Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms

AIM To investigate the feasibility and safety of secondary endoscopic submucosal dissection(ESD) for residual or locally recurrent gastric tumors. METHODS Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups. RESULTS The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD(78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group(10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD. CONCLUSION Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.

Gastric metastasis of small cell lung carcinoma:Three case reports and review of literature

BACKGROUND Small cell lung carcinoma(SCLC)is highly susceptible to metastasis in the early stages of the disease.However,the stomach is an uncommon site of metastasis in SCLC,and only a few cases of this type of metastasis have been reported.Therefore,SCLC gastric metastases have not been systematically characterized and are easily missed and misdiagnosed.CASE SUMMARY We report three cases of gastric metastasis from SCLC in this article.The first patient presented primarily with cough,hemoptysis,and epigastric fullness.The other two patients presented primarily with abdominal discomfort,epigastric distension,and pain.All patients underwent gastroscopy and imaging examinations.Meanwhile,the immunohistochemical results of the lesions in three patients were suggestive of small cell carcinoma.Finally,the three patients were diagnosed with gastric metastasis of SCLC through a comprehensive analysis.The three patients did not receive appropriate treatment and died within a short time.CONCLUSION Here,we focused on summarizing the characteristics of gastric metastasis of SCLC to enhance clinicians'understanding of this disease.

Deep learning model based on primary tumor to predict lymph node status in clinical stage IA lung adenocarcinoma:a multicenter study

Objective:To develop a deep learning model to predict lymph node(LN)status in clinical stage IA lung adeno-carcinoma patients.Methods:This diagnostic study included 1,009 patients with pathologically confirmed clinical stage T1N0M0 lung adenocarcinoma from two independent datasets(699 from Cancer Hospital of Chinese Academy of Medical Sciences and 310 from PLA General Hospital)between January 2005 and December 2019.The Cancer Hospital dataset was randomly split into a training cohort(559 patients)and a validation cohort(140 patients)to train and tune a deep learning model based on a deep residual network(ResNet).The PLA Hospital dataset was used as a testing cohort to evaluate the generalization ability of the model.Thoracic radiologists manually segmented tumors and interpreted high-resolution computed tomography(HRCT)features for the model.The predictive performance was assessed by area under the curves(AUCs),accuracy,precision,recall,and F1 score.Subgroup analysis was performed to evaluate the potential bias of the study population.Results:A total of 1,009 patients were included in this study;409(40.5%)were male and 600(59.5%)were female.The median age was 57.0 years(inter-quartile range,IQR:50.0-64.0).The deep learning model achieved AUCs of 0.906(95%CI:0.873-0.938)and 0.893(95%CI:0.857-0.930)for predicting pN0 disease in the testing cohort and a non-pure ground glass nodule(non-pGGN)testing cohort,respectively.No significant difference was detected between the testing cohort and the non-pGGN testing cohort(P=0.622).The precisions of this model for predicting pN0 disease were 0.979(95%CI:0.963-0.995)and 0.983(95%CI:0.967-0.998)in the testing cohort and the non-pGGN testing cohort,respectively.The deep learning model achieved AUCs of 0.848(95%CI:0.798-0.898)and 0.831(95%CI:0.776-0.887)for predicting pN2 disease in the testing cohort and the non-pGGN testing cohort,respectively.No significant difference was detected between the testing cohort and the non-pGGN testing cohort(P=0.657).The recalls of this model for predicting pN2 disease were 0.903(95%CI:0.870-0.936)and 0.931(95%CI:0.901-0.961)in the testing cohort and the non-pGGN testing cohort,respectively.Conclusions:The superior performance of the deep learning model will help to target the extension of lymph node dissection and reduce the ineffective lymph node dissection in early-stage lung adenocarcinoma patients.

