Vascular Tumor Emboli Research Articles

Survival Analysis of 121 Stage N2-IIIa Non-small Cell Lung Cancer Patients Treated with Surgery

背景与目的N2-Ⅲa期非小细胞肺癌（non-small cell lung cancer, NSCLC）手术抑或非手术仍存颇多争议。我们通过回顾性分析121例手术的N2-Ⅲa期NSCLC患者的生存，探讨N2-Ⅲa期NSCLC患者术后远期生存的因素。方法选取北京大学肿瘤医院单医生组肺癌前瞻性数据库2000年1月-2013年6月共1, 290例NSCLC手术患者，其中N2-Ⅲa期NSCLC患者121例。分析性别、年龄、吸烟、围手术期化疗、切口、病理、脉管癌栓、pT分期、肿瘤大小对N2-Ⅲa期患者生存的影响；比较单站N2与多站N2的生存差异；比较术中或术后病理N2者（Ⅲa1/a2）与治疗前N2者（Ⅲa3/a4）的生存差异。单因素分析采用Kaplan-Meier法计算生存，Log-rank检验。多因素分析采用Cox回归分析。结果全组121例患者5年生存率为43.6%，中位生存时间50.3个月。单因素分析显示单站N2转移与多站N2转移的5年生存率分别为58.3%和25.5%（P=0.001）；Ⅲa1/a2期者与Ⅲa3/a4期者5年生存率分别为52.7%和38.4%（P=0.020）。多因素分析显示仅单站N2转移（HR=0.326, 95%CI: 0.186-0.572, P < 0.001）与Ⅲa1/a2（HR=0.494, 95%CI: 0.259-0.941, P=0.032）是影响本组N2-Ⅲa期患者远期生存的独立因素。结论N2-Ⅲa期NSCLC中单站N2转移者预后好于多站N2转移者。Ⅲa1/a2期患者预后好于Ⅲa3/a4期患者。高选择性N2-Ⅲa期NSCLC患者采取以外科手术为主的多学科综合治疗可获得较满意的远期生存。

Differential diagnosis of CT images in children with neuroblastomas and ganglioneuroblastomas.

To investigate the differential features of CT images in children with neuroblastomas (N) and ganglioneuroblastomas (G). Clinical data of 12 children in group G and 15 in group N undergoing CT examination and definitely diagnosed by pathology were retrospectively analyzed. The focal conditions were observed and compared in the two groups, including location, size, boundaries, morphology, enhanced degree and mode, abdominal vascular involvement, presence or absence of spanning the midline, infiltration of peripheral organs, angiography manifestations in tumors or surroundings, presence or absence of calcification and vascular tumor emboli as well as metastases of distal organs and lymph nodes. In group N, the incidence of tumors in the adrenal area was conspicuously higher than in group G (P<0.05), while that of tumors with regular morphology and clear boundaries was significantly lower than in group G (P<0.01); Angiography manifestation rate and incidences of vascular embedding, lymph node metastasis, infiltration and organic metastasis in group N were all markedly higher than in group G (P<0.05). There was no statistical significance between the two groups in terms of focal size, presence or absence of calcification and spanning the midline, and enhanced degree and mode, as well as vascular tumor emboli (P>0.05). Mostly located in adrenal areas and with vascular embedding as a primary manifestation, the neuroblastoma extremely readily metastases to lymph nodes and other organs as well as infiltrating local tissues, with dilation on angiography frequent in or around the tumors. With vascular displacement as a primary manifestation, ganglioneuroblastoma has a regular morphology and clear boundaries.

Analysis of lymph node metastasis correlation with prognosis in patients with T2 gastric cancer.

