High plasma levels of COL10A1 are associated with advanced tumor stage in gastric cancer patients

BACKGROUND Gastric cancer(GC)remains an aggressive malignancy with a high rate of mortality,being the third leading cause of cancer-related death.More than one million newly diagnosed cases and 782685 deaths due to GC were reported in 2018.GC is characterized by limited effective treatment options and the lack of consistent biomarkers for the diagnosis and prognosis of these patients.The discovery of new biomarkers useful in the early diagnosis of GC is mandatory.AIM To evaluate the potential of COL10A1 as a circulating biomarker for the diagnosis and prognosis of gastric adenocarcinoma patients.METHODS Plasma and tissue obtained from 49 patients with gastric adenocarcinoma have been used in exploring the expression of COL10A1.Real-time PCR and western blot techniques were used to evaluate COL10A1 level in gastric tumor tissue compared to normal adjacent tissue.The circulating level of COL10A1 was also evaluated by ELISA in plasma of gastric adenocarcinoma patients.Survival analysis was made in order to evaluate the potential of COL10A1 as a biomarker for the diagnosis and prognosis of gastric adenocarcinoma patients.RESULTS Our results showed a significant increase in COL10A1 gene expression and protein levels in gastric tumor tissue compared to adjacent normal tissue(P<0.05).COL10A1 seems to show an elevated expression from the beginning of carcinogenesis,in the early stages,and its increased level remains elevated during cancer progression.A significant increase of COL10A1 plasma level in gastric adenocarcinoma patients was also identified.Moreover,increased COL10A1 plasma level was associated with poor survival of the patients.Plasma COL10A1 performed a diagnostic value in GC with area under the receiver operating characteristic curve(AUC)of 0.9171(P=0.0002),sensitivity of 87.76%,and specificity of 100.0%.Furthermore,this study demonstrated the potential role of plasma COL10A1 in the early detection of GC,as in the early stage,we obtained an AUC of 0.8789(P=0.0030),sensitivity of 81.25%,and specificity of 100.0%.CONCLUSION Circulating expression level of COL10A1 is significantly increased in gastric adenocarcinoma patients being associated with poor survival and is a potential biomarker for early detection of GC.

Association of the GNAS1 T393C polymorphism with tumor stage and survival in gastric cancer

AIM:To analyze the impact of the GNAS1 T393C polymorphism on prognosis and histopathology of gastric cancer.METHODS:Genomic DNA was extracted from paraffinembedded tissues of 122 patients with primary gastric carcinoma and from the blood of 820 healthy white individuals.Allelic discrimination was performed by quantitative real-time polymerase chain reaction.Genotyping was correlated with histopathologic parameters and with overall survival according to the Kaplan-Meier approach and with multivariate analysis by multiple stepwise regression.RESULTS:Thirty-nine(32%) patients displayed a CC genotype,57(46.7%) a CT genotype and 26(21.3%) a TT genotype.The frequency of the C allele(fC) in the patient group was 0.55,which was not signif icantly different from that of healthy blood donors.The distribution was compatible with the Hardy-Weinberg equilibrium.Analysis of clinicopathological parameters did not show any signif icant correlation of the T393C genotype with gender(P=0.50),differentiation(P=0.29),pT-category(P=0.19),pN-category(P=0.30),pM-category(P=0.25),R-category(P=0.95),the classifications according to WHO(P=0.34),Laurén(P=0.16),Goseki(P=1.00) and Ming(P=0.74).Dichotomization between C+(CC+CT) and C-genotypes(TT),however,revealed signif icantly more advanced tumor stages(P=0.023) and lower survival rates(P=0.043) for C allele carriers.CONCLUSION:The present study provides strong evidence to suggest that the GNAS1 T393C allele carrier status influences tumor progression and survival in gastric cancer with higher tumor stages and a worse outcome for C allele carriers.

