Prognostic factors of patients with thymic carcinoma after surgery: a retrospective analysis of 58 cases.

BACKGROUND: Thymic carcinoma is reputed to carry a poor prognosis. Although few scholars have studied the prognosis of thymic carcinoma, the prognostic factors of patients after surgery are not well established. We analyze the prognostic significance of undetermined factors to predict the survival of patients after surgery. METHODS: We reviewed 351 cases of thymic epithelial tumor treated with surgery at a single institution in China from 1992 to 2011. A total of 58 patients were histopathologically reconfirmed as having thymic carcinoma. Clinicopathological characteristics and treatment modalities were reviewed. During the follow-up, with a median of 65.8 months, survival time was analyzed using the Kaplan-Meier method. Univariate and multivariate analysis were performed to identify prognostic factors. RESULTS: The overall 3-, 5-, and 10-year survival rate was 69.0, 43.1, and 12.1%, respectively. The Log-rank test revealed that Masaoka stage (p = 0.000), histology group (p = 0.000), completeness of the resection (p = 0.000), great vessel invasion (p = 0.000), and presence of symptoms (p = 0.003) were significant prognostic factors in all patients. However, tumor size (p = 0.086), age (p = 0.677), sex (p = 0.706), smoking (p = 0.065), and alcohol (p = 0.875) were not prognostic factors. A Cox proportional hazards regression model showed that Masaoka stage (hazard ratio = 15.640, p = 0.000) and completeness of the resection (hazard ratio = 18.303, p = 0.000) were the only independent prognostic factors. CONCLUSIONS: The Masaoka stage and completeness of the resection were independent prognostic factors that predicted long-term survival of patients with thymic carcinoma treated with surgery.

Mucin 1 and vascular endothelial growth factor C expression correlates with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis esophagectomy.

BACKGROUND: The purpose of the present study was to investigate the risk factors associated with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis esophagectomy based on the detection of Mucin 1 mRNA and vascular endothelial growth factor (VEGF) C mRNA. METHODS: The subjects were 82 patients with pN0 esophageal cancer who underwent Ivor-Lewis esophagectomy with two-field lymph node dissection from January 2001 to January 2005. A total of 501 lymph nodes obtained from these patients were re-evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR) to detect mucin l (MUC1) mRNA; VEGF-C mRNA was also detected in esophageal cancer issues by RT-PCR. The diagnosis of lymph node micrometastasis (LNMM) was based on the detection of MUC1 mRNA. The Kaplan-Meier method was used to calculate the survival rate and lymph nodal metastatic rate, the log-rank test was performed to compare the recurrence rate, and Cox regression multivariate analysis was performed to determine independent prognostic factors. RESULTS: MUC1 mRNA was detected in 29 lymph nodes from 23 patients, which accounted for 5.79% of all the 501 lymph nodes and 28.05% of all 82 patients, respectively. Vascular endothelial growth factor C mRNA was identified in esophageal cancer issues from 42 (51.22%) patients. The overall 3- and 5-year survival rates of 82 patients were 78.0 and 51.2%, respectively. First recurrence exhibiting lymph nodal metastasis was recognized in 37 patients (45.1%) in the first 3 years after operation. The lymph node metastatic rate in patients in the first 3 years after operation was significantly associated with T status (p < 0.05) and the lymph node metastatic rate of the patients with LNMM was significantly higher than that of the patients without LNMM (p < 0.01). The lymph node metastatic rate of the patients with VEGF-C mRNA expression in esophageal cancer tissues was significantly higher than that of the patients without VEGF-C mRNA expression (p < 0.01).The results of multivariate analysis confirmed that VEGF-C mRNA expression in esophageal cancer tissues, LNMM, and T status in patients with N0 esophageal cancer were independent relevant factors for 3-year lymph node metastatic recurrence after Ivor-Lewis esophagectomy. CONCLUSIONS: Vascular endothelial growth factor C mRNA expression in esophageal cancer tissues, LNMM, and T status in patients with N0 esophageal cancer were independent risk factors for 3-year lymph node metastatic recurrence after Ivor-Lewis esophagectomy. Adjunctive therapy might be beneficial in controlling the locoregional recurrence and elevated healing rates for certain patients.

High-level CXCR4 expression correlates with brain-specific metastasis of non-small cell lung cancer.

