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Clinical treatment considerationsin the intensity-modulated radiotherapy era for patients with NO-category nasopharyngeal carcinoma and enlarged neck lymph nodes

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Chinese Journal of Cancer 2017年第7期36卷 306-314页

作者： Hao Peng Lei Chen Rui Guo Yuan Zhang Wen.Fei Li Yan.Ping Mao Ying Sun Fan Zhang Li.Zhi Liu Li Tian Jun Ma State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Sun Yat-sen University Cancer Center Guangzhou 510060 Guangdong P. R. China Department of Radiation Oncology Sun Yat-sen University Cancer Center Guangzhou 510060 Guangdong P. R. China Imaging Diagnosis and Interventional Center Sun Yat-sen University Cancer Center Guangzhou 510060 Guangdong P. R. China State Key Laboratory of Oncology in South China Department of Radiation OncologySun Yat-sen University Cancer Center 651 Dongfeng Road East Guangzhou 510060 P. R. China

Background:Nasopharyngeal carcinoma(NPC) shows a high proportion of lymph node metastasis,and treatment guidelines have been developed for positive nodes.However,no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes(ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph nodes.This study aimed to determine the prognostic value and radiation dose for ENLNs in NO-category NPC patients treated with intensity-modulated radiotherapy(IMRT).Methods:We reviewed the medical data of 251 patients with non-metastatic,NO-category NPC treated with IMRT.Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure.The biological equivalent dose(BED) for ENLNs was calculated.Patient survival was compared between the small and large ENLN groups.Independent prognostic factors were identified using the Cox proportional hazards model.Results:The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs 0.05 for all survival rates).In the subgroup analysis,patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED <72 Gy in both the small and large ENLN groups.The multivariate analysis also confirmed that BED≥72 Gy was not associated with significantly improved prognosis in patients with NO-category NPC.Conclusions:A BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with NO-category NPC.Prospective studies are warranted to validate the findings in the present study.

关键词： Nasopharyngeal carcinoma N0-category Enlarged neck lymph node Biological equivalent dose Intensity-modulated radiotherapy Prognosis

Initial experience with ablation of the innervation surrounding sinus and atrioventricular nodes to treat paroxysmal bradyarrhythmia

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Chinese Medical Journal 2020年第2期133卷 134-140页

作者： Chun-Shan Lu Cheng-Jun Guo Dong-Ping Fang Peng Hao Dong-Fang He Ai-Guo Xu Division of Cardiology Department of MedicineBeijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China

Background:The symptomatic bradyarrhythmia is Class I indication for pacing therapy which is not a radical cure.The present study aimed to assess the feasibility and to present the initial results of the restricted ablation of the parasympathetic innervation surrounding sinus and atrioventricular(AV)nodes for treating patients with bradyarrhythmia.Methods:A total of 13 patients with cardiogenic syncope were included from May 2008 to June 2015.Under the guidance of fluoroscopy and/or three-dimensional geometry by 64-slice spiral computed tomography,atrial activation sequence in sinus rhythm was mapped.Chamber geometry was reconstructed manually or automatically using the Niobe II magnetic navigation system integrated with the CARTO-remote magnetic technology(RMT)system.Cardioneuroablation was targeted at the high-amplitude fractionated electrograms surrounding the regions of His bundle and the site with the earliest activation in sinus rhythm.Areas surrounding the sinus node,AV node,and the phrenic nerve were avoided.Results:Thirteen patients completed the studies.Ablation was successfully performed in 12 patients and failed in one.The highfrequency potential was recorded in atrial electrograms surrounding the sinus or AV nodes in all the patients and disappeared in 15 s after radiofrequency applications.The vagal reaction was observed before the improvement of the sinus and AV node function.No complications occurred during the procedures.Patients were followed up for a mean of 13.0±5.9 months.During the follow up ten patients remained free of symptoms,and two patients had a permanent cardiac pacemaker implanted due to spontaneous recurrence of syncope.The heart rate of post-ablation was higher than pre-ablation(69.0±11.0 vs.49.0±10.0 beats/min,t=4.56,P=0.008).The sinus node recovery time,Wenckebach block point,and atrium-His bundle interval were significantly shorter after ablation(1386.0±165.0 vs.921.0±64.0 ms,t=7.45,P=0.002;590.0±96.0 vs.464.0±39.0 ms,t=2.38,P=0.023;106.0±5.0 vs.90.0±12.0 ms,t=9.80,P=0.013 befo