Survival analysis of children with stage Ⅱ testicular malignant germ cell tumors treated with surgery or surgery combined with adjuvant chemotherapy

For children with stage II testicular malignant germ cell tumors(MGCT), the survival is good with surgery and adjuvant chemotherapy. However, there is limited data on surgical results for cases in which there was no imaging or pathologic evidence of residual tumor, but in which serum tumor markers either increased or failed to normalize after an appropriate period of half-life time post-surgery. To determine the use of chemotherapy for children with stage II germ cell tumors, we analyzed the outcomes(relapse rate and overall survival) of patients who were treated at the Sun Yat-sen University Cancer Center between January 1990 and May 2013. Twenty-four pediatric patients with a median age of 20 months(range, 4 months to 17 years) were enrolled in this study. In 20 cases(83.3%), the tumors had yolk sac histology. For definitive treatment, 21 patients underwent surgery alone, and 3 patients received surgery and adjuvant chemotherapy. No relapse was observed in the 3 patients who received adjuvant chemotherapy, whereas relapse occurred in 16 of the 21 patients(76.2%) treated with surgery alone. There were a total of 2 deaths. Treatment was stopped for 1 patient, who died 3 months later due to the tumor. The other patient achieved complete response after salvage treatment, but developed lung and pelvic metastases 7 months later and died of the tumor after stopping treatment. For children treated with surgery alone and surgery combined with adjuvant chemotherapy, the 3-year event-free survival rates were 23.8% and 100%, respectively(P = 0.042), and the 3-year overall survival rates were 90.5% and 100%, respectively(P = 0.588). These results suggest that adjuvant chemotherapy can help to reduce the recurrence rate and increase the survival rate for patients with stage II germ cell tumors.

全身磁共振弥散加权成像联合多层螺旋CT对多发性骨髓瘤的诊断价值

目的 探究全身磁共振弥散加权成像(WB-DWI)联合多层螺旋CT对多发性骨髓瘤的诊断价值。方法 选取2019年6月~2023年1月于我院收治的80例多发性骨髓瘤患者为研究对象,并按照检测方式将其分为WB-DWI组(n=25)、多层螺旋CT组(n=25)、联合组(n=30)。分析WB-DWI、多层螺旋CT单一及联合对患者累及部位的检出率,分析两种检查方式单一及联合对多发性骨髓瘤的检出情况,通过ROC曲线分析WB-DWI、多层螺旋CT联合诊断多发性骨髓瘤的临床价值。结果 检测结果主要与Durie-Salmon分期、国际骨髓瘤分期相关(P<0.05)。与WB-DWI、多层螺旋CT单一检测对比,联合检测患者累及部位的检出率较高(P<0.05)。在多发性骨髓瘤诊断中WB-DWI、多层螺旋CT联合检测高于单一检测(P<0.05)。与WB-DWI、多层螺旋CT单项诊断对比,两项联合诊断多发性骨髓瘤的敏感度、特异性、准确性均较高(P<0.05)。结论 相较于WB-DWI、多层螺旋CT单项检测,联合检测可有效提升患者病理检出情况,提高对多发性骨髓瘤的诊断价值。

Detection of the <i>PIK3CA</i>Mutation in Circulating Tumor DNA as a Possible Predictive Indicator for Poor Prognosis of Early-Stage Breast Cancer

Objectives: Circulating tumor DNA (ctDNA) is shown to provide the real-time genomic information of metastatic breast cancer. This study elucidates the clinico-pathological significance of ctDNA in early-stage breast cancer using the PIK3CA mutation as an indicator. Materials and Methods: Twenty-seven primary breast cancers without metastasis were surgically resected and pathologically diagnosed at the University of Tokyo Hospital, Japan. Genomic DNA of primary tumor was extracted from formalin-fixed and paraffin-embedded specimens. ctDNA was extracted from fresh-frozen plasma from patients. The PIK3CA mutations at E542K, E545K and H1047R were examined by Sanger sequencing or droplet digital PCR in 27 tumors and pre- and post-surgery plasma. Results: The PIK3CA mutations were detected in 13 (48%) of 27 primary tumors. These mutations did not significantly correlate with specific clinico-pathological characteristics of tumors. When ctDNA was examined, 4 (33%) of 12 cases carrying the mutated PIK3CA showed the identical mutation in pre-surgery plasma and 2 (50%) of them showed the identical mutations in post-surgery plasma. Interestingly, in these 2 cases in pathological stages IIIA and IA, fractional abundance of the mutated PIK3CA alleles to the total alleles in pre-surgery ctDNA was around 1% or more and was higher than that of the other two cases without PIK3CA mutations in post-surgery ctDNA. Conclusions: The PIK3CA mutation in ctDNA is detectable even in a subset of early-stage breast cancer. Furthermore, fractional abundance of the mutated PIK3CA in pre-surgery ctDNA could provide a possible predictive indicator for tumor burden and for choosing the appropriate adjuvant treatment of breast cancer.

