Objective To determine whether lymph node-targeted chemotherapy with carbon nanoparticles absorbing 5-FU affects expressions of bcl-2, bax and caspase-3 in gastric cancer tissues, metastatic lymph nodes and normal gastric mucosa. Methods Twenty-eight patients with gastric cancer in our department were divided into lymph node-targeted chemotherapy (LNTC) group and control group from October 2005 to August 2006. The patients were treated with carbon nanoparticles absorbing 5-FU before operation in LNTC group and those were operated directly in control group. The gastric cancer tissues, metastatic lymph nodes and normal gastric mucosa were collected after operation. The expressions of bcl-2, bax and caspase-3 in those tissues were determined by immunohistochemical technique. Results In LNTC group, the positive expression rate of bcl-2 in gastric cancer tissues and metastatic lymph nodes was significantly lower than those in control group (28.6% vs . 78.6% , 25.0% vs . 70.0% , P ＜ 0.05), the positive expression rate of bax (85.7% vs . 28.6% , 80.0% vs . 30.0% ) and caspase-3 (57.1% vs . 14.3% , 55.0% vs . 15.0% ) in gastric cancer tissues and metastatic lymph nodes was significantly higher than those in control group ( P ＜ 0.05). The positive expression rate of bcl-2, bax and caspase-3 in normal gastric mucosa was not significantly different between two groups ( P ＞ 0.05). Conclusion The lymph node-targeted chemotherapy with carbon nanoparticles absorbing 5-FU can down-regulate the expression of bcl-2 and up-regulate the expression of bax and caspase-3 in gastric cancer tissues and metastatic lymph nodes, and therefore by affecting the expression levels of these apoptosis molecules may be one of the ways to induce tumor cell apoptosis.
Abstract： Surgery is an effective therapy for non-small cell lung cancer (NSCLC). The standard operation includes lobectomy and systematic dissection of lymph nodes. However, postoperative tumor recurrence is common even among incipient patients due to incomplete dissection of lymph nodes and micrometastasis of lymph nodes. Injecting a carbon nanoparticles suspension is a new technique aimed at preventing this recurrence. The carbon nanoparticles carry lymph node tracers that help surgeons locate lymph nodes in order to clean them thoroughly. The tracers also target the lymph nodes for chemotherapy, thus killing residual tumor cells intraoperatively to avoid postoperative cancer recurrence. Carbon nanoparticles suspension injection is already widely and successfully used in surgery for gastrointestinal and mammary gland tumors, and is being tested for effectiveness in NSCLC patients. Some studies have indicated that carbon nanoparticles suspension injection is effective in NSCLC patients and improves their prognoses. We reviewed the features, application methods, and clinical applications of studies of carbon nanoparticles suspension injection for NSCLC.
目的:研究纳米炭淋巴示踪剂在乳腺癌手术淋巴结病理检查中价值。方法:84例乳腺癌患者随机分为普通组和纳米炭组2组,比较2组患者淋巴结检获情况。结果:两组共计检获淋巴结1660枚,其中纳米炭组(24.5±3.2)枚/例,显著高于常规组(13.5±5.3)枚/例,(t=3.475, Plt;0.05)。纳米炭组检获出更多淋巴结,炭着色淋巴结癌转移率更高。结论:纳米炭示踪剂提高了淋巴结检获率,确保了病理活检的准确性,是一值得推广的示踪剂。
目的:探讨纳米炭混悬注射液在乳腺癌淋巴结清扫及病理检查中的价值。方法:60例乳腺癌患者术前予纳米炭混悬注射液,统计术后淋巴结获检情况。结果:术中可见乳腺引流区淋巴结有广泛不同程度的染色,60例患者共检获淋巴结1 384枚,其中染色淋巴结862枚,171/862查见癌转移;未染色淋巴结522枚,43/522查见癌转移。染色淋巴结及未染色淋巴结转移比率差异有统计学意义(P=0.000)。结论:术前注射纳米炭混悬液对乳腺癌淋巴结清扫术有指导意义。
