Tumor Lymph Node Metastasis Research Articles

Clinical difference between solitary and multiple pulmonary adenocarcinoma nodules.

we compared and analyzed the imaging features, tumor markers, pathological immunohistochemistry, and lymph node metastasis rates of solitary and multiple lung adenocarcinoma to provide a valuable reference for clinical diagnosis and treatment. A retrospective analysis of 212 patients who underwent thoracic surgery in our hospital from 2022 to 2023, including 149 patients with a solitary lung adenocarcinoma nodule and 63 patients with multiple primary nodules. Via propensity score matching, the imaging features, tumor serological markers, pathological immunohistochemistry, and lymph node metastasis rates of the two groups were compared, and the differences in lymph node metastasis rates between solitary and multiple nodules were explored by binary logistic regression. After propensity score matching, there were significant differences in the mean CT value (P = 0.001), Ki-67 expression (P < 0.001), PD-L1 expression (P = 0.002), and the lymph node metastasis rate (P = 0.030) between the two groups, but there were no significant differences in nodule type, imaging features, tumor serological marker levels, and the ALK-positive and SYN-positive rates. With lymph node metastasis as the dependent variable, solitary or multiple nodules as the categorical covariate, and the three variables were included as independent variables for binary logistic regression analysis. The probability of lymph node metastasis was 80.8% lower in patients with multiple primary lung adenocarcinoma nodules than in those with a solitary one (P = 0.042). Multiple primary adenocarcinoma nodules exhibit milder biological behavior than solitary adenocarcinoma nodules and carry a lower risk of lymph node metastasis.

Extensive small cell lung cancer treated by integrated traditional Chinese and Western medicine: A case report.

Patients with extensive small cell lung cancer (SCLC) generally have a dismal survival rate and are conventionally treated with chemotherapy. This study aimed to explore an alternative treatment approach by combining traditional Chinese medicine (TCM) with radiotherapy and chemotherapy. A 68-year-old male was diagnosed with extensive-stage SCLC. Positron emission tomography/computed tomography scans indicated a high metabolism mass in the left hilar region, along with multiple lymph node metastases and metastatic tumors in both lungs. A left lung biopsy verified small cell carcinoma. The patient was confirmed to have extensive stage SCLC based on imaging and biopsy results. The patient received a comprehensive treatment regimen. TCM herbal prescriptions such as Qianjin Weijing Decoction, Wuwei Xiaodu Decoction, Xiaoxianxiong Decoction, and Xiaochengqi Decoction were administered. In parallel, standard Western medicine therapies, including chemotherapy (intravenous cisplatin and etoposide) and radiotherapy, were carried out. Oral ondansetron was given to alleviate nausea and vomiting caused by chemotherapy and radiotherapy. After 30 months, follow-up positron emission tomography/computed tomography demonstrated the complete disappearance of all cancerous lesions. The patient regained normal daily activities and experienced a substantially enhanced quality of life. Four years after the initial treatment, there has been no recurrence, and the patient persists in taking the original TCM decoction. The combination of TCM and Western medicine in treating SCLC proves effective in managing systemic symptoms, mitigating bone marrow suppression, gastrointestinal reactions, immunosuppression, and other chemotherapy-induced adverse reactions. It also significantly prolongs the survival period, suggesting it as a preferable treatment option for SCLC.

Incidence, characteristics, and comorbidities of a complete unselected Danish cohort of patients with thymic epithelial tumors.

We report the incidence, characteristics, and comorbidities of the complete unselected Danish cohort of patients with thymic epitheliums (TETs), which may serve as evidence for guiding treatment, surveillance, and counselling of TET patients. All patients diagnosed with TETs from January 1st, 2015, to December 31st, 2020, were identified using the Danish Pathology Data Registry. Data on patient characteristics, comorbidities, and tumor histology were collected from electronic medical records available for all patients. The cohort consisted of 283 patients with a mean age of 64 years (SD: 12). The crude rate was 8.2/1,000,000 TETs annually, thus higher than the age-standardized rates of 4.8/1,000,000 in the WHO World Standard Population and 6.1/1,000,000 in the European Standard Population. Thymomas were diagnosed in 240 patients (85%) (9% type A, 31% AB, 18% B1, 26% B2, 6% B3, 5% micronodular, 0.4% metaplastic, and 5% of unspecified subtype), thymic carcinomas in 39 patients (14%), and thymic neuroendocrine tumors in 4 patients (1.4%). Tumors in Tumour, Node, Metastasis (TNM) stage I were diagnosed in 181 patients (64%) and were mostly thymomas (72%). Prior to TET diagnosis, 91 (32%) patients presented with autoimmune disorders (19% myasthenia gravis) and 82 patients (29%) had at least one cancer diagnosis. We found a higher incidence of TETs in Denmark than in previous European population-based studies, while reporting a similar distribution of histological types and tumor stages. Furthermore, we found an increased prevalence of autoimmune disorders and cancers in the cohort before TET diagnosis compared to the general population.

