BACKGROUND Liver metastasis(LM)remains a major cause of cancer-related death in patients with pancreatic cancer(PC)and is associated with a poor prognosis.Therefore,identifying the risk and prognostic factors in PC pa...BACKGROUND Liver metastasis(LM)remains a major cause of cancer-related death in patients with pancreatic cancer(PC)and is associated with a poor prognosis.Therefore,identifying the risk and prognostic factors in PC patients with LM(PCLM)is essential as it may aid in providing timely medical interventions to improve the prognosis of these patients.However,there are limited data on risk and prognostic factors in PCLM patients.AIM To investigate the risk and prognostic factors of PCLM and develop corresponding diagnostic and prognostic nomograms.METHODS Patients with primary PC diagnosed between 2010 and 2015 were reviewed from the Surveillance,Epidemiology,and Results Database.Risk factors were identified using multivariate logistic regression analysis to develop the diagnostic mode.The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors needed to develop the prognostic model.The performance of the two nomogram models was evaluated using receiver operating characteristic(ROC)curves,calibration plots,decision curve analysis(DCA),and risk subgroup classification.The Kaplan-Meier method with a logrank test was used for survival analysis.RESULTS We enrolled 33459 patients with PC in this study.Of them,11458(34.2%)patients had LM at initial diagnosis.Age at diagnosis,primary site,lymph node metastasis,pathological type,tumor size,and pathological grade were identified as independent risk factors for LM in patients with PC.Age>70 years,adenocarcinoma,poor or anaplastic differentiation,lung metastases,no surgery,and no chemotherapy were the independently associated risk factors for poor prognosis in patients with PCLM.The C-index of diagnostic and prognostic nomograms were 0.731 and 0.753,respectively.The two nomograms could accurately predict the occurrence and prognosis of patients with PCLM based on the observed analysis results of ROC curves,calibration plots,and DCA curves.The prognostic nomogram could stratify patients into prognostic groups and perform well in internal validation.CONCLUSION Our study identified the risk and prognostic factors in patients with PCLM and developed corresponding diagnostic and prognostic nomograms to help clinicians in subsequent clinical evaluation and intervention.External validation is required to confirm these results.展开更多
The incidence rate of pancreatic neuroendocrine neoplasms （pNENs） has increased rapidly in recent years. However, the clinicopathological characteristics of pNENs are poorly understood. Medical records of patients w...The incidence rate of pancreatic neuroendocrine neoplasms （pNENs） has increased rapidly in recent years. However, the clinicopathological characteristics of pNENs are poorly understood. Medical records of patients who underwent surgery and were confirmed as pNENs by pathological examination from January 2003 to February 2015 in Qilu Hospital were reviewed retrospectively. A total of 100 patients, 36 males and 64 females, were included with a mean operation age of 46.26 ± 13.41 years. Among the 100 cases, 76 had insulinomas and 24 had non-functional pNENs. Tumor size ranged from 0.5 cm to 9 cm, and the mean size was 2.20 ± 1.40 cm. The percentages of TNM stages I, II, III, and IV tumors were 89.0%, 8.0%, 0.0%, and 3.0%, respectively. Based on the WHO classification, pNENs were classified into three grades： G1, G2, and G3. G1, G2, and G3 tumors were confirmed in 72.9%, 23.7%, and 3.4% patients, respectively. The positive rates of CgA and Syn immunohisto- chemical staining were 94.5% （69/73） and 100% （74/74）, respectively. Compared with insulinoma, non-functional pNENs have larger tumor sizes, more advanced TNM staging, a higher Ki-67 index, and a higher rate of liver metastasis （P 〈 0.05）. In conclusion, pNENs are heterogeneous tumors with varying clinical manifestations, diverse tumor biological characteristics, and different prognoses. Non-functional pNENs present a more aggressive behavioral model and have poorer prognosis than functional pNENs.展开更多
