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Rectal Cancer Stages T2 and T3 Identification Based on Asymptotic Hybrid Feature Maps
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作者 Shujing Sun Jiale Wu +4 位作者 Jian Yao Yang Cheng Xin Zhang Zhihua Lu Pengjiang Qian 《Computer Modeling in Engineering & Sciences》 SCIE EI 2023年第10期923-938,共16页
Many existing intelligent recognition technologies require huge datasets for model learning.However,it is not easy to collect rectal cancer images,so the performance is usually low with limited training samples.In add... Many existing intelligent recognition technologies require huge datasets for model learning.However,it is not easy to collect rectal cancer images,so the performance is usually low with limited training samples.In addition,traditional rectal cancer staging is time-consuming,error-prone,and susceptible to physicians’subjective awareness as well as professional expertise.To settle these deficiencies,we propose a novel deep-learning model to classify the rectal cancer stages of T2 and T3.First,a novel deep learning model(RectalNet)is constructed based on residual learning,which combines the squeeze-excitation with the asymptotic output layer and new cross-convolution layer links in the residual block group.Furthermore,a two-stage data augmentation is designed to increase the number of images and reduce deep learning’s dependence on the volume of data.The experiment results demonstrate that the proposed method is superior to many existing ones,with an overall accuracy of 0.8583.Oppositely,other traditional techniques,such as VGG16,DenseNet121,EL,and DERNet,have an average accuracy of 0.6981,0.7032,0.7500,and 0.7685,respectively. 展开更多
关键词 rectal cancer staging T2WI images data expansion asymptotic output layer
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Prophylactic lateral pelvic lymph node dissection in stage Ⅳ low rectal cancer 被引量:6
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作者 Hiroshi Tamura Yoshifumi Shimada +13 位作者 Hitoshi Kameyama Ryoma Yagi Yosuke Tajima Takuma Okamura Mae Nakano Masato Nakano Masayuki Nagahashi Jun Sakata Takashi Kobayashi Shin-ichi Kosugi Hitoshi Nogami Satoshi Maruyama Yasumasa Takii Toshifumi Wakai 《World Journal of Clinical Oncology》 CAS 2017年第5期412-419,共8页
AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent p... AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis. 展开更多
关键词 PROPHYLACTIC LATERAL PELVIC LYMPH node dissection stage Low rectal cancer
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Radical treatment of stage Ⅳ pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation 被引量:10
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作者 Ji-Bing Chen Jia-Liang Li +8 位作者 Li-Hua He Wei-Qun Liu Fei Yao Jian-Ying Zeng Yi Zhang Ke-Qiang Xu Li-Zhi Niu Jian-Sheng Zuo Ke-Cheng Xu 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第47期7056-7062,共7页
AIM:To investigate the therapeutic effect of radical treatment and palliative treatment in stage Ⅳ pancreatic cancer patients.METHODS:81 patients were enrolled in the study.Radical treatment was performed on 51 patie... AIM:To investigate the therapeutic effect of radical treatment and palliative treatment in stage Ⅳ pancreatic cancer patients.METHODS:81 patients were enrolled in the study.Radical treatment was performed on 51 patients,while 30 patients were put under palliative treatment.The procedural safety and interval survival for stage Ⅳ pancreatic cancer(IS-Ⅳ) was assessed by almost 2.5 years of follow-ups.The IS-Ⅳ of patients under the two kinds of treatment,and the effects of treatment timing and frequency on IS-Ⅳ,were compared.RESULTS:The IS-Ⅳ of patients who received radical treatment was significantly longer than those who received palliative treatment(P < 0.001).The IS-Ⅳ of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment(P = 0.0034 and 0.0415,respectively).Multiple treatments can play an important role in improving the IS-Ⅳ of patients who received radical treatment(P = 0.0389),but not for those who received palliative treatment(P = 0.99).CONCLUSION:The effect of radical treatment was significantly more obvious than that of palliative treatment,and multiple radical treatments may contribute more to patients than a single radical treatment. 展开更多
