Tumor deposits in axillary adipose tissue in patients with breast cancer:Do they matter?

Tumor deposits(TDs)are defined as discrete,irregular clusters of tumor cells lying in the soft tissue adjacent to but separate from the primary tumor,and are usually found in the lymphatic drainage area of the primary tumor.By definition,no residual lymph node structure should be identified in these tumor masses.At present,TDs are mainly reported in colorectal cancer,with a few reports in gastric cancer.There are very few reports on breast cancer(BC).For TDs,current dominant theories suggest that these are the result of lymph node metastasis of the tumor with complete destruction of the lymph nodes by the tumor tissue.Even some pathologists classify a TD as two lymph node metastases for calculation.Some pathologists also believe that TDs belong to the category of disseminated metastasis.Therefore,regardless of the origin,TDs are an indicator of poor prognosis.Moreover,for BC,sentinel lymph node biopsy is generally used at present.Whether radical axillary lymph node dissection should be adopted for BC with TDs in axillary lymph nodes is still inconclusive.The present commentary of this clinical issue has certain guiding significance.It is aimed to increase the awareness of the scientific community towards this under-recognized problem in BC pathology.

Development and validation of a nomogram for preoperative prediction of tumor deposits in colorectal cancer

BACKGROUND Based on the clinical data of colorectal cancer(CRC)patients who underwent surgery at our institution,a model for predicting the formation of tumor deposits(TDs)in this patient population was established.AIM To establish an effective model for predicting TD formation,thus enabling clinicians to identify CRC patients at high risk for TDs and implement personalized treatment strategies.METHODS CRC patients(n=645)who met the inclusion criteria were randomly divided into training(n=452)and validation(n=193)cohorts using a 7:3 ratio in this retrospective analysis.Least absolute shrinkage and selection operator regression was employed to screen potential risk factors,and multivariable logistic regression analysis was used to identify independent risk factors.Subsequently,a predictive model for TD formation in CRC patients was constructed based on the independent risk factors.The discrimination ability of the model,its consistency with actual results,and its clinical applicability were evaluated using receiveroperating characteristic curves,area under the curve(AUC),calibration curves,and decision curve analysis(DCA).RESULTS Thirty-four(7.5%)patients with TDs were identified in the training cohort based on postoperative pathological specimens.Multivariate logistic regression analysis identified female sex,preoperative intestinal obstruction,left-sided CRC,and lymph node metastasis as independent risk factors for TD formation.The AUCs of the nomogram models constructed using these variables were 0.839 and 0.853 in the training and validation cohorts,respectively.The calibration curve demonstrated good consistency,and the training cohort DCA yielded a threshold probability of 7%-78%.CONCLUSION This study developed and validated a nomogram with good predictive performance for identifying TDs in CRC patients.Our predictive model can assist surgeons in making optimal treatment decisions.

Risk factors predict microscopic extranodal tumor deposits in advanced stage Ⅲ colon cancer patients

BACKGROUND Colorectal cancer is a frequent cause of cancer-related mortality in patients with lymph node or distant metastases.Pericolonic tumor deposits(TDs)are considered prognostically distinct from lymph node metastases.AIM To investigate risk factors for extranodal TDs in stage III colon cancer.METHODS This was a retrospective cohort study.We selected 155 individuals diagnosed with stage III colon cancer from the database of the Cancer Registry of the Tri-Service General Hospital.The patients were allocated into the groups with/without N1c.Multivariate Cox regression analysis and Kaplan-Meier method were done.The primary outcomes investigate the association between the covariates and extranodal TDs,and prognostic significance of the covariates regarding the survival.RESULTS There were 136 individuals in the non-N1c group and 19 individuals in the N1c group.Patients with lymphovascular invasion(LVI)had a higher risk of TDs.Overall survival rates of patients with and without LVI were 6.64 years and 8.61 years,respectively(P=0.027).The N1c patients without LVI had higher overall survival than those who with LVI(7.73 years vs 4.42 years,P=0.010).CONCLUSION Patients having stage III colon cancer with LVI have a higher probability of having TDs than those with stage III colon cancer without LVI.Stage III colon cancer patients with TDs and LVI could have poor prognosis and outcome.

