Pathological Node Research Articles

Predicting response to initial chemotherapy in pediatric lymphoma using a semiquantitative contrast enhanced CT (CECT)-based abdomino-thoracic score: a pilot prospective observational study.

There is a lack of staging systems in pediatric lymphoma to quantify the burden of the disease based on the anatomical extent of lymph nodal distribution. To evaluate the utility of a CECT-based semiquantitative lymph nodal scoring system in predicting histopathological type of childhood lymphoma and response to initial chemotherapy. Pre-treatment CECT of abdomen and thorax was performed in children with lymphoma and a Checklist-based reporting template was used to report the lymph nodal involvement. Based on the distribution of lymph nodes, a semi-quantitative scoring system was developed to cover all the locations of thorax and abdomen. Anatomical semiquantitative scoring was done for thorax (score 0-10), abdomen (scores 0-10), and a combined thoraco-abdominal score (0-20) was calculated. Also, the mean scores were compared in patients with complete response(CR) and Non-complete response(NCR) to primary treatment. Decrease in size of all the pathological nodes to < 10mm in short axis and < 15mm in long axis was defined as CR. Fifty patients were included with 35 cases of Hodgkin Lymphoma(HL) and 15 cases of Non-Hodgkin Lymphoma(NHL). Mean abdominal, thoracic, and combined lymph nodal scores were significantly lower in the pre-treatment scan in children with HL (3.5 ± 2.3, 3.3 ± 1.75,and6.89 ± 3.54) compared to NHL (4.8 ± 2.1,5.2 ± 2.8,and10.0 ± 3.96). The mean abdominal, thoracic, and combined lymph nodal scores in the pre-treatment scan was significantly higher in NCR group. The lymph nodal burden, estimated by semiquantitative abdominal and thoracic scores is significantly higher in lymphoma patients with non-complete response.

Which surrogate endpoint best predict survival in locally advanced gastric cancer patients undergoing neoadjuvant chemoimmunotherapy followed by surgery? A multicenter retrospective study.

Recent clinical researches have reported that neoadjuvant chemoimmunotherapy (NCIT) significantly improve the pathological complete response (pCR) and major pathological response (MPR) rates. However, surrogate endpoints for survival remains controversy for locally advanced gastric cancer (LAGC) after NCIT. A retrospective analysis was performed on 84 patients with LAGC who had undergone NCIT following radical resection in three medical centers in China, between July 2020 and September 2023. Survival curves for event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and the log-rank test was used to compare survival outcomes. Univariate and multivariate analyses for prognostic factors were based on Cox regression analysis. The rates of ypN0, pCR and MPR were 60.7 % (51/84), 26.2 % (22/84) and 39.3%(33/84),respectively. Patients with ypN0 had better EFS and OS than those with ypN+ (all p<0.05). Survival was equivalent between pCR and non-pCR group (all p>0.05). while patients with MPR had better EFS than those with non-MPR (p=0.028). Furthermore, a multivariate analysis revealed that the lymph nodes(LNs) status was an independent prognostic factor for the EFS (hazard ratio [HR] 5.533, 95% confidence interval [CI] 1.186-25.804, p=0.029) and OS (HR 5.116, 95% CI 1.357-19.281, p=0.016), but not pCR and MPR (all p>0.05). Based on the status of pathologic LNs, ypN0 group showed lower depth of tumor invasion, and lower rate of perineural and vascular invasion (all p<0.05). These findings demonstrated that ypN0 may be important as a surrogate of favorable clinical outcome in LAGC patients who received NCIT plus curative surgery.

Assessment of risk of malignancy with application of Sydney classification for reporting of lymph node cytopathology in pediatric population: An institutional experience.

Fine-needle aspiration cytology (FNAC) has been used as the first line approach to lymphadenopathy, which is a common presentation in pediatric age group. The Sydney system for reporting of lymph node (LN) cytology has been proposed to assess the reliability, performance, and accuracy of the aspiration procedure. This study intends to assess the role of FNAC in the pediatric population according to the Sydney system. This was a retrospective observational study from a tertiary care center in Eastern India. All the patients in the age group of 0-18 years evaluated during years 2016-2024 were reclassified according to the Sydney system. Based on the cytology and histology diagnoses, the cases were categorized into true-negative, true-positive, false-negative, and false-positive. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and risk of malignancy (ROM) was calculated for each category. Of 803 cases of pediatric LN-FNACs, 35 (4.35%) cases were reported as inadequate (L1), 689 (85.8%) cases as benign (L2), four (0.49%) cases as atypical cells of undetermined significance (L3), 22 cases as suspicious for malignancy (L4), and 53 (6.6%) cases as malignant (L5). The sensitivity, specificity, PPV, NPV, and accuracy was 72.34%, 98.48%, 97.14%, 83.33%, and 87.61%, respectively. The ROM was 16.67% for L2 and 100% for both L4 and L5 categories. FNAC is a highly accurate and specific test for LN pathology, especially in the pediatric population. The incorporation of the Sydney system helps to achieve uniformity and reproducibility in LN cytology diagnosis.