Coagulation indices and fibrinogen degradation products as predictive biomarkers for tumor-node-metastasis staging and metastasis in gastric cancer.

Gastric cancer (GC) is a prevalent malignancy with a substantial health burden and high mortality rate, despite advances in prevention, early detection, and treatment. Compared with the global average, Asia, notably China, reports disproportionately high GC incidences. The disease often progresses asymptomatically in the early stages, leading to delayed diagnosis and compromised outcomes. Thus, it is crucial to identify early diagnostic biomarkers and enhance treatment strategies to improve patient outcomes and reduce mortality. To investigate coagulation and fibrinogen products in GC tumor-node-metastasis (TNM) stage and metastasis correlation. Retrospectively analyzed the clinical data of 148 patients with GC treated at the Civil Aviation Shanghai Hospital between December 2022 and December 2023. The associations of coagulation indices - partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen, fibrinogen degradation products (FDP), fasting blood glucose, and D-dimer (D-D) with TNM stage and distant metastasis were examined. Prolongation of APTT, PT, and TT was significantly correlated with the GC TNM stage. Hence, abnormal coagulation system activation was closely related to disease progression. Elevated FDP and D-D were significantly associated with distant metastasis in GC (P < 0.05), suggesting that increased fibrinolytic activity contributes to increased metastatic risk. Our Results reveal coagulation indices, FDPs as GC biomarkers, reflecting abnormal coagulation/fibrinolysis, aiding disease progression, metastasis prediction, and helping clinicians assess thrombotic risk for early intervention and personalized treatment plans.

Primary staging with 2[18F]-FDG-PET/CT and -PET/MRI and radiotherapy response evaluation with MRI in uterine cervical cancer: an interim analysis of a prospective clinical trial

BackgroundIn uterine cervical cancer (UCC), tumour staging is performed according to the 2018 International Federation of Gynecology and Obstetrics (FIGO) system, where imaging is incorporated, or the more generic Tumour Node Metastasis (TNM) classification. With the technical development in diagnostic imaging, continuous prospective evaluation of the different imaging methods contributing to stage determination is warranted. The aims of this interim study were to (1) evaluate the performance of radiological FIGO (rFIGO) and T staging (rT) with 2-fluorine-18-fluoro-deoxy-glucose (2[18F]-FDG)-positron emission tomography with computed tomography (PET/CT) and with magnetic resonance imaging (PET/MRI), compared to clinical FIGO (cFIGO) and T (cT) staging based on clinical examination and conventional imaging, in treatment-naïve UCC, and to (2) identify possible MRI biomarkers for early treatment response after radiotherapy.MethodsTen consecutive patients with newly diagnosed UCC from the prospective PRODIGYN (Prognostic and Diagnostic Added Value of Medical Imaging in Staging and Treatment Planning of Gynecological Cancer) study (ethical approval number 2022-04207-01; NCT05855941) were included. Study participants underwent 2[18F]FDG-PET/CT and -PET/MRI, and an additional MRI one week after radiotherapy. Agreement between rFIGO and cFIGO was analysed using Cohen’s kappa. Differences in rFIGO between 2[18F]FDG-PET/CT and -PET/MRI were evaluated with Wilcoxon signed ranks test, and added value of rFIGO for metastasis assessment was demonstrated with descriptive statistics.ResultsIn 2/10 patients, a higher stage was obtained with rFIGO compared to cFIGO, where presence of metastases led to upstaging. In 3/10, rFIGO was lower than cFIGO, and in 5/10 rFIGO and cFIGO were similar. Degree of agreement between rFIGO and cFIGO was poor, (κ = 0.091, p < 0.005) with 2[18F]FDG-PET/CT and (κ = − 0.010, p > 0.05) with FDG/PET/MRI). There was no significant difference between 2[18F]FDG-PET/CT and -PET/MRI for rFIGO (p = 0.18), or rT stage assessment (p = 0.32). MRI-derived tumour volume and apparent diffusion coefficient (ADC) were most affected on MRI one week after radiotherapy.ConclusionsOur results indicate that there is an added value of rFIGO staging with 2[18F]FDG-PET/CT and -PET/MRI compared to clinical examination and conventional radiology, for metastasis assessment in treatment-naïve UCC. In early treatment response evaluation with MRI, ADC and tumour volume may be predictive parameters of interest in future prognostic analyses.Trial registrationClinical Trials, NCT05855941. Registered 02 May 2023, https://clinicaltrials.gov/study/NCT05855941?term=NCT05855941&rank=1.