PurposeTo investigate the correlated factors for lymph node metastasis and prognosis for patients with T2 gastric cancer.MethodsA total of 442 patients with T2 gastric cancer who underwent gastrectomy from January 1996 to December 2009 were evaluated. The clinicopathological parameters were analyzed for lymph node metastasis and prognosis, including gender, age, tumor size, tumor location, histological type, depth of invasion, vascular tumor emboli, nervous invasion, resection type, and pathological stage.ResultsThe rate of lymph node metastasis was 45.9%. Univariate analysis showed that depth of invasion, tumor size, and vascular tumor emboli were associated with lymph node metastasis. Logistic regression demonstrated that depth of invasion, tumor size, and vascular tumor emboli were independently predictive factors for lymph node metastasis. The 5-year survival rate was 64.0%. Multivariate analysis showed that tumor size, tumor location, resection type, and pathological stage were independent prognostic factors. Based on tumor size, there were significant differences of 5-year survival between small size tumor (<6 cm) and large size tumor (≥6 cm) according to stage IIA (P = 0.006). Based on tumor location, there were significant differences of 5-year survival among different tumor location according to stage IB. Based on resection type, there were significant differences of overall 5-year survival between curative surgery and palliative surgery according to stage IIB (P = 0.015) and IIIA (P = 0.001).ConclusionDepth of invasion, tumor size, and vascular tumor emboli were independently predictive factors for lymph node metastasis. Tumor size, tumor location, resection type, and pathological stage were independent prognostic factors.

Correlation of carcinoembryonic antigen with prognosis of hepatocellular carcinoma after hepatectomy

To investigate the correlation between carcinoembryonic antigen (CEA) and prognosis of hepatocellular carcinoma after hepatectomy. This study retrospectively analyzed the surgical outcomes of hepatocellular carcinoma (HCC) in 562 patients who underwent hepatectomy between January 2002 and December 2009 in the Cancer Hospital, Chinese Academy of Medical Sciences. Postoperative prognostic factors were analyzed using univariate Kaplan-Meier analysis and multivariate Cox proportional hazards model. The sensibility of serum CEA and CEA-AFP combined in the detection of HCC was 7.1% (40/562) and 55.3% (311/562), respectively. The 1-, 3- and 5-year overall survival rates and disease free survival rates of CEA-negative group (CEA<5 ng/ml) were 93.8%, 75.6%, 59.4%, and 75.0%, 55.9%, 44.5%, respectively (P = 0.003); and the 1-, 3- and 5-year overall survival rates and disease free survival rates of CEA-positive group (CEA ≥ 5 ng/ml) were 87.5%, 60.5%, 46.6% and 52.6%, 36.2%, and 25.4%, respectively (P = 0.045). In the univariate analysis, better prognosis for overall survival (OS) was associated with small tumor ( ≤ 5 cm), single lesion, high-grade histological differentiation, no vascular tumor embolus, negative serum AFP expression, negative serum CEA expression, no/mild cirrhosis, no regional lymph node metastasis, no major vascular invasion, no direct invasion of adjacent organs or with perforation of visceral peritoneum, no transfusion as well as earlier BCLC staging (P < 0.05 for all). In the Cox multivariate analysis, serum AFP-negative expression, serum CEA-negative expression, no/mild cirrhosis, no direct invasion of adjacent organs or with perforation of visceral peritoneum, no transfusion and earlier BCLC staging were independent factors for longer disease free survival (P < 0.05 for all). Serum CEA-positive expression is correlated to alcoholism and HCC multiple occurrences. Although serum CEA detection has limited value for HCC diagnosis, its positive expression does affect poor prognosis. Higher serum CEA level is an independent prognostic factor for poorer disease free survival.

Clinicopathologic characteristics and prognostic factors of 63 gastric cancer patients with metachronous ovarian metastasis.

ObjectiveThis study aims to explore the clinicopathologic characteristics and prognostic factors of gastric cancer patients with metachronous ovarian metastasis.MethodsClinicopathologic data were collected from 63 post-operative gastric cancer patients with metachronous ovarian metastasis. The patients were admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Science and Peking Union Medical College between January 1999 and December 2011. A log-rank test was conducted for survival analysis. Possible prognostic factors that affect survival were examined by univariate analysis. A Cox regression model was used for multivariate analysis.ResultsThe incidence of ovarian metastasis was 3.4% with a mean age of 45 years. Up to 65.1% of the patients were pre-menopausal. The mean interval between ovarian metastasis and primary cancer was 16 months. Lowly differentiated carcinoma ranked first in the primary gastric cancers. The majority of lesions occurred in the serous membrane (87.3%). The metastatic sites included N2-3 lymph nodes (68.3%), bilateral ovaries (85.7%), and peritoneal membrane (73%). Total resection of metastatic sites was performed (31.7%). The overall median survival was 13.6 months, whereas the overall 1-, 2-, and 3-year survival rates were 52.5%, 22.0%, and 9.8%, respectively. The 5-year survival rate was zero. Univariate analysis showed that the patient prognosis was correlated with metastatic peritoneal seeding, vascular tumor embolus, range of lesion excision, and mode of comprehensive treatment with adjuvant chemotherapy (P<0.05). Multivariate analysis indicated that metastatic peritoneal seeding was an independent prognostic factor for gastric cancer patients with ovarian metastasis (P<0.01).ConclusionEffective control of peritoneal seeding—induced metastasis is important for improving the prognosis of gastric cancer patients with ovarian metastasis.

