancers and 14.8%, 25.9%, and 46.2% for rectal cancers, respectively. In patients with lymph nodes resected no less than 12, incidence of LNM in AC, MRC, and SRC was 12%, 21%, and 44% for colon tumors and 17%, 30%, and 14% for rectal tumors, respectively. Although, colon patients MAC showed an entirely worse survival rate than AC, rectum patients MAC showed a similar prognosis to AC. We found that in patients with rectal tumors, SRC had a worse 3 and 5-year prognosis than AC. However, for colon cancers, the prognosis of SRC was similar to that of AC. Histology was not found to be an independent prognostic factor in multivariate survival analysis. Conclusions: MAC and SRC are two distinct subtypes of colorectal cancer that require special attention despite their relatively rare prevalence. pT1 patients with SRC of the rectum and patients with MAC of the colon have higher incidences of LNM, and with these adverse outcomes, local excision is not recommended. AlthoughMAC of the rectum and SRC of colon have a high rate of LNM, the prognosis of these types are similar to that of AC.

Expression and clinicopathological significance of S100 calcium binding protein A2 in lung cancer patients of Chinese Han ethnicity

BackgroundS100 family of calcium-binding proteins plays a significant role in the process of many kinds of tumors, including lung cancer. As an important member of this family, S100 calcium binding protein A2 (S100A2) has been confirmed to be associated with many biological processes, and has an abnormal expression in non-small cell lung cancer (NSCLC). However, the S100A2 status in lung cancer is still controversial and undefined. MethodsWe evaluated the pattern and distribution of S100A2 in 109 cases of lung cancer, including five histological types (47 adenocarcinoma, 46 squamous cell carcinoma, 7 small cell carcinoma, 3 large cell carcinoma, and 6 atypical carcinoid), and 30 cases of paired adjacent normal lung tissues by means of immunohistochemistry. ResultsCompared with the normal tissues (0/30), S100A2 experienced a dramatically upward trend of positive expression in lung cancer, with a positive rate of 68/109 (P<0.001). Specifically, squamous cell carcinoma, with 34/12, had the highest expression ratio, followed by large cell carcinoma (2/1), adenocarcinoma (31/16), and atypical carcinoid (1/5) respectively, while no S100A2 protein was detected in small cell carcinoma. Meanwhile, we firstly demonstrated that the high expression of S100A2 was significantly associated with the incidence of lymph node metastasis in adenocarcinoma (P=0.013). ConclusionsThe association between high S100A2 expression and NSCLC at the level of tissue, and S100A2 may serve as an effective biomarker for the diagnosis and prognosis of NSCLC in future.

Patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction in 393 patients

To explore the patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction (AEG). Clinicopathological data of 393 AEG patients who underwent radical resection and lymphadenectomy in the thoracic or abdominal cavity were collected. We analyzed the metastatic patterns of 5 119 excised lymph nodes with an average of 13 nodes per patient according to Siewert classification, and the associations between lymphatic metastasis and clinicopathological factors, such as tumor invasion, differentiation, maximum diameter, or pathological type were analyzed. The lymph node metastasis rate and ratio (LNR) were 70.0% (275/393) and 29.1% (1 492/5 119), respectively. All the Siewert subtypes of AEG mainly metastasize downwards to the abdominal lymph nodes, while also spread upwards to the mediastinal lymph nodes. Among them, the lymph node metastasis rate was highest in Siewert type Ⅰ and lowest in Siewert type Ⅲ AEG. The lymph node metastasis rate and ratio in T1, T2, T3, T4 AEGs were 0%, 29.4%, 75.0%, 74.6% and 0%, 10.1%, 14.2%, 32.0%, respectively (χ(2)=35.305, P<0.001 and χ(2)=134.034, P<0.001). The lymph node metastasis rate and ratio of the poorly differentiated adenocarcinoma were 36.0% and 79.3%, respectively, significantly higher than 22.1% and 61.7% of the well-differentiated adenocarcinoma (χ(2)=14.468, P<0.001 and χ(2)=120.009, P<0.001). The lymph node metastasis rate and ratio of patients with a tumor in maximum diameter ≥4 cm were 73.1% and 30.9%, significantly higher than 46.8% and 14.6%, respectively, in the patients with a tumor in maximum diameter of <4 cm (χ(2)=13.636, P<0.001 and χ(2)=64.767, P<0.001). The group of vascular tumor thrombus showed significantly higher lymph node metastasis rate and ratio than those in the group with no vascular tumor thrombus (84.6% versus 67.1%, χ(2)=7.946, P=0.005; and 45.0% versus 26.0%, χ(2)=112.723, P<0.001). The lymph node metastasis ratio of mucinous and signet ring cell adenocarcinoma was 34.9%, significantly higher than 28.5% of the adenocarcinoma (χ(2)=8.710, P<0.001) The depth of tumor invasion and degree of tumor differentiation were independent factors affecting lymph node metastasis (P=0.001 and P<0.001). The lymph node metastasis rate and ratio of AEG are high and influenced by many clinicopathological factors. The patterns of lymph node metastasis are different among different Siewert subtype AEGs.The depth of tumor invasion and differentiation degree are independent factors affecting lymphatic metastasis.