The Clinical Usefulness of ^(99m)Tc-Tetrofosmin Scintigraphy in the Diagnosis of Lung Neoplasmas and Mediastinal Lymphoid Node Involvement

In order to investigate the clinical significance of 99mTc-Tetrofosmin （TF） scintigraphy in the evaluation of lung cancer and mediastinal lymphoid node involvement, 33 patients with pulmo- nary neoplasmas were subjected to both 99mTc-TF scintigraphies and CT scans in one week before their operations or puncturations. All the images were judged visually and the emission images were analyzed with semi-quantitative methods in addition. The results of each group were compared. There was marked difference in target/non-target （T/N） ratio between the lung cancer group and the benign lesion group （P〈0.001）. Moreover, in the lung cancer group, T/N ratio in tomographies was signifi- cantly higher than that in planar images （P〈0.01）. The sensitivity and accuracy of semi-quantitative analysis in 99mTc-TF SPECT were significantly higher than those of CT in the diagnosis of pulmonary neoplasmas （P〈0.05 and P〈0.01 respectively）, so was the sensitivity of 99mTc-TF SPECT vs CT in the diagnosis of mediastinal lymphoid node metastasis （P〈0.05）. It was also found that epidermoid squamous cell carcinomas and adenocarcinomas had a higher T/N ratio than in small cell carcinomas （P〈0.05）, and 2 h washout rate （WR） of adenocarcinomas was higher than that of epidermoid squamous cell carcinomas （P〈0.05）. In conclusion, 99mTc-TF scintigraphy showed a favorable diag- nostic accuracy in appraising lung cancers and mediastinal lymph node metastases. Furthermore semi-quantitative technology can improve the accuracy, and is potential to offer some information about histological type of the cancer tissue. Therefore, 99mTc-TF scintigraphy will be a useful tool in the diagnosis and staging of lung cancer.

Extrapancreatic malignancies and intraductal papillary mucinous neoplasms of the pancreas

Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms(IPMNs).Additional malignancies have been identified in 10%-52% of patients with IPMNs.The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN.The gastrointestinal tract is most commonly involved in secondary malignancies,with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries.Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms,gastrointestinal stromal tumors,carcinoid tumors,hepatobiliary cancers,breast cancers,prostate cancers,and lung cancers.There is no clear etiology for the development of secondary malignancies in patients with IPMN.Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients,both have reached the same conclusion:there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population.This f inding has signif icant clinical implications for both the initial evaluation and the subsequent long-term followup of patients with IPMNs.If a patient has not had recent colonoscopy,this should be performed during the evaluation of a newly diagnosed IPMN.Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease.Routine screening studies(breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.

SIGNIFICANCE OF ELECTRON MICROSCOPIC EXAMINATION IN THE DIAGNOSIS OF PULMONARY NEOPLASMS

The significance of electronic microscopc examination(EM) in the diagnosis of pulmonary neoplasms was evaIuated in 40 cases of Patients with different kinds of Pulmonary neoplasms.In 27 of the 40 cases,final diagnoses were made by light microscope(LM) examination,while in the remaining 13 cases,LM faded to reach definite diagnoses which were established with the help of EM.By analyzing our data,we conclude that in the following situations,EM helps meet in the diagnosis of pulmonary neoplasm:1.diagnosis of neuroendocrinal carcinomas of the lung;2.diagnosis of some rare pulmonary neoplasm;3.documentation of the histologic origins of the matastatic pulmonary neoplasms and 4.differentiation of malignant mesothelioma with pleural metastasis of Pulmonary adenocarcinoma.

Bioinformatics Identification of ZNFs/LINC00520/miR-181d/BCL2 Axis as a Novel Network in Cisplatin-Resistant Lung Adenocarcinoma Cells