BACKGROUND: Brain-specific metastasis occurs frequently in lung cancer, and the mechanism is still unclear. The present study was designed to investigate the correlation between CXCR4 expression and brain-specific metastasis of non-small cell lung cancer. METHODS: The brain metastatic tumors and lung cancer tissues from 32 patients with solitary brain metastasis of non-small cell lung cancer (M1 group), who underwent combined surgical treatment from January 1998 to June 2008, and 32 paired patients without distant metastasis (M0 group) and 30 patients with primary brain tumor, were examined by immunohistochemistry to detect the expression of CXCR4 protein. The difference of CXCR4 expression was compared by the McNemar χ(2) test or Fisher's exact test. Estimation of survival was calculated with the Kaplan-Meier method, and the statistical differences were analyzed with the log-rank test. RESULTS: Overexpression of CXCR4 protein was observed in 29 (90.6%) M1 non-small cell lung cancers and in all (100%) brain metastatic tumors, which was significantly higher than that in the paired M0 non-small cell lung cancer and the primary brain tumors, respectively (p = 0.000). The 3- and 5-year cumulative survival rates of patients with solitary brain metastasis of lung cancer were 21.9 and 12.5%, significantly lower than the corresponding survival rates of M0 group patients (p = 0.005). CONCLUSIONS: CXCR4 protein was highly overexpressed in M1 non-small cell lung cancer and brain metastatic tumors, which indicated that high-level CXCR4 expression correlates with brain-specific metastasis of non-small cell lung cancer.

Successful Radical Pneumonectomy for a Primitive Neuroendodermal Tumor in the Lung: A Case Report and Review of the Literature.

Peripheral primitive neuroendodermal tumors (PNETs) and Ewing's sarcoma belong to the Ewing family of tumors and are small round-cell malignancies originating from spinal cord cells. These tumors account for 5% of all small round-cell malignant neoplasms. PNETs that arise from the lung parenchyma without pleural or chest wall involvement are very rare. We report a case of an adult female with a large pulmonary PNET who had given birth just 1 month prior to the diagnosis. She had cough and expectoration for 6 months, and the preoperative examination showed no metastases. Thus, we performed radical pneumonectomy and lymph node dissection. The patient recovered well without surgical complications and was discharged 7 days after the surgery. Postoperative pathology confirmed that the tumor was a small round-cell malignancy, and the tumor cells were positive for CD99, Friend leukemia virus integration 1 (FLI-1), and neuron-specific enolase (NSE), which was consistent with the diagnosis of a PNET. For primary large pulmonary PNETs, radical pneumonectomy may be a safe surgical method, worthy of further application in clinical practice.

Management and surgical resection for tumors of the trachea and carina: experience with 32 patients.

BACKGROUND: The purpose of the present study was to investigate the complications, long-term survival, and management lessons learned after surgical resection for patients with primary tumors of the trachea and carina and locally advanced lung cancer directly infiltrating the carina. METHODS: A retrospective study was performed by our department on 32 patients undergoing surgical resection for primary tumors of the trachea and carina and locally advanced lung cancer directly infiltrating the carina between June 1986 and June 2003. RESULTS: Various surgical modalities were performed according to the tumor location and extent: tracheal resection in 10 cases, carinal resection and reconstruction in 4 cases, carinal right upper lobectomy in 8 cases, carinal pneumonectomy in 4 cases, and partial tangential resection of the tracheal wall in 6 cases. Cardiopulmonary bypass was required in two patients for nearly complete obstruction of the trachea. Resected tumors included six distinct histologic types. Perioperative mortality was 9.4% (3/32). Major complications occurred in 31.3% (10/32) of the patients. The overall 1-, 3-, and 5-year survival rates were 87.5%, 56.3%, and 40.6%, respectively. Patients with primary tracheal and carinal tumors experienced a 5-year survival of 55.0% compared to 16.7% for those with locally advanced lung cancer directly infiltrating the carina (P < 0.05). CONCLUSIONS: Surgical resection is the most effective treatment of choice for primary tumors of the trachea and carina. With careful patient selection and meticulous surgical and anesthesia techniques, the operative mortality and complications are acceptable, and long-term survival can be achieved.

[The long-term outcome and prognostic analysis of surgically treated patients with trachea tumors].

