Potential value of detection of minimal residual disease in colorectal cancer following radical resection

Although there has been significant advancement in the identification and management of colorectal cancer(CRC)in recent years,there is still room for improvement in the current standard treatment regimen.One area of concern is the lack of reliable tumor markers to predict treatment efficacy and guide tailored care.Due to its dynamic,effective,and non-invasive benefits over tissue biopsy,the detection of minimal or molecular residual lesions(MRD)based on circulating tumor DNA(ctDNA)is beneficial to the clinical development of drugs for patients with CRC after radical treatment,as well as for continuous monitoring of tumor recurrence and malignancy molecular gene evolution.The detection of ctDNA can currently be used to guide individual postoperative auxiliary treatment decisions(upgrade or downgrade treatment)in CRC,stratify the risk of clinical recurrence more precisely,and predict the risk of recurrence in advance of imaging examination,according to a large number of observational or prospective clinical studies.With increasing clarity comes the possibility of selecting a regimen of treatment based on postoperative ctDNA,which also improves the accuracy of clinical recurrence risk assessment for CRC.Therefore,it is anticipated that the identification of ctDNA would alter the current framework for dealing with CRC and lead to individualized,stratified precision therapy;however,additional confirmation will require subsequent high-quality,prospective,large-scale randomized controlled studies.This article will provide an overview of the definition and clinical significance of MRD,the primary indications and technological challenges for MRD detection,along with the advancement in clinical research about ctDNA detection following radical resection of the CRC.

Residue substitution enhances the immunogenicity of neoepitopes from gastric cancers

Objective:Neoantigens arising from gene mutations in tumors can induce specific immune responses,and neoantigen-based immunotherapies have been tested in clinical trials.Here,we characterized the efficacy of altered neoepitopes in improving immunogenicity against gastric cancer.Methods:Raw data of whole-exome sequencing derived from a patient with gastric cancer were analyzed using bioinformatics methods to identify neoepitopes.Neoepitopes were modified by P1Y(the first amino acid was replaced by tyrosine)and P2L(the second amino acid was replaced by leucine).T2 binding and stability assays were used to detect the affinities between the neoepitopes and the HLA molecules,as well as the stabilities of complexes.Dendritic cells(DCs)presented with neoepitopes stimulated naïve CD8+T cells to induce specific cytotoxic T lymphocytes.ELISA and carboxyfluorescein succinimidyl ester were used to detect IFN-γand TNF-αlevels,and T cell proliferation.Perforin was detected by flow cytometry.The cytotoxicity of T cells was determined using the lactate dehydrogenase assay.Results:Bioinformatics analysis,T2 binding,and stability assays indicated that residue substitution increased the affinity between neoepitopes and HLA molecules,as well as the stabilities of complexes.DCs presented with altered neoepitopes stimulated CD8+T cells to release more IFN-γand had a greater effect on promoting proliferation than wild-type neoepitopes.CD8+T cells stimulated with altered neoepitopes killed more wild-type neoepitope-pulsed T2 cells than those stimulated with wild-type neoepitopes,by secreting more IFN-γ,TNF-α,and perforin.Conclusions:Altered neoepitopes exhibited greater immunogenicity than wild-type neoepitopes.Residue substitution could be used as a new strategy for immunotherapy to target neoantigens.

Can trastuzumab emtansine be replaced by additional chemotherapy plus targeted therapy for HER2-overexpressing breast cancer patients with residual disease after neoadjuvant chemotherapy?