The overexpression of MDM4: an effective and novel predictor of gastric adenocarcinoma lymph node metastasis.

BackgroundMDM4 is the important negative regulator of the tumor suppressor protein p53, which is overexpressed in various human cancers. This study evaluates the MDM4 expression in patients with gastric adenocarcinoma (GTAC) at the mRNA and protein levels and examines relationships among MDM4 expression, clinicopathological features, and prognosis.ResultsThe qRT-PCR and the Western blot analysis showed that the MDM4 expression level was high in GTACN+ but not in GTACN−. The high expression level of MDM4 was significantly associated with age (P = 0.047), lymph node metastasis (LNM) (P < 0.001), pathological stage (P < 0.001), differentiation status (P = 0.001), and preoperative serum CA19-9 level (P < 0.001). Moreover, the survival analysis showed that Borrmann type, depth of invasion, LNM, and preoperative serum CA19-9 level were independent prognostic factors. The univariate analysis revealed that MDM4 expression influenced GTAC prognosis. Furthermore, the influence of overall prognosis relies on whether or not the high MDM4 expression level could lead to LNM.Materials and MethodsWe investigated MDM4 expression in primary GTAC and paired normal gastric tissues (30 pairs) through qRT-PCR and Western blot analyses. We also performed immunohistochemistry analysis on 336 paraffin-embedded GTAC specimens and 33 matched normal specimens.ConclusionsMDM4 expression may result in LMN of GTAC. High MDM4 expression levels are associated with LMN of GTAC and influence the prognosis of patients with GTAC.

Extranodal extension in N1-adenocarcinoma of the pancreas and papilla of Vater: a systematic review and meta-analysis of its prognostic significance.

The aim of the study was to investigate the prognostic role of extranodal extension (ENE) of lymph node metastasis in adenocarcinoma of the pancreas (PDAC) and papilla [cancer of the papilla of Vater (CPV)]. A PubMed and SCOPUS search from database inception until 5 January 2015 without language restrictions was conducted. Eligible were prospective studies reporting data on prognostic parameters in individuals with PDAC and/or CPV, comparing participants with the presence of ENE (ENE+) with those with intranodal extension (ENE-). Data were summarized using risk ratios for number of deaths/recurrences and hazard ratios for time-dependent risk related to ENE+, adjusted for potential confounders. ENE was found to be very common in these tumors (up to about 60% in both N1-PDAC and CPV), leading to a significant increased risk for all-cause mortality [risk ratio=1.20; 95% confidence interval (CI): 1.06-1.35, P=0.003, I(2)=44%; hazard ratio=1.415, 95% CI: 1.215-1.650, P<0.0001, I(2)=0%] and recurrence of disease (risk ratio=1.20, 95% CI: 1.03-1.40, P=0.02, I(2)=0%). On the basis of our results, in PDAC and CPV, ENE should be considered mandatorily from the gross sampling and pathology report to the oncologic staging and therapeutic approach.

Predictors of lymph node metastasis and prognosis in early colorectal cancer patients with signet-ring cell and mucinous adenocarcinomas.