Background: Resistance to cisplatin (DDP) leads to poor prognosis in patients with Lung Adenocarcinoma (LUAD) and limits its clinical application. It has been confirmed that autophagy promotes chemoresistance and, therefore, novel strategies to reverse chemoresistance by regulating autophagy are desperately needed. Methods: The differentially expressed lncRNAs (DElncRNAs), miRNAs (DEmiRNAs), and mRNAs (DEmRNAs) between A549 and A549/DDP cell lines were identified using the limma package in R, after gene expression profiles were obtained from Gene Expression Omnibus (GEO) database. By combining Autophagy-Related Genes (ARGs) from Human Autophagy Database (HADb), the interactions lncRNA-miRNAs and the interactions miRNAs-mRNAs respectively predicted by miRcode and miRDB/Targetscan database, the autophagy-related ceRNA network was constructed. Then, extraction of ceRNA subnetwork and Cox regression analyses were performed. A prognosis-related ceRNA subnetwork was constructed, and the upstream Transcription Factors (TFs) regulating lncRNAs were predicted by the JASPAR database. Finally, the expression patterns of candidate genes were further verified by quantitative real-time polymerase chain reaction (qRT-PCR) experiments. Results: A total of 3179 DEmRNAs, 180 DEmiRNAs, and 160 DElncRNAs were identified, and 35 DEmRNAs were contained in the HADb. Based on the ceRNA hypothesis, we established a ceRNA network, including 10 autophagy-related DEmRNAs, 9 DEmiRNAs, and 14 DElncRNAs. Then, LINC00520, miR-181d, and BCL2 were identified to construct a risk score model, which was confirmed to be a well-predicting prognostic factor. Furthermore, 5 TF ZNF family members were predicted to regulate LINC00520, whereas the RT-PCR results showed that the 5 ZNFs were consistent with the bioinformatics analysis. Finally, a ZNF regulatory LINC00520/miR-181d/BCL2 ceRNA subnetwork was constructed. Conclusions: An ZNFs/LINC00520/miR-181d/BCL2 axis as a novel network in DDP-resistant LUAD has been constructed successfully, which may provide potential therapeutic targets for LUAD.

Expert Consensus on Prevention and Treatment of COVID-19 Infection in Patients with Lung Cancer

Corona virus disease 2019(COVID-19)infection has become a major public health issue affecting human health.The main goal of epidemic prevention and control at the current stage in China is to“protect people’s health and prevent severe cases”.Patients with lung cancer who receive antitumor therapy have low immunity,and the risk of severe illness and death once infected is much higher than healthy people,so they are vulnerable to COVID-19 infection.At present,less attention has been paid to the prevention and treatment of COVID-19 infection in patients with lung cancer in domestic guidelines and consensus.Based on the published data in China and abroad,we proposed recommendations and formed expert consensus on the vaccination of COVID-19,the use of neutralizing antibodies and small molecule antiviral drugs for patients with lung cancer,for physician’s reference.

Intraoperative photodynamic therapy for tracheal mass in non-small cell lung cancer:A case report

BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.

CT引导下经皮肺穿刺活检术并发症发生的影响因素分析

背景与目的 计算机断层扫描引导下经皮肺穿刺活检术(computed tomography guided percutaneous lung biopsy,CT-PLB)是目前临床广泛应用的肺部病变诊断方式,但其为有创检查,最常见的并发症为气胸和肺出血,严重时可危及生命。本研究旨在分析影响CT-PLB不同并发症发生的独立危险因素,以降低并发症发生率。方法回顾性分析2018年5月至2019年12月于我院行CT-PLB且临床资料完整的605例患者的资料。依病变位置分为胸膜下组和非胸膜下组,根据并发症分为气胸组、肺出血组、气胸合并肺出血组及无气胸/肺出血组,计算各并发症的发生率。分析影响不同并发症发生的危险因素及各并发症的独立危险因素。结果气胸发生率为34.1%,肺出血发生率为28.1%,同时发生气胸及肺出血63例,发生率为10.8%。影响胸膜下组气胸发生的独立危险因素为病变大小(P=0.002)。影响非胸膜下组气胸发生的独立危险因素为穿刺针走行区域平扫CT值(P=0.035)、穿刺针经过肺组织长度(P=0.003)、穿刺针经过胸壁厚度(P=0.020);影响非胸膜下组肺出血发生的独立危险因素为穿刺针经过肺组织长度(P<0.001)、穿刺针走行区域△CT值(P=0.001)、病变大小(P=0.034)及患者体位(P=0.014)。影响气胸、肺出血同时发生的独立危险因素为穿刺针经过肺组织长度(P<0.001)、穿刺针走行区域△CT值(P<0.001)。结论 CT-PLB是一种安全、有效的诊断方式,对肺部占位性病变具有较高的诊断价值,选择合适的穿刺方案可减少气胸、肺出血等并发症,提高诊疗效率。

