| Objectives:The pathologic stages of lymph nodes usually differ from preoperatively predicted in lung cancers and it is difficult to predict the metastasis of lymph nodes for the patients diagnosed as clinical stage IA non-small cell lung cancers.This study aimed to investigate the patterns of lymph node metastasis and the risk factors predicting lymph node metastasis in the patients with clinical stage IA non-small cell lung cancers.Materials and methods:All patients diagnosed as clinical stage IA non-small cell lung cancers from July 2014 to July 2017 in our center were retrospectively reviewed,and a total number of 1543 patients who underwent anatomical lobectomy with systematic lymph node dissection were enrolled in this study.Multivariate logistic regression analysis was performed to identify the risk factors predicting lymph node metastasis,and Fisher's exact test were used to confirm the lymph node spread mode according to the locations of primary tumors.Results:Totally,lymph node metastases presented in 131 patients(8.5%)in this series.Sixty-three patients only presented N1 diseases,17 patients only showed skipped N2 diseases,and 51 patients had simultaneous N1 and N2 positive lymph nodes.No lymph node metastasis was found in the patients with pure ground grass opacity(GGO).When patients were arbitrarily divided into six groups by the longest tumor diameter of ?0.5cm,0.6-lcm,1.1-1.5cm,1.6-2.0cm,2.1-2.5cm,2.6-3cm,the lymph node metastasis rates of each group were 0%(0/20),1.5%(4/264),4.7%(20/429),8.6%(29/336),13.1%(38/290),19.6%(40/204),respectively.When the patients with pure GGO were excluded,the lymph node metastasis rates in the patients with partial or total solid tumors were 0%(0/10),2.4%(4/164),6.6%(20/303),11.7%(29/249),16.0%(38/238)and 23.1%(40/173).The cut off value showed by receiver operating characteristic(ROC)curve for tumor size was 1.95cm,and the area under the curve was measured as 0.681(P<0.001,95%CI=0.630-0.726).Multivariate logistic regression analysis indicated that male patients(OR=3.34,P=0.012),smoking history(OR=14.12,P<0.001),solid components(OR=3.34,P=0.01),large tumor size(OR=1.9,P<0.001),poor differentiation(OR=2.25,P=0.013),lymphovascular invasion(OR=58.45,P<0.001),visceral pleural invasion(OR=48.37,P<0.001)were statistically and significantly associated with lymph node metastasis in clinical stage IA NSCLC.The rate of non-lobe specific lymph node metastasis was 15.8%-40.0%when any of the lobe specific lymph nodes was positive,while it was only 0-2.2%when all lobe specific lymph nodes were negative.Conclusions:Tumor size,solid components,poor differentiation,lymphovascular invasion,visceral pleural invasion and smoking history were significant factors predicting lymph node metastasis of clinical stage IA NSCLC.Patients with negative lobe-specific lymph node have very low risk of metastasis to the non-lobe specific lymph nodes.Lobe-specific lymph node dissection may become an alternative lymph node dissection mode for clinical stage IA NSCLC,especially for tumors<2cm.Objectives:Chemokine receptors play an important role in tumorigenesis and progression,and are associated with tumor prognosis.The purpose of this study was to investigate the expression of CCR7?CXCR4?CXCR5?CXCL13 and their effects on the prognosis of non-small cell lung cancers(NSCLC).Different subtypes of lung adenocarcinoma show great heterogeneity in tumor biological characteristics and different prognosis.The prognosis difference of all pathological subtypes in early stage lung adenocarcinoma and its correlation with chemokine receptor expression were also analyzed.Methods:Patients who were diagnosed as stage T1 NSCLC and received radical resection combined with systematic lymph node dissection in our center from 2011.1 to 2012.1 were included in this study.Expression of CCR7,CXCR4,CXCR5 and CXCL13 in paraffin embedded tumor tissues and normal lung tissues were detected by immunohistochemistry.The pathological subtypes of all adenocarcinomas were examined and classified,and the prognosis of different subtypes was analyzed.The correlation of chemokine receptor expression with different adenocarcinoma subtypes was also investigated.Chi-square test was used to analyze the association between immunohistochemistry staining of chemokine receptors and clinicopathological parameters.Kaplan-Meier method with log-rank test was performed to compare DFS rates and OS rates in these NSCLC patients.COX proportional hazards model was used to analyze independent prognostic risk factors affecting DFS and OS.Results:A total of 244 patients diagnosed as stage T1 non-small cell lung cancer were retrospectively recruited,including 189 lung adenocarcinomas(148 cases were stage T1N0M0).The expression of CCR7,CXCR4 and CXCR5 in cancer tissues were significantly higher than that in normal lung tissues,while expression rate of CXCL13 was low both in tumor and normal lung tissues.The recurrence and mortality rate of CCR7 positive-expression group were significantly lower than that of CCR7 negative-expression group.The prognosis of CXCR4 positive-expression patients was significantly worse than that of negative-expression group.Though the 5 year disease-free survival rate of CXCR5 positive-expression group was lower than that of the negative group,the overall survival rate was not statistically significant.Solid or micropapillary predominant subtypes of lung adenocarcinoma showed significantly higher lymph node metastasis rate than other subtypes,and the positive rate of CXCR4 and CXCR5 expression was also significantly higher than other subtypes.Conclusions:The positive expression of CXCR5 and CXCR4 indicate that the tumor is highly malignant with poor prognosis and prone to relapse or metastasis,while positive expression of CCR7 presents a better prognosis.Solid or micropapillary predominant subtypes of lung adenocarcinoma shows poor prognosis.The expression of chemokine receptors and pathological subtypes of adenocarcinoma are helpful to predict the prognosis of early stage NSCLC and guide precise multi-modality treatment in clinical practice.Objective:Esophageal and esophagogastric junction cancers are common malignant diseases of the digestive system with high incidence and mortality,and significantly affected human health.Anastomotic leak is a high risk complication which not only increases postoperative mortality but also delayed postoperative adjuvant therapies.The object of this study was to summarize our experiences in the management of anastomotic leakages and analyze the factors affecting leakage healing in the patients with esophagogastric junction cancer after surgical resection.Methods:All patients who received surgical resections for esophagogastric junction cancer and diagnosed anastomotic leak at our center between January 2009 and December 2014 were retrospectively analyzed,the patients who had a longer hospital stay(>30 days)were also enrolled at first time as they may develop anastomotic leak.The binary logistic regression in SPSS 16.0 was applied to analyze the factors that may affect leakage healing.Results:There are 1815 esophagogastric junction cancer patients who received surgically resection in our hospital during January 2009 and December 2014,and 91 cases were finally diagnosed as anastomotic leakage postoperatively.The patients were divided into two groups based on the median leakage healing time(40 days)in this series:fast healing group(37 cases)and slowly healing group(54 cases).All factors that may affect the leakage healing were put into analysis by using binary logistic regression.The results of the analysis showed that leakage size(P=0.004),thoracic drainage(P=0.037)and smoking index ?400(P=0.04)significantly affected the healing time,while drinking history,duration of fever after anastomotic leak developed,and hypoproteinemia after leak also apparently but not significantly affect the healing time.Conclusion:Though many factors may affect leakage healing in the esophagogastric junction carcinoma patients,leakage size,thoracic drainage and smoking index(?400)are the most important factors affecting the leakage healing.Placement of a chest tube beside the anastomosis area during operation for early identification and control of an anastomotic leak to minimize contamination of the mediastinum is the most important way to promote leakage healing.A chest tube placing into the purulent cavities after the patients experienced leaks is also important for the cure of leakage.Enteral and parenteral nutrition are also important factors which promote leakage healing. |
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