Incorporation of perigastric tumor deposits into the TNM staging system for primary gastric cancer

BACKGROUND The current prognostic significance of perigastric tumor deposits(TDs)in gastric cancer(GC)remains unclear.AIM To assess the prognostic value of perigastric TDs and put forward a new TNM staging framework involving TDs for primary GC.METHODS This study retrospectively analyzed the pathological data of 6672 patients with GC who underwent gastrectomy or surgery for GC with other diseases from January 1,2012 to December 31,2017 at the Chinese PLA General Hospital.According to the presence of perigastric TDs or not,the patients were divided into TD-positive and TD-negative groups by using the method of propensity score matching.The differences between TD-positive and TD-negative patients were analyzed using binary logistic regression modeling.The Kaplan-Meier method was used to plot survival curves.Multivariate Cox regression modeling and the log-rank test were used to analyze the data.RESULTS Perigastric TDs were found to be positive in 339(5.09%)of the 6672 patients with GC,among whom 237 were men(69.91%)and 102 were women(30.09%)(2.32:1).The median age was 59 years(range,27 to 78 years).Univariate and multivariate survival analyses indicated that TD-positive GC patients had a poorer prognosis than TD-negative patients(P<0.05).The 1-,3-,and 5-year overall survival rates of GC patients with TDs were 68.3%,19.6%,and 11.2%,respectively,and these were significantly poorer than those without TDs of the same stages.There was significant variation in survival according to TD locations among the GC patients(P<0.05).A new TNM staging framework for GC was formulated according to TD location.When TDs appear in the gastric body,the original stages T1,T2,and T3 are classified as T4a with the new framework,and the original stages T4a and T4b both are classified as T4b.When TDs appear in the lesser curvature,the previous stages N0,N1,N2,and N3 now both are classified as N3.When TDs appear in the greater curvature or the distant tissue,the patient should be categorized as having M1.With the new GC staging scheme including TDs,the survival curves of patients in the lower grade TNM stage with TDs were closer to those of patients in the higher grade TNM stage without TDs.CONCLUSION TDs are a poor prognostic factor for patients with primary GC.The location of TDs is associated with the prognosis of patients with primary GC.Accordingly,we developed a new TNM staging framework involving TDs that is more appropriate for patients with primary GC.

Isolated axillary tumor deposit consistent with primary breast carcinoma:A case report

BACKGROUND We all know that lymph-node metastasis is an important factor for poor clinical outcome in breast cancer prognosis.Tumor deposit refers to a discrete collection of cancer cells that is found in the lymph nodes or other tissues adjacent to the primary tumor site.These tumor deposits are separate from the primary tumor and are often considered as a manifestation of lymph node metastasis.In gastric and colorectal cancer,tumor deposits in the lymph node drainage area have been included as independent prognostic factors.The question arises whether tumor deposits should also be considered as prognostic factors in breast cancer patients.This article aims to provoke some thoughts on this matter through a case study and literature review.CASE SUMMARY A 70-year-old female patient was found to have a right breast lump for over 2 years.On January 3,2023,a core needle biopsy of the right breast lump was performed,and the pathology report indicated invasive carcinoma.Subsequently,on January 17,2023,the patient underwent right breast-conserving surgery,sentinel lymph node biopsy,and right axillary lymph node dissection.The postoperative pathological staging was determined as stage IIB.The patient received chemotherapy,radiotherapy,and endocrine therapy.At present,nearly one year after the surgery,no obvious signs of metastasis have been observed in the follow-up examinations,but the long-term prognosis is still unknown.CONCLUSION There is a need for increased focus on the matter of tumor deposits in the lymph node drainage region,as well as a requirement for further clinical investigation to ascertain the relevance of tumor deposits in the prognosis of individuals with breast carcinoma.

Radiomics for differentiating tumor deposits from lymph node metastasis in rectal cancer