Clinical characteristics of lymph node metastasis in Siewert type II adenocarcinoma of the gastroesophageal junction

To explore the pattern of lymph node metastasis (LNM) in advanced Siewert type II adenocarcinoma of the gastroesophageal junction (AGEJ) in order to properly guide lymphadenectomy. From January 2009 to Jun 2011, a total of 86 patients with advanced Siewert type II AGEJ underwent radical esophagogastrectomy by thoracic-abdominal incision and two-field lymphadenectomy. The clinical characteristics, pathologic features, LNM, and influence factor of thoracic metastasis were retrospectively analyzed. LNM was observed in 65 of the 86 cases (75.6%). Simple abdominal lymph node metastasis was observed in 49 of the 86 cases (57.0%), simple thoracic lymph node metastasis was 2.3%, and thoracic-abdominal metastasis was 16.3%, with a significant difference between the abdominal and thoracic metastatic patterns. LNM frequency was found in the lymph node groups No. 3, No. 1, No. 7, No. 110, No. 2 and No. 9 (from the highest to the lowest). The incidences of those lymph node metastases were 46.5%, 41.9%, 17.4%, 14.0%, 10.5%, and 5.8%, respectively. Vascular tumor embolus was the only independent factor for thoracic lymph node metastasis. Abdominal lymph node metastases of advanced Siewert type II AGEJ mainly occur around the proximal stomach and the coeliac trunk. The metastatic rate of distal stomach and splenic perihilar lymph nodes is low, but metastatic rate of the group No.110 lymph nodes is high. The thoracic lymph node metastasis is only correlated with vascular tumor embolus.

Prognosis of hepatocellular carcinoma: a study of 832 cases

To investigate the prognostic factors of hepatocellular carcinoma. The purpose of this study was to retrospectively analyze the surgical outcomes of hepatocellular carcinoma (HCC) in 832 patients who underwent hepatic resection between February 2002 and June 2010 in the Cancer Hospital of Chinese Academy of Medical Sciences. Post-resection prognostic factors were assessed using a univariate Kaplan-Meier analysis and a multivariate Cox proportional hazards model. The overall 1-, 3- and 5-year survival rates were 92.0%, 70.2% and 53.6%, respectively. The disease free survival rates (DFS) were 90.2%, 61.5% and 40.5%, respectively. The univariate analysis showed that a better prognosis for overall survival (OS) was associated with asymptomatic presentation, small tumor, single lesion, high-grade histological differentiation, no vascular tumor embolus, negative serum alpha-fetoprotein (AFP), negative serum alkaline phosphatase (ALP), Child-Pugh class A, no ascites, no/mild cirrhosis, new surgical techniques, no blood transfusion, no regional lymph node metastasis, no major vascular invasion, and no extra-hepatic invasion. The multivariate analysis showed that asymptomatic presentation, small tumor, single lesion, no tumor embolus, negative serum alpha-fetoprotein (AFP), no regional lymph node metastasis, no major vascular invasion, no extra-hepatic invasion, no/mild cirrhosis, and surgical techniques are independent factors for a longer overall survival. The prognosis of HCC after resection is influenced by a number of factors. Therefore, regularly screening and early diagnosis, applying surgical techniques to minimize the liver injury, and preventing the aggravation of cirrhosis are important measures to improve the overall survival of HCC patients. For those patients with high risk factors of recurrence, routine follow-up is one of the best methods to be recommended.