OBJECTIVE: To investigate and evaluate the clinical features, diagnostic methods, surgical management of trachea tumors in order to improve patients outcome. METHODS: Clinical data of 32 patients with trachea tumors surgically treated from June 1986 to June 2005 were retrospectively analyzed. There were 22 male and 10 female patients. The age ranged from 14 to 63 years old with a median of 48 years old. The surgical procedures performed were resection and reconstruction of trachea in 10 cases, right or left pneumonectomy and carinal resection and reconstruction in 8 cases, right sleeve upper lobectomy, carinal resection and reconstruction of trachea and carina in 8 cases, and carina resection and reconstruction with tumor removal through tracheal windows 6 cases. The tracheal defect was repaired with a Teflon flap in two patients. Cardiopulmonary bypass was used in 2 patients during surgery. RESULTS: The histological examination of resected lesions revealed squamous cell carcinoma in 19 cases, adenoid cystic carcinoma in 8 cases, adenocarcinoma in 2 cases, carcinoid in 2 cases, leiomyosarcoma in 1 case and adenoma in 1 case. One case had infection of thoracic cavity and 3 cases experienced temporary cardiac arrhythmia. There was no operative death. The follow-up periods were from 5 months to 3 years. The 1, 2 and 3 year survival rates were 93.7%, 59.4% and 50.0% respectively. CONCLUSIONS: Squamous cell carcinoma adenoid cystic carcinoma are the most common in trachea tumors. Preoperative bronchoscope examination and chest CT scan can provide valuable diagnostic data. Proper choice of surgical procedure is important for improved patients' outcome.

[The patterns and prognostic factors of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma].

OBJECTIVE: To investigate the patterns of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors. METHODS: Three hundred and sixty-eight patients with the middle thoracic esophageal squamous cell carcinoma from January 1998 to January 2003 were reviewed. There were 289 male and 79 female patients. The age ranged from 38 to 79 years, with a mean of 56 years. Preoperative clinical stage was stage I to III, and all patients underwent Ivor-Lewis esophagectomy with two-field lymphadenectomy. Follow-up was completed for all patients with a mean time of 68 months. Survival rate was calculated by Kaplan-Meier method. COX regression analysis was performed to identify risk prognostic factors. RESULTS: Abdominal lymph node metastasis occurred in 58 (15.8%) patients, with 36.2% (21/58) of them being in stage T1 or T2. Skipping abdominal lymph node metastasis was recognized in 13.8% (8/58) patients, with all of them being in stage T1 or T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic lymph node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was bad, and nobody could survive over 5 years.COX analysis showed that 5 or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis. CONCLUSIONS: Abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma occurs frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis is poor, especially those with more positive nodes and distant abdominal node metastasis.

[The local control of radiotherapy following Ivor-Lewis esophagectomy in the patients with stage II A middle-third thoracic esophageal cancer].

OBJECTIVE: To investigate the local control of radiotherapy following Ivor-Lewis esophagectomy in the patients with stage IIA middle-third thoracic esophageal cancer. METHODS: From June 1999 to June 2002, 125 patients with stage IIA squamous cell carcinoma of the middle-third thoracic esophagus were treated with Ivor-Lewis esophagectomy with two-fields lymphadenectomy. The survival rate was calculated by Kaplan-meier method and the difference of recurrence rate compared by chi(2) test. RESULTS: The 3-year and 5-year survival rates were 58.4% and 43.2% in this group, respectively. Tumor recurrence occurred in 61 of the 125 patients (48.8%) within 3 years after operation. Of all cases of recurrence, 38 patients (30.4%) developed locoregional recurrence (including 5 patients with locoregional and hematogenous recurrence simultaneously). The locoregional recurrence rate of patients who received postoperative radiotherapy (20.3%) was significantly lower than that of both the group who received adjunctive chemotherapy (40.6%) and the group without adjunctive therapy (41.4%) (P < 0.05). CONCLUSIONS: About half of the patients would develop recurrence disease within 3 years after Ivor-Lewis esophagectomy with two-fields lymph-adenectomy. Radiotherapy following Ivor-Lewis esophagectomy is an effective strategy to control local recurrence of the stage II A middle-third thoracic esophageal cancer.

[A study of correlation between early postoperative relapse with lymph node micrometastasis in patients with N0 esophageal cancer].