BACKGROUND Tumor deposits(TDs)are not equivalent to lymph node(LN)metastasis(LNM)but have become independent adverse prognostic factors in patients with rectal cancer(RC).Although preoperatively differentiating TDs and LNMs is helpful in designing individualized treatment strategies and achieving improved prognoses,it is a challenging task.AIM To establish a computed tomography(CT)-based radiomics model for preoperatively differentiating TDs from LNM in patients with RC.METHODS This study retrospectively enrolled 219 patients with RC[TDs+LNM-(n=89);LNM+TDs-(n=115);TDs+LNM+(n=15)]from a single center between September 2016 and September 2021.Single-positive patients(i.e.,TDs+LNM-and LNM+TDs-)were classified into the training(n=163)and validation(n=41)sets.We extracted numerous features from the enhanced CT(region 1:The main tumor;region 2:The largest peritumoral nodule).After deleting redundant features,three feature selection methods and three machine learning methods were used to select the best-performing classifier as the radiomics model(Rad-score).After validating Rad-score,its performance was further evaluated in the field of diagnosing double-positive patients(i.e.,TDs+LNM+)by outlining all peritumoral nodules with diameter(short-axis)>3 mm.RESULTS Rad-score 1(radiomics signature of the main tumor)had an area under the curve(AUC)of 0.768 on the training dataset and 0.700 on the validation dataset.Rad-score 2(radiomics signature of the largest peritumoral nodule)had a higher AUC(training set:0.940;validation set:0.918)than Radscore 1.Clinical factors,including age,gender,location of RC,tumor markers,and radiological features of the largest peritumoral nodule,were excluded by logistic regression.Thus,the combined model was comprised of Rad-scores of 1 and 2.Considering that the combined model had similar AUCs with Rad-score 2(P=0.134 in the training set and 0.594 in the validation set),Rad-score 2 was used as the final model.For the diagnosis of double-positive patients in the mixed group[TDs+LNM+(n=15);single-positive(n=15)],Rad-score 2 demonstrated moderate performance(sensitivity,73.3%;specificity,66.6%;and accuracy,70.0%).CONCLUSION Radiomics analysis based on the largest peritumoral nodule can be helpful in preoperatively differentiating between TDs and LNM.

Prediction of pathological complete response and prognosis in locally advanced rectal cancer

BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide.Neoadjuvant chemoradiotherapy(nCRT)is standard for locally advanced rectal cancer(LARC).Except for pathological examination after resection,it is not known exactly whether LARC patients have achieved pathological complete response(pCR)before surgery.To date,there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.AIM To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.METHODS Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed.Patients were categorized into pCR and non-pCR groups.Univariate analysis(using the χ^(2) test or Fisher’s exact test)and logistic multivariate regression analysis were used to study clinical predictors affecting pCR.The 5-year disease-free survival(DFS)and overall survival(OS)rates were calculated using Kaplan-Meier analysis,and differences in survival curves were assessed with the log-rank test.RESULTS Univariate analysis showed that pretreatment carcinoembryonic antigen(CEA)level,lymphocyte-monocyte ratio(LMR),time interval between neoadjuvant therapy completion and total mesorectal excision,and tumor size were correlated with pCR.Multivariate results showed that CEA≤5 ng/mL(P=0.039),LMR>2.73(P=0.023),and time interval>10 wk(P=0.039)were independent predictors for pCR.Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates(94.7%vs 59.7%,P=0.002)and 5-year OS rates(95.8%vs 80.1%,P=0.019)compared to the non-pCR group.Tumor deposits(TDs)were significantly correlated with shorter DFS(P=0.002)and OS(P<0.001).CONCLUSION Pretreatment CEA,LMR,and time interval contribute to predicting nCRT efficacy in LARC patients.Achieving pCR demonstrates longer DFS and OS.TDs correlate with poor prognosis.

全容积ADC直方图分析联合ADC值术前预测直肠癌肿瘤沉积的价值

目的探讨基于肿瘤全容积表观扩散系数(apparent diffusion coefficient,ADC)直方图参数联合ADC值在术前预测直肠癌肿瘤沉积(tumor deposits,TDs)中的应用价值。材料与方法回顾性分析苏州大学附属第一医院2016年6月至2023年6月术前行直肠MRI检查且经病理确诊的111例直肠癌患者的临床及影像学资料,依据病理结果将其分为TDs阳性组(n=30)和TDs阴性组(n=81),在ADC图像上手动勾画每一层肿瘤病灶感兴趣区(region of iterest,ROI)并提取ADC直方图参数,包括第10百分位数(ADC_(10%))、第90百分位数(ADC_(90%))、最大值(ADC_(max))、最小值(ADC_(min))、均数(ADC_(mean))、中位数(ADC_(median))、峰度及偏度;同时测量肿瘤最大层面的平均ADC值。分析比较两组患者间ADC值及ADC直方图参数的差异,将差异具有统计学意义的参数纳入多因素logistic回归分析构建联合模型,利用ROC曲线分析ADC值、全容积ADC直方图参数及两者联合模型的预测效能。采用DeLong检验比较各AUC间的差异。结果ADC值、ADC_(10%)、ADC_(90%)、ADC_(max)、ADC_(mean)、ADC_(median)及峰度在TDs阳性组和阴性组间差异具有统计学意义(P<0.05),以ADC_(90%)的预测效能最高(AUC、敏感度、特异度分别为0.778、80.0%、65.4%)。由ADC值、ADC_(10%)、ADC_(90%)、ADC_(mean)构建的联合模型AUC、敏感度、特异度分别为0.940、86.7%、93.8%,其诊断效能优于ADC值(AUC为0.645)及各全容积ADC直方图参数(AUC为0.649~0.778),差异均有统计学意义(P<0.05)。结论全容积ADC直方图参数及肿瘤最大层面的ADC值可用于术前预测直肠癌TDs,尤其当两者联合时具有较高的预测效能。

