ObjectiveTo investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative (cN0) papillary thyroid carcinoma (PTC).MethodsPatients and Methods: The clinicopathologic data of patients with cN0 PTC who underwent at least one lobectomy plus central lymph node dissection at Xuzhou Central Hospital from January 2018 to December 2020 were retrospectively collected and the risk factors of lymph node metastasis analyzed. Univariate and multivariate analyses were performed to detect the risk factors for cervical lymph node metastasis.ResultsA total of 312 patients with cN0 PTC were enrolled in this study. The postoperative pathology results showed that 134 patients (42.9%) had central lymph node metastasis, of whom 24 (17.9%) had lateral lymph node metastasis (LLNM). The univariate analysis results showed that male gender, age <45 years, tumor diameter ≥10 mm, bilateral cancer, capsule invasion, and multiple foci were associated with cervical lymph node metastasis of cN0 PTC (P < 0.05). Further logistic regression analysis results showed that these factors, except age, were independent risk factors for cervical lymph node metastasis of cN0 PTC (P < 0.05). The results also showed that the risk of LLNM increased with an increase in the number of positive central lymph nodes in patients with cN0 PTC (P < 0.05).ConclusionCervical lymph node metastasis of cN0 PTC is related to many factors, and a high number of positive central lymph nodes indicates a high risk of LLNM. Patients with risk factors should undergo preventive central lymph node dissection at the first surgery, and in patients with a high number of positive central lymph nodes, lateral lymph node dissection should be discreetly performed.
Background Although it is only a small redox protein, Thioredoxin-1 (Trx-1) can have a significant impact in many biological processes. In recent years, studies on the increased Trx-1 expression in different solid tumors have gradually increased, but its clinical and diagnostic significance in gastric cancer (GC) have not been confirmed. HIF-1α (Hypoxia-inducible factor-1α) plays an active role in many tumors’ metabolism, while the relevance between its expression levels and clinical value in GC remains to be investigated. Methods: Western blot (WB) and quantitative PCR (qPCR) were used to detect HIF-1α and Trx-1 mRNA and protein level in 20 freshly frozen GC and corresponding normal-tissues. In addition, the protein level of Trx-1 and HIF-1α in 162 GC were determined by immunohistochemistry (IHC) test. The relevance between HIF-1α and Trx-1 expression and the clinicopathological characteristics in GC was assessed as well. And Cox proportional risk model was applied to determine independent prognostic indicators. Results: When HIF-1α level increased, the Trx-1 mRNA and protein levels increased obviously in GC tissues, and they both were related to a bad prognosis (P < 0.001). There was an obvious positive relevance (r = 0.578, P = 0.000) between Trx-1 and HIF-1α expressions. Through multivariate analysis, for GC prognosis, Borrmann type, Trx-1 and HIF-1α were independent predictors (P < 0.001). Conclusion For GC patients, both Trx-1 and HIF-1α may be prospective prognostic indicators and therapeutic target.
ObjectiveThe extent of lymph node dissection for pancreatic head cancer (PHC) is uncertain and controversial; therefore, this study evaluated whether PHC patients can benefit from different extents of lymph node dissection.MethodsA total of 106 PHC patients underwent standard regional lymphadenectomy (SRLN; n = 56,52.8%) and extended regional lymphadenectomy (ERLN; n = 50, 47.2%) between September 2015 and September 2019. None of the study participants had distant metastases. The median survival time and complications were compared between the two groups.ResultsThe median survival time in the SRLN and ERLN groups was 27.01 months and 21.17 months, respectively (P = 0.30). The postoperative major morbidity and mortality rates were 37.50% and 1.79% in the SRLN group, and 46.00% and 2.00% in the ERLN group, respectively. Moreover, the tumor differentiation, tumor diameter, lymph node involvement, perineural invasion, vascular invasion, and margin status all correlated with survival (P < 0.05).ConclusionFor PHC patients, ERLN cannot provide a significant survival benefit over SRLN. Moreover, ERLN increased morbidity and mortality, although without statistical significance. This indicates that ERLN should not be considered in PHC patients.
ObjectiveThe peritoneal cancer index (PCI) has been used for the detailed evaluation of the peritoneal spread in tumors of a gynecologic origin and has been found to be a prognostic indicator of survival. The aim of this study was to identify the significance of the PCI in advanced gastric cancer (AGC) with peritoneal carcinomatosis (PC).MethodsFrom 2010 to 2018, a retrospective analysis was carried out of 60 AGC patients with PC, including 21 patients with a PCI ≤ 13 and 39 with a PCI > 13. All patients were treated with both surgery and intraoperative peritoneal hyperthermic chemotherapy (IPHC). The performance status (Karnofsky performance status), age, sex, Borromann's classification, differentiation, depth of invasion, lymph node metastasis, PCI, extent of gastrectomy, extent of lymph node dissection, and residual tumor volume were retrospectively evaluated and correlated to survival.ResultsThe overall 5-year survival rate was 43% and mean survival was (54.47 ± 4.53) months. The favorable clinical prognostic indicators of survival were Borromann's classification, differentiation, depth of invasion, PCI, and residual tumor volume on univariate analyses (P < 0.05). The Cox proportional regression hazard model showed that only the volume of residual tumor and PCI were associated with postoperative survival. The median survival time was 69.76 months for patients with a PCI ≤ 13 and 39.96 months for patients with a PCI > 13. There was a significant difference in survival rate between the two group (P = 0.004). Postoperative major morbidity and mortality rates were 23.81% and 4.76% in the PCI ≤13 group and 43.59% and 5.12% in the PCI > 13 group, respectively.ConclusionThe peritoneal spread in advanced gastric cancer with peritoneal carcinomatosis can be assessed in detail using the PCI. It is also a significant prognostic factor of survival and is useful in identifying subgroups.
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