OBJECTIVETo analyze the spreading patterns nasopharyngeal carcinoma and nasopharyngeal adenoid cystic carcinoma.

METHODSEighteen pathologically confirmed consecutive cases of adenoid cystic carcinomas (ACC) and 182 cases of untreated nasopharyngeal carcinomas (NPC) were reviewed.

RESULTSCompared with NPC, ACC had higher rates of T4 disease (14.3% vs 38.9%,χ(2) = 7.197, P = 0.007) and paralyzed cranial nerve (6.0% vs 38.9%,χ(2) = 37.936, P < 0.001) . There was no significant difference in skull base invasion rates between 2 groups (53.3% vs 66.7%,χ(2) = 1.181, P = 0.277) . ACC had higher rates of MRI-detected cranial nerve canal invasion (32.4% vs 55.6%,χ(2) = 3.881, P = 0.049) and cavernous sinus invasion (13.7% vs 33.3%,χ(2) = 7.710, P = 0.028) than NPC. Lymph node metastasis occurred in 64.8% of ACC, and 11.1% of NPC (χ(2) = 19.699, P < 0.001) .

CONCLUSIONACC has a higher rate of cranial nerve invasion and NPC has a higher rate of lymphatic metastasis.

Adult ; Aged ; Carcinoma ; Carcinoma, Adenoid Cystic ; pathology ; Diagnostic Imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Neoplasm Invasiveness ; Retrospective Studies

Serum levels of soluble MHC class I-related chain A (sMICA) are related with the prognosis of various types of cancer; however, few studies on the prognostic value of sMICA in hepatocellular carcinoma (HCC) have been reported. In this study, we retrospectively investigated the relationship between sMICA levels and clinical features of advanced HCC, and we assessed the prognostic value of sMICA in advanced HCC. Furthermore, the relationship of serum sMICA levels and natural killer group 2, member D (NKG2D) expression on natural killer (NK) cells was also evaluated. We detected sMICA levels in the serum of 60 advanced HCC patients using enzyme-linked immunosorbent assay (ELISA) and measured expression levels of NKG2D on NK cells using flow cytometry. We found that serum sMICA levels in HCC patients were in the range of 0.10-6.21 ng/mL. Chi-square analyses showed that sMICA level was significantly related with only tumor size. Survival analysis showed that a high sMICA level was significantly related with poor prognosis among HCC patients. Multivariate analyses indicated that sMICA was an independent prognostic factor. In addition, the levels of CD56+NKG2D+ NK cells were within the range of 11.2%-55.4%, and correlation analyses indicated that sMICA level was negatively correlated with the level of NKG2D+ NK cells. Our results suggest that serum sMICA levels may be an independent prognostic factor for advanced HCC.
Adult ; Carcinoma, Hepatocellular ; blood ; immunology ; pathology ; Female ; Histocompatibility Antigens Class I ; blood ; Humans ; Killer Cells, Natural ; immunology ; metabolism ; Liver Neoplasms ; blood ; immunology ; pathology ; Male ; Middle Aged ; Multivariate Analysis ; NK Cell Lectin-Like Receptor Subfamily K ; metabolism ; Neoplasm Staging ; Retrospective Studies ; Survival Rate ; Tumor Burden

BACKGROUND AND OBJECTIVEHypopharyngeal carcinoma has a high risk for early regional lymphatic dissemination. However, reports about regional lymph node metastases, especially retropharyngeal lymph node metastases, are rare. This research explored the spread of hypopharyngeal carcinoma, especially metastases of the retropharyngeal lymph nodes by studying computed tomography (CT) and magnetic resonance imaging (MRI) images.

METHODSThe CT/MRI images of 88 patients with pathologically confirmed hypopharyngeal carcinomas that were performed at our hospital between August 2000 and March 2009 were analyzed retrospectively. The interrelations among local stage and lymph nodes in various regions were analyzed by Chi2 test and multivariate logistical regression.

RESULTSThe rate of regional lymph node metastasis for all patients was 73.9%, and the highest rates of positive lymph nodes were at levels IIa (61.4%), IIb (44.3%), and III (37.5%). Metastases to levels I, IV, V, and VI were rare, as were retropharyngeal lymph-node metastases, which were always combined with metastases at levels II and III. Univariate analysis showed that level-IV metastases correlated to metastases at levels Ib and III; retropharyngeal lymph node metastases were correlated to level IIb and bilateral cervical lymph node metastases. Multivariate analysis showed that level-VI metastases correlated to level IV and that retropharyngeal lymph-node metastases correlated to bilateral cervical lymph node metastases.