关键词： Electrophysiology Radiofrequency ablation Sinus node dysfunction Atrioventricular block Syncope

Diagnostic ability of multi-detector spiral computed tomography for pathological lymph node metastasis of advanced gastric cancer

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World Journal of Gastrointestinal Oncology 2020年第4期12卷 435-446页

作者： Zhi-Yong Jiang Shinichi Kinami Naohiko Nakamura Takashi Miyata Hideto Fujita Hiroyuki Takamura Nobuhiko Ueda Takeo Kosaka Department of Surgical Oncology Kanazawa Medical University1-1 DaigakuUchinada-machiKahoku-gunIshikawa 920-0293Japan

BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as l

关键词： Advanced gastric cancer Lymph node metastasis Multi-detector spiral computed tomography Pathological diagnosis

The neuro-glial coagulonome: the thrombin receptor and coagulation pathways as major players in neurological diseases

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Neural Regeneration Research 2019年第12期14卷 2043-2053页

作者： Shany G.Gofrit Efrat Shavit-Stein Department of Neurology and Joseph Sagol Neuroscience Center Sheba Medical Center Tel Hashomer Sackler Faculty of Medicine Tel Aviv University

The neuro-glial interface extends far beyond mechanical support alone and includes interactions through coagulation cascade proteins. Here, we systematically review the evidence indicating that synaptic and node of Ranvier glia cell components modulate synaptic transmission and axonal conduction by a coagulation cascade protein system, leading us to propose the concept of the neuro-glial coagulonome. In the peripheral nervous system, the main thrombin receptor protease activated receptor 1 (PAR1) is located on the Schwann microvilli at the node of Ranvier and at the neuromuscular junction. PAR1 activation effects can be both neuroprotective or harmful, depending on thrombin activity levels. Low physiological levels of thrombin induce neuroprotective effects in the Schwann cells which are mediated by the endothelial protein C receptor. High levels of thrombin induce conduction deficits, as found in experimental autoimmune neuritis, the animal model for Guillaine-Barre syndrome. In the central nervous system, PAR1 is located on the peri-synaptic astrocyte end-feet. Its activation by high thrombin levels is involved in the pathology of primary inflammatory brain diseases such as multiple sclerosis, as well as in other central nervous system insults, including trauma, neoplasms, epilepsy and vascular injury. Following activation of PAR1 by high thrombin levels the seizure threshold is lowered. On the other hand, PAR1 activation by lower levels of thrombin in the central nervous system protects against a future ischemic insult. This review presents the known structure and function of the neuro-glial coagulonome, focusing on coagulation, thrombin and PAR1 in a pathway which may be either physiological (neuroprotective) or detrimental in peripheral nervous system and central nervous system diseases. Understanding the neuro-glial coagulonome may open opportunities for novel pharmacological interventions in neurological diseases.