不同解剖位置癌结节与胃癌患者预后关系分析

目的分析接受胃切除术联合全网膜切除术的胃癌患者胃周网膜不同解剖区域癌结节的发生率和临床意义。方法回顾性分析2018年1月至2020年11月在中国人民解放军中部战区空军医院和山西省肿瘤医院接受手术治疗的1127例胃癌患者临床资料。根据癌结节的解剖位置分为3个亚组:①癌结节位于胃小弯侧网膜;②癌结节位于胃大弯侧近端网膜;③癌结节位于胃大弯侧远端网膜。使用COX风险比例回归模型分析影响患者3年OS的独立危险因素及相应风险比(HR)。使用Kaplan-Meier法比较不同位置癌结节胃癌患者的3年总生存期(OS)差异。结果全部患者中,术后病理共检出125例(11.09%)患者存在癌结节。所有位置癌结节均较对应无癌结节的,淋巴血管浸润比例更高、pT分期更差、pTNM分期更差和3年死亡比例更高(P<0.05)。此外,胃大弯近端网膜、胃小弯网膜癌结节者较对应无癌结节者≥60岁比例更高、肿瘤大小≥5 cm比例更高、神经侵犯比例更高、pT分期更差(P<0.05)。多因素COX回归分析可见患者年龄≥60岁、肿瘤大小≥5 cm、pT分期、pN分期、胃大弯近端网膜癌结节是影响患者3年OS的独立危险因素。存在任何位置癌结节患者的3年OS均低于无癌结节的患者(P<0.001)。其中胃大弯近端网膜癌结节患者中位OS最短。结论胃大弯近端网膜癌结节是胃癌患者3年内死亡的危险因素,患者3年OS较短。

CT影像组学联合机器学习算法在鉴别结直肠癌肿瘤沉积、淋巴结转移及二者同时发生中的价值

目的:探讨CT影像组学联合机器学习算法对结直肠癌(colorectal cancer,CRC)肿瘤沉积(tumor deposits,TDs)、淋巴结转移(lymph node metastasis,LNM)及二者同时发生的鉴别价值。方法:回顾性分析2017年1月至2023年12月于某院接受治疗的261例CRC患者的临床资料,根据AJCC第8版CRC分期指南,将患者分为TDs阳性组(TDs+组,64例)、LNM阳性组(LNM+组,99例)、TDs阳性合并LNM阳性组(TDs+合并LNM+组,98例)。利用MaZda version 4.6软件勾画感兴趣区,再通过该软件自带的筛选法筛选出最具鉴别价值的纹理特征参数。纳入单因素分析差异有统计学意义(P<0.05)的纹理特征参数绘制ROC曲线,评估所纳入纹理特征参数的诊断效能。基于纳入的纹理特征参数,结合十折交叉验证,评估贝叶斯、决策树、随机森林及Logistic回归4种机器学习算法对TDs+组、LNM+组、TDs+合并LNM+组的诊断效能。采用SPSS 26.0、MedCalc 19.1.3、Weka 3.8.6及R语言软件进行统计学分析。结果:3组间单因素方差分析差异有统计学意义(P均<0.05)的纹理特征参数包括偏度、S(2,-2)和均值、S(0,4)相关性、S(3,3)差方差及S(0,4)逆差矩。在TDs+组和LNM+组中,S(3,3)差方差诊断效能最高;在TDs+合并LNM+组中,偏度诊断效能最高。与贝叶斯、决策树及Logistic回归算法相比,随机森林算法诊断效能最好,其鉴别TDs+组、LNM+组及TDs+合并LNM+组的精确率分别为0.897、0.830、0.861,AUC分别为0.951、0.957、0.958。结论:CT影像组学联合随机森林算法对CRC患者TDs、LNM及二者同时发生具有较高的鉴别价值,可为临床医师提供更全面的诊断信息,并有助于为患者制订更加精准的治疗策略。