717 Background: The local excision of early colorectal cancer is limited by the presence of lymph node metastasis. Signet-ring cell carcinomas and mucinous adenocarcinomas are two relatively infrequent histological subtypes. However, little is known about the predictors of lymph node metastases and prognosis to support the feasibility of local excision in early-stage signet-ring cell and mucinous colorectal adenocarcinomas. Methods: The Surveillance Epidemiology and End Results Database (1988 to 2006) from the National Cancer Institute was used to identify all patients with T1 adenocarcinomas, including conventional adenocarcinoma (AC), mucinous adenocarcinomas (MAC), and signet-ring cell carcinoma (SRC). The prevalence of lymph node metastasis was assessed, and the long-term survival rate in the above three types of colorectal cancer was calculated. Results: Final cohorts of 47,260 patients were eligible for analysis. SRC accounted for 0.3% and MAC accounted for 3.7% of the entire cohort of colorectal adenocarcinomas. Compared to AC, SRC and MAC more frequently presented at a younger age, were located in the proximal colon, and exhibited a higher grade. The incidence of lymph node metastasis in AC, MAC, and SRC was 5.8%, 10.8%, and 15.3%, respectively. Patients with SRC were associated with a worse prognosis, regardless of the tumor location. Patients with MAC of the rectum, but not the colon, were associated with a reduced implication of prognosis. After adjusting for other clinicopathological factors, SRC and MAC of the rectum were independently associated with a high risk of death (HR 2.70, CI 1.77-4.12 and HR 1.65, CI 1.38-1.98 for SRC and MAC, respectively). Histology was not found to be an independent prognostic factor in patients with colon cancer. Conclusions: MAC and SRC are two distinct subtypes of colorectal cancer that require special attention despite their relatively rare prevalence. T1 patients with SRC and patients with MAC of the rectum have higher incidences of lymph node metastasis (LNM), and with these adverse outcomes, local excision is not recommended. Although MAC of the colon has a high rate of LNM, the prognosis of this type is similar to that of AC.

Frequency of Lymph Node Metastasis According to the Size of Tumors in Resected Pulmonary Adenocarcinoma with a Size of 30 mm or Smaller

Background:This study analyzed the relation between the tumor size and the lymph node metastasis in adenocarcinoma of the lung with a size of 30 mm or smaller.Methods:Four hundred thirteen patients who had undergone curative resection for lung adenocarcinoma were enrolled. If the tumor presented ground-glass opacities on the preoperative high-resolution computed tomography, both the total size including ground-glass opacities and the solid size alone were measured. To calculate the rates of lymph node metastasis by the tumor size, the tumors were divided into six groups by their sizes: 5 mm or less, 6 to 10 mm, 11 to 15 mm, 16 to 20 mm, 21 to 25 mm, and 26 to 30 mm.Results:The average numbers of dissected lymph nodes and dissected lymph node stations were 17 and 5, respectively. Seventy-five patients (18%) were postoperatively discovered to have positive nodes. The rates of node metastasis in each total size group were 0/1 (0%), 0/29 (0%), 5/77 (7%), 17/121 (14%), 27/101 (27%), and 26/84 (31%), respectively. The rates of node metastasis in each solid size group were 0/37 (0%), 1/53 (2%), 9/88 (10%), 17/104 (16%), 23/78 (30%), and 25/53 (47%), respectively. The area under the curve of receiver operating characteristic curves for the total size was measured as 0.701, and that for the solid size was measured as 0.777. By multivariate analysis, solid size, maximum standardized uptake value, and lymphovascular invasion were independent significant predictive factors.Conclusions:Solid size, maximum standardized uptake value, and lymphovascular invasion were independent predictors for lymph node metastasis of lung adenocarcinoma. The size of the solid component explained the relation between the tumor size and the lymph node metastasis more accurately than that explained by the total tumor size on high-resolution computed tomography.