超声弹性成像参数结合肿瘤标志物鉴别原发性肝癌TNM分期的价值分析

目的分析超声弹性成像(UE)参数结合肿瘤标志物鉴别原发性肝癌(PHC)TNM分期的价值。方法回顾性分析本院于2017年12月至2022年12月收治的经病理学检查确诊的243例PHC患者的临床资料,所有患者均行UE检查及血清学肿瘤标志物[甲胎蛋白(AFP)、癌胚抗原(CEA)、糖链抗原(CA199)]水平检测。根据TNM分期将PHC患者分为早期(Ⅰ~Ⅱ期)组(n=99)、晚期(Ⅲ~Ⅳ期)组(n=144),比较两组UE参数(UC评分、应变比值)及肿瘤标志物水平,分析UE参数、肿瘤标志物水平对PHC患者TNM分期的鉴别诊断价值。结果晚期组UE评分、应变比值、血清AFP、CEA、CA199水平均高于早期组(P<0.05);U E评分、应变比值联合鉴别诊断PHC患者TNM分期的灵敏度为87.50%、特异度为82.83%、曲线下面积(AUC)为0.877,其中灵敏度高于单独诊断,AUC也高于单独诊断(P<0.05),特异度与单独诊断基本一致;肿瘤标志物AFP、CEA、CA199联合鉴别诊断PHC患者TNM分期的灵敏度、特异度、AUC为79.17%、84.85%、0.862,其中灵敏度高于单独诊断,AUC也高于单独诊断(P<0.05),特异度与单独诊断基本一致;UE参数联合肿瘤标志物鉴别诊断PHC患者TNM分期的灵敏度、特异度、AUC为94.44%、81.82%、0.935,灵敏度高于单独诊断,AUC也高于单独诊断(P<0.05),特异度与单独诊断基本一致。(P>0.05)。结论UE参数、肿瘤标志物均对PHC患者TNM分期具有鉴别价值,但两者联合鉴别效能更高。

Influence of tumor response on the survival of patients with extensive-stage small-cell lung cancer treated with the etoposide plus cisplatin chemotherapy regimen

Objective In this study, we evaluated the difference of progression-free survival(PFS) and overall survival(OS) between extensive-stage small-cell lung cancer(ES-SCLC) patients who acquired partial response(PR) or complete remission(CR) after two cycles of first-line chemotherapy with the etoposide plus cisplatin(EP) regimen and those who acquired PR or CR after four or six cycles.Methods A total of 106 eligible patients treated with the EP chemotherapy regimen for two to six cycles, at The General Hospital of Shenyang Military Region(China) between November 2004 and May 2011, were enrolled in this study. RECIST version 1.1 was used for the evaluation of chemotherapy efficiency. We followed up all eligible patients every 4 weeks. All statistical data were analyzed by using SPSS 21.0 statistical package for Windows.Results After a median follow-up of 293 days(range, 62–1531 days), all patients had died by the cutoff date. Fifty-one patients acquired PR or CR after two cycles of chemotherapy; the median PFS reached 6.0 months(95% CI, 5.1–6.9), and the median OS was 10.5 months(95% CI, 8.6–12.4). Twenty-eight patients acquired PR or CR after four or six cycles; the median PFS was 4.8 months(95% CI, 4.4–5.2), and the median OS was 7.5 months(95% CI, 6.8–8.2). Both PFS and OS showed a statistical difference between the two groups. Conclusion ES-SCLC patients who acquired PR or CR after two cycles of the EP regimen as first-line therapy had longer PFS and OS than those who acquired PR or CR after four or six cycles.