OBJECTIVE: To explore the correlation between early postoperative tumor relapse with lymph node micrometastasis in the patients with pN(0) esophageal cancer. METHODS: Using reverse transcriptase-polymerase chain reaction (RT-PCR), one hundred and sixty-six regional lymph nodes obtained from forty-three patients with esophagus cancer without invasion of the tumor confirmed by histopathologic analysis (pN(0)) were studied for further detecting mRNA of Mucin1 (MUC1) gene and determining nodal micrometastasis. All the patients underwent radical resection and regional lymph node dissection. Patients were followed up for one year to detect early tumor relapse. Difference in relapse was compared by chi(2) test. RESULTS: MUC1 mRNA expression was identified for twenty-six lymph nodes (15.7%), in eighteen patients (42%) who were diagnosed as having nodal micrometastasis. TNM staging for these patients was up-regulated from stages I-II(A) to stages II(B)-III. Relapse disease was found in nine patients with lymph nodes micrometastasis and three patients without nodal micrometastasis (P < 0.05). CONCLUSION: Early tumor relapse after radical surgery in the patients with pN(0) esophageal cancer might be correlated with nodal micrometastasis.

High-level C-X-C chemokine receptor type 4 expression correlates with brain-specific metastasis following complete resection of non-small cell lung cancer.

Brain-specific metastasis is one of the primary causes of recurrence following complete resection of non-small cell lung cancer (NSCLC) and the underlying mechanism remains unclear. The present study was designed to investigate the correlation between C-X-C chemokine receptor type 4 (CXCR4) expression and brain-specific metastasis of NSCLC. Lung cancer tissues from 105 patients who underwent complete tumor resection between January 1998 and June 2008 (sample group, 34 with brain metastasis during the follow-up period; control group 1, 34 without metastasis during the follow-up period; and control group 2, 37 with other organ metastasis, excluding brain metastasis, during the follow-up period) were examined by immunohistochemistry to detect the expression of CXCR4 protein. The differences in CXCR4 expression were compared using McNemar's χ2 test. Estimation of survival was calculated with the Kaplan-Meier method and the statistical differences were analyzed with the log-rank test. Overexpression of CXCR4 protein was observed in 31 (91.2%) NSCLC patients with brain metastasis, which was greater than that observed in the NSCLC patients with other organ metastases (73.0%; P=0.048) and without metastases (14.7%; P<0.001). CXCR4 protein was highly overexpressed in patients with brain-specific metastasis, which indicated that high-level CXCR4 expression correlates with brain-specific metastasis of NSCLC.

microRNA­802 promotes lung carcinoma proliferation by targeting the tumor suppressor menin.

microRNAs play important roles in numerous biological processes, including tumorigenesis, by modulating critical gene transcripts. In the present study, the role of microRNA­802 (miR­802) in lung cancer was investigated. The results of the quantitative polymerase chain reaction revealed that expression levels of miR­802 were significantly upregulated in lung cancer tissues. In vitro experiments demonstrated that miR­802 promoted cell proliferation in A549, NCI­H358 and NCI­H1299 cells. Furthermore, it was indicated that miR­802 promoted the proliferation of lung carcinoma by targeting the tumor suppressor menin. Therefore, these results suggest a previously unknown miR­802/menin molecular network controlling lung carcinoma development.

The relationship between KRAS gene mutations and HLA class I antigen downregulation in the metastasis of non-small cell lung cancer.

OBJECTIVE: To investigate the association between v-Ki-ras2 Kirsten rat sarcoma viral oncogene homologue (KRAS) gene mutations and levels of human leucocyte antigen (HLA) class I antigen in primary lung tumours and metastatic lymph nodes of patients with non-small cell lung cancer (NSCLC). METHODS: Patients with NSCLC undergoing tumour resection were enrolled. KRAS codon 12 mutations were analysed in normal lung and lymph node tissue, primary lung tumours and metastatic lymph nodes using polymerase chain reaction-restriction fragment length polymorphism analysis. HLA class I antigen immunostaining was examined using flow cytometry. RESULTS: A total of 65 patients participated in the study. All normal lung tissues had positive HLA class I antigen immunostaining. The majority of primary lung tumours (56/65) and all of the metastatic lymph nodes (31/31) had downregulated HLA class I antigen immunostaining. There was a positive correlation between downregulated HLA class I antigen in primary tumours and metastatic lymph nodes. There was a negative correlation between KRAS codon 12 mutations and the level of HLA class I antigen in primary and metastatic tumours. CONCLUSIONS: KRAS codon 12 mutations appear to be important in the downregulation of HLA class I antigen in NSCLC. Abnormal activation of the oncogenic KRAS pathway might provide a new treatment target for NSCLC.