Utility of computed tomography (CT) –based staging of mismatch repair deficient (dMMR) colon cancer.

45 Background: dMMR tumors are characterized by rapid primary tumor growth with reduced likelihood for nodal and distant metastases compared to MMR proficient (pMMR) tumors. Neoadjuvant immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy for localized colon cancer with high pathologic complete response rates and low relapse rates. This raises the question if surgical treatment could be avoided with accurate radiographic staging while avoiding overtreatment of early stage tumors. This study assesses the utility of radiographic staging by CT for dMMR tumors compared to pathologic staging. Methods: Patients with stage I-III colon cancer treated with upfront surgical resection were retrospectively reviewed from a single institution from 2012 to 2023 in two cohorts: 1) dMMR colon cancer and 2) pMMR colon cancer limited to similar sample size as matched controls. Clinical stage was determined based on CT scans prior to surgical resection by 2 independent radiologists blinded to pathologic stage, and the results were correlated to pathologic stage. Clinical characteristics were extracted from the electronic medical record. Statistical analysis was performed using SPSS. Results: We identified 80 patients with dMMR colon cancer and 66 with pMMR tumors. CT clinical tumor staging was discordant from pathologic staging for 68% of dMMR tumors and 61% for pMMR tumors. For T4 dMMR tumors, CT had a 74% sensitivity and 44% specificity. T4 tumors were understaged by radiology to less than T4 for 56% of cases. For dMMR nodal staging, CT had 89% sensitivity and 50% specificity (Table 1). For pathologic node positive tumors, 14% were understaged by radiologist CT read to node negative. For pathologic node negative tumors, 50% of tumors were overstaged to node positive by radiologist CT read. There was poor inter-rater reliability for both T stage and N stage for dMMR and pMMR tumors. The weakest agreement between radiologists was for T stage (dMMR kappa = 0.246, mMMR kappa = 0.145). Conclusions: Radiologic clinical staging of dMMR and pMMR colon cancer does not correlate well with pathologic staging. There were high rates of understaging by CT evaluation for patients who may be candidates for neoadjuvant treatment (T4, N+). Furthermore, there was poor inter-rater reliability between radiologists, indicating that CT staging alone may not be sufficient. Additional diagnostic modalities for nodal detection may be necessary to accurately clinically stage patients before neoadjuvant ICIs in patients with locally advanced disease. Comparing utility of pMMR versus dMMR tumors for T4 and node positive disease. pMMR (n = 66) dMMR (n = 80) T4 versus T3 or less Sensitivity (%) 92 74 Specificity (%) 51 47 PPV (%) 80 77 NPV (%) 82 63 Node positive versus node negative Sensitivity (%) 60 50 Specificity (%) 75 89 PPV (%) 81 89 NPV (%) 53 50 Abbreviations: PPV = positive predictive value; NPV = negative predictive value.

Orally administered live BCG and heat-inactivated Mycobacterium bovis protect bison against experimental bovine tuberculosis

Bovine tuberculosis (BTB) is an infectious disease of livestock and wildlife species that is caused by pathogenic members of the Mycobacterium tuberculosis complex such as Mycobacterium bovis. Due to the introduction of M. bovis-infected bison in the 1920s, BTB is now endemic in wood bison (Bison bison athabascae) population within the Wood Buffalo National Park (WBNP) in northern Canada. This disease poses a grave threat to the long-term survival of this ecologically and culturally important species and has the potential to cause zoonotic TB and spill over to BTB-free livestock and other bison herds that live in the surrounding areas. Thus, effective BTB control strategies in WBNP bison are urgently needed. To this end, we aerosol challenged young bison with different doses of virulent M. bovis and observed disease-associated delayed-type hypersensitivity, gross lung and lymph node pathology and histopathology, as well as M. bovis burden in target organs, thus confirming the establishment of BTB in challenged animals. We then assessed the safety and efficacy of oral live BCG versus oral heat-inactivated M. bovis (HIMB) given in a homologous prime-boost regimen in bison. While both BCG and HIMB offered protection against BTB, BCG-treated bison thrived more, presented with fewer lung lesions at necropsy and lower burden of virulent M. bovis than HIMB-treated animals. Strikingly, oral HIMB induced almost no delayed-type hypersensitivity to intradermal tuberculin while oral live BCG induced very low sensitivity to tuberculin in bison, indicating their potential as DIVA (differentiating infected from vaccinated animals) vaccines for use in this important wildlife species.