安罗替尼联合一线化疗治疗晚期非小细胞肺癌的效果

目的研究安罗替尼联合化疗一线治疗晚期非小细胞肺癌(NSCLC)的价值。方法回顾分析2018年3月至2022年5月郑州大学第五附属医院收治的90例晚期NSCLC患者资料,其中45例接受单纯一线化疗的患者纳入对照组,45例联合安罗替尼治疗的患者纳入观察组。两组均连续治疗4个化疗周期。记录两组治疗效果、肿瘤标志物水平[细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)和神经元特异性烯醇化酶(NSE)]、生存情况、不良反应发生情况。结果治疗后,观察组治疗总有效率高于对照组(P<0.05)。治疗前,两组CYFRA21-1、NSE、CEA差异无统计学意义(P>0.05);治疗后,两组CYFRA21-1、NSE、CEA均降低,且观察组低于对照组,差异有统计学上的意义(P<0.05)。观察组生存时间长于对照组,生存率高于对照组,差异有统计学上的意义(P<0.05)。治疗期间,两组不良反应发生率差异无统计学意义(P>0.05)。结论安罗替尼联合化疗一线治疗晚期NSCLC可以进一步提高效果,降低肿瘤标志物水平,有助于延长患者生存时间,且不会增加不良反应,安全性较好。

DWI、DCE-MRI在中老年宫颈癌诊断、分期中的价值

目的探讨弥散加权序列(DWI)及动态增强磁共振成像(DCE-MRI)在宫颈癌诊断、分期中的价值。方法选取经病理证实的宫颈癌患者47例,行常规MR、扩散加权成像(DWI)扫描和动态对比增强磁共振(DCE-MR)扫描。按照FIGO分期分为两组,由两名有经验的影像医师勾画ROI,比较Ⅰ期+ⅡA期组与ⅡB及以上分期组组间不同定量参数之间的差异。结果1组平均ADC值为(0.869±0.181)×10^(-3)mm^(2)/s,2组为(0.716±0.1)×10^(-3)mm^(2)/s,差异有统计学意义(P<0.05)。1、2组K^(trans)、K_(ep)、V_(e)非参数检验结果示差异有统计学意义(P<0.05)。结论在常规MRI扫描基础上,应用DWI及DCE-MRI可以更全面、准确地对宫颈癌进行诊断和分期评估,对临床制定个性化的治疗方案具有重要的参考价值。

代谢综合征与胰腺癌患者的临床病理特征和预后的相关性研究

目的:探讨代谢综合征(MS)及其组分与胰腺癌患者临床病理特征的相关性和预后影响,为胰腺癌的综合防治、个性化诊疗提供理论参考。方法:回顾性分析2017年1月至2021年12月广西医科大学第一附属医院收治的184例胰腺癌患者的临床资料。根据MS诊断标准,分为非MS组(144例)和MS组(40例)。比较两组临床病理特征。Cox回归模型分析未经抗癌治疗的49例患者预后的影响因素,Kaplan-Meier法分析MS及其组分与预后的关系。结果:与非MS组比较,MS组患者TNM分期晚,肿瘤远处转移发生率高(P<0.05)。低水平高密度脂蛋白胆固醇(HDL-C)和高血糖均为胰腺癌TNM分期的独立危险因素(P<0.05)。49例未经抗癌治疗的患者中位生存时间为2.5个月。生存分析显示,TNM分期晚、高血糖为生存时间的独立危险因素(P<0.05),其中Ⅳ期患者中位生存时间为2.2个月,高血糖是Ⅳ期患者预后的独立危险因素,超重是保护因素(均P<0.05)。MS患者与非MS患者生存时间比较,差异无统计学意义(P>0.05)。有无高血压、高甘油三酯(TG)、低HDL-C的患者之间的中位生存时间比较,差异均无统计学意义(均P>0.05)。结论:MS与胰腺癌患者的临床分期、肿瘤远处转移发生率相关,但尚不能证明是患者生存的影响因素,高血糖和超重分别是患者预后的独立危险因素和保护因素。