Chirurgische Optionen bei „cancer of unknown primary“ (CUP)

Cancer of unknown primary site (CUP) comprises a relatively frequently occurring group of heterogeneous malignant tumors in the clinical routine, which currently has an abysmal prognosis for affected patients. Based on the improved diagnostic tools it is now possible to identify subgroups of patients with different clinical prognoses. New therapies adapted to these identified subgroups are becoming increasingly more relevant. This review aims to evaluate the role of surgery and different surgical options in the therapy of patients with CUP. For the treatment of patients with CUP it is important to identify subgroups of patients with a better prognosis. Surgical resection of CUP metastasis is a therapy option leading to a prolonged survival in (1) women with papillary peritoneal adenocarcinomatosis, (2) women with axillary lymph node metastasis of adenocarcinoma, (3) patients with cervical lymph node metastasis of squamous cell carcinoma, (4) patients with inguinal lymph node metastasis, (5) patients with poorly differentiated carcinomas with midline distribution (e.g. extragonadal germ cell syndrome) and (6) patients with small resectable tumors. Surgery is an important therapy option in different subgroups of patients with CUP. Together with multimodal therapy, adjusted according to the identified most likely origin of the primary tumor, it is possible to prolong patient survival.

Collet Siccard Syndrome without skull base metastasis : A rare presentation of bronchogenic adenocarcinoma

A 54 year old female on evaluation of dysarthria was found to have left IX, X and XII cranial nerve palsy. General physical examination revealed bilateral cervical level V multiple lymph nodes which were firm to hard and nontender; respiratory system examination suggested left sided mild pleural effusion. MRI brain and cervical spine did not show any evidence of meningeal enhancement or skull base metastasis. Bronchoscopy revealed a mass lesion in left main bronchus. Her cranial nerve symptoms were attributed to Collet-Sicard syndrome because of the lymph node metastasis from lung cancer. It is a rare case of Collet-Sicard syndrome resulting from lymph node metastasis of adenocarcinoma of lung and is important as a differential diagnosis of lower cranial nerve palsy.

Significance of TRIM29 and β-catenin expression in non-small-cell lung cancer

BackgroundTRIM29 belongs to the tripartite motif (TRIM) protein family. It has been reported to be up-regulated or be down-regulated in many cancer types, suggesting the oncogenic function of TRIM29 may be depend on different molecular signaling pathway. It was found that β-catenin function (a key molecule in the Wnt signaling pathway) was required for TRIM29’s oncogenic effects. TRIM29 gene expression was also found to be heterogeneous in non-small-cell lung cancer (NSCLC) subtypes. In this study, the possible associations of TRIM29 expression with clinicopathological factors, prognosis, and β-catenin in human NSCLC were analyzed. MethodsTRIM29 and β-catenin expression of tumor and adjacent normal tissues in 251 cases of NSCLC treated by surgery was detected by the Immunohistochemical method. The relationship between clinical pathological data, β-catenin, and TRIM29 expression was analyzed. ResultsTRIM29 expression of tumor tissues was significantly higher than adjacent normal tissues. Expression of TRIM29 in squamous cell carcinoma (SC) tissues was positively correlated with abnormal expression of β-catenin, histological grade, tumor-node-metastasis (TNM) stage, and lymph node metastasis and that was positively correlated with tumor size, histological grading, TNM stage and lymph node metastasis in adenocarcinoma (AC). TRIM29 expression in SC and AC was significantly different and the intensity of poorly differentiated SC was significantly higher than that of AC. High-expression of TRIM29, poorly differentiated grade, and high clinical stage were independent prognostic indicators. ConclusionWe considered that TRIM29 may play a reference role in distinguish poorly differentiated AC and SC of NSCLC, combining with CK5/6 and CK7, and it could improve postoperative assessment and have the reference value for clinical treatment. The interaction between TRIM29 and β-catenin may participate in the development of lung SC.