Assessing the diagnostic potential of SATB2 and β-catenin as biomarkers and therapeutic targets in pancreatic ductal adenocarcinoma

IntroductionPancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. The roles of the transcription factor special AT-rich binding protein-2 (SATB2) and β-catenin in PDAC have been a subject of controversy. We aimed to assess the diagnostic and prognostic impact of SATB2 and β-catenin in PDAC.MethodsWe analyzed 44 paraffin-embedded tissue blocks along with corresponding blood and pancreatic tissues. We evaluated SATB2 expression using immunohistochemistry (IHC) and enzyme-linked immunosorbent assay (ELISA). β-catenin was assessed using IHC and real-time polymerase chain reaction (qPCR).ResultsHigh SATB2 expression and low β-catenin expression were associated with a poor prognosis in PDAC, including advanced pathological tumor stage (pT-stage), pathological lymph node stage (pN-stage), and TNM stage. We found a positive correlation between SATB2 expression assessed by IHC and the concentration of SATB2 in both serum and tissue samples measured by ELISA. We observed a positive correlation between β-catenin expression assessed by IHC and β-catenin levels measured by qPCR.ConclusionsSATB2 and β-catenin could provide valuable insights into the development of pancreatic cancer, and targeting them may be beneficial for the prevention and treatment of PDAC. The levels of SATB2 in serum show promise for the diagnosis and tumor invasion of pancreatic cancer.

P-62 A CASE OF PAPILLARY THYROID CARCINOMA WITH ISOLATED BONE METASTASES

Abstract Introduction Thyroid carcinomas constitute less than 3% of all cancers (1). Papillary thyroid carcinoma (PTC) accounts for 80% of thyroid carcinomas and generally has a good prognosis(2). Lymph node metastases are frequently observed in thyroid cancers(30-40%). However, distant metastases are quite rare(1-4%)(2). Clinical Case A 52-year-old female patient presented to the neurosurgery department due to back pain of approximately 2 months. A mass lesion was observed in the T9 vertebral body on a thoracic CT scan, which was destroying the bone structure, causing a compression fracture in the vertebra, and extending into the spinal canal. A total laminectomy of T9 vertebra and partial laminectomies of T8 and T10 vertebrae were performed. Pathology revealed strongly positive for Vimentin, TTF-1, Thyroglobulin, and Pax 8, consistent with carcinoma metastasis. It was recommended to perform a whole-body scan, primarily focusing on the thyroid gland. PET-CT, thoracic and abdominal CT scans revealed a 62x48 mm metastatic lesion in the right iliac bone and metastatic involvement of the T9 vertebra, with no other pathological findings. The patient's history revealed that she had undergone a total thyroidectomy six years ago, and the result was reported as benign. She was on levothyroxine sodium replacement therapy. Blood tests revealed TSH: 0.288 (0.27-4.2 µIU/ml), T4: 18.7 (12-22 pmol/L), T3: 4.78 (3.1-6.8 pmol/L), Anti-Thyroglobulin Antibody: 60.8 (0-115 IU/ml), and Thyroglobulin: &amp;gt;500 (3.5-77 ng/ml). Neck ultrasonography did not reveal any residual thyroid tissue or pathological lymph nodes. Given the suspicion of thyroid carcinoma metastasis and high thyroglobulin levels, the pathology preparations of the total thyroidectomy were re-consulted by our hospital's pathology department. The pathology result was consistent with papillary thyroid carcinoma composed of 55% follicular subtype and 45% solid/trabecular subtype. As surgery for the iliac bone metastasis was not considered appropriate, the patient was referred to the nuclear medicine department for radioactive iodine therapy and to the radiation oncology department for radiotherapy. The nuclear medicine, radiation oncology, and our department continue to follow up and treat the patient. Conclusion PTC is generally a slowly progressing cancer with a good prognosis. The most common site of metastasis in all PTC cases is the cervical lymph node, and only 3.5-3.8% have distant metastases(3). Distant metastases are most commonly seen in the lungs (53.4%), followed by bones (28.1%), liver (8.3%), and brain (4.7%) (1,4). Distant metastases significantly increase mortality from PTC. Therefore, the importance of adjuvant therapy (endocrine therapy, radiotherapy, etc.) and regular follow-up after thyroid cancer surgery should be emphasized. It should be kept in mind that, as in our case, papillary thyroid carcinomas can also present with isolated bone metastases without cervical lymph node metastases.

