AIM:To compare and evaluate the appropriate prog-nostic indicators of lymph node basic staging in gastric cancer patients who underwent radical resection.METHODS:A total of 1042 gastric cancer patients who underwent r...AIM:To compare and evaluate the appropriate prog-nostic indicators of lymph node basic staging in gastric cancer patients who underwent radical resection.METHODS:A total of 1042 gastric cancer patients who underwent radical resection and D2 lymphadenectomy were staged using the 6th and 7th edition International Union Against Cancer(UICC)N staging methods and the metastatic lymph node ratio(MLNR)staging.Ho-mogeneity,discriminatory ability,and gradient mono-tonicity of the various staging methods were compared using linear trend χ2,likelihood ratio χ2 statistics,and Akaike information criterion(AIC)calculations.The area under the curve(AUC)was calculated to compare the predictive ability of the aforementioned three stag-ing methods.RESULTS:Optimal cut-points of the MLNR were cal-culated as MLNR0(0),MLNR1(0.01-0.30),MLNR2(0.31-0.50),and MLNR3(0.51-1.00).In univariate,multivariate,and stratified analyses,MLNR staging was superior to the 6th and 7th edition UICC N stag-ing methods.MLNR staging had a higher AUC,higher linear trend and likelihood ratio χ2 scores and lower AIC values than the other two staging methods.CONCLUSION:MLNR staging predicts survival after gastric cancer more precisely than the 6th and 7th edi-tion UICC N classif ications and should be considered as an alternative to current pathological N staging.展开更多
Background Diffusion weighted imaging with background suppression （DWIBS） is potentially useful in detecting metastatic lymph nodes. This study aimed to evaluate the efficacy of DWIBS at 3T magnetic resonance （MR）...Background Diffusion weighted imaging with background suppression （DWIBS） is potentially useful in detecting metastatic lymph nodes. This study aimed to evaluate the efficacy of DWIBS at 3T magnetic resonance （MR） for diagnosing metastatic lymph nodes in cervical cancer.Methods This retrospective study included 25 patients with cervical cancer who underwent MR examination and were treated by hysterectomy and lymphadenectomy. The metastatic and non-metastatic lymph nodes were histologically proven by operation. Apparent diffusion coefficient （ADC） values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of all the identifiable lymph nodes were measured and compared.Results Twenty-five primary tumor lesions, 17 metastatic lymph nodes and 140 non-metastatic lymph nodes were pathologically confirmed in 25 cases with cervical cancer. The difference of ADC values between primary tumor lesions,metastatic and non-metastatic lymph nodes were statistically significant （F=7.93, P=0.001）. There was no statistically significant difference between primary tumor lesions of cervical cancer and metastatic lymph nodes （t=-0.75, P=-0.456）,and the difference between primary tumor lesions and non-metastatic lymph nodes was statistically significant （t =4.68, P〈0.001）. The ADC values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of metastatic and non-metastatic lymph nodes were （0.86±0.36）×10-3 mm2/s vs. （1.12±0.34）×10-3 mm2/s, （1.51±0.41） cm vs.（1.19±0.36） cm, （1.16±0.35） cm vs. （0.77±0.22） cm, 0.78±0.17 vs. 0.68±0.19 respectively, and statistically significant difference existed between two groups.Conclusions DWIBS at 3T MR has the distinct advantages in detecting pelvic lymph nodes of cervical cancer.Quantitative measurement of ADC values could reflect the degree of restriction of diffusion of metastatic and non-metastatic lymph nodes. The combination of size and ADC value would be useful in the accurate展开更多
AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic...AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic lymph nodes （LN） from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively. RESULTS： Of 88 solitary node metastases cases, 65 were limited to perigastric nodes （N1）, while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN （station number： No.1）, and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10 were found in LN of the lesser curvature （No.3） and 6 in LN of the left gastric artery （No.7）; 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum （No.10）. Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN （No.6）; 9 of the 29 cases along the lesser curvature were involved in No.6. CONCLUSION： Transversal and skipping metastases of sentinel lymph nodes （SLN） are notable, and rational lymphadenectomy should, therefore, be performed.展开更多
AIM: To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. METHODS: Two hundred and thirty-six patients with gastric cancer from the cardi...AIM: To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. METHODS: Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed ret- rospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and mul- tivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients. RESULTS: The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (χ2 = 4.26, P = 0.0389), tumor size (χ2 = 18.48, P < 0.001), Borrmann type (χ2 = 7.41, P = 0.0065), histological grade (χ2 = 5.07, P = 0.0243), pT category (χ2 = 49.42, P < 0.001), pN category (χ2 = 87.7, P < 0.001), total number of re- trieved lymph nodes (χ2 = 8.22, P = 0.0042) and MLR (χ2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (χ2 = 7.985, P = 0.018), pTcategory (χ2 = 30.82, P < 0.001) and MLR (χ2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple lin- ear regression (β = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%. CONCLUSION: The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.展开更多
背景与目的:淋巴瘤与转移性淋巴结均可表现为体积增大,实时剪切波弹性成像(shear wave elastography,SWE)能获得组织内部的弹性分布的定量信息,以不同色彩反映组织的软硬度。该研究旨在探讨SWE在鉴别淋巴瘤与转移性淋巴结中的应用价值...背景与目的:淋巴瘤与转移性淋巴结均可表现为体积增大,实时剪切波弹性成像(shear wave elastography,SWE)能获得组织内部的弹性分布的定量信息,以不同色彩反映组织的软硬度。该研究旨在探讨SWE在鉴别淋巴瘤与转移性淋巴结中的应用价值。方法:采用回顾性、总结的研究方法,选取2016年4月—2017年3月在北京大学首钢医院诊治的疑似淋巴瘤与转移性淋巴结的颈部恶性淋巴结肿大的80例患者作为研究对象,所有患者都给予常规超声与SWE诊断,记录诊断参数与鉴别诊断价值。结果:在80例患者中,病理诊断为转移性淋巴结的患者40例(转移组),恶性淋巴瘤患者40例(淋巴瘤组)。淋巴瘤组的淋巴结直径显著长于转移组(P<0.05),两组长短径比值对比差异无统计学意义(P>0.05)。转移组淋巴结的弹性模量平均值与最大值显著高于淋巴瘤组(P<0.05)。以弹性模量平均值15.80 k Pa为诊断界值时,灵敏度为95.3%,特异度为81.3%;以弹性模量最大值38.35 k Pa为诊断界值时,灵敏度为85.0%,特异度为98.8%。受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,应用淋巴结弹性模量平均值和最大值鉴别转移性淋巴结和淋巴瘤淋巴结的曲线下面积(area under curve,AUC)分别为0.945和0.952。结论:SWE在鉴别诊断转移性淋巴结与淋巴瘤的准确性较高,可给临床医师提供客观、直观的硬度信息,具有重要的临床诊断价值。展开更多
基金Supported by The Science and Technology Program of Guangdong Province (2009B030801112)the Natural Science Foundation of Guangdong Province,China,No.9151008901000119the Science and Technology Program of Huangpu District,Guangdong Province (031)
文摘AIM:To compare and evaluate the appropriate prog-nostic indicators of lymph node basic staging in gastric cancer patients who underwent radical resection.METHODS:A total of 1042 gastric cancer patients who underwent radical resection and D2 lymphadenectomy were staged using the 6th and 7th edition International Union Against Cancer(UICC)N staging methods and the metastatic lymph node ratio(MLNR)staging.Ho-mogeneity,discriminatory ability,and gradient mono-tonicity of the various staging methods were compared using linear trend χ2,likelihood ratio χ2 statistics,and Akaike information criterion(AIC)calculations.The area under the curve(AUC)was calculated to compare the predictive ability of the aforementioned three stag-ing methods.RESULTS:Optimal cut-points of the MLNR were cal-culated as MLNR0(0),MLNR1(0.01-0.30),MLNR2(0.31-0.50),and MLNR3(0.51-1.00).In univariate,multivariate,and stratified analyses,MLNR staging was superior to the 6th and 7th edition UICC N stag-ing methods.MLNR staging had a higher AUC,higher linear trend and likelihood ratio χ2 scores and lower AIC values than the other two staging methods.CONCLUSION:MLNR staging predicts survival after gastric cancer more precisely than the 6th and 7th edi-tion UICC N classif ications and should be considered as an alternative to current pathological N staging.