关键词 CRYOSURGERY stage pancreatic cancer Iodine-125 seed
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Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy 被引量:2
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作者 Keishi Yamashita Akira Ema +4 位作者 Kei Hosoda Hiroaki Mieno Hiromitsu Moriya Natsuya Katada Masahiko Watanabe 《World Journal of Gastrointestinal Oncology》 SCIE CAS 2017年第4期166-175,共10页
AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological sta... AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer. 展开更多
关键词 Macroscopic feature Gastric cancer Type Giant type stage Ⅱ/Ⅲ
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Resection of the primary tumor in stage Ⅳ breast cancer
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作者 Tadahiko Shien Hiroyoshi Doihara 《World Journal of Clinical Oncology》 CAS 2014年第2期82-85,共4页
Stage Ⅳ breast cancer refers to breast cancer that has already metastasized to distant regions when initially diagnosed. Treatment for stage Ⅳ is intended to "prolong survival and palliate symptoms". Resec... Stage Ⅳ breast cancer refers to breast cancer that has already metastasized to distant regions when initially diagnosed. Treatment for stage Ⅳ is intended to "prolong survival and palliate symptoms". Resection of a primary tumor is considered to be "effective only at alleviating chest symptoms and providing local control" in spite of the advances of imaging examination and medication for breast cancer. Molecular target and endocrine drugs are very effective and useful to tailor-make a treatment strategy according to breast cancer subtypes. Positron emission tomography-computed tomography can detect and diagnose the very small metastases and recurrences which can potentially be cured even if they are distant metastases. Recently, many retrospective studies have reported the survival benefit of surgery for breast cancer patients with metastases and some clinical trials which confirm the surgical prognostic benefit for them have started to enrol patients. The goal of treatment has to be clearly identified:increase the patient's survival time, provide local control or perform histology to determine the cancer's properties. The best evidence is absolutely essential to treat patients who need surgery at the right time. We need to evaluate the treatment strategy, including primary resection for stage Ⅳ breastcancer particularly, and find new evidence by prospective analysis. 展开更多
关键词 BREAST cancer METASTASIS Surgery SURVIVAL stage Clinical TRIAL
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Effect of TCM Combined with Chemotherapy on Immune Function and Quality of Life of Patients with Non-small Cell Lung Cancer inStage Ⅲ-Ⅳ
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作者 杨祖贻 吴雪梅 +3 位作者 欧亚龙 余萍 罗洁 宋秀云 《Chinese Journal of Integrated Traditional and Western Medicine》 SCIE CAS 2004年第3期181-186,共6页
Objective: To observe and compare the effect of traditional Chinese medicine (TCM) combined with chemotherapy (CT) on immune function and quality of life (QOL)of patients with non-small cell lung cancer (NSCLC) in sta... Objective: To observe and compare the effect of traditional Chinese medicine (TCM) combined with chemotherapy (CT) on immune function and quality of life (QOL)of patients with non-small cell lung cancer (NSCLC) in stage Ⅲ-Ⅳ. Methods: One hundred cases with stage Ⅲ-Ⅳ NSCLC were randomly divided into two groups. The treated group (n=50) received CT combined with TCM, and the control group received CT alone. The percentage of T lymphocyte subset in peripheral blood and the change of natural killer (NK) cell count were observed after treatment. The QOL and tolerance of CT were also compared between the two groups after treatment. Results: In the treated group, CD3 cell count, CD4 cell count, CD4/ CDg ratio and NK cell activity were higher than those in control group, while CD8 cell count in the treated group was lower than that in the control group (P<0.05), and QOL and tolerance of CT in the treated group were also better (P<0.05). Conclusion: TCM combined with CT could raise the patients' ability in tolerating CT in stage Ⅲ-ⅣNSCLC. 展开更多