Human epidermal growth factor receptor 2(HER2)-overexpressing breast cancer is an aggressive phenotype with a poor prognosis,and can easily metastasize and recur.Currently,chemotherapy plus HER2-targeted therapy is the standard systemic treatment for most of these patients.Given that neoadjuvant chemotherapy(NAC)has an efficacy equivalent to that of adjuvant chemotherapy and some additional benefits,many patients,especially those with more advanced tumors,prefer NAC and generally will not receive additional chemotherapy after surgery,irrespective of the pathological response.However,achieving pathological complete response to NAC is strongly correlated with prognosis,especially in triple-negative and HER2-overexpressing breast cancer.Therefore,postoperative treatment of these patients with residual diseases should be optimized to achieve favorable outcomes.The CREATE-X study has confirmed that additional chemotherapy can improve the outcomes of patients with HER2-negative residual disease after NAC.In addition,chemotherapy plays an indispensable role in the treatment of patients who receive surgery directly or who have recurrent lesions.Therefore,can additional chemotherapy improve prognosis of patients with HER2-overexpressing residual breast cancer?At present,no studies have compared the efficacy of additional chemotherapy plus trastuzumab with that of anti-HER2 therapy alone in residual cancer.The KATHERINE study revealed that trastuzumab emtansine(T-DM1)can reduce the risk of recurrence or death by 50%compared with trastuzumab in patients with HER2-positive residual invasive breast cancer after neoadjuvant therapy.T-DM1 is an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine,and thus,to an extent,T-DM1 is equivalent to simultaneous application of chemotherapy and targeted therapy.However,high cost and low accessibility limit its use especially in low-and middle-income countries and regions.Hence,we proposed this perspective that additional chemotherapy plus trastuzumab should be given to HER2-overexpressing breast cancer patients with residual disease after NAC to improve their prognosis by discussing that the efficacy of additional chemotherapy plus trastuzumab is superior to that of anti-HER2 therapy alone and not inferior to T-DM1.Additional chemotherapy plus trastuzumab-based HER2-targeted therapy can be used as an alternative regimen to T-DM1 when T-DM1 is unavailable.However,further clinical research on the selection of chemotherapeutic agents is warranted.

Esophageal intramural pseudodiverticulosis of the residual esophagus after esophagectomy for esophageal cancer

A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer(T3N2M0 Stage Ⅲ) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation,including redness,erosion,edema,bleeding,friability,and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine,gastrografinfilled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly,endoscopic balloon dilatation was performed and antifungal therapy was started in the hospital. Seven weeks later,endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently,the patient was discharged. At the latest follow-up,the patient was symptomfree and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.

Prognostic relevance of minimal residual disease in colorectal cancer

Presence of occult minimal residual disease in patients with colorectal cancer(CRC)has a strong prognostic impact on survival.Minimal residual disease plays a major role in disease relapse and formation of metastases in CRC.Analysis of circulating tumor cells(CTC)in the blood is increasingly used in clinical practice for disease monitoring of CRC patients.In this review article the role of CTC,disseminated tumor cells(DTC)in the bone marrow and micrometastases and isolated tumor cells(ITC)in the lymph nodes will be discussed,including literature published until September 2013.Occult disease is a strong prognostic marker for patient survival in CRC and defined by the presence of CTC in the blood,DTC in the bone marrow and/or micrometastases and ITC in the lymph nodes.Minimal residual disease could be used in the future to identify patient groups at risk,who might benefit from individualized treatment options.

Coexisting opportunities and challenges:In which scenarios can minimal/measurable residual disease play a role in advanced non-small cell lung cancer?

Curative therapy was not previously available for patients with advanced non-small cell lung cancer(NSCLC);thus,the concept of minimal/measurable(or molecular)residual disease(MRD)was not applicable to these patients.However,advances in targeted and immunotherapy have revolutionized the treatment landscape for patients with advanced NSCLC,with emerging evidence of long-term survival and even the hope of complete remission(CR)by imaging examination.The latest research shows that patients with oligometastatic lung cancer can benefit from local treatment.After removing the lesions,the choice of follow-up therapy and monitoring of the lesions could remain uncertain.MRD plays a role in identifying early-stage NSCLC patients with high risks of recurrence and determining adjuvant therapy after radical treatment.In recent years,evidence has been accumulating regarding the use of circulating cell-free tumor DNA(ctDNA)to assess MRD in solid tumors.This study discussed the possible applications of ctDNA-based MRD monitoring in advanced NSCLC and described the current challenges and unresolved problems in the application of MRD in advanced NSCLC.

Photodynamic therapy as salvage therapy for residual microscopic cancer after ultra-low anterior resection: A case report

BACKGROUND The rate of positive resection margins(R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy(PDT) as a remedial treatment for esophageal cancer.Colorectal cancer and esophageal cancer has many similarities,however,PDT as a salvage therapy for rectal cancer is rare.CASE SUMMARY Here,we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia,which had been aggravated for 1 mo. Colonoscopy revealed a 3 × 4 cm ulcerated mass in the rectum 4 cm from the anus.Preoperative pathological examination showed villous adenoma,moderate-tohigh-grade dysplasia,good differentiation,and invasion of the mucosal muscle.The patient had R1 after ultra-low anterior resection,but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately,the patient underwent PDT to remove R1. After five years of follow-up,there was no liver function impairment,recurrence,metastasis,sexual dysfunction,or abnormal defecation function.CONCLUSION This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.