Histological Type-Specific Behavior in Sarcomas: Analysis of Head and Neck Cancer Registry of Japan.

The goal of this study was to better understand the epidemiology, clinical characteristics, and treatment outcomes of head and neck sarcomas using real-world data from Japan. Using the Japanese Head and Neck Cancer Registry, we identified 438 patients who were pathologically diagnosed with head and neck sarcoma between 2011 and 2020. We compared epidemiological, clinical, and prognostic data for the different histological types of sarcoma. The top five most common histopathological types were rhabdomyosarcoma, osteosarcoma, chondrosarcoma, leiomyosarcoma, and liposarcoma. The most common primary sites were the nasal cavity and paranasal sinuses. The overall cohort had clinical, pathologic, and occult lymph node positivity rate (OLR) of 18%, 15%, and 2%, respectively. Clinical lymph node positivity was highest in rhabdomyosarcoma (46%), followed by angiosarcoma (26%), with leiomyosarcoma, chondrosarcoma, and liposarcoma accounting for less than 10%. The 3-year overall survival rate was 74.8% among the 147 patients with available prognostic information. The histological type with the lowest 3-year overall survival was undifferentiated pleomorphic sarcoma (54%), followed by leiomyosarcoma (65%), and angiosarcoma (69%). In six of seven histological types, the 3-year locoregional-free survival rate was less than 70%. Sarcomas of the head and neck most commonly occur in the nasal cavity and paranasal sinuses. The prevalent histological type depended on the primary site. Rhabdomyosarcoma and angiosarcoma are histological types with a high risk of cervical metastasis. In the head and neck region, there are numerous histological types many of which lack local control. Level 3 Laryngoscope, 2025.

PSMA PET/CT based multimodal deep learning model for accurate prediction of pelvic lymph-node metastases in prostate cancer patients identified as candidates for extended pelvic lymph node dissection by preoperative nomograms.

To develop and validate a prostate-specific membrane antigen (PSMA) PET/CT based multimodal deep learning model for predicting pathological lymph node invasion (LNI) in prostate cancer (PCa) patients identified as candidates for extended pelvic lymph node dissection (ePLND) by preoperative nomograms. [68Ga]Ga-PSMA-617 PET/CT scan of 116 eligible PCa patients (82 in the training cohort and 34 in the test cohort) who underwent radical prostatectomy with ePLND were analyzed in our study. The Med3D deep learning network was utilized to extract discriminative features from the entire prostate volume of interest on the PET/CT images. Subsequently, a multimodal model i.e., Multi kernel Support Vector Machine was constructed to combine the PET/CT deep learning features, quantitative PET and clinical parameters. The performance of the multimodal models was assessed using final histopathology as the reference standard, with evaluation metrics including area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis, and compared with available nomograms and PET/CT visual evaluation result. Our multimodal model incorporated clinical information, maximum standardized uptake value (SUVmax), and PET/CT deep learning features. The AUC for predicting LNI was 0.89 (95% confidence interval [CI] 0.81-0.97) for the final model. The proposed model demonstrated superior predictive accuracy in the test cohort compared to PET/CT visual evaluation result, the Memorial Sloan Kettering Cancer Center (MSKCC) and the Briganti-2017 nomograms (AUC 0.85 [95% CI 0.69-1.00] vs. 0.80 [95% CI 0.64-0.95] vs. 0.79 [95% CI 0.61-0.97] and 0.69 [95% CI 0.50-0.88], respectively). The proposed model showed similar calibration and higher net benefit as compared to the traditional nomograms. Our multimodal deep learning model, which incorporates preoperative PSMA PET/CT imaging, shows enhanced predictive capabilities for LNI in clinically localized PCa compared to PSMA PET/CT visual evaluation result and existing nomograms like the MSKCC and Briganti-2017 nomograms. This model has the potential to reduce unnecessary ePLND procedures while minimizing the risk of missing cases of LNI.