关键词 non-small cell lung cancer in stage Ⅲ- traditional Chinese medicine combined with chemotherapy immune function quality of life
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Ⅳ期非小细胞肺癌患者营养风险及营养相关血液学指标分析
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作者 桓香 《中国医学创新》 CAS 2024年第22期98-101,共4页
目的:探讨Ⅳ期非小细胞肺癌患者营养风险发生情况及营养相关血液学指标的变化,并通过指标分析为营养支持提供一定的依据。方法:采用回顾性研究方法,收集安徽医科大学第二附属医院肿瘤科2020年1月—2023年1月收治的92例首次确诊Ⅳ期非小... 目的:探讨Ⅳ期非小细胞肺癌患者营养风险发生情况及营养相关血液学指标的变化,并通过指标分析为营养支持提供一定的依据。方法:采用回顾性研究方法,收集安徽医科大学第二附属医院肿瘤科2020年1月—2023年1月收治的92例首次确诊Ⅳ期非小细胞肺癌患者的临床资料,包括年龄、性别、体重指数(BMI)、营养风险筛查2002(NRS 2002)评分、血液学指标。根据年龄将患者分为老年组(66~89岁)和中青年组(18~65岁),并分析两组营养不足发生情况和血液学指标异常情况。结果:92例Ⅳ期非小细胞肺癌患者营养风险发生率为22.83%,66~89岁患者营养风险发生率明显高于18~65岁患者,差异有统计学意义(χ^(2)=8.573,P=0.003)。Ⅳ期非小细胞肺癌患者营养不足发生率为13.04%(12/92),老年组营养不足发生率(21.57%)显著高于中青年组(2.44%),差异有统计学意义(P=0.007)。Ⅳ期非小细胞肺癌患者血液指标异常率较高,超过25%的患者存在白蛋白(ALB)、血红蛋白(Hb)、白细胞(WBC)计数、淋巴细胞绝对值(LYM)。老年组白蛋白(ALB)、钾(K)、镁(Mg)异常率均明显高于中青年组,WBC异常率低于中青年组,差异均有统计学意义(P<0.05)。结论:Ⅳ期非小细胞肺癌患者存在较高的营养风险,其营养相关血液学指标显著异常。 展开更多
关键词 期非小细胞肺癌 营养风险 血红蛋白 电解质
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血清TAP、proGRP、cyfra21-1与Ⅲ~Ⅳ期NSCLC新辅助化疗疗效及预后的关系
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作者 高宇 石冰心 赵明娟 《实用癌症杂志》 2024年第5期713-716,720,共5页
目的探讨血清肿瘤异常蛋白(TAP)、胃泌素释放肽前体(proGRP)、细胞角蛋白19片段(cyfra21-1)与Ⅲ~Ⅳ期非小细胞肺癌(NSCLC)新辅助化疗(NCT)疗效及预后的关系。方法选取100例Ⅲ~Ⅳ期NSCLC患者为研究对象,所有患者均采用NCT治疗,根据疗效... 目的探讨血清肿瘤异常蛋白(TAP)、胃泌素释放肽前体(proGRP)、细胞角蛋白19片段(cyfra21-1)与Ⅲ~Ⅳ期非小细胞肺癌(NSCLC)新辅助化疗(NCT)疗效及预后的关系。方法选取100例Ⅲ~Ⅳ期NSCLC患者为研究对象,所有患者均采用NCT治疗,根据疗效将患者分为有效组和无效组,比较不同疗效患者化疗前后TAP、proGRP、cyfra21-1水平,分析化疗后TAP、proGRP、cyfra21-1水平对NSCLC患者NCT疗效的评估价值。所有患者均随访1年,分析化疗后TAP、proGRP、cyfra21-1表达水平与预后的关系。结果化疗后,有效组TAP、proGRP、cyfra21-1水平低于无效组(P<0.05)。ROC曲线结果显示,TAP评估NSCLC患者NCT疗效的AUC和截点值分别为0.739、178.18μm 2,proGRP评估NSCLC患者NCT疗效的AUC和截点值分别为0.810、52.21 ng/L,cyfra21-1评估NSCLC患者NCT疗效的AUC和截点值分别为0.775、7.70μmol/L,联合评估NSCLC患者NCT疗效的AUC为0.913,高于单项诊断(P<0.05)。TAP、proGRP、cyfra21-1高表达患者的1年生存率均低于低表达患者(P<0.05)。结论TAP、proGRP、cyfra21-1联合评估Ⅲ~Ⅳ期NSCLC患者NCT疗效具有较高价值,且其均与NSCLC患者预后密切相关。 展开更多
关键词 非小细胞肺癌 Ⅲ~ 肿瘤异常蛋白 胃泌素释放肽前体 细胞角蛋白19片段 新辅助化疗 疗效 预后
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How useful is rectal endosonography in the staging of rectal cancer? 被引量:34
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作者 Taylan Kav Yusuf Bayraktar 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第6期691-697,共7页
It is essential in treating rectal cancer to have adequate preoperative imaging,as accurate staging can influence the management strategy,type of resection,and candidacy for neoadjuvant therapy.In the last twenty year... It is essential in treating rectal cancer to have adequate preoperative imaging,as accurate staging can influence the management strategy,type of resection,and candidacy for neoadjuvant therapy.In the last twenty years,endorectal ultrasound(ERUS) has become the primary method for locoregional staging of rectal cancer.ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers(T stage) .Lower accuracy for T2 tumors is commonly reported,which could lead to sonographic overstaging of T3 tumors following preoperative therapy.Unfortunately,ERUS is not as good for predicting nodal metastases as it is for tumor depth,which could be related to the unclear definition of nodal metastases.The use of multiple criteria might improve accuracy.Failure to evaluate nodal status could lead to inadequate surgical resection.ERUS can accurately distinguish early cancers from advanced ones,with a high detection rate of residual carcinoma in the rectal wall.ERUS is also useful for detection of local recurrence at the anastomosis site,which might require fine-needle aspiration of the tissue.Overstaging is more frequent than understaging,mostly due to inflammatory changes.Limitations of ERUS are operator and experiencedependency,limited tolerance of patients,and limited range of depth of the transducer.The ERUS technique requires a learning curve for orientation and identification of images and planes.With sufficient time and effort,quality and accuracy of the ERUS procedure could be improved. 展开更多
