Esophageal cancer is a common malignant tumor in China. For resectable ones, surgery is still the primary treatment. At present, the extent of lymph node dissection remains controversial. Extended lymphadenectomy makes metastatic lymph nodes more likely to be resected, which contributed to pathological staging and postoperative treatment. However,it may also increase the risk of postoperative complications and affect prognosis. Therefore, it is controversial how to balance the optimal extent/number of dissected lymph nodes for radical resection with the lower risk of severe complications. In addition, whether the lymph node dissection strategy should be modified after neoadjuvant therapy needs to be investigated, especially for patients who have a complete response to neoadjuvant therapy. Herein, we summarize the clinical experience on the extent of lymph node dissection in China and worldwide, aiming to provide guidence for the extent of lymph node dissection in esophageal cancer.
Humans ; Lymphatic Metastasis/pathology* ; Lymph Node Excision ; Lymph Nodes/pathology* ; Prognosis ; Esophageal Neoplasms/pathology* ; Neoplasm Staging ; Esophagectomy

Objective:This study mainly discussed the clinical characteristics, autoimmune status and lymphocyte subsets of patients with Takayasu arteritis (TA) without hormone and immunosuppressive therapy, in order to provide guidance for immunotherapy.Methods:Using cross-sectional study, twenty-nine patients with TA admitted to the Department of Rheumatology and the Department of Vasculitis of Beijing Anzhen Hospital from January 2018 to November 2019 were selected, including 28 females and 1 male, with the middle age of 39 year. These patients met the diagnostic criteria of American Society of Rheumatology for TA, and were not treated with hormone and immunosuppressant. Clinical data of these patients were collected, and the immunological indexes and lymphocyte subsets of peripheral blood were detected simultaneously. At the same time, the immunological indexes and peripheral blood lymphocyte subsets of 21 healthy normal people were detected as control. Chi square test, independent sample t test and nonparametric test were used for analysis. Results:Among the 29 patients with TA, 28 were female, 26 were in the active stage of disease; the main manifestations of systemic symptoms were malaise (62.07%) and headache (41.38%), the main manifestations of vascular symptoms were bruits and pulse weakening (68.97%), and the most of Numano type was V type (79.31%). The absolute value of total T (CD3) lymphocytes [(1 337.14±312.46)μl vs (1 139.95±340.96)μl, t=2.120, P=0.039], the percentage [46.29%±6.55% vs 36.55%±7.42%, t=4.903, P<0.000 1] and the absolute value [(815.52±194.11)μl vs (571.44±187.55)μl, t=4.450, P<0.000 1] of helper T (CD4) lymphocytes, the ratio of CD4/CD8 [1.83 (1.41-2.30) vs 1.32 (1.03-1.39), Z=3.401, P=0.001] were higher compared with those of healthy controls, while the percentage of natural killer (NK) cells (CD56) [10.71%(6.45%-14.30%) vs 14.57%(10.87%-18.47%), Z=2.408, P=0.016] decreased. The complement C3 [1.16 (1.02-1.31) g/L vs 1.05 (0.93-1.15) g/L, Z=2.383, P=0.021] in patients with TA was higher than those in healthy controls and immunoglobulin (Ig) G [11.97 (8.74-14.43) g/L vs 14.37 (13.11-15.47) g/L, Z=3.017, P=0.003] in patients with TA was lower than those in healthy controls. Compared with the control group, the ESR [19.31 (9.50-28.50) mm/h vs 3.71 (2.00-5.00) mm/h, Z=5.338, P<0.000 1], hs-CRP [6.52 (0.32-8.62) mg/L vs 0.73 (0.35-1.07) mg/L, Z=2.983, P=0.003] and Q-CRP [8.73 (1.03-7.72) mg/L vs 0.57 (0.08-0.98) mg/L, Z=4.263, P<0.000 1] of patients with TA were all increased. Conclusions:The autoimmunity of patients with TA without hormone or immunosuppressant treatment is in active state, and the total T-lymphocytes and helper T-lymphocytes in peripheral blood are significantly increased in order to cope with the inflammatory response of the systemic artery vessels.

Objective:To investigate the relationship between neutrophil/lymphocyte (NLR), red blood cell distribution width (RDW), platelet/lymphocyte (PLR), platelet mean volume (MPV), platelet hematocrit (PCT) and platelet distribution width (PDW) and the disease activity of Takayasu arteritis (TA).Methods:A retrospective analysis was conducted on 86 TA patients (TA group) in Anzhen hospital from January 2017 to June 2019. Meanwhile, 85 healthy controls (control group) whose age and gender matched with TA were selected from the health examination center of Beijing Anzhen hospital. The blood samples were collected to measure the neutrophil/lymphocyte (NLR), red blood cell distribution width (RDW), platelet/lymphocyte (PLR), platelet mean volume (MPV), platelet hematocrit (PCT) and platelet distribution width (PDW) by resistance method. TA activity was determined according to the national institutes of health (NIH) score and India TA clinical activity score (ITAS2010). Spearman correlation analysis was used to evaluate the relationship between whole blood cell count indicators and ESR and hs-CRP. ROC curve was used to determine the threshold of TA disease activity.Results:The NLR, RDW and PDW in the TA group were higher than those in the control group [3.00 (1.78-3.48) vs. 1.76 (1.34-2.01), 14.10 (13.00-14.83) vs. 13.08 (12.50-13.35) and 13.65 (11.20-16.00) vs. 12.24 (11.20-13.20), P<0.000 1]. MPV and PCT in the TA group were lower than those in the control group [10.06±1.11 vs. 10.44±0.83 and 0.25 (0.20-0.28) vs. 0.27 (0.23-0.31), P = 0.011 and 0.014, respectively]. RDW and PCT in the active group of TA patients were both higher than those in the inactive group [14.61 (13.38-15.48) vs. 13.81 (12.88-14.33) and 0.27±0.07 vs. 0.23±0.06], with P values of 0.007 and 0.008, respectively. PCT in the active group of TA patients was positively correlated with ESR ( r=0.33, P=0.002). The optimal RDW threshold for determining the activity of TA disease was 14.150 (sensitivity was 55.0%, specificity was 100.0%, area under ROC curve was 0.802). The optimal threshold for judging the activity of TA disease by PCT was 0.245 (sensitivity was 66.7%, specificity was 92.3%, area under ROC curve was 0.84). The optimal threshold for PLR to determine the activity of TA disease was 131.257 (sensitivity was 71.7%, specificity was 76.9%, area under ROC curve was 0.714). Conclusion:RDW and PCT may be helpful to judge the activity of TA, however, the other indexes of whole blood cell count were not closely related to the activity of TA.