Immune response evaluation criteria in solid tumors for assessment of atypical responses after immunotherapy

In 2017,immune response evaluation criteria in solid tumors(iRECIST)were introduced to validate radiologic and clinical interpretations and to better analyze tumor’s response to immunotherapy,considering the different time of following and response,between this new therapy compared to the standard one.However,even if the iRECIST are worldwide accepted,to date,different aspects should be better underlined and well reported,especially in clinical practice.Clinical experience has demonstrated that in a non-negligible percentage of patients,it is challenging to determine the correct category of response(stable disease,progression disease,partial or complete response),and consequently,to define which is the best management for those patients.Approaching radiological response in patients who underwent immunotherapy,a new uncommon kind of target lesions behavior was found.This phenomenon is mainly due to the different mechanisms of action of immunotherapeutic drug.Therefore,new groups of response have been described in clinical practice,defined as“atypical responses,”and categorized into three new groups:pseudoprogression,hyperprogression,and dissociated response.This review summarizes and reports these patterns,helping clinicians and radiologists get used to atypical responses,in order to identify patients that respond best to treatment.

A Practical Solution to the Small Sample Size Bias and Uncertainty Problems of Model Selection Criteria in Two-Input Process Multiple Response Surface Methodology Datasets

Multiple response surface methodology (MRSM) most often involves the analysis of small sample size datasets which have associated inherent statistical modeling problems. Firstly, classical model selection criteria in use are very inefficient with small sample size datasets. Secondly, classical model selection criteria have an acknowledged selection uncertainty problem. Finally, there is a credibility problem associated with modeling small sample sizes of the order of most MRSM datasets. This work focuses on determination of a solution to these identified problems. The small sample model selection uncertainty problem is analysed using sixteen model selection criteria and a typical two-input MRSM dataset. Selection of candidate models, for the responses in consideration, is done based on response surface conformity to expectation to deliberately avoid selection of models using the problematic classical model selection criteria. A set of permutations of combinations of response models with conforming response surfaces is determined. Each combination is optimised and results are obtained using overlaying of data matrices. The permutation of results is then averaged to obtain credible results. Thus, a transparent multiple model approach is used to obtain the solution which gives some credibility to the small sample size results of the typical MRSM dataset. The conclusion is that, for a two-input process MRSM problem, conformity of response surfaces can be effectively used to select candidate models and thus the use of the problematic model selection criteria is avoidable.

Comparison of RECIST version 1.0 and 1.1 in assessment of tumor response by computed tomography in advanced gastric cancer

Objective： Response Evaluation Criteria in Solid Tumors （RECIST） guideline version 1.0 （RECIST 1.0） was proposed as a new guideline for evaluating tumor response and has been widely accepted as a standardized measure. With a number of issues being raised on RECIST 1.0, however, a revised RECIST guideline version 1.1 （RECIST 1.1） was proposed by the RECIST Working Group in 2009. This study was conducted to compare CT tumor response based on RECIST 1.1 vs. RECIST 1.0 in patients with advanced gastric cancer （AGC）. Methods： We reviewed 61 AGC patients with measurable diseases by RECIST 1.0 who were enrolled in other clinical trials between 2008 and 2010. These patients were retrospectively re-analyzed to determine the concordance between the two response criteria using the κ statistic. Results： The number and sum of tumor diameters of the target lesions by RECIST 1.1 were significantly lower than those by RECIST 1.0 （P〈0.0001）. However, there was excellent agreement in tumor response between RECIST 1.1 and RECIST 1.0 0（κ=0.844）. The overall response rates （ORRs） according to RECIST 1.0 and RECIST 1.1 were 32.7% （20/61） and 34.5% （20/58）, respectively. One patient with partial response （PR） based on RECIST 1.0 was reclassified as stable disease （SD） by RECIST 1.1. Of two patients with SD by RECIST 1.0, one was downgraded to progressive disease and the other was upgraded to PR by RECIST 1.1. Conclusions： RECIST 1.1 provided almost perfect agreement with RECIST 1.0 in the CT assessment of tumor response of AGC.