The effect of downregulation of ARL9 expression on the proliferation, metastasis and biological behavior of AGS gastric cancer cell lines.

Some ADP ribosylation factors (ARF) and ADP ribosylation factor-like (ARL) family are involved in the regulation of certain cancers, but the role of ADP ribosylation factor-like 9 (ARL9) in gastric tumorigenesis remains elusive. The main aim of this study was to evaluate the ARL9 expression within stomach cancer cells and elucidate its influence on the modulation of cancer cell behavior. Differential ARL9 protein expression in normal stomach and stomach cancer tissue was ascertained through data sourced from the University of Alabama at Birmingham Cancer Data Analysis Portal (UALCAN). Quantitative analysis of ARL9 expression in gastric cancer tissue and its association with clinicopathological features was performed using quantitative polymerase chain reaction (qPCR) and western blot analysis (WB). Small interfering RNA (siRNA) was employed to suppress ARL9 protein expression in the human stomach gastric adenocarcinoma human gastric adenocarcinoma cells (AGS) cell line. Assessment of AGS gastric cancer (GC) cell proliferation, invasion and migration was performed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and transwell techniques. The expression of ARL9 protein exhibited a significant upregulation in GC tissue, and showed a close association between tumor dimensions (p < 0.05) and the presence of distant metastases (p < 0.05) among individuals diagnosed with GC. However, no significant link was observed with sex, age and tumor-node-metastasis (TNM) staging in gastric malignancy patients. After the introduction of si-ARL9 in the experimental set, there was a noteworthy decrease in ARL9 protein levels in AGS cells (p < 0.01). In contrast to the control cohort, the restraint of ARL9 expression significantly hampered the growth, mobility and infiltration abilities of the AGS GC cell line (p < 0.01). The significant correlation of ARL9 with the biological behavior of GC indicates its potentially pivotal role in the pathophysiology of the malignancy.

Comparative evaluation of TNM staging systems (eighth vs. ninth edition) for the non-surgical treatment of localized and locally advanced anal squamous cell carcinoma: Prognostic significance of T classification and lymph node status.

This study aims to compare the survival discrimination of the Tumor-Node-Metastasis (TNM) eighth and ninth editions for patients with localized and locally advanced (LLA) anal squamous cell carcinoma (ASCC) treated non-surgically and to evaluate the prognostic impact of T classification and lymph node (LN) status with data from the Surveillance, Epidemiology, and End Results database. We retrospectively included 6,876 patients in the comparison. We observed the inversion of survival outcomes for stages IIB and IIIA diseases in the TNM eighth edition [median overall survival (OS): 112 months for stage IIB vs. not reached for stage IIIA]. By contrast, it demonstrated improvement in the TNM ninth edition (median OS: not reached for IIB disease vs. 120 months for IIIA disease, P<0.001). In the correlation analysis, we observed an increased correlation between T classification and TNM staging systems (r value increased from 0.78 to 0.93) and a decreased correlation for the LN status (r value decreased from 0.83 to 0.59). For OS, variable importance analysis demonstrated more weight of importance for the T classification than the LN status (0.0871 vs. 0.0048). Additionally, decision curve analysis and time-dependent receiver operating characteristic analysis confirmed the prognostic accuracy of T classification rather than the LN status. In conclusion, TNM ninth edition is a better prognostic indicator than the eighth edition for patients with LLA ASCC treated non-surgically. T classification plays a more important prognostic role than the LN status and warrants further validation.

Tumor-Educated Platelets lncRNA-STARD4-AS1 and ELOA-AS1 as Potential Novel Biomarkers for the Early Diagnosis of Non-Small Cell Lung Cancer.