BACKGROUND Hepatic solitary fibrous tumor(SFT)is a rare neoplasm.Up to now,only 90 cases have been reported in the English language literature.This report describes a case of SFT of the liver misdiagnosed as hepatocel...BACKGROUND Hepatic solitary fibrous tumor(SFT)is a rare neoplasm.Up to now,only 90 cases have been reported in the English language literature.This report describes a case of SFT of the liver misdiagnosed as hepatocellular carcinoma.CASE SUMMARY A 42-year-old male had a two-year history of a gradually enlarging intrahepatic nodule.The preoperative imaging revealed a mass with a size of 2.7 cm×2.3 cm located in the segment IV of the liver.The patient was subjected to the resection of the segment IV,such as the medial segment of the left lobe of the liver.The histological examination of the mass showed various spindled cells irregularly arranged in the stroma.The immunohistochemistry of this mass revealed a positive staining for CD34 and STAT6.The history of intracranial tumor and postoperative pathological results led to the diagnosis of SFT of the liver(SFTL)due to a metastasis from the brain.CONCLUSION SFTL is an uncommon mesenchymal neoplasm that can be easily overlooked or misdiagnosed.The best treatment choice is the complete surgical resection of the mass.A regular follow-up after the surgery should be performed due to the poor prognosis of metastatic or recurrent SFT.展开更多
Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit t...Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.展开更多
胰腺癌肝转移(pancreatic cancer with liver metastases,PCLM)为临床难治性恶性肿瘤,其起病隐匿、进展迅速、预后极差,仅极少数患者具有手术机会。全身化疗为主要治疗手段,FOLFIRINOX方案(氟尿嘧啶、奥沙利铂、伊立替康和亚叶酸钙)已...胰腺癌肝转移(pancreatic cancer with liver metastases,PCLM)为临床难治性恶性肿瘤,其起病隐匿、进展迅速、预后极差,仅极少数患者具有手术机会。全身化疗为主要治疗手段,FOLFIRINOX方案(氟尿嘧啶、奥沙利铂、伊立替康和亚叶酸钙)已成为体能状况良好的PCLM患者的一线化疗方案。以吉西他滨为基础的化疗仍居重要地位,其中吉西他滨联合白蛋白结合型紫杉醇凸显优势,成为PCLM一线化疗的新标准。吉西他滨联合分子靶向治疗的研究暂无新的突破。全身化疗联合经动脉灌注化疗栓塞(transcatheter arterial chemoembolization,TACE)有可能改善PCLM患者的生存率,尚需进一步开展前瞻性的随机对照临床试验加以证实。射频消融(radio frequency ablation,RFA)、近距离放疗栓塞术等尚处探索阶段。基于化疗、放疗与中草药的多学科综合治疗模式方兴未艾。本文就PCLM的治疗进展进行综述。展开更多
目的：评价立体定向放疗在肝转移癌治疗中的临床价值及不良反应。方法42例在该科进行钴60立体定向放疗的肝转移癌患者（转移病灶小于或等于3个，单个病灶小于或等于5 cm ），50％等剂量曲线包绕靶区，每次3．5～4．5 Gy ，共10次。统计...目的：评价立体定向放疗在肝转移癌治疗中的临床价值及不良反应。方法42例在该科进行钴60立体定向放疗的肝转移癌患者（转移病灶小于或等于3个，单个病灶小于或等于5 cm ），50％等剂量曲线包绕靶区，每次3．5～4．5 Gy ，共10次。统计分析其中位生存期、局部控制率、并发症及放射性肝损伤。结果全组患者中位生存期为7．9月，完全缓解2例，部分缓解27例，局部控制率为69％，无一例发生重度放射性肝损伤。结论立体定向放疗是治疗肝转移癌的安全、有效手段。展开更多
文摘BACKGROUND Liver metastasis(LM)remains a major cause of cancer-related death in patients with pancreatic cancer(PC)and is associated with a poor prognosis.Therefore,identifying the risk and prognostic factors in PC patients with LM(PCLM)is essential as it may aid in providing timely medical interventions to improve the prognosis of these patients.However,there are limited data on risk and prognostic factors in PCLM patients.AIM To investigate the risk and prognostic factors of PCLM and develop corresponding diagnostic and prognostic nomograms.METHODS Patients with primary PC diagnosed between 2010 and 2015 were reviewed from the Surveillance,Epidemiology,and Results Database.Risk factors were identified using multivariate logistic regression analysis to develop the diagnostic mode.The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors needed to develop the prognostic model.The performance of the two nomogram models was evaluated using receiver operating characteristic(ROC)curves,calibration plots,decision curve analysis(DCA),and risk subgroup classification.The Kaplan-Meier method with a logrank test was used for survival analysis.RESULTS We enrolled 33459 patients with PC in this study.Of them,11458(34.2%)patients had LM at initial diagnosis.Age at diagnosis,primary site,lymph node metastasis,pathological type,tumor size,and pathological grade were identified as independent risk factors for LM in patients with PC.Age>70 years,adenocarcinoma,poor or anaplastic differentiation,lung metastases,no surgery,and no chemotherapy were the independently associated risk factors for poor prognosis in patients with PCLM.The C-index of diagnostic and prognostic nomograms were 0.731 and 0.753,respectively.The two nomograms could accurately predict the occurrence and prognosis of patients with PCLM based on the observed analysis results of ROC curves,calibration plots,and DCA curves.The prognostic nomogram could stratify patients into prognostic groups and perform well in internal validation.CONCLUSION Our study identified the risk and prognostic factors in patients with PCLM and developed corresponding diagnostic and prognostic nomograms to help clinicians in subsequent clinical evaluation and intervention.External validation is required to confirm these results.