Vascular endothelial growth factor C: the predicator of early recurrence in patients with N2 non-small-cell lung cancer.

OBJECTIVE: Mediastinal lymph node metastasis (N2) is a key prognostic factor for lung carcinoma. This study was undertaken to investigate the relationship between vascular endothelial growth factor C (VEGF-C) expression and postoperative early recurrence in patients with N2 non-small-cell lung cancer. METHODS: Cancer tissue samples from 92 patients with pN2 non-small-cell lung cancer and benign lung disease tissues samples from 30 patients were examined by reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry assays to detect VEGF-C expression. The difference of VEGF-C expression was compared by chi(2) test. All patients with N2 disease were evaluated within 1 year after surgery to detect early tumour recurrence. Cox regression analysis was performed to determine the risk factors of postoperative early recurrence of N2 lung cancer. RESULTS: VEGF-C mRNA expression was observed in 64 (70%) pN2 lung cancer tissues, but was not found in benign lung disease tissues. Early recurrence occurred in 43 patients (47%) at 1 year after operation. The main pattern was distant recurrence, and the most frequent sites were the brain and lung. The early recurrence rate in patients with positive VEGF-C expression was significantly higher than that of those with negative VEGF-C expression (P=0.006, log-rank test). Cox regression analysis revealed that positive VEGF-C expression in tumours (hazard ratio (HR)=2.523, P=0.037) was an independent risk factor of postoperative early recurrence of N2 lung cancer. CONCLUSIONS: VEGF-C expression was high in N2 lung cancer, with significant correlation to postoperative early recurrence. About one-half of the patients with N2 non-small-cell lung cancer would develop recurrence disease within 1 year after surgery, frequently with mediastinal nodes, brain or lung metastases. VEGF-C might be a predictor of postoperative early recurrence in patients with N2 non-small-cell lung cancer.

Adjuvant radiotherapy after modified Ivor-Lewis esophagectomy: can it prevent lymph node recurrence of the mid-thoracic esophageal carcinoma?

BACKGROUND: Even if complete resection was performed, some patients with esophageal carcinoma still develop tumor recurrence. This study was undertaken to evaluate the effectiveness of adjuvant radiotherapy after modified Ivor-Lewis esophagectomy on preventing lymph node recurrence of the mid-thoracic esophageal carcinoma. METHODS: Three hundred sixty-six patients with mid-thoracic esophageal squamous cell carcinoma who underwent modified Ivor-Lewis esophagectomy between June 1999 and June 2004 were retrospectively reviewed. All patients were followed up within 3 years after surgery to detect lymph node recurrence. The Kaplan-Meier method was used to calculate the recurrence rate, and Cox regression analysis was performed to identify risk factors of lymph node recurrence. RESULTS: The overall 3-year and 5-year survival rates in all patients were 57.9% and 43.7%, respectively. Lymph node recurrence occurred in 105 patients (28.7%) within 3 years after surgery. The lymph node recurrence rate of patients with postoperative adjuvant radiotherapy was significantly lower than that of those with adjuvant chemotherapy (p = 0.03) and those without adjuvant therapy (p < 0.01). Cox regression analysis showed that T stage, N status, and postoperative adjuvant radiotherapy were independent relevant factors for lymph node recurrence. CONCLUSIONS: Postoperative adjuvant radiotherapy after modified Ivor-Lewis esophagectomy might prevent lymph node recurrence of mid-thoracic esophageal carcinoma.

Clinical study of modified Ivor-Lewis esophagectomy plus adjuvant radiotherapy for local control of stage IIA squamous cell carcinoma in the mid-thoracic esophagus.