关键词 rectal cancer Colorectal cancer STAGING Endorectal ultrasonography Endorectal ultrasound Accuracy Tumor invasion Nodal metastases Other rectal tumors DIAGNOSTICS
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Multimodal imaging evaluation in staging of rectal cancer 被引量:18
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作者 Suk Hee Heo Jin Woong Kim +2 位作者 Sang Soo Shin Yong Yeon Jeong Heoung-Keun Kang 《World Journal of Gastroenterology》 SCIE CAS 2014年第15期4244-4255,共12页
Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to cont... Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to control rectal cancer. Endorectal ultrasonography (EUS) is suitable for assessing the extent of tumor invasion, particularly in early-stage or superficial rectal cancer cases. In advanced cases with distant metastases, computed tomography (CT) is the primary approach used to evaluate the disease. Magnetic resonance imaging (MRI) is often used to assess preoperative staging and the circumferential resection margin involvement, which assists in evaluating a patient&#x02019;s risk of recurrence and their optimal therapeutic strategy. Positron emission tomography (PET)-CT may be useful in detecting occult synchronous tumors or metastases at the time of initial presentation. Restaging after neoadjuvant chemoradiotherapy (CRT) remains a challenge with all modalities because it is difficult to reliably differentiate between the tumor mass and other radiation-induced changes in the images. EUS does not appear to have a useful role in post-therapeutic response assessments. Although CT is most commonly used to evaluate treatment responses, its utility for identifying and following-up metastatic lesions is limited. Preoperative high-resolution MRI in combination with diffusion-weighted imaging, and/or PET-CT could provide valuable prognostic information for rectal cancer patients with locally advanced disease receiving preoperative CRT. Based on these results, we conclude that a combination of multimodal imaging methods should be used to precisely assess the restaging of rectal cancer following CRT. 展开更多
关键词 rectal cancer MULTIMODALITY IMAGING STAGING RESTAGING
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Clinical significance of magnetic resonance imaging findings in rectal cancer 被引量:19
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作者 Charles F Bellows Bernard Jaffe +2 位作者 Lorenzo Bacigalupo Salvatore Pucciarelli Guiseppe Gagliardi 《World Journal of Radiology》 CAS 2011年第4期92-104,共13页
Staging of rectal cancer is essential to help guide clini-cians to decide upon the correct type of surgery and determine whether or not neoadjuvant therapy is indicated. Magnetic resonance imaging (MRI) is currently o... Staging of rectal cancer is essential to help guide clini-cians to decide upon the correct type of surgery and determine whether or not neoadjuvant therapy is indicated. Magnetic resonance imaging (MRI) is currently one of the most accurate modalities on which to base treatment decisions for patients with rectal cancer. MRI can accurately detect the mesorectal fascia, assess the invasion of the mesorectum or surrounding organs and predict the circumferential resection margin. Although nodal disease remains a difficult radiological diagnosis, new lymphographic agents and diffusion weighted imaging may allow identification of metastatic nodes by criteria other then size. In light of this, we have reviewed the literature on the accuracy of specific MRI findings for staging the local extent of primary rectal cancer. The aim of this review is to establish a correlation between MRI findings, prognosis, and available treatment options. 展开更多
关键词 Magnetic RESONANCE imaging PREOPERATIVE STAGING PROGNOSTIC FACTORS rectal cancer
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Evolving treatment strategies for colorectal cancer: A critical review of current therapeutic options 被引量:10
