目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy N B I-M E)、内镜病理活检在早期胃癌诊断中的价值.方法:首先在普通白光下系统观察,发现可疑病变(胃黏膜形态或颜色改变)后行NBIME观察,采集照片并做...目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy N B I-M E)、内镜病理活检在早期胃癌诊断中的价值.方法:首先在普通白光下系统观察,发现可疑病变(胃黏膜形态或颜色改变)后行NBIME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查.所有患者均行内镜下切除或外科手术治疗,术后行病理活检.分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率.比较内镜活检与术后切除病理的一致性,并计算Kappa值.结果:123例纳入本研究,最终术后切除病理示胃炎51例,低级别上皮内瘤变(low-grade neoplasia,LGIN)24例,早期胃癌48例.NBIM E诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为97.9%、80.0%、75.8%、98.4%、87.0%,内镜活检的对应值分别为66.7%、94.7%、88.9%、81.6%、83.7%.NBI-ME诊断早期胃癌的敏感度明显高于内镜活检(P<0.005),特异度低于内镜活检(P<0.005),两者准确率无明显差异(P>0.05).内镜下活检病理与术后切除病理Kappa值为0.642(P<0.05).结论:NBI-ME对早期胃癌诊断价值较高,对于NBI-ME下符合早期胃癌诊断的患者建议行内镜或手术进一步治疗.展开更多
Objective:lreversible electroporation(IRE)is emerging as a new therapy for locally advanced pancreatic cancer(LAPC).We aimed to conduct survival and safety analyses in L APC patients after treatment with IRE combined ...Objective:lreversible electroporation(IRE)is emerging as a new therapy for locally advanced pancreatic cancer(LAPC).We aimed to conduct survival and safety analyses in L APC patients after treatment with IRE combined with chemotherapy.Methods:A total of 64 patients with LAPC who had received IRE and chemotherapy were retrospectively collected from August 2015 to March 2019 at Sun Yat-sen University Cancer Center.Overall survival(OS)and progression-free survival(PFS)were evaluated using Kaplan-Meier method and compared by the log-rank test.A multivariate Cox regression model was used to determine the prognostic factors of survival.The perioperative complications of IRE were also evaluated.The study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center(approval No.C2021-003).Results:The median survival of all included patients were 24.63(95%confidence interval:21.78-27.49)for overall survival and 13.00(95%confidence inteval:8.81-17.19)months for progression-free survival,with 96.8%,51.9%,18.3%;and 52.3%,21.5%,7.9%as the 1-,2-and 3-year OS and PFS rates,respectively.Tumor size[OS,hazard ratio(HR)=1.768,P=0.048;PFS,HR=0.304,P=0.010],neoadjuvant chemotherapy(OS,HR=0338,P=0.030;PFS,HR=0.358,P=0.034),carbohydrate antigen 19-9 variation after IRE(OS,HR=19.320,P=0.003;PFS,HR=14.591,P=0.021)and tumor response after neoadjuvant chemotherapy(OS,HR-8.779,P=0.033;PFS,HR-5.562,P=0.008)were predictive factors of survival in patients with LAPC after IRE.Complications were observed in 20.3%of patients.Grade B pancreatic fistula was the most common complication.The complication rates of the late treatment group(6.1%)were significantly lower than those of the first 15 patients after IRE treatment(66.7%).The median length of hospital stay of late treatment group was 8.6days,which was also shorter than that of the early treatment group(10.0days).Conclusions:IRE combined with chemotherapy could improve survival of LAPC patients with acceptable complication rates.Therefore,it may be a suitable method for LAPC but should be validated in prospective randomized trials.展开更多
文摘目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy N B I-M E)、内镜病理活检在早期胃癌诊断中的价值.方法:首先在普通白光下系统观察,发现可疑病变(胃黏膜形态或颜色改变)后行NBIME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查.所有患者均行内镜下切除或外科手术治疗,术后行病理活检.分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率.比较内镜活检与术后切除病理的一致性,并计算Kappa值.结果:123例纳入本研究,最终术后切除病理示胃炎51例,低级别上皮内瘤变(low-grade neoplasia,LGIN)24例,早期胃癌48例.NBIM E诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为97.9%、80.0%、75.8%、98.4%、87.0%,内镜活检的对应值分别为66.7%、94.7%、88.9%、81.6%、83.7%.NBI-ME诊断早期胃癌的敏感度明显高于内镜活检(P<0.005),特异度低于内镜活检(P<0.005),两者准确率无明显差异(P>0.05).内镜下活检病理与术后切除病理Kappa值为0.642(P<0.05).结论:NBI-ME对早期胃癌诊断价值较高,对于NBI-ME下符合早期胃癌诊断的患者建议行内镜或手术进一步治疗.
基金This work was supported by the National Natural Science Funds(Nos.82102166,81972299)Guangdong Basic and Applied Basic Research Foundation(No.2020A1515110954).
文摘Objective:lreversible electroporation(IRE)is emerging as a new therapy for locally advanced pancreatic cancer(LAPC).We aimed to conduct survival and safety analyses in L APC patients after treatment with IRE combined with chemotherapy.Methods:A total of 64 patients with LAPC who had received IRE and chemotherapy were retrospectively collected from August 2015 to March 2019 at Sun Yat-sen University Cancer Center.Overall survival(OS)and progression-free survival(PFS)were evaluated using Kaplan-Meier method and compared by the log-rank test.A multivariate Cox regression model was used to determine the prognostic factors of survival.The perioperative complications of IRE were also evaluated.The study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center(approval No.C2021-003).Results:The median survival of all included patients were 24.63(95%confidence interval:21.78-27.49)for overall survival and 13.00(95%confidence inteval:8.81-17.19)months for progression-free survival,with 96.8%,51.9%,18.3%;and 52.3%,21.5%,7.9%as the 1-,2-and 3-year OS and PFS rates,respectively.Tumor size[OS,hazard ratio(HR)=1.768,P=0.048;PFS,HR=0.304,P=0.010],neoadjuvant chemotherapy(OS,HR=0338,P=0.030;PFS,HR=0.358,P=0.034),carbohydrate antigen 19-9 variation after IRE(OS,HR=19.320,P=0.003;PFS,HR=14.591,P=0.021)and tumor response after neoadjuvant chemotherapy(OS,HR-8.779,P=0.033;PFS,HR-5.562,P=0.008)were predictive factors of survival in patients with LAPC after IRE.Complications were observed in 20.3%of patients.Grade B pancreatic fistula was the most common complication.The complication rates of the late treatment group(6.1%)were significantly lower than those of the first 15 patients after IRE treatment(66.7%).The median length of hospital stay of late treatment group was 8.6days,which was also shorter than that of the early treatment group(10.0days).Conclusions:IRE combined with chemotherapy could improve survival of LAPC patients with acceptable complication rates.Therefore,it may be a suitable method for LAPC but should be validated in prospective randomized trials.