囊腔型肺腺癌临床多特征分析及浸润性风险预测模型的构建

背景与目的囊腔型肺癌作为一种特殊类型的肺癌逐步得到人们的关注,其最常见的病理类型为腺癌。囊腔型肺腺癌的浸润性对诊疗方案的选择和预后至关重要。本研究旨在分析囊腔型肺腺癌临床多特征,探讨其浸润性的独立危险因素并建立风险预测模型。方法回顾性分析2021年1月至2022年7月于南京医科大学第一附属医院胸外科行手术治疗的129例囊腔型肺腺癌患者,根据病理结果分成浸润前组:非典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)、原位腺癌(adenocarcinoma in situ,AIS)、微浸润型腺癌(minimally invasive adenocarcinoma,MIA)与浸润组:浸润性腺癌(invasive adenocarcinoma,IAC)。其中浸润前组47例,男性19例,女性28例,平均年龄(51.23±14.96)岁;浸润组82例,男性60例,女性22例,平均年龄(61.27±11.74)岁。收集两组病例多组临床特征,采用单因素分析、LASSO回归、多因素Logistic回归分析得出囊腔型肺腺癌浸润性的独立危险因素,建立浸润性风险预测模型。结果单因素分析显示年龄、性别、吸烟史、肺气肿、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、囊腔数、病灶直径、囊腔直径、结节直径、实性成分直径、囊壁结节、囊壁光滑程度、囊腔形状、分叶征、短毛刺征、胸膜牵拉、血管穿行与支气管穿行在囊腔型肺腺癌浸润前组与浸润组间存在统计学差异(P<0.05)。上述变量经LASSO回归降维处理,进一步筛选出的变量包括:年龄、性别、吸烟史、NSE、囊腔数、病灶直径、囊腔直径、囊壁结节、囊壁光滑程度与分叶征,并纳入多因素Logistic回归分析,发现囊壁结节(P=0.035)与分叶征(P=0.001)是囊腔型肺腺癌浸润性的独立危险因素(P<0.05)。建立预测模型如下:P=e^x/(1+e^x),x=-7.927+1.476*囊壁结节+2.407*分叶征,曲线下面积(area under the curve,AUC)为0.950。结论囊壁结节及分叶征为囊腔型肺腺癌浸润性的独立危险因素,对囊腔型肺腺癌的浸润性预测具有一定的指导意义。

共表达IL-7/CCL19的新抗原反应性T细胞对小鼠肺癌的抗肿瘤研究

背景与目的新抗原反应性T细胞(neoantigen reactive T cell,NRT)具有抑制表达特异性新抗原的肿瘤生长的能力。然而,由于免疫浸润困难和肿瘤微环境的抑制,NRT在实体瘤中的治疗效果有限。本研究针对小鼠肺癌细胞设计出可以同时表达白细胞介素7(interleukin 7,IL-7)和趋化因子19(chemokine C-C motif ligand 19,CCL19)的NRT细胞(7×19 NRT),并对7×19 NRT细胞和常规NRT细胞的抗肿瘤效果差异进行了评估。方法针对小鼠Lewis肺癌细胞(Lewis lung carcinoma,LLC)进行了新一代测序和新抗原预测,制备了RNA疫苗,培养了NRT细胞,构建了编码IL-7和CCL19的逆转录病毒载体,转导NRT细胞并成功表达IL-7和CCL19,成功获得了7×19 NRT,并在小鼠体内外对其抗肿瘤效果进行了评估。结果7×19 NRT细胞通过分泌IL-7和CCL19显著增强T细胞的增殖和侵袭能力,在小鼠肺癌中实现了显著的抑瘤作用,延长了小鼠的生存期。经7×19 NRT治疗后,T细胞浸润肿瘤组织及肿瘤组织坏死显著增加。此外,7×19 NRT治疗与常规NRT治疗均安全。结论通过IL-7和CCL19的表达,NRT细胞的抗实体瘤能力显著增强,这是一种对NRT安全有效的基因修饰。