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作者 Daniel C Damin Anderson R Lazzaron 《World Journal of Gastroenterology》 SCIE CAS 2014年第4期877-887,共11页
Management of rectal cancer has markedly evolved over the last two decades.New technologies of staging have allowed a more precise definition of tumor extension.Refinements in surgical concepts and techniques have res... Management of rectal cancer has markedly evolved over the last two decades.New technologies of staging have allowed a more precise definition of tumor extension.Refinements in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this malignancy.Although,preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors,many controversial matters in management of rectal cancer still need to be defined.These include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy,the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor resection.In this article,after an extensive search in PubMed and Embase databases,we critically review the current strategies and the most debatable matters in treatment of rectal cancer. 展开更多
关键词 rectal cancer Colorectal cancer STAGING Sphincter preservation Neoadjuvant chemo-radiotherapy SURGERY
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Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer 被引量:36
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作者 Ahmet Mesrur Halefoglu Sadik Yildirim +2 位作者 Omer Avlanmis Damlanur Sakiz Adil Baykan 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第22期3504-3510,共7页
AIM: To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. METHODS: Thirty-four patients (15 ... AIM: To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. METHODS: Thirty-four patients (15 males, 19 females) with ages ranging between 29 and 75 who have biopsy proven rectal tumor underwent both MRI and ERUS examinations before surgery. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases. Imaging results were correlated with histopathological findings regarded as the gold standard and both modalities were compared in terms of predicting preoperative local staging of rectal carcinoma. RESULTS: The pathological T stage of the tumors was: pT1 in 1 patient, pT2 in 9 patients, pT3 in 21 patients and pT4 in 3 patients. The pathological N stage of the tumors was: pN0 in 19 patients, pN1 in 9 patients and pN2 in 6 patients. The accuracy of T staging for MRI was 89.70% (27 out of 34). The sensitivity was 79.41% and the specificity was 93.14%. The accuracy of T staging for ERUS was 85.29% (24 out of 34). The sensitivity was 70.59% and the specificity was 90.20%. Detection of lymph node metastases usingphased-array MRI gave an accuracy of 74.50% (21 out of 34). The sensitivity and specificity was found to be 61.76% and 80.88%, respectively. By using ERUS in the detection of lymph node metastases, an accuracy of 76.47% (18 out of 34) was obtained. The sensitivity and specificity were found to be 52.94% and 84.31%, respectively. CONCLUSION: ERUS and phased-array MRI are complementary methods in the accurate preoperative staging of rectal cancer. In conclusion, we can state that phased-array MRI was observed to be slightly superior in determining the depth of transmural invasion (T stage) and has same value in detecting lymph node metastases (N stage) as compared to ERUS. 展开更多
关键词 Endoscopic ultrasonography Magnetic resonance imaging Pelvic phased-array coil Preoperative staging rectal cancer
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Multidisciplinary treatment of rectal cancer in 2014: Where are we going? 被引量:6
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作者 Andrea Vignali Paola De Nardi 《World Journal of Gastroenterology》 SCIE CAS 2014年第32期11249-11261,共13页
In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of n... In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended.The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer. 展开更多
关键词 rectal cancer cancer staging cancer restaging Neoadjuvant chemoradiation Response Treatment Local control Local excision Complete pathologic response rectal cancer surgery