CONCLUSIONSRegional lymph node metastases in patients with hypopharyngeal carcinoma follow some regulations, and skip metastasis is rare. The highest rates of positive lymph nodes are at levels II and III. Bilateral lymph node metastases may be a risk factor for retropharyngeal lymph node metastases.

Adult ; Aged ; Carcinoma in Situ ; diagnosis ; diagnostic imaging ; pathology ; Carcinoma, Squamous Cell ; diagnosis ; diagnostic imaging ; pathology ; Female ; Humans ; Hypopharyngeal Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Lymph Nodes ; diagnostic imaging ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck ; Neoplasm Staging ; Pharynx ; Retrospective Studies ; Tomography, X-Ray Computed

Objective: To describe the current status and trends in the outcomes and care practices of extremely preterm infants at 22-25 weeks' gestation age from the Chinese Neonatal Network (CHNN) from 2019 to 2021. Methods: This cross-sectional study used data from the CHNN cohort of very preterm infants. All 963 extremely preterm infants with gestational age between 22-25 weeks who were admitted to neonatal intensive care units (NICU) of the CHNN from 2019 to 2021 were included. Infants admitted after 24 hours of life or transferred to non-CHNN hospitals were excluded. Perinatal care practices, survival rates, incidences of major morbidities, and NICU treatments were described according to different gestational age groups and admission years. Comparison among gestational age groups was conducted using χ² and Kruskal-Wallis tests. Trends by year were evaluated by Cochran-Armitage and Jonckheere-Terpstra tests for trend. Results: Of the 963 extremely preterm infants enrolled, 588 extremely preterm infants (61.1%) were male. The gestational age was 25.0 (24.4, 25.6) weeks, with 29 extremely preterm infants (3.0%), 88 extremely preterm infants (9.1%), 264 extremely preterm infants (27.4%), and 582 extremely preterm infants (60.4%) at 22, 23, 24, and 25 weeks of gestation age, respectively. The birth weight was 770 (680, 840) g. From 2019 to 2021, the number of extremely preterm infants increased each year (285, 312, and 366 extremely preterm infants, respectively). Antenatal steroids and magnesium sulfate were administered to 67.7% (615/908) and 51.1% (453/886) mothers of extremely preterm infants. In the delivery room, 20.8% (200/963) and 69.5% (669/963) extremely preterm infants received noninvasive positive end-expiratory pressure support and endotracheal intubation. Delayed cord clamping and cord milking were performed in 19.0% (149/784) and 30.4% (241/794) extremely preterm infants. From 2019 to 2021, there were significant increases in the usage of antenatal steroids, antenatal magnesium sulfate, and delivery room noninvasive positive-end expiratory pressure support (all P<0.05). Overall, 349 extremely preterm infants (36.2%) did not receive complete care, 392 extremely preterm infants (40.7%) received complete care and survived to discharge, and 222 extremely preterm infants (23.1%) received complete care but died in hospital. The survival rates for extremely preterm infants at 22, 23, 24 and 25 weeks of gestation age were 10.3% (3/29), 23.9% (21/88), 33.0% (87/264) and 48.3% (281/582), respectively. From 2019 to 2021, there were no statistically significant trends in complete care, survival, and mortality rates (all P>0.05). Only 11.5% (45/392) extremely preterm infants survived without major morbidities. Moderate to severe bronchopulmonary dysplasia (67.3% (264/392)) and severe retinopathy of prematurity (61.5% (241/392)) were the most common morbidities among survivors. The incidences of severe intraventricular hemorrhage or periventricular leukomalacia, necrotizing enterocolitis, and sepsis were 15.3% (60/392), 5.9% (23/392) and 19.1% (75/392), respectively. Overall, 83.7% (328/392) survivors received invasive ventilation during hospitalization, with a duration of 22 (10, 42) days. The hospital stay for survivors was 97 (86, 116) days. Conclusions: With the increasing number of extremely preterm infants at 22-25 weeks' gestation admitted to CHNN NICU, the survival rate remained low, especially the rate of survival without major morbidities. Further quality improvement initiatives are needed to facilitate the implementation of evidence-based care practices.
Infant ; Infant, Newborn ; Male ; Humans ; Female ; Pregnancy ; Infant, Extremely Premature ; Gestational Age ; Magnesium Sulfate/therapeutic use* ; Cross-Sectional Studies ; Infant, Premature, Diseases/epidemiology* ; Infant, Newborn, Diseases ; Steroids ; Intensive Care Units, Neonatal ; China/epidemiology*