Objective To explore the feasibility and clinical effect of the nano-carbon particles in laparoscopic operation for adenocarcinoma of esophagogastric junction. Methods From 2008 to 2011， 119 patients with adenocar-cinoma of esophagogastric junction who underwent the laparoscopic operation were divided into study group （n=56） and control group （n=63）. The nano-carbon particle was injected into the subserosa around the tumor using the injection needle made by ourselves for lymphatic tracing before the laparoscopic operation in the study group， while no tracer was given in the control group. The indexes of lymph nodes， operation time， intraoperative blood loss， and postoperative hospital stay were compared in two groups. Results The nano-carbon particle was injected into the subserosa around the tumor successfully in the study group. The numbers of dissected lymph nodes and metastatic lymph nodes in the study group were significantly more than those in the control group （dissected lymph nodes：20.52±4.51 versus 16.44±3.80， t=5.341，P=0.000；metastatic lymph nodes：8.88±3.15 versus 6.49±2.49， t=4.602， P=0.000）. There were no statistical diff-erences in the intraoperative blood loss， operation time， and postoperative hospital stay in two groups 〔intraoperative blood loss：（97.50±27.52） ml versus （96.03±22.83） ml， t=0.318， P=0.751；operation time：（221.07±24.25） min versus （230.48±38.54） min， t=-1.570， P=0.119；postoperative hospital stay （10.82±1.67） d versus （10.29±1.33） d， t=1.945， P=0.054〕. Conclusions Injection of the nano-carbon particles using the injection needle made by ourselves is feasible in laparoscopic operation for adenocarcinoma of esophagogastric junction. It can increase number of dissected lymph nodes without increasing operation time， intraoperative blood loss， and postoperative hospital stay.
ObjectiveTo evaluate the lymphatic tracing effects of nano-carbon particles for radical gastrectomy. MethodsTotally eighty-six cases of gastric cancer patients were randomly divided into experimental group (n=43) and control group (n=43). In the experimental group, nanocarbon was injected into the subserosa around the tumor for lymphatic tracing before operation, while no tracer was given in the control group. Then the number of lymph nodes dissected, operation time, and postoperative complications of patients were compared. ResultsThe number of lymph nodes dissected in patients of experimental group was 30.20±11.63 (17-45), which was significantly more than that of control group 〔22.47±7.60 (15-31)〕, Plt;0.05. The blacken rate of lymph nodes in patients of the experimental group was 74.56% (1 260/1 690). Of 302 metastatic lymph nodes, the blacken rate of metastatic lymph nodes was 61.26% (185/302), which was significantly higher than the nonblacken rate of metastatic lymph nodes (38.74%, 117/302), Plt;0.05. The operation time of patients in experimental group 〔(3.51±0.43) h〕 was not different from that in control group 〔(3.49±0.51) h〕, Pgt;0.05. The postoperative complications of patients in two groups was not different and no local or systemic adverse reaction occurred in patients of experimental group. ConclusionSubserosal injection of nanocarbon particles around the tumor is safe and can provide the guidance to lymph node dissection in radical gastrectomy.
Objective To evaluate the adoption of carbon nano-particle in the pathologic examination of lymph node for lower rectal cancer. Methods Sixty consecutive patients with rectal cancers located at or below the peritoneal reflection were randomly allocated to the routine method group or the group using carbon nano-particle. Resultsof pathologic examination were compared. Results Altogether, 1 070 lymph nodes were examined from the 2 study groups. The average examined number of the carbon nano-particle group was (20.2±4.9)/case, which was significantly higher than the other group 〔(15.4±6.8)/case〕, P=0.003. More tiny lymph nodes were examined in the nano-particle group (P=0.029) and more metastases were proved from the lymph nodes dyed by nano-particle (P=0.000). The majority of examined lymph nodes were located along the superior rectal vessel and its branches. ConclusionAdoption of nano-particle in pathologic examination of rectal cancer surgery can increase the examined number of lymph nodes, while detect small nodes harboring cancer, thus ensuring the correctness of pathologic report. The distribution of mesorectal lymph nodes underlines the execution of TME principle in dissection.