基于铜死亡基因识别脑膜瘤亚型并筛选脑膜瘤-免疫相关的关键基因

目的筛选铜死亡相关的脑膜瘤亚型并识别与疾病-免疫相关的关键基因。方法利用公共数据库中脑膜瘤相关的基因表达数据筛选差异表达的铜死亡基因,并基于其在肿瘤样本中的表达值识别脑膜瘤亚型。分析亚型间的差异表达基因以及亚型与肿瘤免疫微环境的关联。以亚型间显著差异的免疫细胞为表型,利用加权基因共表达网络分析(WGCNA)筛选疾病-免疫相关的模块并提取模块基因。通过交集分析筛选出差异表达的疾病-免疫相关基因,进行后续蛋白-蛋白相互作用(PPI)网络分析、功能富集分析、Friends分析、基因表达验证以及关键基因与临床因素关联分析。结果在脑膜瘤和正常样本中检测到6个铜死亡基因的差异表达,如CDKN2A和GLS,并鉴定了2个相关的铜死亡亚型。两个亚型间涵盖397个差异表达基因,包括8种免疫细胞,其浸润丰度在亚型间存在显著差异。通过WGCNA筛选到282个疾病-免疫相关基因,交集分析得到74个差异表达的疾病-免疫相关基因。PPI和Friends分析最终确认了5个关键基因,包括LTBP1、LTBP2和MFAP5等。其中,LTBP2和MFAP5在脑膜瘤不同级别中表达存在显著差异。Western Blot和免疫组化实验证实,MFAP5在WHOⅠ级和WHOⅢ级之间以及WHOⅠ级和WHOⅡ级之间存在显著差异。结论本研究筛选到2个铜死亡相关的脑膜瘤亚型,这两个亚型在免疫细胞浸润和免疫反应方面存在差异。两个亚型间的免疫相关关键基因,如LTBP2和MFAP5,可能是铜死亡调控脑膜瘤发生和发展的关键机制,有望成为脑膜瘤诊断生物标志物或免疫治疗靶点。

miR-9、miR-194在鼻咽癌组织中的表达及与其预后的关系

目的 探讨miR-9、miR-194在鼻咽癌组织中的表达水平变化及其预后价值。方法 选取鼻咽癌患者76例,随访3~36个月,根据预后情况分为死亡组(n=21例),存活组(n=55例)。统计比较miR-9、miR-194不同表达水平的鼻咽癌患者的临床资料,以及不同预后的鼻咽癌患者miR-9、miR-194表达水平,采用Logistic回归分析鼻咽癌患者预后相关影响因素。结果 76例鼻咽癌患者miR-9高表达29例,低表达47例,miR-194高表达35例,低表达41例;miR-9、miR-194低表达患者的临床分期为Ⅲ~Ⅳ期、肿瘤分期为T3~T4期、组织分化程度为高中分化、发生淋巴结转移及远处转移的比例高于miR-9、miR-194高表达患者(P<0.05);两组临床分期、肿瘤分期、组织分化程度、淋巴结转移及远处转移情况、miR-9表达水平、miR-194表达水平比较差异显著(P<0.05);临床分期、肿瘤分期、组织分化程度、淋巴结转移及远处转移情况、miR-9表达水平、miR-194表达水平为鼻咽癌患者预后影响因素(P<0.05)。结论 miR-9、miR-194低表达与鼻咽癌患者恶性生物学行为进程及预后有关,该研究提示miR-9、miR-194可能是鼻咽癌预后评估的有效分子靶点,值得临床进一步深入探究。