Clinical Usefulness of D2-40 in Non-Small Cell Lung Cancer

D2-40 is a recently developed monoclonal antibody that reacts with a 40kDa O-linked sialoglycoprotein and has been used for the assessment of lymphatic invasion in tumor specimens. We have evaluated the diagnostic usefulness of D2-40 and association of its immunopositivity with clinicopathological parameters in adenocarcinoma and squamous cell carcinoma of the lung. We investigated 97 cases of surgically resected adenocarcinoma or squamous cell carcinoma of the lung for the determination of D2-40 positivity in tumor cells and peritumoral lymphatic vessel density (LVD) using an immunostaining method. D2-40 immunoreactivity in tumor cells was invariably negative in adenocarcinoma but 47% of squamous cell carcinomas were positive. D2-40 positivity in the tumor was significantly associated with high LVD in squamous cell carcinoma (P<0.006). There was no significant association between peritumoral LVD and clinicopathologic parameters, including lymphatic vessel invasion, lymph node metastasis, and survival in adenocarcinoma and squamous cell carcinoma. These results suggest that D2-40 immunoreactivity in tumor cells can be used for distinguishing between adenocarcinoma and squamous cell carcinoma and that the reactivity of tumor cells with D2-40 is positively correlated with LVD in squamous cell carcinoma but not with lymph node metastasis in adenocarcinoma and squamous cell carcinoma.

Risk of lymph node metastasis associated with deeper invasion by early adenocarcinoma of the esophagus and cardia: study based on endoscopic resection specimens

Most risk estimations for lymph node metastasis in adenocarcinoma of the esophagus and cardia (AEC) with invasion into the muscularis mucosae (m3) or submucosa are based on surgical series. This study aimed to correlate the lymph node metastasis rate with m3 and submucosal infiltration depth of AEC in endoscopic resection specimens. Patients undergoing endoscopic resection for AEC between January 2000 and March 2008 at two centers were included if the endoscopic resection specimen showed m3 or submucosal cancer. Infiltration into the muscularis mucosae was defined as m3. Submucosal invasion was classified as sm1 (≤ 500 µm) or sm2/3 (> 500 µm). Exclusion criteria were chemotherapy or radiotherapy and nonradical endoscopic resection. 82 patients included 57 with m3, 12 with sm1, and 13 with sm2/3 cancers. Of the tumors, 13 were poorly differentiated and five showed lymphovascular invasion. After initial endoscopic resection, seven patients underwent surgery and 75 endoscopic therapy. No lymph node metastases were found in 158 lymph nodes of the esophagectomy specimens and none of the endoscopically treated patients were diagnosed with lymph node metastasis during a median follow-up of 26 months (interquartile range [IQR] 14 - 41). This study suggests that lymph node metastasis risk for m3 and submucosal AEC may be lower than has been assumed on the basis of surgical series, and that current guidelines are valid regarding suitability of m3 AECs for endoscopic therapy. It may also suggest that selected patients with submucosal cancers are also eligible for endoscopic management. Confirmation of these results is needed in larger series with longer follow-up.

Transthoracic esophagectomy of adenocarcinoma in Barrett’s esophagus in Japanese patients: analysis of localization of lymph node metastases in 19 cases

The incidence of esophageal adenocarcinoma is only 1%–2% in Japan. For this reason, many aspects of this disease have not been clarified, such as its generation, progress, and the potential of malignancy. It is necessary to investigate the strategy for treating this disease. Between 1998 and 2008, 19 cases were diagnosed as adenocarcinoma with Barrett’s esophagus and treated with esophagectomy at Juntendo University: 13 cases were early stage and 6 cases were advanced stage. Distribution of lymph node metastasis and prognosis were investigated. The incidence of lymph node metastases of adenocarcinoma is statistically lower (15.4%) compared with that of squamous cell carcinoma (SCC) (44.0%) (P = 0.034) when the depth of the tumor is not beyond the submucosal layer. Even in the early stages of adenocarcinoma, positive nodes were found in the lower mediastinum and gastric cardia. In advanced cases, cancer had spread randomly to the upper mediastinum or celiac region. Mean survival time of superficial and advanced adenocarcinoma after esophagectomy was 3,517.5 ± 330.6 and 2,061.4 ± 451.3 days, respectively, whereas that of SCC was 2,794.7 ± 131.0 and 1,669.1 ± 101.5 days, respectively. Overall survival of superficial or advanced adenocarcinoma was better than that of SCC but was not statistically superior. Endoscopic mucosal resection is limitedly proposed for mucosal tumors. Esophagectomy with a mediastinal lymphadenectomy should be conducted for tumors invading the submucosa. An individualized strategy is required that could approach the upper mediastinum based on staging and location of lymph node metastases.