Tumor response assessment by the single-lesion measurement per organ in small cell lung cancer

Background： The criterion of two target lesions per organ in the Response Evaluation Criteria in Solid Tumors （RECIST） version I. 1 is an arbitrary one, being supported by no objective evidence. The optimal number of target lesions per organ still needs to be investigated. We compared tumor responses using the RECIST 1.1 （measuring two target lesions per organ） and modified RECIST I. 1 （measuring the single largest lesion in each organ） in patients with small cell lung cancer （SCLC）. Methods： We reviewed medical records of patients with SCLC who received first-line treatment between January 2004 and December 2014 and compared tumor responses according to the two criteria using computed tomography. Results： There were a total of 34 patients who had at least two target lesions in any organ according to the RECIST 1.1 during the study period. The differences in the percentage changes of the sum of tumor measurements between RECIST 1.1 and modified RECIST 1.1 were all within 13%. Seven patients showed complete response and fourteen showed partial response according to the RECIST I.I. The overall response rate was 61.8%. When assessing with the modified RECIST 1.1 instead of the RECIST 1.1, tumor responses showed perfect concordance between the two criteria （k= 1.0）. Conclusions： The modified RECIST 1.I showed perfect agreement with the original RECIST 1.I in the assessment of tumor response of SCLC. Our result suggests that it may be enough to measure the single largest target lesion per organ for evaluating tumor response.

A time-domain nonlinear effective-stress non-Masing approach of ground response analysis of Guwahati city, India

The response of subsoil strata subjected to seismic excitations plays an important role in governing the response of the overlying superstructures at any site. Ground response analysis(GRA) helps to assess the influence of soil characteristics on the propagating seismic stress waves from the bedrock level to the ground surface during an earthquake. For the northeastern region of India, located in the highest seismic zone in the country, conducting an extensive GRA study is of prime importance. Conventionally, most of the GRA studies are carried out using the equivalent linear method, which, being a simplistic approach, cannot capture the nonlinear behavior of soil during seismic shaking. This paper presents the outcomes of a one-dimensional effective stress based nonlinear GRA conducted for Guwahati city(located in northeast India) incorporating the non-Masing load/unload/reload characteristics. The various ground response parameters evaluated from this study help in assessing the ground shaking, soil amplification, and site responses expected in this region. 2D contour maps, which are representative of the distribution of some of these parameters throughout Guwahati city, are also developed. The results presented herein can serve as guidelines for the design of foundations and superstructures in this region.

Imaging response predictors following drug eluting beads chemoembolization in the neoadjuvant liver transplant treatment of hepatocellular carcinoma

BACKGROUND Drug-eluting bead transarterial chemoembolization(DEB-TACE)is an endovascular treatment to release chemotherapeutic agents within a target lesion,minimizing systemic exposure and adverse effects to chemotherapeutics.Therefore,identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best candidates.Predictors of the response after DEB-TACE still have not been fully elucidated.This is the first prospective study performed with standardized DEBTACE technique that aim to identify predictors of radiological response,assessing patients clinical and laboratory characteristics,diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver transplantation.AIM To identify pre-and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization(DEB-TACE)for the neoadjuvant treatment of hepatocellular carcinoma(HCC).METHODS This is prospective,cohort study,performed in a single transplant center,from 2011 to 2014.Consecutive patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were recruited.Pre and post-chemoembolization imaging studies were performed by computed tomography or magnetic resonance.The radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of necrosis.RESULTS Two hundred patients with 380 HCCs were examined.Analysis of the objective response(nodule-based analysis)demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules(P=0.01),and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4%(P<0.001).Analysis of the percentage of necrosis through multiple linear regression revealed that the addition of each 1mg of the chemoembolic agent caused an average increase of 0.65%(P<0.001)in necrosis in the treated lesion,whereas the hepatocellular carcinoma with pseudocapsules presented 18.27%(P<0.001)increased necrosis compared to those without pseudocapsules.CONCLUSION The presence of a pseudocapsule and the addition of the amount of chemoembolic agent increases the chance of an objective response in hepatocellular carcinoma and increases the percentage of tumor necrosis following drug-eluting bead chemoembolization in the neoadjuvant treatment,prior to liver transplantation.