Prognostic Factors in Patients with Node-Negative Gastric Cancer: A Single Center Experience from China

Background and ObjectivesLymph node metastasis was the most important prognostic factor in gastric cancer. Patients with node-negative gastric cancer presented better survival. However, some of them would die of the disease. The aim of this study was to evaluate the prognostic factors of patients with node-negative gastric cancer. MethodsFrom 1996 to 2007, 4,426 patients had undergone curative D2 gastrectomy for gastric cancer at the Fudan University Shanghai Cancer Center. Patients with node-negative gastric cancer who underwent curative D2 gastrectomy with more than 15 lymph nodes dissected were selected into this study. The prognostic value of pathological features was investigated. ResultsThis study included 234 patients with node-negative gastric cancer. The 5-year overall survival in these patients was 85 %. The factors correlating significantly with overall survival on univariate analysis included age (P = 0.016), depth of invasion (P = 0.000), tumor size (P = 0.013), tumor site (P = 0.000), histological grade (P = 0.009), lymphatic tumor emboli (P = 0.014), vascular tumor emboli (P = 0.005), and nervous invasion (P = 0.033). Multivariate analysis showed that lymphatic tumor emboli (hazard ratio (HR) = 7.270), vascular tumor emboli (HR = 3.010), and depth of invasion (HR = 2.735) were defined as independent prognostic factors. ConclusionAmong patients with node-negative gastric cancer and higher risk for recurrence, the use of adjuvant therapies should be considered.

Clinical curative effects of preoperative neoadjuvant chemotherapy on cervical cancer: analysis of 62 patients

To explore the clinical curative effects of preoperative neoadjuvant chemotherapy (NACT) on locally advanced cervical cancer. A total of 62 patients of stage Ib2-IIb cervical cancer received neoadjuvant chemotherapy of paclitaxel plus cisplatin for 2 - 3 courses. The clinical curative effects were evaluated according to the changes of lesion size, intraoperative conditions and postoperative pathological reactions. The overall response rate was 90.32% (56/62) and the complete response rate 30.65% (19/62). The tumor volumes decreased after NACT. The differences were significant (P < 0.05). After NACT, 56 patients undergoing radical hysterectomy recovered smoothly. The surgical resection rate was 90.32%. Chemotherapeutic reactions of cancerous tissue and a large number of infiltrated lymphocytes were seen in 50 cases. Lymph nodes were positive in 3 cases. There were parametrial invasion (n = 2) and vascular tumor emboli (n = 2). Preoperative neoadjuvant chemotherapy is efficacious in cervical cancer. The parametrium becomes softer and the tumor staging decreases.

Down regulation of galectin-3 in primary tumor tissues of breast predict axillary lymph node metastasis

Identification of axillary lymph node metastasis in breast cancer patients is a challenge in routine pathology practice. Serial sectioning and immunohistochemistry is labor intensive and cannot be followed even for sentinel node examination. So identification of a biomarker predicting axillary lymph node metastasis in primary tumor tissue is of great interest. Galectins are a family of low molecular weight β-galactoside specific endogenous lectins which functions in cell growth, cell activation, cell-cell and cell-matrix adhesion. The clinical significance of galectins, T-antigen and Bcl-2 were analyzed in a series of 550 patients by immunohistochemistry method and correlated with various clinico pathological features to see whether any of these factors can predict axillary lymph node metastasis in primary tumor tissue. A higher clinical stage (p= <0.0001), presence of vascular and lymphatic tumor emboli (p= <0.0001) and down regulation of galectin-3 (p= < 0.0001) were found to be useful to predict axillary node metastasis. Also down regulation of galectin-3 was found to be associated with poor prognosis (P = 0.0317). Hence evaluation of galectin-3 in primary tumor tissue of breast prior to radical therapy can have some role in predicting of axillary lymph node metastasis and prognosis. Key words: Galectins, T- antigen, predictor lymph node metastasis breast cancer.

Pulmonary Tumor Embolism

A 36-year-old woman with breast cancer was admitted with shortness of breath. A computed tomography angiogram was obtained and was negative for pulmonary embolism. She quickly developed hypoxemic respiratory failure and was transferred to the intensive care unit. She appeared to be improving when she suffered sudden cardiac death. Autopsy showed extensive lymphatic and vascular tumor emboli, which were the immediate cause of death. Tumor emboli are rarely diagnosed before death but seem to be more common than realized. It is important to recognize this entity, because there have been some case reports of cure. The usual mechanism of death is progressive right heart failure; sudden death from tumor embolism has rarely been described.