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Current trends in staging rectal cancer 被引量:26
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作者 Abdus Samee Chelliah Ramachandran Selvasekar 《World Journal of Gastroenterology》 SCIE CAS CSCD 2011年第7期828-834,共7页
Management of rectal cancer has evolved over the years. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an ... Management of rectal cancer has evolved over the years. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hot spots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. In future, functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy. 展开更多
关键词 rectal cancer STAGING INVESTIGATIONS Magnetic resonance imaging ULTRASOUND Endoanal ultrasound Positron emission tomography Computerized tomography
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Magnetic resonance imaging for diagnosis and neoadjuvant treatment evaluation in locally advanced rectal cancer:A pictorial review 被引量:9
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作者 Gulgun Engin Rasul Sharifov 《World Journal of Clinical Oncology》 CAS 2017年第3期214-229,共16页
High-resolution pelvic magnetic resonance imaging(MRI) is the primary method for staging rectal cancer.MRI is highly accurate in the primary staging of rectal cancer;however,it has not proven to be effective in restag... High-resolution pelvic magnetic resonance imaging(MRI) is the primary method for staging rectal cancer.MRI is highly accurate in the primary staging of rectal cancer;however,it has not proven to be effective in restaging,especially in complete response evaluation after neoadjuvant therapy.Neoadjuvant chemoradiotherapy produces many changes in rectal tumors and on adjacent area,as a result,local tumor extent may not be accurately determined.However,adding diffusion-weighted sequences to the standard approach can improve diagnostic accuracy.In this pictorial review,an overview of the situation of MRI in the staging and re-staging of rectal cancer is exhibited as a pictorial assay.An experience-and literature-based discussion of limitations and difficulties in interpretation are also presented. 展开更多
关键词 rectal cancer LOCALLY advanced Magnetic resonance imaging STAGING NEOADJUVANT treatment
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Increased proliferation activity measured by immunoreactive Ki67 is associated with survival improvement in rectal/recto sigmoid cancer 被引量:15
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作者 Eeva Salminen Salla Palmu +2 位作者 Tero Vahlberg Peter J.Roberts Karl-Owe S(o|¨)derstr(o|¨)m 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第21期3245-3249,共5页
AIM: To assess the expression of Ki67 as prognosticator in rectal/recto sigmoid cancer.METHODS: Samples from 146 patients with rectal and recto sigmoid cancer were studied for expression of Ki67 and its prognostic sig... AIM: To assess the expression of Ki67 as prognosticator in rectal/recto sigmoid cancer.METHODS: Samples from 146 patients with rectal and recto sigmoid cancer were studied for expression of Ki67 and its prognostic significance in comparison with clinicopathological predictors of survival. Formalin-fixed, paraffin-embedded tissues from 6 (4.1%) patients with T1, 26 (17.8%) with T2, 94 (64.4%) with T3, and 20 (13.7%) with T4 tumors were studied. Ki67 expression was determined immunohistochemically. Samples were divided according to mean value into high (>40%) and low (≤40%) expression. Areas of extensive proliferation (>50%) were defined as 'hot spot' areas. RESULTS: Hot spot areas were present in samples regardless of histopathological grade. Lower TNM and Dukes stage and higher expression of Ki67 and presence of Ki67 hot spot areas in histopathological samples were associated with better survival, whereas no association was observed with histopathological grade (P = 0.78). In Cox multivariate regression analysis, significant prognostic factors were Dukes stage (P<0.001), presence of lymph node metastases (P = 0.015), age (P = 0.035) andpresence of Ki67 hot spot areas (P = 0.044). CONCLUSION: Proliferative activity as measured by Ki67 in rectal cancer is associated with survival improvement compared with patients with low Ki67. Areas of prognostically significant increased proliferation were found independently of histopathological tumor grade. 展开更多