Objective response rate assessment in oncology: Current situation and future expectations

The tumor objective response rate(ORR)is an important parameter to demonstrate the efficacy of a treatment in oncology.The ORR is valuable for clinical decision making in routine practice and a significant end-point for reporting the results of clinical trials.World Health Organization and Response Evaluation Criteria in Solid Tumors(RECIST)are anatomic response criteria developed mainly for cytotoxic chemotherapy.These criteria are based on the visual assessment of tumor size in morphological images provided by computed tomography(CT)or magnetic resonance imaging.Anatomic response criteria may not be optimal for biologic agents,some disease sites,and some regional therapies.Consequently,modifications of RECIST,Choi criteria and Morphologic response criteria were developed based on the concept of the evaluation of viable tumors.Despite its limitations,RECIST v1.1 is validated in prospective studies,is widely accepted by regulatory agencies and has recently shown good performance for targeted cancer agents.Finally,some alternatives of RECIST were developed as immune-specific response criteria for checkpoint inhibitors.Immune RECIST criteria are based essentially on defining true progressive disease after a confirmatory imaging.Some graphical methods may be useful to show longitudinal change in the tumor burden over time.Tumor tissue is a tridimensional heterogenous mass,and tumor shrinkage is not always symmetrical;thus,metabolic response assessments using positron emission tomography(PET)or PET/CT may reflect the viability of cancer cells or functional changes evolving after anticancer treatments.The metabolic response can show the benefit of a treatment earlier than anatomic shrinkage,possibly preventing delays in drug approval.Computer-assisted automated volumetric assessments,quantitative multimodality imaging in radiology,new tracers in nuclear medicine and finally artificial intelligence have great potential in future evaluations.

Optimized management of advanced hepatocellular carcinoma:Four long-lasting responses to sorafenib

The therapeutic options for hepatocellular carcinoma (HCC) have been so far rather inadequate.Sorafenib has shown an overall survival benefit and has become the new standard of care for advanced HCC.Nevertheless,in clinical practice,some patients are discontinuing this drug because of side effects,and misinterpretation of radiographic response may contribute to this.We highlight the importance of prolonged sorafenib ad-ministration,even at reduced dose,and of qualitative and careful radiographic evaluation.We observed two partial and two complete responses,one histologically confirmed,with progression-free survival ranging from 12 to 62 mo.Three of the responses were achieved following substantial dose reductions,and a gradual change in lesion density preceded or paralleled tumor shrinkage,as seen by computed tomography.This report supports the feasibility of dose adjustments to allow prolonged administration of sorafenib,and highlights the need for new imaging criteria for a more appropriate characterization of response in HCC.

Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation

AIM To investigate the prognostic value of the radiological response after transarterial chemoembolization(TACE)and inflammatory markers in patients affected by hepatocellular carcinoma(HCC)awaiting liver transplantation(LT).METHODS We retrospectively evaluated the preoperative pre dictors of HCC recurrence in 70 patients treated with conventional(n=16)or doxorubicin-eluting bead TACE(n=54)before LT.The patient and tumour characteristics,including the static and dynamic alpha-fetoprotein,neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio( LR)measurements,were recorded.Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours(m RECIST)and the European Association for the Study of the Liver(EASL)criteria as complete response(CR),partial response( R),stable disease o progressive disease.After examination of the explanted livers,histological necrosis was classified as complete(100%of the cumulative tumour area),partia(50%-99%)or minimal(<50%)and was correlated with the preoperative radiological findings.RESULTS According to the pre-TACE radiological evaluation,22/70(31.4%)and 12/70(17.1%)patients were beyond Milan and University of San Francisco(UCSF)criteria,respectively.After TACE procedures,the objective response(CR+ R)rates were 71.4%and 70.0%according to m RECIST and EASL criteria,respectively.The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response(weighted k-value:0.98 and 0.93,respectively).Complete and partial histological necrosis were achieved in 14/70(20.0%)and 28/70(40.0%)patients,respectively.Using histopathology as the reference standard,m RECIST criteria correctly classified necrosis in 72.9%(51/70)of patients and EASL criteria in 68.6%(48/70)of cases.The m RECIST non-response to TACE[Exp(b)=9.2, =0.012],exceeding UCSF criteria before TACE[Exp(b)=4.7, =0.033]and a preoperative LR>150[Exp(b)=5.9, =0.046]were independent predictors of tumour recurrence.CONCLUSION The radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT.