结肠癌叉头框蛋白P3、促泛素结合衔接子p62及核因子-κB与癌旁肿瘤沉积形成相关性分析

目的探究结肠癌患者叉头框蛋白P3(Foxp3)、促泛素结合衔接子(p62)及核因子κB(NF-κB)表达及与癌旁肿瘤沉积形成相关性。方法选取河北北方学院附属第一医院普通外科2019年1月至2022年1月收治的结肠癌患者80例,根据其是否合并癌旁肿瘤沉积分为对照组(36例),沉积组(44例)。使用实时荧光定量PCR技术(qRT-PCR)检测患者Foxp3、p62、NF-κB mRNA表达,使用免疫组化检测患者Foxp3、p62、NF-κB阳性细胞表达,使用蛋白质印迹法检测两组患者病灶组织中Foxp3、p62、NF-κB mRNA相对蛋白表达量。并使用多因素Logistic回归分析以上指标与患者癌旁肿瘤沉积形成相关性。结果比较两组基线资料,差异无统计学意义。沉积组Foxp3、p62、NF-κB mRNA表达显著高于对照组,差异具有统计学意义(P<0.05);沉积组Foxp3、p62、NF-κB免疫组化阳性细胞占比表达显著高于对照组,差异具有统计学意义(P<0.05);沉积组Foxp3、p62、NF-κB蛋白相对表达显著高于对照组,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,Foxp3、p62、NF-κB mRNA,Foxp3、p62、NF-κB阳性细胞占比,Foxp3、p62、NF-κB蛋白相对表达均与患者癌旁肿瘤沉积发生具有显著相关性,其高表达均是患者发生癌旁肿瘤沉积的独立危险因素(P<0.05)。结论合并癌旁肿瘤沉积结肠癌患者病灶Foxp3、p62、NF-κB mRNA,Foxp3、p62、NF-κB阳性细胞占比及Foxp3、p62、NF-κB蛋白相对表达均升高,且其高水平表达是结直肠癌患者癌旁肿瘤沉积形成独立危险因素,在患者实际治疗中,应重视以上指标表达,有助于评估及预测患者病情进展。

肿瘤沉积在结直肠癌中的研究进展

肿瘤沉积(tumor deposit,TD)可在多种恶性肿瘤中被检测到,尤其是在结直肠癌患者中,其被视为一种侵袭性边界并具有重要的组织病理学特征。在现行的第8版结直肠癌TNM分期中,TD作为一个定性变量的潜在预后价值得到证实,但仍有许多方面需要探讨,如TD计数对患者预后影响、TD形状和大小的影响,以及如何有机地将TD状态和数量与阳性淋巴结的状态和数量整合在一起以更新TNM分期的可行性等。针对上述的问题,本文总结了TD起源与定义的演变,探讨其预后价值,旨在为解决目前TNM分期存在的弊端与争议提供新的思路。