肺癌患者自我超越现状及影响因素分析

背景与目的肺癌患者存在不同程度的自我超越,其能够激发患者的自我意识,推动其积极面对生活中的负性事件,从而改善患者的生活质量及健康结局,但国内关于肺癌患者自我超越的研究鲜有报道,相关影响因素尚未明确。本研究旨在了解肺癌患者自我超越现状并探讨其影响因素,为临床干预决策提供理论依据。方法选取2023年9月至2024年2月在四川大学华西医院肺癌中心入院治疗的243例肺癌患者为研究对象;采用一般资料调查表、自我超越量表、Herth希望量表及社会支持评定量表进行调查,并对肺癌患者自我超越的影响因素进行分析。结果肺癌患者自我超越总均分为(44.73±8.94)分,希望水平总均分为(37.60±4.98)分,社会支持总均分为(41.31±7.27)分。肺癌患者自我超越与希望水平及社会支持均呈正相关(P<0.001,P<0.001)。学历、希望水平及社会支持是肺癌患者自我超越的影响因素(P<0.05,P<0.001,P<0.05)。结论肺癌患者的自我超越处于较低水平,受希望水平与社会支持的影响。医护人员应重视提高肺癌患者的希望水平,开展针对性心理干预,同时引导其增强社会支持感知,从而促进患者自我超越的实现。

基于CT残差神经网络-101-金字塔网络模型鉴别肺良、恶性结节

目的 观察基于CT的残差神经网络(ResNet)-101-金字塔网络(FPN)模型鉴别肺良、恶性结节的价值。方法 回顾性分析2 000例肺结节患者共2 040个肺结节,包括良性1 150个、恶性890个;按8∶2比例将结节分为训练集(n=1 632)与测试集(n=408),前者包括良性结节881个、恶性结节751个,后者包括良性269个、恶性139个。以ResNet-101为主干网络、结合FPN基于胸部CT建立分类模型,观察其单一及联合医师评估鉴别肺良、恶性结节的效能。结果 测试集269个肺良性结节中,ResNet-101-FPN模型诊断正确214个(214/269,79.55%),联合医师评估后诊断正确230个(230/269,85.50%);139个恶性结节中,ResNet-101-FPN模型诊断正确124个(124/139,89.21%),联合医师评估后诊断正确131个(131/139,94.24%)。ResNet-101-FPN模型联合医师评估鉴别肺良、恶性结节的敏感度、准确率和精确度均高于而特异度则低于单一ResNet-101-FPN模型,但差异均无统计学意义(P均>0.05)。结论基于CT的ResNet-101-FPN模型可鉴别肺良、恶性结节;联合医师评估可提高诊断效能。

初诊Ⅳ期肺癌患者中性粒细胞/淋巴细胞比值与营养不良风险的相关性分析

背景与目的 恶性肿瘤患者往往伴随营养不良,与预后密切相关。中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)作为体内炎症的指标,能够预测多种疾病的营养不良风险,然而其与肺癌患者营养不良的关系尚不明确。本研究旨在分析NLR与初诊Ⅳ期肺癌患者营养不良风险的关系,并进一步确定NLR的截断值以更好地预测患者营养不良的风险。方法 回顾性分析2019年5月至2021年2月天津医科大学总医院肿瘤内科收治的209例初诊Ⅳ期肺癌患者,应用营养风险筛查2002 (nutritional risk screening 2002,NRS 2002)量表对其营养状况进行评估,同时收录患者人口学信息、病理、卡氏体能状态(Karnofsky performance status,KPS)评分、体重指数、合并疾病及临床生化指标的资料。分析NLR与营养不良风险的关系,并采用受试者工作特征(receiver operating characteristic,ROC)曲线来确定预测营养不良风险的最佳NLR临界值。应用多因素Logistic回归进一步评估NLR与营养不良风险之间的关系。结果 初诊Ⅳ期肺癌患者存在营养不良风险的比率为36.36%(76/209)。对NLR与NRS 2002营养不良风险评分进行分析发现,NLR与营养不良风险评分呈正相关(r=0.765,P<0.001)。通过ROC曲线分析,确定初诊Ⅳ期肺癌患者营养不良风险的最佳截断值NLR为3.94 [曲线下面积(area under the curve,AUC)=0.747,95%CI:0.678-0.815,P<0.001],敏感性为55%,特异性为86%,阳性预测值为68%,阴性预测值为77%。相比于NLR≤3.94组的患者,NLR>3.94组的患者更容易发生营养不良(69.49%vs 23.33%,P<0.001),并且NLR为初诊Ⅳ期肺癌患者营养不良风险的独立危险因素。结论 NLR在初诊Ⅳ期肺癌患者中与营养不良风险有关,NLR可作为Ⅳ期肺癌患者营养风险筛查的指标之一。