Characteristics of the lymph node metastases and influencing factors and their value in target region delineation in postoperative radiotherapy for thoracic esophageal carcinoma

To explore the distribution of lymph node metastases, to analyze the cliniopathologic factors of thoracic esophageal carcinoma after curative resection, and to provide the criteria of irradiated region delineation in radiotherapy for esophageal carcinoma. The clinicopathological data of 763 patients who underwent esophagecotomy from Jun 2002 to Jun 2006 were retrospectively analyzed. The regularity of lymph node metastases of thoracic esophageal cancer and clinicopathological factors were stratified and analyzed with SPSS13.0 software. Of the 763 patients, a total of 5846 lymph nodes were dissected with an average of 7.7 lymph nodes in each case. Metastatic lymph nodes were 711, the ratio of metastatic lymph node was 12.2%, and 297 patients had lymph node involved, the lymph node metastasis rate was 38.9%. The metastatic lymph nodes of upper-thoracic esophagus were mainly observed in the supraclavicular and paratracheal regions (P < 0.05), the metastatic lymph nodes of middle-third thoracic esophagus were bidirectional, and those of the lower-third thoracic esophagus mainly metastasized to the regions adjacent to the esophagus, gastric cardia and gastric artery (P < 0.05). Both the metastasis ratio and rate of lymph nodes adjacent to the gastric artery in the lower-thoracic esophageal cancer were significantly higher than those in the middle-third and upper-third thoracic esophageal cancers (P = 0.007, P = 0.001). The multiple factors logistic regression analysis showed that tumor length, depth of tumor invasion, vascular tumor emboli and distant metastasis were major factors for lymphatic metastasis (P < 0.01). For the whole group of patients the lymph node metastatic rate was 28.5% in upper-thoracic esophageal cancer, significantly lower than 38.8% of the lower-thoracic esophageal cancer (P = 0.039) and 43.4% in the middle-thoracic esophageal cancer (P = 0.010). However, the lymph node metastatic rates were 37.0%, 37.9% and 41.4% in the upper-, middle- and lower-thoracic esophageal cancers of the 592 cases receiving left chest notches, with a non-significant difference among them (P = 0.715). The lesion length, depth of tumor invasion, vascular tumor embolus and distant metastasis are the most important parameters for lymph node metastases. Operative modes have obvious influence on the distribution of regional lymph node metastases. Therefore, in the clinical management, a postoperative prophylactic radiotherapy may be selected according to the tumor length, depth of tumor invasion, vascular tumor embolus and distant lymph node metastasis.

Uterine adenosarcoma associated to lymphovascular emboli: a case report

IntroductionUterine adenosarcoma is a rarely observed polypoid tumor with a mixed benign epithelial element and malignant stromal component. The treatment is total hysterectomy with bilateral salpingo-oophorectomy. It could be difficult to diagnose and associated to lymphovascular invasion.Case presentationA 45-year-old caucasian uniparous woman presented with uterine bleeding. She had several surgical procedures and pathology of removed recurrent polyps showed no malignancy. Finally, a total abdominal hysterectomy was performed because of atypical cells and suspected uterine adenosarcoma. The hysterectomy specimen confirmed the presence of uterine adenosarcoma associated with lymphatic and vascular tumor emboli. Surgery was completed with a second bilateral salpingo-oophorectomy and pelvic lymphadenectomy.ConclusionIn our report, we present a case of uterine adenosarcoma which was diagnosed after multiple surgical procedures and associated to lymphovascular emboli known to have a significant impact on overall survival and distant metastasis-free survival.

Impact of surgical resection extent on the prognosis of clinical stage I endometrial carcinoma