Correlation of tumor-associated macrophage density and proportion of M2 subtypes with the pathological stage of colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a prevalent global malignancy with complex prognostic factors.Tumor-associated macrophages(TAMs)have shown paradoxical associations with CRC survival,particularly concerning the M2 subset.AIM We aimed to establish a simplified protocol for quantifying M2-like TAMs and explore their correlation with clinicopathological factors.METHODS A cross-sectional study included histopathological assessment of paraffinembedded tissue blocks obtained from 43 CRC patients.Using CD68 and CD163 immunohistochemistry,we quantified TAMs in tumor stroma and front,focusing on M2 proportion.Demographic,histopathological,and clinical parameters were collected.RESULTS TAM density was significantly higher at the tumor front,with the M2 proportion three times greater in both zones.The tumor front had a higher M2 proportion,which correlated significantly with advanced tumor stage(P=0.04),pathological nodal involvement(P=0.04),and lymphovascular invasion(LVI,P=0.01).However,no significant association was found between the M2 proportion in the tumor stroma and clinicopathological factors.CONCLUSION Our study introduces a simplified protocol for quantifying M2-like TAMs in CRC tissue samples.We demonstrated a significant correlation between an increased M2 proportion at the tumor front and advanced tumor stage,nodal involvement,and LVI.This suggests that M2-like TAMs might serve as potential indicators of disease progression in CRC,warranting further investigation and potential clinical application.

21世纪以来胃癌治疗进展及未来展望

胃癌作为中国发病率及死亡率均位居前列的恶性肿瘤,具有异质性高、预后差等特点。进入21世纪,随着基因组学、腹腔镜微创技术、靶向治疗及免疫治疗的迅速发展,胃癌诊疗水平取得了长足进步。本文总结21世纪以来胃癌防治领域中的重要研究进展,并对未来进行展望,期待在胃癌早期筛查、诊断和精准治疗方面取得更大进步和突破,进一步提高患者的总生存率,将胃癌转变为可以控制的“慢性病”。

NRS-2002与PG-SGA在中晚期肿瘤患者营养筛查及评估中的应用

目的 研究欧洲营养风险筛查工具(NRS-2002)与主观整体评估量表(PG-SGA)在中晚期肿瘤患者营养筛查及评估中的应用效果。方法 回顾性分析2020年1月至2022年1月长安医院收治的116例中晚期肿瘤患者的临床资料,根据其在入院后接受的营养状况筛查和评估结果的不同分为营养正常组72例和营养不良组44例。比较两组患者的NRS-2002与PG-SGA评分情况、NRS-2002与PG-SGA不同分组患者的营养指标水平、应用NRS-2002与PG-SGA评分分组后两组患者近期的疗效及远期生存情况;采用Spearman秩相关分析法分析NRS-2002与PG-SGA评分与中晚期肿瘤患者营养指标的相关性。结果 营养正常组患者的NRS-2002与PG-SGA评分分别为(2.07±0.79)分、(3.52±1.01)分,明显低于营养不良组的(4.69±0.74)分、(5.22±1.14)分,差异均有统计学意义(P<0.05);NRS-2002评分中营养正常组患者的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平明显高于营养不良组,PG-SGA评分中营养正常组的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平也明显高于营养不良组,差异均有统计学意义(P<0.05);经Spearman秩相关分析法分析结果显示,NRS-2002和PG-SGA评分均与患者体质量指数、红细胞计数、血红蛋白、白蛋白、前白蛋白呈负相关(P<0.05);营养正常组患者的近期总有效率为94.44%,明显高于营养不良组的70.45%,差异有统计学意义(P<0.05);营养正常组患者的中位生存时间为(12.86±2.27)个月,明显长于营养不良组的(8.26±1.41)个月,生存率为93.06%,明显高于营养不良组的65.91%,而局部复发和远处转移率分别为16.67%、6.94%,明显低于营养不良组患者的34.09%、34.09%,差异均具有统计学意义(P<0.05)。结论 NRS-2002与PG-SGA均是筛查和评估中晚期肿瘤患者营养状态的有效方法,能及时发现患者的营养风险,以便及时对患者营养不良状况进行纠正,值得临床推广应用。