基于脑MRI的机器学习预测非小细胞肺癌T790M突变

目的:本研究基于脑部T_(1)C和T_(2)W MRI建立人工智能模型,预测肺癌脑转移患者在靶向治疗中的耐药性T790M突变。方法:本研究收集80例肺癌脑转移患者(2017年6月—2019年12月)的T_(1)C和T_(2)W MRI影像和临床数据进行回顾性分析(患者按照2∶1的比例分成训练集和测试集)。采用无监督k-means算法将肿瘤区域划分为高亮度区域和低亮度区域,提取不同区域的影像组学图像特征构建模型,评估每个模型的诊断效果。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线,计算ROC曲线下面积(Area under curve,AUC)、特异性和敏感性作为模型评价指标,分析模型的潜在临床应用价值。结果:对T_(1)C和T_(2)W MRI和临床特征融合的统计计算表明,本研究建立的模型对T790M突变具有良好的预测能力,在训练集和测试集上的AUC分别为0.899和0.818。结论:本研究建立的计算机模型可以有效预测肺癌脑转移患者T790M突变,具有潜在的临床辅助诊断价值。

CT双能量成像参数对肺结节病变性质的鉴别价值研究

目的:研究CT双能量成像参数对肺结节病变性质的鉴别价值。方法:2021年12月一2023年1月合肥市第二人民医院收治的102例恶性肺结节患者作为恶性组,同期收治的106例良性肺结节患者作为良性组,所有患者均经病理学检查确诊,比较两组患者影像学特征及CT双能量成像参数,进行肺结节病变性质的CT双能量成像征象、参数多因素分析,采用受试者工作特征(ROC)曲线分析CT双能量成像参数对肺结节病变性质的鉴别价值。结果:恶性组强化不均匀、淋巴结增大、结节边缘毛刺/分叶、血管受累患者占比高于良性组(P<0.05)。恶性组动脉期、静脉期能谱曲线斜率及容积CT剂量指数均高于良性组(P<0.05)。多因素Logistic回归分析结果显示,动脉期、静脉期能谱曲线斜率及容积CT剂量指数较高是肺结节恶性病变的危险因素(OR=1.451、1.502、1.640,P<0.05)。动脉期、静脉期能谱曲线斜率及容积CT剂量指数联合鉴别肺结节病变性质的曲线下面积(AUC)值高于三者单独检测(P<0.05)。结论:肺结节良性病变和恶性病变患者之间影像学特征、动脉期及静脉期能谱曲线斜率、容积CT剂量指数存在明显差异,且动脉期、静脉期能谱曲线斜率及容积CT剂量指数是肺结节恶性病变的危险因素,三者联合对肺结节病变性质的鉴别具有较好价值。

基于肺部CT生境模型预测表皮生长因子受体突变型肺腺癌脑转移

目的观察基于肺部CT生境模型预测表皮生长因子受体(EGFR)突变型肺腺癌脑转移(BM)的价值。方法回顾性分析198例EGFR突变型肺腺癌患者肺部平扫CT资料,按7∶3比例将其分为训练集(n=138)与测试集(n=60)并进一步划分BM亚组与非BM亚组。筛选训练集亚组间差异有统计学意义的变量构建逻辑回归(LR)临床模型;分别于瘤体及瘤体亚区提取特征,基于随机森林、高斯过程(GP)及支持向量机(SVM)算法构建影像组学及生境模型并筛选其中泛化能力最佳者,基于泛化能力最佳影像组学、生境模型及临床模型预测值构建LR联合模型;绘制受试者工作特征曲线,计算曲线下面积(AUC),评估各模型预测EGFR突变型肺腺癌BM的效能,以Spearman相关分析观察EGFR突变型肺腺癌Ki-67水平与生境特征的相关性。结果LR临床模型、GP影像组学模型、SVM生境模型及LR联合模型预测训练集EGFR突变型肺腺癌BM的AUC分别为0.700、0.726、0.801及0.834,在测试集分别为0.754、0.600、0.715及0.848。LR联合模型在训练集的AUC高于LR临床模型(P<0.001)、在测试集的AUC高于GP影像组学模型(P=0.010);其在训练集的效能相比GP影像组学模型及SVM生境模型均有显著正向提高[综合判别改善指数(IDI)=8.60%、8.55%,P均<0.001]。EGFR突变型肺腺癌Ki-67水平与生境图谱中的habitatmap_original_glszm_lalgle呈低度正相关(│rs│=0.201,P=0.004)。结论基于肺部CT生境模型可有效预测EGFR突变型肺腺癌BM。