(Tumor-educated platelets) TEPs have emerged as active players in all steps of tumorigenesis, confrontation of platelets with tumor cells via transfer of tumor-associated biomolecules and results in the sequestration of such biomolecules. The current study was aimed to examine whether TEPs lncRNA-STARD4-AS1 and ELOA-AS1 might be potential biomarkers for NSCLC. TEPs were obtained by low-speed centrifugation. Quantitative real-time PCR was used to determine the expression level of TEPs-STARD4-AS1, ELOA-AS1 in the training cohort and the validation cohort. ROC curve was generated to evaluate their diagnostic value. Correlations between TEPs-STARD4-AS1, ELOA-AS1 and clinical parameters were further analyzed. Our results showed that the level of TEPs-STARD4-AS1 and ELOA-AS1 significantly upregulated in patients with NSCLC compared with healthy controls in the two cohorts. By ROC analysis, we found that TEPs-STARD4-AS1, ELOA-AS1 could offer valuable diagnostic performance for NSCLC patients (AUCSTARD4-AS1 = 0.800/0.774, and AUCELOA-AS1 = 0.754/0.718 for diagnosing adenocarcinoma and squamous cell carcinoma cases from controls, respectively). The combination of TEP-STARD4-AS1 and ELOA-AS1 improved the diagnostic efficiency of NSCLC. Clinicopathological analysis further revealed that TEPs-STARD4-AS1 level significantly correlated with tumor-node-metastasis (TNM) stage (p = 0.011), while TEPs-ELOA-AS1 expression significantly correlated with tumor-node-metastasis (TNM) stage and (p = 0.019) distant metastasis (p = 0.004). Our data suggested that TEPs-STARD4-AS1 and ELOA-AS1 are promising non-invasive circulating diagnostic markers for NSCLC.

LcProt: Proteomics-based identification of plasma biomarkers for lung cancer multievent, a multicentre study.

Plasma protein has gained prominence in the non-invasive predicting of lung cancer. We utilised Zeolite Zotero NaY-based plasma proteomics to investigate its potential for multiple event predicting, including lung cancer diagnosis (task #1), lymph node metastasis detection (task #2) and tumour‒node‒metastasis (TNM) staging (task #3). A total of 4703 plasma proteins were quantified from 241 participants based on a prospective cohort of 2757 participants. An additional 46 participants from external prospective cohort of 735 participants were used for validation. Feature selection was performed using differential expressed protein analysis, area under curve (AUC) evaluation and least absolute shrinkage and selection operator (LASSO) regression. Random forest was used for multitask model construction based on the key proteins. Feature importance was interpreted using Shapley additive explanations (SHAP) algorithm. For task #1, 10 proteins panel showed an AUC of.87 (.77‒.97) in the external validation. After integrating clinical factors, a significant increase diagnostic accuracy was observed with AUC of.91 (.85‒.98). For task #2, nine proteins panel achieved an AUC of.88 (.80‒.96), integration model showed an increase diagnostic accuracy with AUC of.90 (.85‒.97). For task #3, 10 proteins panel showed an AUC of.88 (.74‒.96) for stage I,.92 (.84‒.97) for stage II,.88 (.76‒.96) for stage III and.99 (.98‒.99) for stage IV in the integration model. This study comprehensively profiled the NaY-based plasma proteome biomarker, laying the foundation for a high-performance blood test for predicting multiple events in lung cancer. Our study developed an innovative nanomaterial, Zeolite NaY, which addressed the masking effect and improved the depth of the proteome. The performance of NaY-based plasma proteomics as a preclinical diagnostic tool was validated through both internal and external cohort. Furthermore, we explored the different patterns of plasma protein changes during the progression of lung cancer and used the explanations method to elucidate the roles of proteins in the multitask predictive model.

Association between lymphovascular invasion and lymph node metastases in colon cancer: A National Cancer Database analysis.

Lymphovascular invasion (LVI) is a well-known risk factor in colorectal cancer that is associated with a worse prognosis. The present study aimed to assess the characteristics of patients with LVI-positive colon cancer according to the status of nodal metastases and to study the association between LVI-nodal status and survival. This retrospective study assessed the association between LVI and lymph node metastases in colon cancer, using data from the National Cancer Database. Patients were classified according to the pathological N stage into pN0 and pN1-2. The risk factors for LVI were determined in each group using multivariable regression analyses. The primary outcome was LVI and the secondary outcome was 5-year overall survival (OS). A modification of the tumour, node, metastasis (TNM) staging system that incorporates LVI in each stage was proposed. The study included 357 724 patients (51.1% female, median age 70 years). LVI was detected in 11.6% and 52.5% of patients with node-negative and node-positive disease, respectively. The independent predictors of LVI in pN0 stage were poorly differentiated carcinomas (OR: 3.6, p < 0.001), undifferentiated carcinomas (OR: 3.3, p < 0.001), mucinous carcinomas (OR: 0.61, p < 0.001), and perineural invasion (OR: 4.2, p < 0.001). The independent predictors of LVI in pN1-2 disease were poorly differentiated carcinomas (OR: 2.36, p < 0.001), undifferentiated carcinomas (OR: 3.23, p < 0.001), and perineural invasion (OR: 3.33, p < 0.001). LVI was significantly associated with worse 5-year OS and the adverse survival impact of LVI was higher in pN1-2 disease (HR: 1.47, p < 0.001) than in pN0 disease (HR: 1.28, p < 0.001). When LVI was present, the 5-year OS was reduced by 1.5% in stage I, 5.6% in stage II, and 11.5% in stage III. LVI was more prevalent in patients with colon cancer with lymph node metastases than in patients with node-negative disease. However, LVI was not detected in approximately half of patients with nodal disease. The adverse survival effect of LVI was proportional to the stage of colon cancer.