New approaches for precise response evaluation in hepatocellular carcinoma

With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors,are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue.Therefore,the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired.In this review,we will discuss the conventional and new approaches to assess tumor burden.Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes,these functional tumor burden analyses are very promising.However,some of them have not gone thorough all steps for standardization and validation.Nevertheless,these new techniques and criteria will play an important role in the cancer management,and provide each patient more tailored therapy.

Assessment of clinical and radiological response to sorafenib in hepatocellular carcinoma patients

Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.

RAMAN SPECTROSCOPIC STUDY ON PREDICTION OF TREATMENT RESPONSE IN CERVICAL CANCERS

Concurrent chemoradiotherapy(CCRT)is the choice of treatment for locally adv anced cervical cancers;however,tumors exhibit diverse response to treatment.Early prediction of tumor response leads to individualizing treatment regimen.Response evaluation criteria in solid tumors(RECIST),the current modality of tumor response assessment,is often subject ive and carried out at the first visit after treatment,which is about four months.Hence,there is a need for better predictive tool for radioresponse.Optical spectroscopic techniques,sensitive to molecular alteration,are being pursued as potential diagnostic tools.Present pilot study ains to explore the fiber-optic-based Raman spectroscopy approach in prediction of tumor response to CCRT,before taking up extensive in vivo studies.Ex vivo Raman spectra were acquired from biopsies collected from 11 normal(148 spectra),16 tumor(201 spectra)and 13 complete response(151 CR spectra),one partial response(8 PR spectra)and one nonresponder(8 NR spectra)subjects.Data was analyzed using principal component linear discriminant analysis(PC-LDA)followed by leave-one-out cross-validation(LOO-CV).Findings suggest that normal tissues can be efficiently classified from both pre-and post-treated tumor biopsies,while there is an overlap between pre-and post-CCRT tumor tissues.Spectra of CR,PR and NR tissues were subjected to principal component analysis(PCA)and a tendency of classification was observed,corroborating previous studies.Thus,this study further supports the feasibility of Raman spectroscopy in prediction of tumor radioresponse and prospective noninvasive in vivo applications.

杭州湾溶解性无机氮、活性磷酸盐营养物基准研究

制定氮磷营养物基准是预防和控制水体富营养化的重要手段。本研究梳理了2010-2022年杭州湾历史监测数据,通过主成分分析、相关性分析等方法筛选了杭州湾营养物基准关键指标,并综合运用频数分布法、压力-响应模型等方法对指标进行统计分析,推导营养物基准值。结果表明:①溶解性无机氮(DIN)和活性磷酸盐(SPR)是制定杭州湾营养物基准的关键营养物指标,其浓度变化直接影响水体的富营养化程度和生态系统的稳定性;Chla和DO则是关键生物学指标,可用于评价水体健康程度。②由于频数分布法和压力-响应模型法的适用性不同,两种方法推导出的杭州湾营养物基准值存在较大差异,由压力响应模型法得出的营养物基准值比频数分布法高。③根据杭州湾目前的水质状况和富营养化水平,本研究提出杭州湾DIN、SPR的基准值分别为0.732和0.033 mg/L。研究显示,采用多种方法联合推导出的营养物基准值更符合水生态保护的实际需求,本研究结果可为杭州湾水体富营养化控制及营养物标准修订提供科学支撑。

基于成长体系的电动汽车充电站需求响应方法研究

随着中国新型电力系统建设的逐步开展,需求响应作为优化电网调控的方式之一,在新型电力系统中得到了广泛的应用。为解决电动汽车充电站对不同类型的电动汽车用户需求响应激励不足的问题,提出了一种基于成长体系的电动汽车充电站需求响应方法。该方法采用电动汽车充电需求和电池退化成本计算电动汽车充电站需求响应成本,通过电动汽车用户需求响应成长值等级激励措施,实现了对不同需求的电动汽车用户需求响应价格的浮动,从而保持了前段电动汽车用户的需求响应活跃度,提升了电动汽车充电站需求响应的盈利能力。在某城市的实例运行表明,相较于多时间尺度随机优化需求响应方法,该方法的利润提高了77.97%。该方法能激励电动汽车参与需求响应,提升电动汽车充电站盈利能力。