Could Sequential Residual Centering Resolve Low Sensitivity in Moderated Regression? Simulations and Cancer Symptom Clusters

Multicollinearity constitutes shared variation among predictors that inflates standard errors of regression coefficients. Several years ago, it was proven that the common practice of mean centering in moderated regression cannot alleviate multicollinearity among variables comprising an interaction, but merely masks it. Residual centering (orthogonalizing) is unacceptable because it biases parameters for predictors from which the interaction derives, thus precluding interpretation of moderator effects. I propose and validate residual centering in sequential re-estimations of a moderated regression—sequential residual centering (SRC)—by revealing unbiased multicollinearity conditioning across the interaction and its related terms. Across simulations, SRC reduces variance inflation factors (VIF) regardless of distribution shape or pattern of regression coefficients across predictors. For any predictor, the reduced VIF is used to derive a lower standard error of its regression coefficient. A cancer sample illustrates SRC, which allows unbiased interpretations of symptom clusters. SRC can be applied efficiently to alleviate multicollinearity after data collection and shows promise for advancing synergistic frontiers of research.

Why is endosonography insufficient for residual diagnosis after neoadjuvant therapy for esophageal cancer?Solutions using muscle layer evaluation

BACKGROUND The diagnosis of residual tumors using endoscopic ultrasound(EUS)after neoadjuvant therapy for esophageal cancer is considered challenging.However,the reasons for this difficulty are not well understood.AIM To investigate the ultrasound imaging features of residual tumors and identify the limitations and potential of EUS.METHODS This exploratory prospective observational study enrolled 23 esophageal squamous cell carcinoma patients receiving esophagectomy after neoadjuvant therapy[15 patients after neoadjuvant chemotherapy(NAC)and 8 patients after chemoradiotherapy(CRT)]at the Department of Surgery,Chiba University Hospital,between May 2020 and October 2021.We diagnosed the T stage for specimens using ultrasound just after surgery and compared ultrasound images with the cut surface of the fixed specimens of the same level of residual tumor.The ratio of esophageal muscle layer defect measured by ultrasound was compared with clinicopathological factors.Furthermore,the rate of reduction for the muscle layer defect was evaluated using EUS images obtained before and after neoadjuvant therapy.RESULTS The accuracy of T stage rate was 61%(n=14/23),which worsened after CRT(38%,n=3/8)than after NAC(73%,n=11/15)because of overstaging.Moreover,pT0 could not be diagnosed in all cases.The detection rate of residual tumor for specimens using ultrasound retrospectively was 75%(n=15/20).There was no correlation between after-NAC(79%,n=11/14)and after-CRT(67%,n=4/6)detection rate.The detection of superficial and submucosal types was poor.The pathologic tumor size and pathological response were correlated.Tumor borders were irregular and echogenicity was mixed type after CRT.There was a correlation between the pT stage(pT0/1 vs pT2/3)and the length of muscle layer circumference(P=0.025),the length of muscle layer defect(P<0.001),and the ratio of muscle layer defect(P<0.001).There was also a correlation between the pT stage and the rate of muscle layer defect reduction measured by EUS(P=0.001).CONCLUSION Compared to pathological images,some tumors are undetectable by ultrasound.Focusing on the esophageal muscle layer might help diagnose the depth of the residual tumor.