单孔胸腔镜肺切除术治疗早期肺癌的效果及对肿瘤标志物水平的影响

目的:探讨单孔胸腔镜肺切除术治疗早期肺癌的效果及对肿瘤标志物水平的影响。方法:选取苏州市中医医院2020年7月—2022年12月收治的116例早期肺癌患者,根据手术方式将其分为单孔组和两孔组,每组58例。单孔组采用单孔胸腔镜肺切除术,两孔组采用两孔胸腔镜肺切除术。对比两组手术效果、疼痛评分、肿瘤标志物水平及并发症发生率。结果:两组手术时间、淋巴结清扫数对比,差异均无统计学意义(P>0.05)。单孔组术中出血量少于两孔组,术后引流时间、住院时间均短于两孔组,差异均有统计学意义(P<0.05)。术后24 h、3 d和出院时,单孔组疼痛评分均低于两孔组,差异均有统计学意义(P<0.05)。术后24 h,单孔组可溶性细胞角蛋白19片段(Cyfra21-1)、糖类抗原125(CA125)、癌胚抗原(CEA)均低于两孔组,差异均有统计学意义(P<0.05)。两组并发症发生率对比,差异无统计学意义(P>0.05)。结论:与两孔胸腔镜肺切除术治疗早期肺癌相比,单孔胸腔镜肺切除术手术效果更好,可减少手术创伤,缓解术后疼痛,降低肿瘤标志物水平,促进患者术后恢复,且不会增加术后并发症发生率,安全可靠。

Clinical Utility of Tumor Markers

Tumor markers comprise a wide spectrum of biomacromolecules excessively synthesized by a variety of neoplastic cells. These markers can be endogenous products of highly active metabolites from malignant neoplastic cells or the products of newly activated genes. Ideally, tumor markers should be highly sensitive, specific, and reliable with a high prognostic value and organ specificity. In addition, they should reflect the tumor stage. However, no tumor markers identified thus far have all of these characteristics. Nevertheless, most tumor markers show excellent clinical relevance for monitoring the efficacy of a variety of therapies. We herein review how to use the recommended tumor markers to diagnose malignancies, such as gastrointestinal carcinoma, liver cancer, bile duct/pancreatic cancer, lung cancer, breast cancer, gynecologic cancer, and urologic cancer.

可逆性后部脑病综合征患者CT及MRI影像学表现及临床诊疗价值

目的分析可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)患者电子计算机断层扫描(computed tomography,CT)、核磁共振成像(magnetic resonance imaging,MRI)影像学表现特征;并绘制风险预测模型。方法对我院2022年1月~2023年8月收治的PRES患者42例临床资料进行分析。同时选取我院收治的可逆性脑血管收缩综合征(reversible cerebral vasoconstriction syndrome,RCVS)患者40例及同期正常体检患者40例为对照组。分析患者CT及MRI影像特征,分析两类检查方法对该病的诊断预测价值。结果单因素分析结果显示:CT双侧额顶枕叶多发片状低CT密度灶、CT左右对称、CT病灶边界、MRI双侧顶枕叶信号、MRI基底节区信号、MRI额叶信号、MRIT1WI病灶信号、MRIT2WI病灶信号在PRES、RCVS、正常者中存在统计学差异(P<0.05)。进一步分析结果显示:有CT双侧额顶枕叶多发片状低CT密度灶、CT左右对称、CT病灶边界、MRI双侧顶枕叶信号异常、MRI基底节区信号异常、MRIT2WI病灶信号底信号是PRES患者病灶主要影响因素(P<0.05)。通过回归系数得出两项联合的数值,经过统计分析得出联合数据。进一步ROC曲线显示,CT、MRI的诊断AUC为0.884、0.887,敏感度、特异度分别为78.6%、87.5%,76.2%、85.0%,联合预测AUC为:0.982、敏感度、特异度分别为:92.9%、92.5%。结论CT、MRI对可逆性后部脑病综合征诊断预测具有一定价值。但为避免单一检测的局限性,建议临床结合患者症状及其他检查手段,进行综合评估。

Radiomics approach for preoperative identification of stages Ⅰ-Ⅱand Ⅲ-Ⅳ of esophageal cancer