Objective To explore the effect of carbon nanoparticles dyeing on axillary lymph node dissection in modified radical mastectomy for breast cancer. Methods Eighty-eight patients with breast cancer who received modified radical mastectomy in Mianyang Central Hospital between Mar. 2012 and May. 2013 were recruited in the study, and they were equally divided into areola group and peripheral tumor group. After induction of anesthesia before operation, carbon nanoparticles were injected around the areolar in the areola group, and carbon nanoparticles were injected around the tumor in the peripheral tumor group. The number of dissected lymph nodes(be dyed or not be dyed), metastatic lymph nodes, and black dyed lymph nodes, as well as value of operation related indexes were recorded and compared. Results In the areola group, lymph nodes were detected in 1 453, in which 1 396 lymph nodes were stained black(96.1%); the average number of dissected lymph nodes were 33.0±7.1 per case; and 19 patients (43.2%, in total of 220 metastatic lymph nodes) of them were suffered from lymph node metastasis with the average number of metastatic lymph nodes of 5±2 per case. in addition, in the areola group, operative time were(122.1±10.2) min, blood loss were(83.8±10.1) mL, postoperative hospital stay were(7±1) d, and postoperative complications occurred in 3 patients. In the peripheral tumor group, lymph nodes were detected in 909, in which 594 lymph nodes were stained black (65.3%); the average number of dissected lymph nodes were 20.7±3.2 per case; 20 patients (45.5%, in total of 88 metastatic lymph nodes) of them were suffered from lymph nodes metastasis, with the average number of metastatic lymph nodes of 2±1 per case. In addition, in the peripheral tumor group, operative time were (121.6±11.4) min, blood loss were (84.2±11.3) mL, postoperative hospital stay were (7±2) d, postoperative complications occurred in 3 patients. The black staining rate of lymph nodes, the number of lymph nodes retrieved, and the number of metastatic lymph nodes in areola group were significantly higher than those of peripheral tumor group(P < 0.01). Operative time, blood loss, postoperative hospital stay, and postoperative complication rate did not significantly differ between the 2 groups (P > 0.05). Conclusion The dyeing effect of carbon nanoparticles suspension, which was injected at areola area after induction of anesthesia, is better than that of injected around the tumor, without increasing the incidence of complication.
ObjectiveTo investigate effect of carbon nanoparticles on number of lymph nodes harvested in radical operation of rectal cancer after neoadjuvant chemoradiotherapy. MethodsOne hundred and five patients diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy in Cancer Hospital, Chinese Academy of Medical Sciences from March 1, 2014 to October 31, 2015 were included. Thirtysix patients were injected with carbon nanoparticles by colonoscopy before surgery and were classified as study group, and the rest patients were classified as control group. According to the same principle of surgery and procedure of pathological specimen handling, the effect of carbon nanoparticles on lymph node harvested in resected specimens was analyzed. ResultsThe total lymph nodes harvested were 764 in the study group and 1 242 in the control group. Among them, the metastatic lymph nodes were 19 in the study group, 58 in the control group. Although the average lymph nodes harvested in each patient had no significant difference between the study group and the control group (21.22±7.13 versus 18.00±9.84, t=1.739, P=0.085), the proportion of patients with 12 or more than 12 lymph nodes harvested in the study group was significantly higher than that in the control group [88.9% (32/36) versus 71.0% (49/69), χ2=4.287, P=0.038]. The ratio of patients with metastatic lymph nodes [27.8% (10/36) versus 33.3% (23/69), χ2=0.339, P=0.561] and the average metastatic lymph nodes harvested in each patient (1.90±1.29 versus 2.52±2.33, t=0.788, P=0.437) all had no significant differences between the study group and the control group. ConclusionThe injection of carbon nanoparticles by colonoscopy before surgery could increase detection rate of 12 or more than 12 lymph nodes in resected specimens of patients who were diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy.
Objective To evaluate the feasibility of sentinel lymph node (SLN) mapping after 99Tcm sulfur colloid (99Tcm-sc) and carbon nanoparticles injection in patients with colon cancer. Methods Forty patients with colon cancer underwent complete mesocolic excision between August 2015 and July 2016 at Qingdao Central Hospital were considered for prospective inclusion. Before resection, SLN mapping was performed with injection of 99Tcm-sc and carbon nanopar-ticles, then all dissected lymph nodes were detected by pathological examination. Results A total of 660 cases of lymph nodes were found in the 40 patients (average of 16.5 cases per patient). Of them, 88 nodes (average of 2.2 cases per patient) were identified as SLN in 36 of 40 patients, with a successful detection rate of 90.0% (36/40). The diagnostic accuracy, sensitivity, and false-negative rate were 87.5% (35/40), 96.2% (25/26), and 3.8% (1/26) respectively. Conclusion 99Tcm-sc and carbon nanoparticles suspension injection for mapping SLN is a feasiblely diagnostic method for predicting local lymph node metastasis in the patient with colon cancer.