进展期胃癌生存预测:基于增强CT深度学习模型的构建

目的:探讨基于术前增强CT构建的深度学习(DL)模型对进展期胃癌(AGC)1、2、3年生存概率的预测价值。方法:回顾性分析2013年1月-2015年12月在本院经病理证实为AGC的337例患者的临床和CT资料。按照7:3的比例将患者随机分为训练集(n=237)和验证集(n=100)。采用数据增强技术增加训练集的数据量,随后基于术前CT增强静脉期图像构建残差卷积神经网络结构的DL模型,预测AGC患者1、2、3年的生存概率。经Cox单因素及多因素分析构建临床模型,然后联合DL模型和临床模型构建综合模型并绘制其诺莫图。计算各模型的Harrel一致性指数(C-index)和风险比(HR),并应用Kaplan-Meier曲线、校准曲线及临床决策曲线比较3种模型对OS的预测效能。结果:在训练集和验证集中,临床模型、DL模型和综合模型的C-index值分别为0.70(95%CI:0.65~0.75)、0.72(95%CI:0.67~0.76)、0.74(95%CI:0.69~0.78)和0.64(95%CI:0.56~0.71)、0.66(95%CI:0.58~0.73)、0.67(95%CI:0.59~0.74),表明综合模型具有最优的生存期预测能力;三个模型的HR分别为2.72(95%CI:2.06~4.02)、2.88(95%CI:1.89~4.39)、2.72(95%CI:2.13~3.49)和2.11(95%CI:1.43~3.11)、4.32(95%CI:1.66~11.24)、1.89(95%CI:1.36~2.60),均以DL模型的HR最高,表明DL模型预测的高危人群具有更高的死亡风险。校准曲线分析显示基于综合模型的诺莫图预测AGC患者1、2、3年生存概率与实际的预后随访结果具有较高的一致性。临床决策曲线显示综合模型的净收益优于其它2种模型。结论:基于CT增强静脉期图像利用残差卷积神经网络构建的DL模型是一种良好的AGC患者生存风险评估模型,对AGC患者生存期的早期预判具有较高的临床应用价值。

复发性卵巢癌患者术后血清CA125、D-D水平及残留病灶大小对无瘤生存期的影响

目的 探讨复发性卵巢癌患者术后血清糖链抗原125(CA125)、D-二聚体(D-D)水平及残留病灶大小对无瘤生存期的影响。方法 回顾性分析50例复发性卵巢癌患者的临床资料,随访并记录无瘤生存期。统计患者一般资料及术后血清CA125、D-D水平,分析无瘤生存期影响因素;以Pearson相关系数分析术后CA125、D-D水平及残留病灶大小与无瘤生存期的相关性。结果 不同临床分期、分化程度、化疗疗程、CA125、D-D水平及残留病灶大小的患者无瘤生存期比较,差异有统计学意义(P<0.05);COX回归分析显示,术前临床分期、术后CA125水平、术后D-D水平及术后残留病灶大小是复发性卵巢癌患者无瘤生存期的独立影响因素(P<0.05);Pearson相关性分析显示,术后CA125、D-D水平及残留病灶大小与无瘤生存期均呈负相关(P<0.05)。结论 复发性卵巢癌患者术后CA125、D-D水平及残留病灶大小是影响其无瘤生存期的重要因素。

肿瘤检测个体化和精准化的探索与思考——评早期肺癌头对头对比MRD检测策略的MEDAL研究

1文献来源Chen K,Yang F,Shen H,et al.Individualized tumor⁃informed circulating tumor DNA analysis for postoperative monitoring of non⁃small cell lung cancer[J].Cancer Cell,2023,41(10):1749-1762.e6.

舒更葡糖钠对胸腔镜肺癌根治术后患者肌松恢复及凝血功能的影响

目的探讨舒更葡糖钠注射液对胸腔镜肺癌根治术后患者肌松恢复及凝血功能的影响。方法选取2020年2月至2022年1月在江苏大学附属镇江三院、常州市第七人民医院于全麻下行胸腔镜肺癌根治术的86例患者为研究对象。应用随机数字表法将患者分成A、B两组,每组各43例。两组麻醉诱导和术中全麻维持方案相同,使用肌松监测仪(TOF)监测肌松。手术结束后,TOF计数≥2时,A组静脉推注新斯的明(2 mg/kg)、阿托品(0.5 mg/kg)逆转肌松药,B组静脉推注舒更葡糖钠(2 mg/kg)。记录推注肌松拮抗药后5、15、30 min时肌松残余率。观察注射罗库溴铵后5 min(T0)、推注肌松拮抗药后5 min(T1)、15 min(T2)、30 min(T3)时血浆凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平。同时记录气管导管拔除时间及患者发生恶心、呕吐等情况。结果A组给予肌松拮抗药5、15 min后肌松残余率明显高于B组(100.00%vs 13.95%,65.12%vs 0.00%)(χ^(2)=64.939、41.517,P<0.01)。两组患者在相同时间点TT、APTT、PT、FIB指标差异均无统计学意义(P均>0.05)。B组气管导管拔管时间[(3.8±1.1)min]短于A组[(13.9±4.3)min],差异有统计学意义(t=14.922,P<0.001);B组呼吸抑制发生率低于A组(0.00%vs 11.63%)(χ^(2)=5.309,P=0.021)。结论舒更葡糖钠注射液用于胸腔镜肺癌根治术患者,可快速拮抗罗库溴铵的肌松作用,降低肌松残余发生率,缩短气管导管拔管时间,利于患者术后康复。