Tracing Metastatic Evolutionary Patterns in Lung Adenocarcinoma: Prognostic Dissection Based on a Multi-state Model.

After surgery for lung adenocarcinoma, a patient may experience various states of recurrence, with multiple factors potentially influencing the transitions between these states. Our purpose was to investigate the effects of clinical and pathological factors on tumor recurrence, death, and prognosis across various metastasizing pathways. Our study group included 335 patients with all demographic and pathologic data available who underwent surgical resection for lung adenocarcinoma for more than 10 years. The following states of disease were defined: initial state, operation (OP); three intermediate states of local recurrence (LR), metastasis (Meta), and concurrent LR with metastasis (LR+Meta); and a terminal state, death. We identified 8 transitions representing various pathways of tumor progression. We employed a multi-state model (MSM) to separate the impacts of multiple prognostic factors on the transitions following surgery. After surgery, approximately half of patients experienced recurrence. Specifically, 142 (42.4%), 54 (16.1%), and 7 (2.1%) patients developed Meta, LR+Meta, and LR, respectively. Clinical and pathological factors associated with the transitions were different. Impact of pathological lymph node remained a risk factor for both OP to Meta (λ02, p-value=0.001) and OP to LR+Meta (λ03, p-value = 0.001). Lung adenocarcinoma displays a broad spectrum of clinical scenarios even after curative surgery. Incidence, risk factors, and prognosis varied across different pathways of recurrence in lung adenocarcinoma patients. The greatest implication of this MSM is its ability to predict the timing and type of clinical intervention that will have the greatest impact on survival.

Long-term survival analysis based on tumor location in patients with pancreatic ductal adenocarcinoma who underwent pancreatectomy following neoadjuvant chemoradiotherapy

BackgroundThe study aimed at assessing whether long-term survival outcomes were different based on tumor location in pancreatic ductal adenocarcinoma (PDAC) patients who underwent pancreatectomy following neoadjuvant chemoradiotherapy (CRT).MethodsFollowing CRT, resection rate was 60.5% (286/473) and the resected patients had pancreatic head (n = 218), body (n = 34) and tail (n = 34) tumors. Survival analyses were conducted, independent predictors of disease-free survival (DFS) and overall survival (OS) were identified, and then survival outcomes were stratified by the predictors of DFS and OS.ResultsResection rates were; 64.7% (head) vs. 46.6% (body) and 54.0% (tail) cases, p = 0.009. Among these cases, pancreatic head patients exhibited a higher incidence of initial clinical stage 3 tumors; 48.2% (head) vs. 29.4% (body) and 0% (tail) cases, p < 0.001 with more unresctable-locally advanced tumors; 22.0% (head) vs. 11.8% (body) and 0% (tail), p < 0.001, but demonstrated a better response to CRT; Evans grades 3/4 in 49.1% (head) vs. 23.5% (body) and 26.5% (tail), p = 0.012. Five-year DFS rates were; 19.9% (head) vs. 11.8% (body) vs. 24.6% (tail), p = 0.565 and OS rates; 25.4% (head) vs. 27.7% (body) vs. 32.0% (tail), p = 0.341. Significant predictors of DFS and OS included post-CRT CA19-9 levels, tumor differentiation, resection margins and pathological portal vein invasion. Based on these predictors, survival outcomes were also comparable. Pathological nodal invasion influenced DFS, while pathological stage impacted OS.ConclusionPancreatic head patients had the best resection rate and long-term survival outcomes were comparable, attributable to the better response to CRT by pancreatic head than the body and tail PDAC patients.

Clinical characteristics and predictive factors of pathological lateral pelvic lymph node metastasis in patients with rectal cancer.