基金This study was supported by the Shandong Provincial Natural Science Foundation, China （No. ZR2013HQ049）.
文摘The incidence rate of pancreatic neuroendocrine neoplasms （pNENs） has increased rapidly in recent years. However, the clinicopathological characteristics of pNENs are poorly understood. Medical records of patients who underwent surgery and were confirmed as pNENs by pathological examination from January 2003 to February 2015 in Qilu Hospital were reviewed retrospectively. A total of 100 patients, 36 males and 64 females, were included with a mean operation age of 46.26 ± 13.41 years. Among the 100 cases, 76 had insulinomas and 24 had non-functional pNENs. Tumor size ranged from 0.5 cm to 9 cm, and the mean size was 2.20 ± 1.40 cm. The percentages of TNM stages I, II, III, and IV tumors were 89.0%, 8.0%, 0.0%, and 3.0%, respectively. Based on the WHO classification, pNENs were classified into three grades： G1, G2, and G3. G1, G2, and G3 tumors were confirmed in 72.9%, 23.7%, and 3.4% patients, respectively. The positive rates of CgA and Syn immunohisto- chemical staining were 94.5% （69/73） and 100% （74/74）, respectively. Compared with insulinoma, non-functional pNENs have larger tumor sizes, more advanced TNM staging, a higher Ki-67 index, and a higher rate of liver metastasis （P 〈 0.05）. In conclusion, pNENs are heterogeneous tumors with varying clinical manifestations, diverse tumor biological characteristics, and different prognoses. Non-functional pNENs present a more aggressive behavioral model and have poorer prognosis than functional pNENs.
基金Supported by National Natural Science Foundation of China,No.81770614.
文摘BACKGROUND Hepatic solitary fibrous tumor(SFT)is a rare neoplasm.Up to now,only 90 cases have been reported in the English language literature.This report describes a case of SFT of the liver misdiagnosed as hepatocellular carcinoma.CASE SUMMARY A 42-year-old male had a two-year history of a gradually enlarging intrahepatic nodule.The preoperative imaging revealed a mass with a size of 2.7 cm×2.3 cm located in the segment IV of the liver.The patient was subjected to the resection of the segment IV,such as the medial segment of the left lobe of the liver.The histological examination of the mass showed various spindled cells irregularly arranged in the stroma.The immunohistochemistry of this mass revealed a positive staining for CD34 and STAT6.The history of intracranial tumor and postoperative pathological results led to the diagnosis of SFT of the liver(SFTL)due to a metastasis from the brain.CONCLUSION SFTL is an uncommon mesenchymal neoplasm that can be easily overlooked or misdiagnosed.The best treatment choice is the complete surgical resection of the mass.A regular follow-up after the surgery should be performed due to the poor prognosis of metastatic or recurrent SFT.
基金supported by the National Natural Science Foundation of China(Grant number,82141127).
文摘Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.
文摘胰腺癌肝转移(pancreatic cancer with liver metastases,PCLM)为临床难治性恶性肿瘤,其起病隐匿、进展迅速、预后极差,仅极少数患者具有手术机会。全身化疗为主要治疗手段,FOLFIRINOX方案(氟尿嘧啶、奥沙利铂、伊立替康和亚叶酸钙)已成为体能状况良好的PCLM患者的一线化疗方案。以吉西他滨为基础的化疗仍居重要地位,其中吉西他滨联合白蛋白结合型紫杉醇凸显优势,成为PCLM一线化疗的新标准。吉西他滨联合分子靶向治疗的研究暂无新的突破。全身化疗联合经动脉灌注化疗栓塞(transcatheter arterial chemoembolization,TACE)有可能改善PCLM患者的生存率,尚需进一步开展前瞻性的随机对照临床试验加以证实。射频消融(radio frequency ablation,RFA)、近距离放疗栓塞术等尚处探索阶段。基于化疗、放疗与中草药的多学科综合治疗模式方兴未艾。本文就PCLM的治疗进展进行综述。
文摘目的：评价立体定向放疗在肝转移癌治疗中的临床价值及不良反应。方法42例在该科进行钴60立体定向放疗的肝转移癌患者（转移病灶小于或等于3个，单个病灶小于或等于5 cm ），50％等剂量曲线包绕靶区，每次3．5～4．5 Gy ，共10次。统计分析其中位生存期、局部控制率、并发症及放射性肝损伤。结果全组患者中位生存期为7．9月，完全缓解2例，部分缓解27例，局部控制率为69％，无一例发生重度放射性肝损伤。结论立体定向放疗是治疗肝转移癌的安全、有效手段。