文摘Background Diffusion weighted imaging with background suppression （DWIBS） is potentially useful in detecting metastatic lymph nodes. This study aimed to evaluate the efficacy of DWIBS at 3T magnetic resonance （MR） for diagnosing metastatic lymph nodes in cervical cancer.Methods This retrospective study included 25 patients with cervical cancer who underwent MR examination and were treated by hysterectomy and lymphadenectomy. The metastatic and non-metastatic lymph nodes were histologically proven by operation. Apparent diffusion coefficient （ADC） values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of all the identifiable lymph nodes were measured and compared.Results Twenty-five primary tumor lesions, 17 metastatic lymph nodes and 140 non-metastatic lymph nodes were pathologically confirmed in 25 cases with cervical cancer. The difference of ADC values between primary tumor lesions,metastatic and non-metastatic lymph nodes were statistically significant （F=7.93, P=0.001）. There was no statistically significant difference between primary tumor lesions of cervical cancer and metastatic lymph nodes （t=-0.75, P=-0.456）,and the difference between primary tumor lesions and non-metastatic lymph nodes was statistically significant （t =4.68, P〈0.001）. The ADC values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of metastatic and non-metastatic lymph nodes were （0.86±0.36）×10-3 mm2/s vs. （1.12±0.34）×10-3 mm2/s, （1.51±0.41） cm vs.（1.19±0.36） cm, （1.16±0.35） cm vs. （0.77±0.22） cm, 0.78±0.17 vs. 0.68±0.19 respectively, and statistically significant difference existed between two groups.Conclusions DWIBS at 3T MR has the distinct advantages in detecting pelvic lymph nodes of cervical cancer.Quantitative measurement of ADC values could reflect the degree of restriction of diffusion of metastatic and non-metastatic lymph nodes. The combination of size and ADC value would be useful in the accurate
基金Supported in part by the Gastric Cancer Laboratory of Chinese Medical University
文摘AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic lymph nodes （LN） from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively. RESULTS： Of 88 solitary node metastases cases, 65 were limited to perigastric nodes （N1）, while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN （station number： No.1）, and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10 were found in LN of the lesser curvature （No.3） and 6 in LN of the left gastric artery （No.7）; 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum （No.10）. Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN （No.6）; 9 of the 29 cases along the lesser curvature were involved in No.6. CONCLUSION： Transversal and skipping metastases of sentinel lymph nodes （SLN） are notable, and rational lymphadenectomy should, therefore, be performed.
文摘AIM: To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. METHODS: Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed ret- rospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and mul- tivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients. RESULTS: The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (χ2 = 4.26, P = 0.0389), tumor size (χ2 = 18.48, P < 0.001), Borrmann type (χ2 = 7.41, P = 0.0065), histological grade (χ2 = 5.07, P = 0.0243), pT category (χ2 = 49.42, P < 0.001), pN category (χ2 = 87.7, P < 0.001), total number of re- trieved lymph nodes (χ2 = 8.22, P = 0.0042) and MLR (χ2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (χ2 = 7.985, P = 0.018), pTcategory (χ2 = 30.82, P < 0.001) and MLR (χ2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple lin- ear regression (β = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%. CONCLUSION: The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.
文摘背景与目的:淋巴瘤与转移性淋巴结均可表现为体积增大,实时剪切波弹性成像(shear wave elastography,SWE)能获得组织内部的弹性分布的定量信息,以不同色彩反映组织的软硬度。该研究旨在探讨SWE在鉴别淋巴瘤与转移性淋巴结中的应用价值。方法:采用回顾性、总结的研究方法,选取2016年4月—2017年3月在北京大学首钢医院诊治的疑似淋巴瘤与转移性淋巴结的颈部恶性淋巴结肿大的80例患者作为研究对象,所有患者都给予常规超声与SWE诊断,记录诊断参数与鉴别诊断价值。结果:在80例患者中,病理诊断为转移性淋巴结的患者40例(转移组),恶性淋巴瘤患者40例(淋巴瘤组)。淋巴瘤组的淋巴结直径显著长于转移组(P<0.05),两组长短径比值对比差异无统计学意义(P>0.05)。转移组淋巴结的弹性模量平均值与最大值显著高于淋巴瘤组(P<0.05)。以弹性模量平均值15.80 k Pa为诊断界值时,灵敏度为95.3%,特异度为81.3%;以弹性模量最大值38.35 k Pa为诊断界值时,灵敏度为85.0%,特异度为98.8%。受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,应用淋巴结弹性模量平均值和最大值鉴别转移性淋巴结和淋巴瘤淋巴结的曲线下面积(area under curve,AUC)分别为0.945和0.952。结论:SWE在鉴别诊断转移性淋巴结与淋巴瘤的准确性较高,可给临床医师提供客观、直观的硬度信息,具有重要的临床诊断价值。