The Clinical Value of the Combined Detection of Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Prognostic Nutritional Index (PNI) in Early Diagnosis of Gastric Cancer.

Gastric cancer (GC) is a common malignant tumor of the digestive tract. Accumulating studies suggest that inflammation is linked with the pathogenesis of GC. The study delves into novel hematological inflammatory markers, such as systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and prognostic nutritional index (PNI), to explore their potential applications in early diagnosis of GC. From October 2020 and August 2024, 1339 GC patients admitted to our hospital were enrolled in this study. The pre-treatment SII, SIRI, and PNI was calculated from peripheral blood samples. Univariate and multivariate logistic regression analyses were utilized to verify independent risk factors for patients, and constructed the nomograms. The correlation between hematological indicators and tumor-node-metastasis (TNM) stage was assessed through Spearman's analysis. Eligible patients and healthy controls were grouped by gender. The diagnostic ability of PNI was significantly superior to other indicators to diagnose male GC (area under the curve [AUC]=0.908, 95% CI: 0.892-0.925) and female GC (AUC=0.890, 95% CI: 0.865-0.914). Besides, the combination of hematological indicators is more effective in diagnosing GC patients, especially for male patients (AUC=0.916, 95% CI: 0.901-0.932, sensitivity: 84.98%, specificity: 84.29%). The C-statistic of Nomogram model was 0.917 for males and 0.875 for females. In both male and female cohorts, CEA, SII, and SIRI were positively correlated with TNM stage, while PNI was negatively correlated. The AUC of CEA, SII, SIRI, and PNI combined for the diagnosis in the early stage of male GC patients was 0.897 (95% CI: 0.875-0.918, sensitivity: 86.57%, specificity: 80.30%) is higher than that of in the advanced stage (AUC: 0.745, 95% CI: 0.710-0.780, sensitivity: 56.53%, specificity: 82.86%). The combined CEA, SII, PNI, and SIRI could be used as screening biomarkers in diagnosing GC, especially in the early stage of male GC patients.

Insights in biomarkers complexity and routine clinical practice for the diagnosis of thyroid nodules and cancer.

The differential diagnosis between benign and malignant thyroid nodules continues to be a major challenge in clinical practice. The rising incidence of thyroid neoplasm and the low incidence of aggressive thyroid carcinoma, urges the exploration of strategies to improve the diagnostic accuracy in a pre-surgical phase, particularly for indeterminate nodules, and to prevent unnecessary surgeries. Only in 2022, the 5th WHO Classification of Endocrine and Neuroendocrine Tumors, and in 2023, the 3rd Bethesda System for Reporting Thyroid Cytopathology and the European Thyroid Association included biomarkers in their guidelines. In this review, we discuss the integration of biomarkers within the routine clinical practice for diagnosis of thyroid nodules and cancer. The literature search for this review was performed through Pub Med, Science Direct, and Google Scholar. We selected 156 publications with significant contributions to this topic, with the majority (86, or 55.1%) published between January 2019 and March 2024, including some publications from our group during those periods. The inclusion criteria were based on articles published in recognized scientific journals with high contributions to the proposed topic. We excluded articles not emphasizing molecular biomarkers in refine the pre-surgical diagnosis of thyroid nodules. We explored genetic biomarkers, considering the division of thyroid neoplasm into BRAF-like tumor and RAS-like tumor. The specificity of BRAF mutation in the diagnosis of papillary thyroid carcinoma (PTC) is nearly 100% but its sensitivity is below 35%. RAS mutations are found in a broad spectrum of thyroid neoplasm, from benign to malignant follicular-patterned tumors, but do not increase the ability to distinguish benign from malignant lesions. The overexpression of miRNAs is correlated with tumor aggressiveness, high tumor node metastasis (TMN) stage, and recurrence, representing a real signature of thyroid cancer, particularly PTC. In addition, associations between the expression levels of selected miRNAs and the presence of specific genetic mutations have been related with aggressiveness and worse prognosis. The knowledge of genetic and molecular biomarkers has achieved a high level of complexity, and the difficulties related to its applicability determine that their implementation in clinical practice is not yet a reality. More studies with larger series are needed to optimize their use in routine practice. Additionally, the improvement of new techniques, such as liquid biopsy and/or artificial intelligence, may be the future for a better understanding of molecular biomarkers in thyroid nodular disease.