基于3.0T MR增强影像构建鉴别结直肠癌周围癌结节与转移性淋巴结的预测模型

目的:探讨基于3.0T MR增强影像构建的预测模型对结直肠癌周围癌结节(TD)与转移性淋巴结(MLN)的鉴别诊断价值。方法:分析经手术病理确诊为结直肠癌伴有灶周TD和/或MLN的106例患者的病例资料。其中,A组22例(20.8%),共发现28个灶周TD和32个MLN;B组84例(79.2%),仅发现150个MLN。所有患者在术前1周内行MRI检查,扫描序列主要包括T1WI、FS-T2WI、DWI及肝脏快速容积增强成像(LAVA+)。主要评估征象:结节数目、形态、短径、ADC值、强化方式及强化率。两组之间临床资料及灶周结节(TD/MLN)MRI特征中连续变量的比较采用独立样本t检验,分类变量的比较采用χ2检验或Fisher精确检验,等级变量采用Wilcoxon符号秩和检验。对组间差异有统计学意义(P<0.05)的变量进行二元Logistic回归分析,建立预测模型,并采用ROC曲线评估模型对TD与MLN的鉴别效能。结果:两组患者的临床和病理资料中,性别、年龄、肿瘤发生部位、血清肿瘤标记物CA19-9和CA50水平、肿瘤分化程度、周围脉管及神经侵犯情况的差异均无统计学意义(P>0.05);而肿瘤周围结节的数目及血清肿瘤标记物CEA的水平在两组之间的差异均具有统计学意义(P<0.05)。两组灶周结节MRI征象的比较:强化方式的差异无统计学意义(P>0.05),而结节形态、短径、ADC值及强化率的差异均具有统计学意义(P<0.05)。二元Logistic回归分析发现结节强化率和短径是预测TD的独立影响因素(P<0.05)。ROC曲线分析显示当结节短径>10.45 mm时,诊断TD的AUC、敏感度和特异度分别为0.719、67.7%和73.6%;当结节强化率<75.0%,诊断TD的AUC、敏感度和特异度分别为0.869、83.2%和80.1%。构建的影像预测模型的AUC为0.872,高于结节强化率和短径的AUC,且其诊断符合率、敏感度和特异度分别为89.7%、84.6%和73.5%。结论:结节短径及强化率是鉴别结直肠癌周围TD与MLN的独立影响因素,且两者构建的影像预测模型的准确性更高,可为临床术前评估结直肠癌的分期提供有价值的信息。

结肠癌发生肿瘤沉积的CT诊断及与患者预后结局的关系研究

目的探讨结肠癌发生肿瘤沉积的多层螺旋CT(MSCT)参数特征及与患者预后结局的相关性。方法选取东营市人民医院2017年2月—2019年12月102例经病理学诊断为结肠癌的患者。其中,66例患者发现结肠癌癌旁肿瘤沉积84枚、经病理学检查发现55例患者肿瘤淋巴结转移67枚。所有患者术前接受MSCT检查;比较肿瘤沉积及淋巴结转移的MSCT影像学特征和MSCT参数。根据患者3年随访结局将患者分为死亡组和存活组,比较两组患者的临床资料,采用多因素一般Logistic回归模型分析患者不良预后结局的影响因素。结果结肠癌患者的肿瘤沉积与转移淋巴结的结节直径比较,差异无统计学意义(P>0.05);结肠癌患者的肿瘤沉积结节的边缘特征模糊、有毛刺征、有结节内部坏死占比均高于转移淋巴结(P<0.05);结肠癌患者的肿瘤沉积结节纵横径比值小于转移淋巴结(P<0.05);结肠癌患者的肿瘤沉积结节的平扫CT值、动脉期强化CT值、静脉期强化CT值均高于转移淋巴结(P<0.05);多因素一般Logistic回归模型分析结果显示,肿瘤呈低分化OR是结肠癌患者不良预后结局的独立危险因素(P<0.05)。结论MSCT的影像学特征及参数对临床鉴别结肠癌癌旁肿瘤沉积及转移淋巴结有重要价值,结肠癌癌旁肿瘤沉积与患者不良预后结局有一定的关系。

结肠癌肠外静脉侵犯、肿瘤沉积的CT特征对诊断及预后预测的价值

目的:探讨结肠癌肠外静脉侵犯、肿瘤沉积的CT特征对诊断及患者预后预测的价值。方法:选取2014年4月至2017年4月间收治的90例结肠癌患者作为研究对象,总结分析结肠癌肠外静脉侵犯、肿瘤沉积的CT特征,并以5年随访结果建立Cox比例风险模型,分析结肠癌肠外静脉侵犯、肿瘤沉积与患者不良预后的关系;采用ROC曲线分析肠外静脉侵犯、肿瘤沉积的CT特征对患者预后的预测价值。结果:以术后病理结果为金标准,CT检查结果提示肠外静脉侵犯阳性42例,阴性48例,诊断符合率为75.56%。CT检查结果提示肿瘤沉积阳性39例,阴性51例,诊断符合率为80.00%。病理确诊的肿瘤沉积阳性患者33例,阴性患者57例,病理肿瘤沉积阳性组的肿瘤静脉期不均匀强化、T分期中T3及T4分期的患者占比均显著高于阴性组,差异有统计学意义(P<0.05)。病理确诊的肠外静脉侵犯阳性患者36例,阴性患者54例,病理肠外静脉侵犯阳性组的肿瘤静脉期不均匀强化、T分期中T3及T4分期、静脉期CT值>64 HU的患者占比均显著高于阴性组,差异有统计学意义(P<0.05)。Logistic回归模型分析结果显示T分期为T3及T4分期、发生淋巴结转移、肿瘤呈低分化、发生肿瘤沉积、发生肠外静脉侵犯、肿瘤静脉期强化不均匀、静脉期CT值>64 HU是结肠癌患者不良预后结局的独立危险因素(P<0.05)。肠外静脉侵犯、肿瘤沉积的CT特征预测患者预后的AUC分别为0.686、0.728,两者联合预测的AUC为0.802。结论:结肠癌肠外静脉侵犯、肿瘤沉积的CT特征对诊断与预测患者预后具有一定价值,可为临床诊疗提供参考。