Evaluation of the Reliability Performance of Failure Criteria for Composite Structures

Evolution of materials, following the design requirements of special structures, has shifted interest towards development of composite members able to meet strength requirements “tailored” to specific applications. These members can provide appropriate, more cost effective structures, however absence of generic design guidelines raise constraints towards derivation of optimized structures. Reliability-based assessment can overcome this limitation by ensuring that acceptable levels of target reliability are achieved throughout their service life. This paper presents a methodology for reliability assessment of composite members based on appropriate limit state functions derived according to fundamental failure criteria, Tsai-Hill and Tsai-Wu, applicable to composite materials. The methodology that is proposed employs a Stochastic Response Surface Method (SRSM) which combines in discrete steps FEA modelling, numerical simulations and analytical probabilistic assessment techniques, allowing use of commercial and custom developed specialized numerical tools. Application of the proposed methodology on a complex composite structural geometry will illustrate its efficiency and evaluate the reliability performance of the limit states derived and examined.

基于AHP-CRITIC混合加权法和星点设计-效应面法的荆防活血乳膏处方优化研究

目的研究并优选荆防活血乳膏剂的制备工艺。方法以荆防活血乳膏剂的离心稳定性、耐热稳定性、涂抹分散性为考察指标,采用层次分析法(AHP)、基于指标相关性的权重确定方法(CRITIC)、AHPCRITIC混合加权法确定各评价指标的权重系数,并结合星点设计(central composite design,CCD)-效应面优化法筛选荆防活血乳膏处方中出对基质质量影响较大的3个因素硬脂酸、甘油、混合乳化剂(平平加、三乙醇胺)的用量,验证优化后的最佳处方。结果按AHP-CRITIC混合加权法得到离心稳定性、耐热稳定性、涂抹分散性的权重系数分别为0.5216,0.3372,0.1412,最佳处方比例为:硬脂酸4.4 g,甘油14.3 g,混合乳化剂4.2 g,单硬脂酸甘油酯2 g,凡士林8.5 g,二甲基硅油10 g,纯化水20 g,冰片1.5 g(2%),苯甲酸钠0.1%,荆防活血方组方药物提取干膏用量7.5 g(每100 g乳膏中含主药量约10 g)。结论优选出的荆防活血乳膏剂制备工艺经验证简单、合理,所得制剂具有良好的外观性状、涂抹分散性和稳定性。

基于PSR和信息敏感性的城市韧性度评价:以北京市为例

为有效判断城市韧性的发展趋势,构建科学合理的城市韧性度评价指标体系至关重要。首先,基于“压力-状态-响应”(PSR)模型,建立涵盖68个初选指标的城市韧性度评价指标体系;其次,采用信息敏感性和相关性分析优化指标体系;然后,采用CRITIC赋权法和综合指数法确定各指标权重并建立评价模型;最后,以北京市为例,结合区域特点及2010—2021年实际数据,确立包括31个指标的指标体系,分析该城市韧性度的发展趋势。结果表明:2010—2021年,北京市的城市韧性整体呈现上升趋势,城市韧性指数由2010年0.4367上升至2021年的0.5586。利用构建的评价指标体系和评价模型分析城市韧性时序演化趋势,可找出城市在应对突发事件过程中存在的薄弱环节,便于相关部门采取有针对性的措施。

胶州湾水体氮磷营养物基准研究

海湾营养物基准是指对海湾地区没有不利或有害影响的环境营养物参数的最大剂量或浓度,能够为富营养化风险评估和水质目标管理提供参照条件。本研究根据2014—2017年的胶州湾现场监测数据,采用频数分布法、分类回归树模型以及非参数拐点分析等统计分析法,推导营养物基准候选值,并基于赤潮敏感藻生态响应,通过室内多藻种实验开展营养物基准校验。结果表明:不同方法得到的营养物基准值存在一定差异,多藻种实验得到的生态响应值普遍高于统计分析法得到的基准候选值。综合考虑胶州湾目前的水质状况及富营养化水平,胶州湾水体溶解无机氮、总氮、活性磷酸盐和总磷的营养物基准推荐值分别为0.152、0.394、0.0032和0.0089 mg/L。研究结果有望为青岛胶州湾水体富营养化控制和营养物标准制定提供科学支撑。

Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer

BACKGROUND Obstruction or fullness after feeding is common in gastric cancer(GC)patients,affecting their nutritional status and quality of life.Patients with digestive obstruction are generally in a more advanced stage.Existing methods,including palliative gastrectomy,gastrojejunostomy,endoluminal stent,jejunal nutrition tube and intravenous chemotherapy,have limitations in treating these symptoms.AIM To analyze the efficacy of continuous gastric artery infusion chemotherapy(cGAIC)in relieving digestive obstruction in patients with advanced GC.METHODS This study was a retrospective study.Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine.The oxaliplatin-based intra-arterial infusion regimen was applied in all patients.Mild systemic chemotherapy was used in combination with local treatment.The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors(RECIST)criteria.Digestive tract symptoms and toxic effects were analyzed regularly.A comparison of the Karnofsky Performance Status(KPS)score and Stooler’s Dysphagia Score before and after therapy was made.Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival.RESULTS All patients finished cGAIC successfully without microcatheter displacement,as confirmed by arteriography.The median follow-up time was 24 mo(95%CI:20.24-27.76 mo).The overall response rate was 89.7%after cGAIC according to the RECIST criteria.The postoperative Stooler’s Dysphagia Score was significantly improved.Twentytwo(75.9%)of the 29 patients experienced relief of digestive obstruction after the first two cycles,and 13(44.8%)initially unresectable patients were then considered radically resectable.The median overall survival time(mOS)was 16 mo(95%CI:9.32-22.68 mo).Patients who received radical surgery had a significantly longer mOS than other patients(P value<0.001).Multivariate Cox regression analysis indicated that radical resection after cGAIC,intravenous chemotherapy after cGAIC,and immunotherapy after cGAIC were independent predictors of mOS.None of the patients stopped treatment because of adverse events.CONCLUSION cGAIC was effective and safe in relieving digestive obstruction in advanced GC,and it could improve surgical conversion possibility and survival time.

三维可视化技术在儿童实体肿瘤手术中的应用价值研究

目的探讨术前三维可视化技术在儿童实体肿瘤手术中的应用价值。方法回顾性分析电子科技大学附属妇女儿童医院·成都市妇女儿童中心医院2019年1月至2021年12月收治的23例接受手术治疗的实体肿瘤患儿临床资料,按照术前是否完善三维可视化分为研究组(n=11)和对照组(n=12)。研究组基于CT数据对患儿影像学结果进行三维可视化处理,通过可视化模型了解肿瘤及周围脏器血管的空间三维关系,明确邻近血管有无变异情况,进行精确的术前规划(组织血管保护、预切除路径等),并在三维模型指导下行儿童实体肿瘤切除手术;对照组仅在传统CT图像指导下完成手术。收集两组患儿的一般资料和术中资料,并进行比较分析。结果23例均顺利完成手术。研究组和对照组的年龄分别为(3.1±0.9)岁和(2.1±0.6)岁;体重分别为(12.2±2.7)kg和(15.7±2.5)kg;住院时间分别为(11.4±1.8)d和(13.4±1.6)d;手术时间分别为(330.4±61.0)min和(208.8±30.7)min;术中出血量分别为(43.6±17.6)mL和(204.2±70.2)mL;术中输血人数分别为1例和6例;肿瘤最大直径分别为(8.0±0.8)cm和(10.5±1.2)cm;体积误差值分别为(4.3±0.9)cm^(3)和(15.4±1.6)cm^(3);研究组发生贫血1例、低蛋白血症1例、凝血功能异常1例,对照组发生贫血3例、低蛋白血症1例、凝血功能异常1例。研究组的术中出血量[(43.6±17.6)mL比(204.2±70.2)mL]、术中输血人数(1/11比6/12)均少于对照组,差异具有统计学意义(P<0.05)。结论术前三维可视化技术是评估儿童实体肿瘤手术可切除性的有效且简便的方法,对提高儿童实体肿瘤手术的精准性和安全性具有重要价值。