关键词 rectal cancer stage Grade Proliferative activity KI67
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Surgical treatment for rectal cancer:An international perspective on what the medical gastroenterologist needs to know 被引量:13
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作者 Rolv-Ole Lindsetmo Yong-Geul Joh Conor P Delaney 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第21期3281-3289,共9页
Rectal cancer accounts for one third of all colorectal cancers.The age adjusted death rates from colorectal cancer have declined over recent decades due to a combination of colorectal cancer screening,improved diagnos... Rectal cancer accounts for one third of all colorectal cancers.The age adjusted death rates from colorectal cancer have declined over recent decades due to a combination of colorectal cancer screening,improved diagnostic tests,improved standardized surgical technique,improved medical support,neoadjuvant chemotherapies and radiation treatment or combinations of these.Because of complex treatment algorithms,use of multidisciplinary teams in the management of rectal cancer patients has also been popularized.Medical gastroenterologists performing colonoscopies are frequently the first health care provider to raise the suspicion of a rectal cancer.Although the diagnosis depends on histological confirmation,the endoscopic presentation is almost diagnostic in many cases.In order to meet the patient's immediate needs for information,it is important that the endoscopist has knowledge about the investigations and treatment options that will be required for their patient.The aim of this paper is to describe the modern preoperative investigations and operative procedures commonly offered to rectal cancer patients taking into account perspectives of three colorectal surgeons,practicing in the USA,Europe and Asia. 展开更多
关键词 rectal cancer management Evaluation STAGING NEOADJUVANT ADJUVANT Surgical treatment SURVEILLANCE
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Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer 被引量:14
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作者 Sφren R Rafaelsen Chris Vagn-Hansen +2 位作者 Torben Sφrensen John Plφen Anders Jakobsen 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第36期5021-5026,共6页
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 pati... 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 ram) 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 Phil- ips unit. The TRUS findings were blinded to the radiol- ogist 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, where- as 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 ultra- sound 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 ram) 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 out- growth was 4.9 mm (95% CI: 3.7-6.1 turn) 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. 展开更多
关键词 ULTRASOUND Magnetic resonance imaging rectal cancer Tumor staging METASTASES
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Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer 被引量:13
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作者 Pietro Marone Mario de Bellis +7 位作者 Valentina D'Angelo Paolo Delrio Valentina Passananti Elena Di Girolamo Giovanni Battista Rossi Daniela Rega Maura Claire Tracey Alfonso Mario Tempesta 《World Journal of Gastrointestinal Endoscopy》 CAS 2015年第7期688-701,共14页
The prognosis of rectal cancer(RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally adv... The prognosis of rectal cancer(RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC(LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy(NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound(EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor(T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery. 展开更多
关键词 rectal cancer STAGING Endoscopic ultrasonography ACCURACY Therapeutic strategy
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