In recent years, selective lateral lymph node dissection (LLND) has been performed more frequently. The present study aimed to explore the clinical characteristics and predictive factors of pathological lateral pelvic lymph node metastasis (LPLNM), which may be helpful for pre-treatment decisions. The present study included 64 patients with rectal cancer and clinically suspected LPLNM who underwent total mesorectal excision (TME) and LLND between February 2019 and April 2024. According to pathological outcomes, the patients were divided into the negative LPLN (n=40) and positive LPLN (n=24) groups. The primary endpoints were the overall pathological LPLNM positivity rate and different clinical characteristics between the two groups. The secondary endpoint was the identification of predictive factors of pathological LPLNM before surgery. Among the 64 patients, 24 (37.5%) had pathologically confirmed LPLNM, and pathological LPLNM was related to initial lymph node size. When initial LPLN size was <7 mm, the pathological LPLNM rate was 10.5%, whereas when LPLN size was between 7 and 10 mm, the rate was 34.6%, and when LPLN size was >10 mm, the rate was 68.4%. Initial LPLN size (≥7.1 mm, P=0.003) and cN stage (N1-2, P=0.005) were significantly associated with pathological LPLNM. In multivariate analysis of risk factors, initial LPN size (≥7.1 mm; hazard ratio=4.856, 95% confidence interval 1.158-20.359, P=0.031) was the only independent risk factor for pathological LPLNM. When the cut-off initial LPLN size was 7.1 mm, the sensitivity and specificity were 87.5 and 52.5%, respectively, and the area under the curve was 0.748 (P=0.0009). When both LPLN size ≥7.1 mm and cN1-2 were satisfied, the sensitivity was 66.7%, the specificity increased to 77.5%, and the positive and negative predictive values were 64.0 and 79.5%, respectively. In conclusion, initial LPLN size and cN stage were identified as significant clinical characteristics associated with pathological LPLNM. Patients with an initial LPLN size of ≥7.1 mm and with cN1-2 stage cancer could benefit from TME + LLND surgery.

Posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair

To investigate the effectiveness of posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair. Between December 2018 and December 2023, 16 patients with the maxillary malignant tumors were admitted. There were 10 males and 6 females, with an average age of 64.3 years (range, 54-75 years). There were 7 cases of maxillary gingival cancer, 5 cases of hard palate cancer, and 4 cases of maxillary sinus cancer. According to the 2017 American Joint Committee on Cancer (AJCC) TNM stage, there were 8 cases of stage Ⅲ, 6 cases of stage Ⅳa, and 2 cases of stage Ⅳb. After resection of the lesion, the remaining maxillary defects were classified into class Ⅱa in 3 cases, class Ⅱb in 5 cases, and class Ⅲb in 8 cases according to Brown's classification. The size of soft tissue defects ranged from 4 cm×3 cm to 8 cm×6 cm. The posterior lateral perforator flap in lower limb in size of 5 cm×4 cm-9 cm×7 cm were harvested to repair soft tissue defects, and free fibula in length of 6-11 cm were used to repair bone defects. The donor sites of the lower limb were sutured directly (6 cases) or repaired with free skin grafting (10 cases). Six patients with positive lymph node pathology were treated with radiotherapy after operation. At 6 and 12 months after operation, the self-assessment was performed by the University of Washington Quality of Survival Questionnaire Form (QUW-4) in five dimensions (facial appearance, swallowing function, chewing function, speech function, and mouth opening), and swallowing function was evaluated by using the Kubota water swallowing test. Postoperative pathological examination showed that all patients were squamous cell carcinoma. One patient who was treated with radiotherapy developed osteomyelitis and 1 patient developed venous crisis of skin flap. The rest of the flaps and all skin grafts survived, and the wounds healed by first intention. All patients were followed up 1-5 years (mean, 2.8 years). Two patients died of local recurrence of the tumor at the 4th and 5th years after operation, respectively. Except for the chewing function score and total score at 6 months after operation, which showed significant differences compared to preoperative scores ( P<0.05), there was no significant difference in other QUW-4 scale scores between different time points ( P>0.05). The patients' swallowing function evaluated by Kubota water swallowing test reached normal in 4 cases, suspicious in 9 cases, and abnormal in 3 cases at 6 months after operation, and 10, 6, and 0 cases at 12 months after operation, respectively. The swallowing function at 12 months was significantly better than that at 6 months ( Z=-2.382, P=0.017). The posterior lateral perforator flap in the lower limb combined with free fibula to repair maxillary tissue defects can repair soft and hard tissue defects at the same time, so that the patient's facial appearance, swallowing function, chewing function, speech function, and mouth opening are satisfactorily restored and the mid-term effectiveness is good.