Objective: To predict preoperative staging using a radiomics approach based on computed tomography(CT)images of patients with esophageal squamous cell carcinoma(ESCC).Methods: This retrospective study included 154 patients(primary cohort: n=114; validation cohort: n=40) with pathologically confirmed ESCC. All patients underwent a preoperative CT scan from the neck to abdomen. High throughput and quantitative radiomics features were extracted from the CT images for each patient. A radiomics signature was constructed using the least absolute shrinkage and selection operator(Lasso). Associations between radiomics signature, tumor volume and ESCC staging were explored. Diagnostic performance of radiomics approach and tumor volume for discriminating between stages Ⅰ-Ⅱ and Ⅲ-Ⅳ was evaluated and compared using the receiver operating characteristics(ROC) curves and net reclassification improvement(NRI).Results: A total of 9,790 radiomics features were extracted. Ten features were selected to build a radiomics signature after feature dimension reduction. The radiomics signature was significantly associated with ESCC staging(P<0.001), and yielded a better performance for discrimination of early and advanced stage ESCC compared to tumor volume in both the primary [area under the receiver operating characteristic curve(AUC): 0.795 vs. 0.694,P=0.003; NRI=0.424)] and validation cohorts(AUC: 0.762 vs. 0.624, P=0.035; NRI=0.834).Conclusions: The quantitative approach has the potential to identify stage Ⅰ-Ⅱ and Ⅲ-Ⅳ ESCC before treatment.

Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer

AIM:To evaluate the agreement between transrectal ultrasound(TRUS) and magnetic resonance imaging(MRI) in classification of ≥ T3 rectal tumors.METHODS:From January 2010 to January 2012,86 consecutive patients with ≥ T3 tumors were included in this study.The mean age of the patients was 66.4 years(range:26-91 years).The tumors were all ≥ T3 on TRUS.The sub-classification was defined by the penetration of the rectal wall:a:0 to 1 mm;b:1-5 mm;c:6-15;d:> 15 mm.Early tumors as ab(≤ 5 mm) and advanced tumors as cd(> 5 mm).All patients underwent TRUS using a 6.5 MHz transrectal transducer.The MRI was performed with a 1.5 T Philips unit.The TRUS findings were blinded to the radiologist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread.RESULTS:TRUS found 51 patients to have an early ≥ T3 tumors and 35 to have an advanced tumor,whereas MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors.No patients with tumors classified as advanced by TRUS were found to be early on MRI.The kappa value in classifying early versus advanced T3 rectal tumors was 0.93(95% CI:0.85-1.00).We found a kappa value of 0.74(95% CI:0.63-0.86) for the total sub-classification between the two methods.The mean maximal tumor outgrowth measured by TRUS,5.5 mm ± 5.63 mm and on MRI,6.3 mm ± 6.18 mm,P = 0.004.In 19 of the 86 patients the following CT scan or surgery revealed distant metastases;of the 51 patients in the ultrasound ab group three(5.9%) had metastases,whereas 16(45.7%) of 35 in the cd group harbored distant metastases,P = 0.00002.The odds ratio of having distant metastases in the ultrasound cd group compared to the ab group was 13.5(95% CI:3.5-51.6),P = 0.00002.The mean maximal ultrasound measured outgrowth was 4.3 mm(95% CI:3.2-5.5 mm) in patients without distant metastases,while the mean maximal outgrowth was 9.5 mm(95% CI:6.2-12.8 mm) in the patients with metastases,P = 0.00004.Using the MRI classification three(6.3%) of 48 in the MRI ab group had distant metastases,while 16(42.1%) of the 38 in the MRI cd group,P = 0.00004.The MRI odds ratio was 10.9(95% CI:2.9-41.4),P = 0.00008.The mean maximal MRI measured outgrowth was 4.9 mm(95% CI:3.7-6.1 mm) in patients without distant metastases,while the mean maximal outgrowth was 11.5 mm(95% CI:7.8-15.2 mm) in the patients with metastases,P = 0.000006.CONCLUSION:There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors.Distant metastases are more frequent in the advanced group.