胃癌患者出现癌结节的危险因素及预后影响分析

目的探讨胃癌患者出现癌结节的危险因素及其预后影响。方法回顾性分析2015-01—2018-06郑州大学第一附属医院胃肠外科收治的462例确诊为胃癌并行根治性胃切除术+D2淋巴结清扫术患者的临床资料,按照是否出现癌结节分为癌结节阳性组和癌结节阴性组。比较2组患者的临床病理特征、5 a生存率和5 a无瘤生存率。单因素分析采用χ^(2)检验或Fisher确切概率法比较,将单因素分析有统计学意义的因素纳入多因素Logistic回归模型中。采用Kaplan-Meier法绘制生存曲线,生存率的比较采用Log-rank检验。P<0.05表示差异有统计学意义。结果单因素分析显示,肿瘤大小、肿瘤部位、大体类型、印戒细胞成分、T分期、N分期、TNM分期、脉管浸润和神经侵犯,是胃癌患者出现癌结节的影响因素(P<0.05);多因素分析显示,含印戒细胞成分(OR=4.207,95%CI:1.851~9.562,P<0.05)、N分期较晚(OR=1.643,95%CI:1.071~2.522,P<0.05)和脉管浸润阳性(OR=2.614,95%CI:1.095~6.238,P<0.05)是胃癌患者出现癌结节的独立危险因素;生存分析显示,癌结节阳性患者的5 a生存率和无瘤生存率均劣于癌结节阴性患者,差异有统计学意义(P<0.05)。亚组分析显示,Ⅰ期胃癌患者,癌结节阳性组与癌结节阴性组生存率的差异无统计学意义(P>0.05);Ⅱ、Ⅲ期胃癌患者,癌结节阳性组生存率劣于癌结节阴性组,差异有统计学意义(P<0.05)。对于癌结节阳性的胃癌患者,完成辅助化疗可以显著改善总生存时间和无瘤生存时间(P<0.05)。结论含印戒细胞癌成分、N分期较晚、脉管浸润阳性是胃癌患者出现癌结节的高危因素,癌结节阳性患者的预后不良,术后辅助化疗可以改善癌结节阳性患者的预后。

结直肠癌旁肿瘤沉积的CT检查影像学特征分析

目的探究结直肠癌(CRC)旁肿瘤沉积的计算机断层扫描(CT)检查影像学特征。方法随机选取2017年9月至2020年9月我院收治的82例CRC患者,所有患者采用全腹部CT平扫和动脉期、静脉期增强扫描。观察患者病灶旁肿瘤沉积表现,并对肿瘤沉积的CT影像学特征以及各参数进行分析。结果共计82例患者全部完成检查,其中44例患者的CT平扫结果显示病灶周围存在短径>5 mm的结节灶,确诊为肿瘤沉积;其余38例患者并未显示出病灶周围存在短径>5 mm的结节灶,暂无肿瘤沉积表现。肿瘤沉积患者与无肿瘤沉积患者的CT检查显示肿瘤短径、长径、最大径以及长短径比值比较,差异无统计学意义(P>0.05)。肿瘤发病部位:结肠脾曲13例、结肠肝曲16例、升结肠14例、降结肠12例,直乙状结肠11例、直肠癌16例。CRC患者的CT平扫结果可观察到部分患者存在不同程度的癌旁肿瘤沉积现象,部分肿瘤沉积密度不均匀,严重的可出现坏死,主要形态表现为毛刺或分叶状。肿瘤沉积CRC患者的平扫CT值、动脉期强化CT值、静脉期强化CT值明显高于无肿瘤沉积患者(P<0.05)。结论CRC患者肿瘤沉积在CT检查过程中可表现出与其他结节类似的特征;与无肿瘤沉积的患者相比,肿瘤沉积患者的CT值出现上升;目前并无肿瘤沉积成因的确切报道。