动态监测ctDNA⁃MRD预测局部晚期NSCLC放化疗疗效

1文献来源Pan Y,Zhang JT,Gao X,et al.Dynamic circulating tumor DNA during chemoradiotherapy predicts clinical outcomes for locally advanced non⁃small cell lung cancer patients[J].Cancer Cell,2023,41(10):1763-1773.e4.2证据水平2b。

血清miR-155、miR-24检测对宫颈癌同步放化疗后肿瘤残留的早期预测价值

目的分析血清miR-155、miR-24表达水平对宫颈癌同步放化疗(CCRT)后肿瘤残留的早期预测价值。方法回顾性选取行CCRT治疗的宫颈癌患者300例为研究对象,按照7∶3的分配比例分为建模组210例和验证组90例。建模组患者根据术后MRI结果分为残留组81例与非残留组129例。收集建模组患者CCRT前临床基线资料与实验室检验指标,筛选独立影响因素,构建宫颈癌CCRT后早期肿瘤残留列线图预测模型,并通过验证组资料收集配合完成预测模型的验证与价值分析。结果宫颈癌患者血清miR-155、宫旁浸润、FIGO分期是影响患者CCRT后早期肿瘤残留的独立危险因素,血清miR-24是影响患者CCRT后早期肿瘤残留的独立保护因素(OR分别=1.77、3.22、8.55、0.18,P均<0.05)。基于以上独立影响因素构建了宫颈癌CCRT后早期肿瘤残留预测模型。建模组ROC曲线下面积(AUC)为0.84(95%CI:0.79~0.89),区分度良好;验证组ROC曲线AUC为0.90(95%CI:0.81~0.98)。内、外部校准曲线与标准曲线均有较好贴合度。内、外部决策曲线显示模型能提供显著的临床净收益。结论血清miR-155、miR-24表达水平对宫颈癌CCRT后早期肿瘤残留具有良好的预测价值,结合宫旁浸润、FIGO分期等临床特征构建列线图预测模型可为早期肿瘤残留高风险患者的有效筛选提供数据支持。

多尺度特征融合的改进残差网络乳腺癌病理图像分类

现有模型病理特征提取不充分以及开源数据集各类型数量不平衡等问题,使得乳腺癌病理图像的多分类研究仍具挑战性。本研究提出了一种多尺度特征融合的改进残差网络乳腺癌病理图像多分类方法。首先,以ResNet101残差网络作为基础,将CBAM注意力模块插入到每一个残差块中;接着,为了优化特征提取,将横向和纵向的多尺度特征融合集成到残差网络中;最后,引入焦点损失函数以解决数据分配不平衡问题。经BreakHis公开数据集混合放大倍数1582张病理图像训练验证,所提出的改进残差网络在乳腺癌病理图像八分类上的识别准确率为94.4%,较原始模型提升2.8%,优于大多数已有公开深度学习模型。该模型的提出为女性乳腺癌的筛查诊断和病理分类提供了更为有效的方法。

基于相似网络融合算法的癌症亚型预测

从基因表达数据中挖掘基因之间的相互作用关系,构建基因调控网络,是生物信息学中重要的研究课题之一。但目前流行的神经网络在其架构中仅考虑基因之间的交互和关联,不考虑患者之间的交互和关联。为此,提出了一种基于加权基因相似网络和样本相似网络融合算法的癌症亚型预测模型,即WGCSS(Weighted Genetic Correlation network and Sample Similarity network)。该方法实现了特征空间和样本空间信息的融合,同时考虑了基因之间和样本之间的相互作用关系,并使用图卷积网络进行预测。在两个空间中聚合信息会导致严重的过度平滑问题,为此在该模型中引入残差层以缓解过度平滑问题。该方法通过聚合两个空间中的数据信息,可以使得癌症亚型预测的结果更加准确。为了验证方法的泛化性能,使用了乳腺浸润癌(BRCA)、多形性胶质母细胞瘤(GBM)和肺癌(LUNG)数据集进行分析,由此产生的高分类精度结果可以表明该方法的优越性。另外,还对3类数据集进行了生存分析,证明该方法在3个癌症数据集上癌症亚型的生存曲线存在显著差异。