关键词： thrombin protease activated receptor 1 protease nexin 1 glia node of Ranvier synapse epilepsy glioblastoma Guillaine-Barre syndrome

Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis

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World Journal of Gastroenterology 2019年第19期25卷 2338-2353页

作者： Xiao-Hao Zheng Wen Zhang Lin Yang Chun-Xia Du Ning Li Gu-Sheng Xing Yan-Tao Tian Yi-Bin Xie Department of Pancreatic and Gastric Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical College Department of Medical Oncology National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Department of Radiation Oncology National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Department of Diagnostic Radiology National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College

BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis(PALM) and evaluation of therapeutic effects in gastric cancer, which leads to inevitable false-positive findings in imaging. Patients with clinical PALM may have entirely different pathological stages(stage IV or not), which require completely different treatment strategies. There is no consensus on whether surgical intervention should be implemented for this group of patients. In particular, the value of D2 gastrectomy in a multidisciplinary treatment(MDT)approach for advanced gastric cancer with clinical PALM remains unknown.AIM To investigate the value of D2 gastrectomy in a MDT approach for gastric cancer patients with clinical PALM.METHODS In this real-world study, clinico-pathological data of all gastric cancer patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences between 2011 and 2016 were reviewed to identify those with clinically enlarged PALM. All the clinico-pathological data were prospectively documented in the patient medical record. For all the gastric cancer patients with advanced stage disease,especially those with suspicious distant metastasis, the treatment methods were determined by a multidisciplinary team.RESULTS In total, 48 of 7077 primary gastric cancer patients were diagnosed as having clinical PALM without other distant metastases. All 48 patients received chemotherapy as the initial treatment. Complete or partial response was observed in 39.6%(19/48) of patients in overall and 52.1%(25/48) of patients in the primary tumor. Complete response of PALM was observed in 50.0%(24/48)of patients. After chemotherapy, 45.8%(22/48) of patients received D2 gastrectomy, and 12.5%(6/48) of patients received additional radiotherapy. The postoperative major complication rate and mortality were 27.3%(6/22) and 4.5%(1/22), respectively. The median overall survival and progression-free survival of all the p

关键词： Gastric cancer Para-aortic lymph node Multidisciplinary Gastrectomy Conversion Neoadjuvant

Differential analysis of lymph node metastasis in histological mixed-type early gastric carcinoma in the mucosa and submucosa

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World Journal of Gastroenterology 2018年第1期24卷 87-95页

作者： Qian Zhong Qi Sun Gui-fang Xu Xiu-Qin Fan Yuan-Yuan Xu Fei Liu Shi-Yi Song Chun-Yan Peng Lei Wang Department of Gastroenterology the Affiliated Drum Tower Hospital of Nanjing University Medical School Department of Pathology the Affiliated Drum Tower Hospital of Nanjing University Medical School

AIM To investigate the relationship between histological mixed-type of early gastric cancer(EGC) in the mucosa and submucosa and lymph node metastasis(LNM).METHODS This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated(pure D), pure undifferentiated(pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.RESULTS Of the 298 patients, 165(55.4%) had mucosa-confined EGC and 133(44.6%) had submucosa-invasive EGC. Only 13(7.9%) cases of mucosa-confined EGC and 30(22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion(OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type(OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixedtype(OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixedtype group(P = 0.012) and pure U group(P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group(P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixedtype(P = 0.012) and pure U group(P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group(P = 0.375). Multivariate logistic analysis showed that only female sex(OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion(OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC(P = 0.106).CONCLUSION for mucosal EGC, histological mixed-type is not an

关键词： early gastric carcinoma mixed-type lymph node metastasis mucosa lymphovascular invasion

Predictive Value of BRAF^V600E Mutation for Lymph node Metastasis in Papillary Thyroid Cancer:A Meta-analysis

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Current Medical Science 2018年第5期38卷 785-797页

作者： Jing-yong SONG Shi-ran SUN Fang DONG Tao HUANG Bin WU Jing ZHOU Department of Breast and Thyroid Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWukan 430022China Department of Gastrointestinal Surgery Hainan Cancer HospitalHaikou 570000China Department of Hepatobiliary Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Department of Orthopaedics Surgery Union HospitalTongji Medical CollegeHuazhong University of Scienceand TechnologyWuhan 430022China