OBJECTIVE: To control the postoperative local recurrence is one of the critical factors to improve prognosis of patients with esophageal carcinoma. The aim of this study is to evaluate the effectiveness of modified Ivor-Lewis esophagectomy plus adjuvant radiotherapy for local control of stage IIA squamous cell carcinoma in the mid-thoracic esophagus. METHODS: One hundred and twenty-five patients with stage IIA mid-thoracic esophageal squamous cell carcinoma who underwent modified Ivor-Lewis esophagectomy between June 1999 and June 2002 were included in the retrospective analysis. All the patients were evaluated within 3 years after surgery to detect tumor recurrence. Kaplan-Meier method was used to calculate the survival rate and logistic regression analysis was performed to identify risk factors of locoregional recurrence. RESULTS: The overall 3-year and 5-year survival rate in all patients was 58.4% and 43.2%, respectively. Tumor recurrence occurred in 61 patients (48.8%) within 3 years after operation. The median disease-free interval was 12.6 months. Thirty-three patients (26.4%) developed locoregional recurrence, 23 patients (18.4%) developed distant recurrence and 5 patients (4.0%) developed locoregional and distant recurrence simultaneously. Locoregional recurrence rate of patients with postoperative radiotherapy was significantly lower than that of those without postoperative radiotherapy (p<0.05). Logistic regression analysis showed that adjuvant radiotherapy (p=0.007) was an independent risk factor for tumor locoregional recurrence. Cox regression analysis showed that locoregional recurrence but not adjuvant radiotherapy was a relevant prognostic factor of patients with stage IIA esophageal cancer. CONCLUSIONS: Modified Ivor-Lewis esophagectomy with two-field lymph node dissection plus adjuvant radiotherapy might be an effective strategy to achieve local control of stage IIA mid-thoracic esophageal squamous cell carcinoma.

Abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma.

BACKGROUND: There are few reports about abdominal lymph node metastasis of mid thoracic esophageal carcinoma. This study was designed to explore the pattern of abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors. METHODS: The complete data of 368 patients with mid thoracic esophageal squamous cell carcinoma, who underwent modified Ivor-Lewis esophagectomy with two-field lymphadenectomy from January 1998 to January 2003, were reviewed. Survival rate was calculated by Kaplan-Meier method. Cox regression analysis was performed to identify risk prognostic factors. RESULTS: Abdominal lymph node metastasis occurred in 58 (15.8%) patients: 34.5% (20/58) of them were stage T1 and T2. Skipping abdominal node metastasis was recognized in 13.8% (8/58) patients: all were stage T1 and T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was poor, and no one could survive more than 5 years. Cox regression analysis showed that five or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis. CONCLUSIONS: Abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma occurred frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis was poor, especially those with more positive nodes and distant abdominal node metastasis.

Gene diagnosis and prognostic significance of lymph node micrometastasis after complete resection of histologically node-negative non-small cell lung cancer.

BACKGROUND: The purpose of the present study was to investigate the prevalence of lymph node micrometastasis (LNMM) based on the detection of MUC1 mRNA, and assess the impact of these micrometastases on prognosis after resection of pathologic N0 (pN0) non-small cell lung cancer (NSCLC). METHODS: The subjects were 89 patients who underwent complete resection of pN0 NSCLC at our department between January 2000 and January 2002. All lymph nodes (402 stations) obtained from these patients were re-evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR) to detect MUC1 mRNA. The diagnosis of LNMM was based on the detection of MUC1 mRNA. The Kaplan-Meier method was used to calculate the survival rate, and Cox regression multivariate analysis was performed to determine independent prognostic factors. RESULTS: Micrometastases were detected in 36 lymph node stations (9.0%) from 21 patients (23.6%). The TNM staging of these 21 patients was upregulated from stage IA-IIB to stage IIIA. The 5-year survival rate of patients with LNMM was significantly lower than that of patients without LNMM (23.8% versus 44.1%; p < 0.05). The results of multivariate analysis confirmed that T status, histology, and LNMM were independent prognostic factors. CONCLUSIONS: The prevalence of LNMM in patients with pN0 NSCLC was 23.6% (21/89). T status, histology, and LNMM were independent prognostic factors.

Clinical significance of detecting mucin 1 mRNA in diagnosing occult lymph node micrometastasis in esophageal cancer patients.