Preoperative CT lymph node size as a predictor of nodal metastasis in resectable Colon cancer: a retrospective study of 694 patients

PurposeThis study aimed to investigate the efficacy of measuring lymph node size on preoperative CT imaging to predict pathological lymph node metastasis in patients with colon cancer to enhance diagnostic accuracy and improve treatment planning by establishing more reliable assessment methods for lymph node metastasis.MethodsWe retrospectively analyzed 1,056 patients who underwent colorectal resection at our institution between January 2004 and March 2020. From this cohort, 694 patients with resectable colon cancer were included in the study. We analyzed the relationship between lymph node size on preoperative CT imaging and lymph node metastasis identified on postoperative pathological examination.ResultsThe optimal cutoff values for the maximum long diameter and short diameter of regional lymph nodes on preoperative CT were identified as 6.5 mm and 5.5 mm, respectively, with an AUC of 0.7794 and 0.7755, respectively. Notably, the predictive accuracy varied by tumor location. Higher cutoff values were observed in the right-sided colon (maximum long diameter: 7.7 mm, maximum short diameter: 5.9 mm) compared to the left-sided colon (maximum long diameter: 5.8 mm, maximum short diameter: 5.2 mm).ConclusionLymph node size on preoperative CT is a significant predictor of pathological lymph node metastasis in colon cancer. Notably, the optimal cutoff values for predicting lymph node metastasis vary depending on the specific region within the colon.

No evidence for active viral infection in unicentric and idiopathic multicentric Castleman disease by Viral-Track analysis

Castleman disease (CD) is a rare hematologic disorder characterized by pathologic lymph node changes and a range of symptoms due to excessive cytokine production. While uncontrolled infection with human herpesvirus-8 (HHV-8) is responsible for the cytokine storm in a portion of multicentric CD (HHV-8-associated MCD) cases, the etiology of unicentric CD (UCD) and HHV-8-negative/idiopathic MCD (iMCD) is unknown. Several hypotheses have been proposed regarding the pathogenesis of UCD and iMCD, including occult infection given the precedent established by HHV-8 infection. To investigate potential active infections in UCD and iMCD, we implemented Viral-Track, a computational method that identifies viral mRNA sequences from next-generation sequencing data. We applied Viral-Track to short sequencing reads from a cohort of UCD (n = 22), iMCD (n = 19), and controls (n = 86). While viral sequences for several unusual viruses were identified in individual CD patients, sequences for the same virus were not found across multiple CD patients or they were not specific to CD samples and were also found in non-CD samples. These results suggest that active viral infection is unlikely to be a pathological driver of UCD or iMCD.

Comprehensive analysis pinpoints CCNA2 as a prognostic and immunological biomarker in non-small cell lung cancer

BackgroundLung cancer is a leading cause of morbidity and mortality globally. Despite advances in targeted and immunotherapies, overall survival (OS) rates remain suboptimal. Cyclin-A2 (CCNA2), known for its upregulation in various tumors and role in tumorigenesis, has an undefined function in non-small cell lung cancer (NSCLC).MethodsWe analyzed three microarray datasets from the Gene Expression Omnibus (GEO) repository to identify differentially expressed genes. Using STRING, we constructed a protein-protein interaction (PPI) network to pinpoint hub genes. The expression and prognostic relevance of CCNA2 were validated using GEPIA and the Kaplan-Meier plotter. Clinicopathological correlations were assessed via the Human Protein Atlas (HPA) and UALCAN databases. qRT-PCR and immunohistochemistry (IHC) were performed to validate CCNA2 mRNA and protein levels. Loss-of-function assays in lung cancer cell lines evaluated the biological role of CCNA2. Immune infiltration and single-cell sequencing were also explored.ResultsAnalysis of GSE18842, GSE101929, and GSE116959 datasets identified 321 upregulated and 623 downregulated genes in NSCLC. CCNA2 was confirmed to be highly expressed in NSCLC through qRT-PCR and IHC, with overexpression correlating with advanced pathological stages and lymph node metastasis. The area under the curve (AUC) of CCNA2 indicating high diagnostic accuracy. Immune infiltration and single-cell sequencing revealed that CCNA2 expression was significantly associated with immune cell infiltration, particularly in Tprolif cells.ConclusionCCNA2 is upregulated in NSCLC and shows significant correlation with clinicopathological characteristics. Our findings suggest that CCNA2 may serve as a promising biomarker for both the prognosis and diagnosis of NSCLC.