Significance of Relative Left Ventricle Wall Thickness in Predicting Acute Kidney Injury After Video-Assisted Thoracoscopic Surgery for Lung Cancer.

Aims/Background Given the strong association between relative wall thickness (RWT) and cardiovascular dysfunction, this study aims to explore RWT as a novel cardiovascular indicator to predict the risk of acute kidney injury (AKI) after lung cancer surgery and guide clinical interventions. Methods This study retrospectively analyzed 170 patients who underwent video-assisted thoracoscopic surgery (VATS) for lung cancer in Nanjing First Hospital, China, between January 2022 and December 2023. Patients were divided into AKI group (n = 52) and non-AKI group (n = 118) based on the occurrence of AKI. Univariate analysis was performed to identify factors affecting the development of AKI in patients undergoing VATS for lung cancer. Moreover, multivariate logistic regression analysis was conducted to determine influencing factors. Correlation analysis was used to analyze the relationships between variables, and receiver operating characteristic (ROC) curve analysis was conducted to assess predictive ability. Results There were no statistically significant differences in gender, comorbidities, smoking history, tumor location, Tumor-Node-Metastasis (TNM) Staging System, tumor differentiation, neutrophil count, red blood cell count, white blood cell count, creatinine, urea nitrogen, intraoperative blood loss, and operation time (p > 0.05). The comparison of age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, mean arterial pressure, and RWT between the two groups showed statistically significant differences (p < 0.05). Multivariate logistic regression analysis indicated that age, APACHE II score, mean arterial pressure, and RWT significantly influenced the development of AKI in patients undergoing VATS for lung cancer (p < 0.05). RWT was negatively correlated with mean arterial pressure (r = -0.558, p < 0.05), and positively correlated with age and APACHE II Score (r = 0.573, 0.520, p < 0.05). Moreover, AKI showed a positive correlation with age, APACHE II Score, and RWT (r = 0.726, 0.685, 0.772, p < 0.05), and a negative correlation with mean arterial pressure (r = -0.724, p < 0.05). ROC analysis revealed that the area under the predicted curve for RWT was 0.864, and the standard error was 0.030 (95% confidence interval (CI): 0.805~0.923), with a Youden index of 0.55. At this time, the sensitivity was 87.29% and the specificity was 67.31%. Conclusion RWT shows excellent predictive value for postoperative AKI in patients undergoing VATS for lung cancer.

Prognostic value of lymph node metrics in lung squamous cell carcinoma: an analysis of the SEER database

IntroductionAlthough the Tumor-Node-Metastasis (TNM) staging system is widely used for staging lung squamous cell carcinoma (LSCC), the TNM system primarily emphasizes tumor size and metastasis, without adequately considering lymph node involvement. Consequently, incorporating lymph node metastasis as an additional prognostic factor is essential for predicting outcomes in LSCC patients.MethodsThis retrospective study included patients diagnosed with LSCC between 2004 and 2018 and was based on data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The primary endpoint of the study was cancer-specific survival (CSS), and demographic characteristics, tumor characteristics, and treatment regimens were incorporated into the predictive model. The study focused on the value of indicators related to pathological lymph node testing, including the lymph node ratio (LNR), regional node positivity (RNP), and lymph node examination count (RNE), in the prediction of cancer-specific survival in LSCC. A prognostic model was established using a multivariate Cox regression model, and the model was evaluated using the C index, Kaplan–Meier, the Akaike information criterion (AIC), decision curve analysis (DCA), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI), and the predictive efficacy of different models was compared.ResultsA total of 14,200 LSCC patients (2004–2018) were divided into training and validation cohorts. The 10-year CSS rate was approximately 50%, with no significant survival differences between cohorts (p = 0.8). The prognostic analysis revealed that models incorporating LNR, RNP, and RNE demonstrated superior performance over the TNM model. The LNR and RNP models demonstrated better model fit, discrimination, and reclassification, with AUC values of 0.695 (training) and 0.665 (validation). The RNP and LNR models showed similar predictive performance, significantly outperforming the TNM and RNE models. Calibration curves and decision curve analysis confirmed the clinical utility and net benefit of the LNR and RNP models in predicting long-term CSS for LSCC patients, highlighting their value in clinical decision-making.ConclusionThis study confirms that RNP status is an independent prognostic factor for CSS in LSCC, with predictive efficacy comparable to LNR, with both models enhancing survival prediction beyond TNM staging.

Surgical indications for pleurectomy/decortication in pleural mesothelioma based on the newly revised 9th edition of the tumour-node-metastasis classification.