To investigate the impact of surgical resection extent and other clinicopathological characteristics on the prognosis in patients with clinical stage I endometrial carcinoma. The data of 135 surgically treated patients with clinical stage I endometrial carcinoma were retrospectively analyzed. Fifty-seven patients (group A) underwent simple hysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy. The other 78 patients (group B) received sub-radical or radical hysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy. The impact of surgery extent and other clinicopathological characteristics on the prognosis in patients with clinical stage I endometrial carcinoma were retrospectively analyzed. There were no significant differences between two groups in the pathological stage, pathologic type, tumor grade, depth of myometrial invasion, vascular tumor emboli, ovary invasion, lymph node metastasis, positive peritoneal cytology and adjuvant therapy (P > 0.05). However, the patients in group A had a significantly shorter operating time (105 vs. 145 min), less estimated blood loss (150 vs. 300 ml) and blood transfusion (0 approximately 600 vs. 0 approximately 1200 ml), and a shorter postoperative hospital stay (12 vs. 13 days) than that in group B (all P < 0.05). The overall rates of post-operative complications were 15.8% in group A versus 26.9% in group B (P > 0.05). The recurrence rate in the group A was 14.0% versus 6.4% in group B (P > 0.05). Furthermore, the five-year survival rate in group A was 76.9% versus 85.8% in group B (P > 0.05). Multivariate analysis demonstrated that the important risk factors for clinical stage I endometrial carcinoma were deep myometrium invasion, high pathological grade, positive peritoneal cytology and ovarian metastasis, rather than surgical resection extent. Surgery extent is not an important factor affecting the prognosis in patients with clinical stage I endometrial carcinoma, and extended surgery does not improve their survival. Therefore, excessive resection should be avoided in such cases.

Novel human breast cancer cell lines IBH‐4, IBH‐6, and IBH‐7 growing in nude mice

Breast cancer is the most frequent cancer in women. However, in vivo hormone receptor positive and metastatic models are scarce. The aim of the present manuscript was to assess if the novel steroid receptor positive human cell lines IBH-4, IBH-6, and IBH-7 developed in our laboratory from primary infiltrant ductal carcinomas are good models to study in vivo human breast cancer. Cell lines or tumors were inoculated to nude mice in the presence or absence of hormone supplementation. Growth was analyzed by ANOVA followed by Tukey-Kramer's test. Steroid hormone expression was assessed by immunohistochemistry and Western blotting. The histology of the tumors was analyzed. IBH-4 and IBH-6 cells were inoculated to nude mice and 100% of the injected mice developed tumors in the presence or absence of hormone treatment, although tamoxifen inhibited growth. IBH-4 and IBH-6 cell lines in vivo gave rise to poorly differentiated carcinomas with areas of solid growth and sarcomatoid areas showing no morphological signs of epithelial differentiation. Distinct features of malignancy were observed. IBH-7 tumors in animals receiving estradiol were semi-differentiated adenocarcinomas. IBH-7 cells grew only in the presence of estradiol, but even with hormone addition, the tumor take was 20%. These tumors metastasized to the uterus and lung and vascular tumor emboli were evident. IBH-7 tumors were invasive and able to break through the peritoneum. As a conclusion, IBH-4 and IBH-6 are good models for studying tumor progression, whereas IBH-7 is a good model for tumor take, being metastatic and strictly estrogen-dependent.

Analysis of lymph node metastases of 1,526 cases with thoracic esophageal and cardiac carcinomas: A random sampling report from the Fourth Hospital of Hebei Medical University from 1996 to 2004

To summarize the regular pattern and state of lymph node metastasis of patients with esophageal and cardiac carcinomas, so as to analyze factors influencing lymph node metastasis. Clinical data collected from 1,526 thoracic esophageal and cardiac carcinoma patients who were admied in the Fourth Hospital of Hebei Medical University during a period from January 1996 to December 2004, were randomly selected and an Access Database of the patient’s information was set up. Eight clinico-pathologic factors, including the patient’s age, tumor location and size, pathological classification, the depth of tumor invasion, vascular tumor embolus (VTE), the state of surrounding organ encroachment and the status of tumor residues, were identified. A correlation between these factors and metastases was statistically analyzed using SPSS13.0 so ware. Lymph node metastatic sites from esophageal carcinomas included the thoracic and abdominal cavity. Lymph node metastasis from the superior esophageal carcinomas mainly occurred in the neck and thoracic cavity. There was a two-way lymph node metastasis in the patients with the middle esophageal carcinoma. The inferior esophageal carcinomas mainly metastasized to the paraesophageal, paragastric cardia, and left gastric artery lymph nodes. The rate and degree of the metastasis from the inferior esophageal carcinomas were significantly higher compared to those of the superior and the middle esophageal carcinomas (P 0.05). Multifactorial logistic regression analysis showed that the tumor size, depth of tumor encroachment, VTE, and tumor residues could all bring about obvious impact on lymph-node metastases (P < 0.05). Lymph node metastasis from superior esophageal carcinomas mainly occurs in the neck and thoracic cavity. The middle esophageal carcinomas presented a two-way lymph-node metastasis (both the upwards and the downwards), and the lymph node metastasis from inferior esophageal carcinomas mainly occurred in the thoracic and abdominal cardia were most commonly found in the abdominal cavity, with frequent paraesophageal lymph-node metastasis. The sufficient attention should be paid to neck lymph node clearance in cases of esophageal carcinoma. What is of the greatest concern is the clearance of the le gastric artery lymph nodes, and also in cases of gastric cardia carcinoma, clearance, the paraesophageal lymph nodes. With an increase in the tumor size and depth of tumor encroachment, and occurrence of VTE and tumor residual cells, the risk of lymph node metastasis is significantly raised (P < 0.05).