BACKGROUND & OBJECTIVE: Early postoperative relapse in esophageal cancer might be related to occult lymph node micrometastasis that could not be detected by routine histopathologic examination. This study was to investigate the clinical significance of detecting Mucin 1 (MUC1) mRNA in diagnosing occult lymph node micrometastasis in esophageal cancer patients, and to evaluate its prognostic significance. METHODS: The expression of MUC1 mRNA in 366 regional lymph nodes from 63 esophageal squamous cell cancer (ESCC) patients without histopathologically confirmed invasion (pN0), 30 paraesophageal lymph nodes from patients with benign esophageal diseases, and 15 lymph nodes and 15 tumor tissues from ESCC patients with histopathologically proved metastasis (pN1) were detected by reverse transcription-polymerase chain reaction (RT-PCR) to determine micrometastasis. Survival difference was compared by Chi(2) test. Logistic regression analysis was performed to assess independent prognostic factors. RESULTS: Specificity of genetic diagnosis was 100.0% (30/30) for occult lymph node micrometastasis, and 90.0% (27/30) for lymph node micrometastasis. MUC1 mRNA was identified in 30 (8.2%) lymph nodes from 22 (34.9%) patients. Occult lymph node micrometastasis was diagnosed in these patients. The 3-year survival rate was significantly lower in the patients with lymph node micrometastasis than in the patients without lymph node micrometastasis (54.5% vs. 80.5%, P<0.01). In Logistic regression analysis, lymph node micrometastasis (P<0.05, odds ratio=3.71) and T3 tumor (P<0.05, odds ratio=7.17) were independent prognostic factors. CONCLUSIONS: It is helpful to diagnose occult lymph node micrometastasis by detecting the expression of MUC1 mRNA in lymph nodes of pN0 ESCC patients. Lymph node micrometastasis may predict poor prognosis of the patients after radial operation.

Recurrence pattern of squamous cell carcinoma in the middle thoracic esophagus after modified Ivor-Lewis esophagectomy.

BACKGROUND: Despite increasingly radical surgery for esophageal carcinoma, many patients still develop tumor recurrence after operation. This study was designed to evaluate the recurrence pattern of squamous cell carcinoma in the middle thoracic esophagus after modified Ivor-Lewis esophagectomy. METHODS: We retrospectively reviewed data of 196 patients who underwent modified Ivor-Lewis esophagectomy with two-field lymph node dissection from January 1997 to January 2001. Recurrence was classified as locoregional or hematogenous recurrence. Logistic regression analysis was performed to identify risk factors of postoperative recurrence. RESULTS: The overall 3-year and 5-year survival rates in all patients were 53% and 31%, respectively. Recurrence was recognized in 96 patients (48.9%) in the 3 years after operation. The median time to tumor recurrence was 12.2 months. The pattern of recurrence was locoregional in 52 patients (mainly mediastinal in 41, single cervical/supraclavicular in 8), hematogenous in 44 patients (simultaneous locoregional and hematogenous in 10; mainly liver, bone, or lung in 39). The locoregional recurrence rate was significantly lower in patients with postoperative radiotherapy than that in patients without postoperative radiotherapy (p = 0.02). Logistic regression analysis showed that T3 (p = 0.032), N1 (p = 0.003), and postoperative radiotherapy (p = 0.022) were independent risk factors for tumor locoregional recurrence. CONCLUSIONS: About one half of the patients would develop recurrent disease within 3 years after modified Ivor-Lewis esophagectomy with two-field lymph node dissection, and most of them had mediastinal lymph node, liver, bone, or lung metastasis. Postoperative radiotherapy was beneficial in the control of locoregional recurrence.

Lymph node micrometastasis: a predictor of early tumor relapse after complete resection of histologically node-negative esophageal cancer.

PURPOSE: To investigate the prevalence of lymph node micrometastasis (LNMM) on the basis of the detection of MUC1 mRNA, and assess the impact of these micrometastases on disease-free interval after resection of pathologic N0 (pN0) esophageal squamous cell cancer (ESCC). METHODS: The subjects were 93 patients who underwent complete resection of pN0 ESCC at our department between January 1999 and January 2001. All lymph nodes (426 stations) obtained from these patients were reevaluated by reverse transcription-polymerase chain reaction to detect MUC1 mRNA. The diagnosis of LNMM was based on the detection of MUC1 mRNA. A log-rank test was performed to compare the disease-free interval, and Cox regression multivariate analysis was performed to determine the independent prognostic factors. RESULTS: Micrometastasis was detected in 40 lymph node stations (9.4%) from 32 patients (34.4%). Disease-free interval was significantly associated with LNMM (P = 0.0138). The 5-year survival rate of patients with LNMM was significantly lower than that of those without LNMM (P = 0.004). The results of multivariate analysis confirmed that T status and LNMM were independent prognostic factors. CONCLUSIONS: The prevalence of LNMM in patients with pN0 ESCC was 34.4% (32/93). Thus, LNMM was significantly associated with the disease-free interval. T status and LNMM were both independent prognostic factors.