The MARS2 trial questioned the efficacy of curative intent surgery for pleural mesothelioma (PM), while real-world clinical data from Japan suggest a favourable prognosis in surgical cases, indicating survival benefits in selected patients. The newly revised 9th edition of the tumour-node-metastasis (TNM) classification introduces a novel indicator based on pleural thickness. We conducted a retrospective evaluation of patients with PM who underwent pleurectomy/decortication between 2012 and 2022. Patient characteristics, complications and treatment outcomes were assessed. Additionally, outcomes were analysed based on the 9th edition of the TNM classification. A total of 62 patients were included in the analysis. The median overall survival (OS) was 37.3 months, with a median relapse-free survival (RFS) of 15.5 months. Patients with the epithelioid subtype (OS: 61.6 months; RFS: 26.0 months) and pStage IA (OS: not reached; RFS: 69.1 months) had significantly better outcomes. The 9th edition of the TNM classification showed a stronger prognostic correlation than the 8th edition, with a median OS of 77.0, 31.9, 20.4 and 25.3 months for stages I, II, IIIA and IIIB (P = 0.0016) and median RFS of 34.3, 12.3, 13.7 and 6.9 months for stages I, II, IIIA and IIIB (P = 0.013), respectively. Surgical intervention remains crucial in the treatment of PM, particularly for patients with epithelioid histology and early stages of the disease. This study evaluates surgical indications for PM using the newly revised 9th edition of the TNM classification, indicating that it enhances the precision of surgical candidate selection and potentially improves patient outcomes.

Circulating MiR-126 as a potential biomarker in Egyptian colorectal cancer patients: A case-control study.

Globally, colorectal cancer (CRC) is among the most prevalent malignant tumors. It is characterized by unlimited proliferation, invasion, and metastasis. MicroRNA-126 (miR-126) has been shown in many studies to play a significant role in CRC, but data regarding its role in CRC Egyptian patients are limited. This case-control study aimed to investigate the miR-126 as a potential marker in CRC Egyptian patients and to correlate its expression levels with CRC tumor, node, metastasis (TNM) stage, distant metastasis, and tumor size. The study included 50 adult Egyptian participants (30 patients with CRC, 10 patients with colorectal adenoma as a pathological control, and 10 healthy controls). MiR-126 expression levels were detected using Real-Time Quantitative PCR (qPCR) along with the endogenous reference gene hsa-miR-103a in all participants. MiR-126 expression was significantly decreased in CRC patients than both control groups. It was associated with advanced TNM stage (p = 0.001) and distant metastasis (p = 0.002). However, it was not correlated with tumor size (p = 0.980), carcinoembryonic antigen (CEA) (p = 0.397), and cancer antigen 19-9 (CA19-9) (p = 0.236). The best cut-off point of miR-126 to discriminate CRC from both controls was 0.7 and to discriminate metastatic CRC from non-metastatic CRC was 0.3. Our results suggest that miR-126 could be used as an early marker for CRC detection among Egyptian patients and a good prognostic indicator associated with metastasis.

Clinicopathologic Characteristics of Breast Cancer Patients Who Had a Pathologic Complete Response after Neoadjuvant Treatment.

Breast cancer is the most common cancer in women and is a leading cause of cancer-related mortality. The role of neoadjuvant therapy (NAT) in conjunction with surgical intervention is becoming increasingly prominent in the field of oncology. NAT enhance the probability of breast-conserving surgery in cases of locally advanced breast cancer and in patients with metastatic or inoperable disease. The study included patients who underwent surgery following neoadjuvant chemotherapy for breast cancer between 2012 and 2022. Their files were retrospectively analyzed. The following parameters were examined and statistically analyzed for patients with and without pathological complete response: age, gender, tumor size, location, stage, pathological type, grade, hormone receptor status, molecular type, and the type of surgery performed. The study cohort comprised 329 patients who received NAT for breast cancer. Of the patients included in the study, 243 underwent mastectomy and 86 underwent breast-conserving surgery. A postoperative histopathologic examination revealed pathologic complete response (pCR) in 89 patients. The results of the statistical analysis indicated that certain parameters, including high grade, negative hormone receptor status, human epidermal growth factor receptor 2 (HER2) positivity, Ki-67 ≥30, and early tumor stage, were associated with higher rates of pCR following NAT. The biomarkers identified in this study, including hormone receptor negativity, anatomical Tumour, Node, Metastasis (TNM) Stages 1-2 tumors, positive HER2 amplification, Ki-67 proliferation ≥30%, luminal B/HER2 (+) and HER2 (+) molecular subtypes, are crucial in predicting the likelihood of a complete response to NAT in breast cancer. The presence of these clinicopathologic biomarkers facilitates the process of therapeutic decision-making by identifying patients who are likely to achieve a complete response.

Metabolic insights into tumor lymph node metastasis in melanoma.