基于Ghost卷积的高级别浆液性卵巢癌复发预测方法

高级别浆液性卵巢癌是一种恶性肿瘤疾病,进行术前复发预测能帮助临床医生为患者提供个性化治疗方案,降低病人的死亡率。因该疾病的医学数据较少且难以获取,导致其深度学习模型难以得到充分的训练,复发预测准确率有待提高。针对此问题,本文设计了一种改进的低参数残差网络TGE-ResNet34,以ResNet34为主干网络,将传统卷积模块用Ghost卷积代替,完成病灶区特征的提取,降低模型的参数量,在2个Ghost卷积之间融入ECA(Efficient Channel Attention)注意力机制,抑制无用特征提取的干扰,最后通过5折交叉验证模型,避免数据随机划分的偶然性。实验结果表明,改进设计的TGE-ResNet34网络准确率为96.01%,相比原基线网络准确率提高4.52个百分点,参数量减少15.98 M。

凯格尔运动辅助经皮低频电刺激在中老年保留神经的宫颈癌根治术后留置导尿管患者中的临床应用

目的观察凯格尔运动辅助经皮低频电刺激对缩短保留神经的宫颈癌根治术后留置导尿管时间的影响。方法选择2022年5月—2023年3月于复旦大学附属肿瘤医院收治中老年行保留神经的宫颈癌根治术患者42例,采用随机数字表法分为试验组和对照组,每组21例。对照组采用常规导尿管护理联合凯格尔运动干预,试验组采用在与对照组相同干预的基础上加用经皮低频电刺激干预,2组均干预1周。观察并比较2组干预前后残余尿量、导尿管拔除后重新插入率、术后导尿管留置天数、初次排尿时膀胱容量(FD)、膀胱顺应性(BC)、最大膀胱测压容量(MCC)。结果干预后,试验组残余尿量低于对照组[(35.11±6.06)mL vs(46.27±8.14)mL,P<0.05];试验组拔管后导尿管重插率显著低于对照组(19.05%vs 52.38%,P<0.05);试验组术后导尿管留置时间少于对照组[(6.09±1.37)d vs(11.35±2.85)d,P<0.05];试验组BC、MCC值低于对照组,而FD值高于对照组(P<0.05)。结论凯格尔运动辅助经皮低频电刺激可改善保留神经的宫颈癌根治术后患者的排尿功能,减少患者残余尿量及导尿管留置时间,降低拔管后重插率,具有一定的临床应用价值。

超声造影检查对肝癌患者微波消融治疗后局部残余及复发的评估价值

目的探讨超声造影(CEUS)检查对肝癌患者微波消融(MWA)治疗后局部残余及复发的评估价值。方法选取86例行MWA治疗的肝癌患者,分别于术前、术后1个月进行CEUS检查,以临床综合诊断结果为金标准,分析CEUS检查对肝癌患者MWA治疗后局部残余的评估价值。术后随访1年,根据复发情况将患者分为复发组(n=27)和未复发组(n=59),比较两组患者的临床特征,采用Logistic回归模型分析肝癌患者MWA治疗后复发的影响因素。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析峰值强度(PI)、达峰时间(TTP)单独及联合检测对肝癌患者MWA治疗后复发的评估价值。结果临床综合诊断结果显示,117个病灶中,完全消融91个,局部残余26个;CEUS检查结果显示,完全消融87个,局部残余30个。CEUS检查评估肝癌患者MWA治疗后局部残余的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为84.62%、91.21%、89.74%、73.33%、95.40%。复发组中边界不清晰、形态不规则、肿瘤最大径>3 cm的患者比例及PI均高于未复发组,TTP、到达时间(AT)均短于未复发组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,肿瘤最大径>3 cm、PI升高均是肝癌患者MWA治疗后复发的独立危险因素(P<0.01),TTP升高是肝癌患者MWA治疗后复发的独立保护因素(P<0.01)。ROC曲线显示,PI、TTP联合检测评估肝癌患者MWA治疗后复发的AUC、灵敏度及特异度均高于二者单独检测。结论CEUS检查对肝癌患者MWA治疗后局部残余及复发具有较高的评估价值,值得临床推广应用。