BRAF^V600E mutation has been thought to be a valuable molecular marker that may predict a worse prognosis for papillary thyroid cancer (PTC).But whether BRAF^V600E mutation is associated with lymph node metastasis (LNM)remains controversial. Different surgical strategies may bring a bias in demonsstrating the association between them.In order to delineate a risk stratification to guide a tailored initial approach to tumors that express BRAF^V600E mutation,we performed this meta-analysis by using the articles in which total or near-total thyroidectomy plus bilateral central lymph node dissection was routinely performed to avoid the bias from the surgical strategy.We searched the Medline,Embase and CNKI database for eligible studies from January 2003 to May 2018.Meta-analysis was performed using the STATA 12.0 software.Odds ratios (ORs)and 95% confidence intervals (CIs)were calculated under fixed-effects or random-effects models.Fifteen clinical studies were included with a total of 4909 PTC patients. Our meta-analysis results reported that BRAF^V600E mutation was associated with LNM (OR=1.34;95% CI:1.09-1.65;P=0.005),as well as central LNM (OR=1.59;95% CI: 1.35-1.88;P<0.00001).Moreover,in patients with papillary thyroid microcarcinoma, we also confirmed the predictive value of BRAF^V600E mutation for LNM (OR=3.49;95% CI:2.02-6.02;P<0.00001).This meta-analysis demonstrates that BRAF^V600E mutation is closely related to LNM in PTC patients.The results suggest that BRAF^V600E mutation can be considered as a risk factor for LNM in PTC.Moreover,combining BRAF^V600E mutation with other risk factors to determine the initial surgical treatment may bring benefits for PTC patients.

关键词： B-Raf proto-oncogene thyroid cancer papillary thyroid carcinoma lymph node metastasis meta-analysis

Radiomics-based predictive risk score: A scoring system for preoperatively predicting risk of lymph node metastasis in patients with resectable non-small cell lung cancer

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Chinese Journal of Cancer Research 2019年第4期31卷 641-652页

作者： Lan He Yanqi Huang Lixu Yan Junhui Zheng Changhong Liang Zaiyi Liu Department of Radiology Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China Department of Pathology Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China

Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.

关键词： Lymph node radiomics risk score CT non-small cell lung cancer

Lymph node mapping in rabbit liver cancer with nanocarbon and methylene blue injecta

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Asian Pacific Journal of Tropical Medicine 2013年第5期6卷 400-403页

作者： Zhong Li General Surgery Department Affiliated Hospital of Armed Police Logistics College

Objective:To discuss the value of lymph node mapping in rabbit liver cancer with nanocarbon and methylene blue injecta.Methods:Rabbit liver cancer model was established by transplanting VX2 cells with laparotomy in celiac planting method.Twenty Japan white rabbits were divided into two groups randomly.Each group had 10 rabbits.Lymph node mapping in (wo groups rabbit liver cancer were observed.Two groups rabbit liver cancer and local lymph nodes were removed.The number and location of local lymph nodes were recorded,and then the samples were obtained from both groups.Results:The lymph nodes dyed time was(100.50±29.92) s in nanocarbon group,and(11.20+4.18) s in methylene blue group with statistical significance between two groups(P=0.000).In the comparison of lymph node fading time,nanocarbon group was(2.22±0.74) h,methylene blue group was(1.63+0.54) h,nanocarbon group was longer than the methylene blue group,but without statistical significance(P=0.058).The accuracy was 87.5% (35/40) in methylene blue group,while,the nanocarbon group was 87.2%(34/39),with statistical significance(P=1.000).Conclusions:Experimental results show that application of nanocarbon injection and methylene blue injection during resection of liver cancer and local lymph nodes in rabbit liver cancer model has obvious tracer function in liver cancer and lymphatic drainage. It can reduce the complexity and risk of the operation,and avoid the blindness in the process of traditional lymph node dissection surgery.Besides,they can effectively reduce the number of residual lymph nodes after operation.It can achieve the lymph node dissection more thoroughly, promptly,easily and safely.

关键词： Nanocarbon injecta Methylene blue injecta Lymph mapping Lymph node dissection Liver cancer model