肺癌脑转移患者早期死亡预测模型的构建与验证

目的构建并验证一个模型以预测肺癌脑转移(lung cancer with brain metastases,LCBM)患者确诊后三个月内死亡的风险。方法本研究纳入监测,流行病学和最终结果(Surveillance,Epidemiology and End Results,SEER)数据库内2010年1月至2015年12月期间确诊为LCBM的患者。以是否发生早期死亡为研究终点将患者分为早期死亡组和非早期死亡组。以8∶2为比例将数据分为训练集和验证集。在训练集上采用最小绝对值收缩和筛选算子(least absolute shrinkage and selection operator,LASSO)回归法筛选预测因子,并使用多因素Logistic回归构建预测模型并创建列线图。使用受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线和临床决策曲线(decision curve analysis,DCA)分别在训练集和验证集上评估模型性能。结果共纳入5035例患者,早期死亡发生率28.3%。LASSO回归筛选出13个变量,Logistic回归最终保留了13个与LCBM患者早期死亡相关的危险因素,包括年龄、从诊断到开始治疗时间、肿瘤大小、肿瘤部位、肿瘤分化程度和组织学类型、T分期、N分期、手术、放疗、化疗、肝转移和骨转移。验证集的一致性指数(concordance index,C-index)为0.84,校准曲线和DCA显示模型具有较好的预测效能和临床净效益。结论基于多因素Logistic回归构建的LCBM患者发生早期死亡的预测模型的区分度较好,能够为临床决策提供一定的帮助。

飞行时间和点扩散函数对18F-FDGPET/CT肺癌纵隔淋巴结转移的增益价值

目的探讨飞行时间(TOF)和点扩散函数(PSF)重建对18F-FDGPET/CT显像肺癌纵隔淋巴结转移的增益价值。资料与方法回顾性分析2020年3月9日—2021年7月23日在佛山市第一人民医院行PET/CT检查的肺癌纵隔淋巴结转移患者68例。分别采用有序子集最大期望值迭代法(OSEM)、OSEM+TOF、OSEM+PSF、OSEM+TOF+PSF重建图像,比较不同重建算法对肺癌纵隔淋巴结转移病灶的分辨能力,以及病灶信噪比(SNR)和标准化摄取值(SUV)的差异。结果使用OSEM+TOF+PSF重建可获得病灶SUVmax、SUVmean和SNR的最高值,与常规OSEM比较分别增加了21.99%、22.86%和60.14%(t=28.321、19.11、11.059,P均<0.01);其差异百分比在直径≤22 mm的较小病灶中明显大于直径>22 mm的较大病灶(24.1%比21.1%、25.3%比19.3%、70.6%比63.3%;Z=-3.658、-4.313、-2.154,P均<0.05),在SNR≤15.31的低对比度病灶中明显大于SNR>15.31的高对比度病灶(23.6%比21.4%、25.3%比21.1%、85.7%比46.0%;Z=-3.519、-2.336、-5.106,P均<0.05);在不同重建算法的病灶可检测性评价结果中,OSEM+TOF+PSF图像对纵隔淋巴结转移病灶的显示最清晰,其中87.4%的病灶为明确存在,显著高于OSEM图像的73.1%(χ^(2)=11.704,P=0.001),但OSEM+PSF图像中病灶明确存在的比例与OSEM比较并未显著增加(73.1%比75.8%;χ^(2)=0.361,P=0.548)。结论TOF和PSF结合能显著提高肺癌纵隔淋巴结转移病灶的探测能力,以及病灶SNR和SUV,尤其在小病灶和低对比度病灶中更为显著。