Although accounting for only a small amount of skin cancers, melanoma contributes prominently to skin cancer-related deaths, which are mostly caused by metastatic diseases, and lymphatic metastasis constitutes the main route. In this review, we concentrate on the metabolic mechanisms of tumor lymph node (LN) metastasis in melanoma. Two hypotheses of melanoma LN metastasis are introduced, which are the premetastatic niche (PMN) and parallel progression model. Dysregulation of oxidative stress, lactic acid concentration, fatty acid synthesis, amino acid metabolism, autophagy, and ferroptosis construct the metabolic mechanisms in LN metastasis of melanoma. Moreover, melanoma cells also promote LN metastasis by interacting with non-tumor cells through metabolic reprogramming in TIME. This review will deepen our understanding of the mechanism of lymph node metastasis in melanoma.

Proteomic profiling reveals the significance of lipid metabolism in small cell lung cancer recurrence and metastasis

BackgroundSmall cell lung cancer (SCLC) is a lethal and recalcitrant malignancy with early metastases. However, the molecular and cellular mechanisms underlying its aggressive characteristics remain relatively elusive.MethodsIn this study, we conducted a comprehensive proteomic analysis of 90 primary tumors, 15 patient-matched lymph node metastatic tumors, and 15 brain metastatic tumors derived from a cohort of 105 SCLC patients. The potential mechanism for SCLC metastasis was investigated based on the variety of protein expression profiles.ResultsPrimary tumors were divided into two categories according to the their different protein expression profiles, using metastatic tumors as reference. Proteomic comparisons across different groups revealed that lipid metabolism, especially phospholipid metabolism, and immune response had a critical role in SCLC metastasis. Additionally, it was shown that high- and low-density lipoprotein cholesterol were both independent prognostic factors for disease free survival of SCLC patients. To identify critical regulators of metastasis in SCLC, support vector machine was adopted to generate a biomarker combination of ten proteins, all of which significantly correlated with the infiltration of immune cells. Furthermore, it was demonstrated that high expression of phospholipase A2 group IIA in stroma was associated with delayed disease recurrence in limited stage SCLC.ConclusionsThis study highlighted the critical significance of lipid metabolism, especially phospholipid metabolism in the disease recurrence and metastasis of SCLC.

The Role of Dynamic Contrast Enhanced Magnetic Resonance Imaging in Evaluating Prostate Adenocarcinoma: A Partially-Blinded Retrospective Study of a Prostatectomy Patient Cohort With Whole Gland Histopathology Correlation and Application of PI-RADS or TNM Staging.

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in the current Prostate Imaging-Reporting and Data System version 2.1 (PI-RADS v2.1) is considered optional, with primary scoring based on T2-weighted imaging (T2WI) and diffusion weighted imaging (DWI). Our study is designed to assess the relative contribution of DCE MRI in a patient-cohort with whole mount prostate histopathology and spatially-mapped prostate adenocarcinoma (PCa) for reference. We performed a partially-blinded retrospective review of 47 prostatectomy patients with recent multi-parametric MRI (mpMRI). Scans included T2WI, DWI with apparent diffusion coefficient (ADC) mapping, and DCE imaging. Lesion conspicuity was scored on a 10-point scale with ≥ 6 considered "positive," and image quality was assessed on a 4-point scale for each sequence. The diagnostic contribution of DCE images was evaluated on a 4-point scale. The mpMRI studies were assigned PI-RADS scores and tumor, node, metastasis (TNM) T-stage with blinded comparison to spatially-mapped whole-mount pathology. Results were compared to the prospective clinical reports, which used standardized PI-RADS templates that emphasize T2WI, DWI and ADC. Per lesion sensitivity for PCa was 93.5%, 82.6%, 63.0%, and 58.7% on T2WI, DCE, ADC and DWI, respectively. Mean lesion conspicuity was 8.5, 7.9, 6.2, and 6.1, on T2W, DCE, ADC and DWI, respectively. The higher values on T2WI and DCE imaging were not significantly different from each other but were both significantly different from DWI and ADC (p < 0.001). DCE scans were determined to have a marked diagnostic contribution in 83% of patients, with the most common diagnostic yield being detection of contralateral peripheral zone tumor or delineating presence/absence of extra-prostatic extension (EPE), contributing to more accurate PCa staging by PI-RADS or TNM, as compared to histopathology. We demonstrate that DCE may contribute to lesion detection and local staging as compared to T2WI plus DWI-ADC alone and that lesion conspicuity using DCE is markedly improved as compared to DWI-ADC. These findings support modification of PI-RADS v2.1 to include use of DCE acquisitions and that a TNM staging is feasible on mpMRI as compared to surgical pathology.