Prognostic Value of Tumor Regression Grade Combined with Pathological Lymph Node Status in Initially Node-Positive Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy

Background The prognostic value of tumor regression grade (TRG) after neoadjuvant chemoradiotherapy for rectal cancer is inconsistent in the literature. Both TRG and post-therapy lymph node (ypN) status could reflect the efficacy of neoadjuvant therapy. Here, we explored whether TRG combined with ypN status could be a prognostic factor for MRI-based lymph node-positive (cN+) rectal cancer following neoadjuvant chemoradiotherapy. Methods 671 cN + rectal cancer patients who received neoadjuvant chemoradiotherapy followed by radical resection were enrolled. Patients were innovatively divided into three groups based on TRG and ypN status: TRG0-1N0, TRG2-3N0 or TRG0-1N+, TRG2-3N+. Kaplan–Meier method and log-rank test were used to compare the disease-free survival (DFS) and overall survival (OS) among three groups. Univariate and multivariate analyses were performed to explore the prognostic value of the modified TRG in cN + rectal cancer following neoadjuvant chemoradiotherapy. Results The mean duration of follow-up was 30.4 months. Significant survival differences were observed among the three groups. The 3-year DFS were 83.0%, 69.2% and 55.9%, respectively. The 5-year OS were 83.5%, 80.4% and 57.8%, respectively. TRG combined with ypN status was an independent predictor for both DFS and OS in multivariate analysis. Conclusion TRG combined with ypN status is a novel prognostic factor in cN + rectal cancer following neoadjuvant chemoradiotherapy, which assists clinicians make appropriate decisions regarding postoperative treatment and surveillance.

Clinicopathological and molecular characteristics of papillary thyroid carcinoma in adolescent and young adult patients

Adolescent and young adult (AYA, 15-39 years old) patients with papillary thyroid carcinoma (PTC) experience significant psychological distress and place great importance on obtaining information regarding the disease; however, their demands remain unmet. We aimed to investigate clinicopathological and molecular features of PTC in AYA patients and compare them to those of PTC in older patients (≥40 years). This retrospective study enrolled 1,677 patients diagnosed with PTC from January 2018 to December 2022, with 400 AYA patients and 1,277 older adults. At the time of diagnosis, AYA patients with PTC had higher rates of presentation in females, larger tumor size (>2.0 cm), lymphatic vessel invasion, chronic thyroiditis, clinical lymph node metastasis, and pathologic lymph node metastasis, but lower rates of multifocality and extrathyroidal extension compared with PTC in older adults. The two groups had no significant differences regarding surgical method and distant metastasis. The prevalences of BRAF p.V600E and TERT promoter mutations of PTC were significantly lower in AYA patients (69.1% vs. 82.6% and 1.3% vs. 18.8%, respectively; both p < 0.001). In conclusion, PTC in AYA patients differed from PTC in older patients. Particularly, BRAF p.V600E and TERT promoter mutations in AYA with PTC were less frequently observed than in older adults.

Single-cell RNA-sequencing and spatial transcriptomic analysis reveal a distinct population of APOE- cells yielding pathological lymph node metastasis in papillary thyroid cancer.

Thyroid cancer is one of the most common endocrine tumors worldwide, especially among women and the metastatic mechanism of papillary thyroid carcinoma remains poorly understood. Thyroid cancer tissue samples were obtained for single-cell RNA-sequencing and spatial transcriptomics, aiming to intratumoral and antimetastatic heterogeneity of advanced PTC. The functions of APOE in PTC cell proliferation and invasion were confirmed through in vivo and in vitro assays. Pseudotime analysis and CellChat were performed to explore the the molecular mechanisms of the APOE in PTC progression. We identified a subpopulation of tumor cells with lower expression levels of APOE, associated with advanced stages of PTC and cervical metastasis. APOE overexpression significantly reduced tumor cell proliferation and invasion, both in vitro and in vivo, by activating the ABCA1-LXR axis. APOE- tumor cells may promote tumor growth by interacting with dendritic cells and CD4+ T cells via CD99- rather than CD6-regulated signaling. We established a machine learning-based scRNA-seq data, 13-gene signature predictive of lymph node metastasis. We identified a distinct APOE- tumor cell population associated with cervical metastasis and poor prognosis. Our results and models have potential clinical, prognostic, and therapeutic implications for advanced PTC. A subpopulation of tumor cells with lower expression levels of APOE was strongly associated with more advanced stages and metastasis of PTC. APOE-negative (APOE-) cellsoverall exhibited weaker interactions with immune cells. A machine-learning bioinformatics model based on scRNA-seq data of in-situ thyroid cancer tissue was established to predict lymph node metastasis.

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.