基于CT增强图像的影像组学模型对鉴别结直肠癌旁肿瘤沉积及转移淋巴结的诊断价值

目的:探讨基于CT增强图像的影像组学模型对鉴别结直肠癌旁肿瘤沉积(TD)及转移淋巴结(MLN)的诊断价值。方法:回顾性分析经手术病理证实且CT增强图像上可辨识的45个结直肠癌旁TD和45个转移性淋巴结的影像学资料。所有患者在术前一周内行全腹部CT平扫和动静脉双期增强扫描。使用Mazda软件,在CT静脉期增强图像上提取病灶的影像组学特征,随后采用软件自带的FPM法及主成分分析法对纹理特征进行特征选择及抽取的降维方法,筛选出有预测价值的纹理特征。并将样本随机分为训练集与验证集,使用降维后的特征和临床高危因素建立随机森林、决策树、朴素贝叶斯和逻辑式回归共4种机器学习模型,计算4种模型在验证集的鉴别诊断符合率,进行ROC曲线分析并获得曲线下面积(AUC)。结果:共提取794个影像组学特征,经降维后获得有鉴别诊断意义的9个主成分特征参数。建立的随机森林、决策树、朴素贝叶斯和逻辑式回归机器学习模型在验证集中对鉴别TD与MLN的符合率分别为100%、100%、100%和92.86%,ROC曲线下面积分别为0.83、0.71、0.94和0.89。结论:基于CT增强静脉期图像的影像组学模型对结直肠癌旁肿瘤沉积及转移性淋巴结的鉴别诊断具有较大价值。

螺旋CT多参数测量对结直肠癌旁肿瘤沉积的诊断价值

目的:探讨MSCT多参数测量在结直肠癌旁肿瘤沉积(TD)中的诊断价值,筛选最佳诊断参数。方法:回顾性分析经病理证实且CT上可辨识的结直肠癌旁TD病灶30个及淋巴结转移病灶30个的术前全腹部MSCT图像。测量结直癌旁TD及转移性淋巴结的多项参数值,包括病灶的长径、短径、平均径、长短径比、平扫、动脉期及静脉期CT值。比较2组病灶间各项参数值的差异并分析其诊断效能。结果:TD组中病灶的长径、短径、最大径和长短径比分别为(1.29±0.40)、(1.17±0.37)和(1.23±0.39)cm及1.11±0.07,淋巴结转移组分别为(1.01±0.32)、(0.80±0.34)和(0.91±0.33)cm及1.32±0.22,两组间差异均有统计学意义(P<0.05);TD组中病灶的平扫CT值、动脉期强化值和静脉期强化值分别为(29.13±6.82)、(33.67±8.49)和(52.77±9.82)HU,均大于淋巴结转移组[分别为(15.03±3.47)、(18.07±5.64)和(40.67±7.85)HU],组间差异均有统计学意义(P<0.05)。TD组中病灶的长径、短径、平均径、长短径比、平扫CT值、动脉期强化值和静脉期强化值诊断TD的受试者工作特征曲线(ROC)的曲线下面积(AUC)均>0.722,其中以平扫CT值、动脉期强化值和长短径比的诊断效能为佳,其AUC分别为0.965、0.911和0.881,最佳诊断阈值分别为21和45HU及1.33,相应的诊断敏感度分别为86.67%、83.33%和76.67%,特异度分别为100%、93.33%和90.00%。结论:MSCT多参数测量对鉴别结直肠癌旁肿瘤沉积与转移性淋巴结有较大价值,其中以平扫CT值、动脉期CT强化值和长短径比值的诊断效能为佳。

结直肠癌旁肿瘤沉积的研究进展

结直肠癌的临床研究发现一些患者常存在结肠旁肿瘤沉积(PTDs),他有别于淋巴结转移癌,通常沿着血管周围,神经周围或者血管内生长.PTDs的特性及其与预后的相关性引起了学者们的广泛关注.本文综述了PTDs的生长与组织结构特点,在TNM分期中价值,提示其在结直肠癌病理及生物学行为方面的重要价值,并可能成为评估预后,制定个体化治疗方案的指标.