A “class action” against the microenvironment: do cancer cells cooperate in metastasis?

The authors review how cancer cells may cooperate in metastasis by means of microenvironmental changes. The main mechanisms underlying this cooperation are clustered migration of cancer cells, extracellular matrix degradation, paracrine loops of released signaling factors and/or induction of adhesion molecules on stromal cells. Another critical factor could be temporal cooperation: successive waves of cancer cells may induce progressive conditioning of the microenvironment. The "class action" of cancer cells against the microenvironment involves successive steps of the metastatic process: invasion of the primary tumor microenvironment, collective migration through the extracellular matrix, blood vessel disruption, vascular or lymphatic tumor emboli, establishment of a premetastatic niche by secreted factors and endothelial precursor recruitment, induction of cell adhesion molecule expression in endothelial cells, extravasation, micrometastasis dormancy and establishment of a new growth in distant sites. As a result, after completion of the metastatic process, the series of microenvironmental changes from the primary tumor to the metastatic site may promote colonization of metastases by nonmetastatic cancer cells of the primary tumor.

Pictorial Essay: Multinodular Disease

The evaluation of patients presenting with multinodular pulmonary disease provides an important clinical challenge for physicians. The differential diagnosis includes an extensive list of benign and malignant processes making the management of these cases frequently problematic. With the introduction of high-resolution CT (HRCT) scanning, the ability to assess various patterns of diffuse multinodular disease has evolved into an essential part of the diagnostic process. The purpose of this article is to develop an approach to the diagnosis of multinodular parenchymal disease using HRCT scan pattern recognition as a point of departure.

From Proteomic Analysis to Clinical Significance: Overexpression of Cytokeratin 19 Correlates with Hepatocellular Carcinoma Metastasis

To better understand the mechanism underlying the hepatocellular carcinoma (HCC) metastasis and to search potential markers for HCC prognosis, differential proteomic analysis on two well-established HCC cell strains with high and low metastatic potentials, MHCC97-H and MHCC97-L, was conducted using two-dimensional gel electrophoresis followed by matrix-assisted laser desorption/time-of-flight mass spectrometry. Cytokeratin 19 (CK19) was identified and found to be overexpressed in MHCC97-H as compared with MHCC97-L. This result was further confirmed by two-dimensional Western blot analysis and immunofluorescence assay. Furthermore, one-dimensional Western blot analysis showed consistently increased CK19 expression in progressively more metastatic cells. Immunohistochemical study on 102 human HCC specimens revealed that more patients in the CK19-positive group had overt intrahepatic metastases (satellite nodules, p < 0.05; vascular tumor emboli, p < 0.001; tumor node metastatis staging, p < 0.001). CK19 fragment CYFRA 21-1 levels measured in sera from nude mice model of human HCC metastasis with radioimmunoassay increased in parallel with tumor progression and rose remarkably when pulmonary metastases occurred. The results demonstrated that overexpression of CK19 in HCC cells is related to metastatic behavior. Serum CK19 level might reflect the pathological progression in some HCC and may be a useful marker for predicting tumor metastasis and a therapeutic target for the treatment of HCC patients with metastases.

P31 Prognostic significance of vascular tumor emboli in 1518 breast carcinoma patients with small tumor size (≤3 cm)

P31 Prognostic significance of vascular tumor emboli in 1518 breast carcinoma patients with small tumor size (≤3 cm)