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Long term survival achieved through combination of almonertinib and pyrotinib in EGFR-mutant/HER2-amplified advanced NSCLC patient: a case report and literature review 在表皮生长因子受体-突变/表皮生长因子-2-扩增的晚期NSCLC患者中联合使用阿莫替尼和派罗替尼可获得长期生存:病例报告和文献综述
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1397238
Xin Pan, Xiao Zhou
Human epithelial growth factor receptor 2 (HER2) amplification is an important mechanism of acquired resistance to anti-epidermal growth factor receptor (EGFR) therapy in non-small cell lung cancer (NSCLC) patients. For patients with both EGFR mutation and HER2 amplification, there is currently no unified standard treatment, and further exploration is needed on how to choose the therapy.A female NSCLC patient developed bone and brain metastases 14 and 42 months after radical surgery, respectively. The second genetic sequencing detected EGFR L858R mutation and HER2 amplification, and therefore initiated treatment with almonertinib and pyrotinib. The patient achieved partial remission and did not show any further progression during the follow-up period.For NSCLC patients with both EGFR mutation and HER2 amplification, the combination of almonertinib and pyrotinib is a valuable therapy that can continuously reduce tumor burden and achieve long-term survival.
人类上皮生长因子受体2(HER2)扩增是非小细胞肺癌(NSCLC)患者对抗表皮生长因子受体(EGFR)治疗产生获得性耐药的重要机制。对于同时存在表皮生长因子受体(EGFR)突变和HER2扩增的患者,目前还没有统一的标准治疗方法,如何选择治疗方法还需要进一步探索。一名女性NSCLC患者在根治术后14个月和42个月分别出现骨转移和脑转移。第二次基因测序检测出表皮生长因子受体(EGFR)L858R突变和HER2扩增,因此开始使用阿莫替尼和派罗替尼治疗。对于同时存在表皮生长因子受体(EGFR)突变和HER2扩增的NSCLC患者,阿莫替尼和吡罗替尼联合治疗是一种有价值的疗法,可以持续减轻肿瘤负担,实现长期生存。
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引用次数: 0
Patients’ perspectives on cancer care disparities in Central and Eastern European countries: experiencing taboos, misinformation and barriers in the healthcare system 中欧和东欧国家患者对癌症护理差异的看法:经历医疗保健系统中的禁忌、误导和障碍
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1420178
Veronica Coppini, Giulia Ferraris, Maria Vittoria Ferrari, Margherita Dahò, Iva Kirac, Ira Renko, Dario Monzani, R. Grasso, Gabriella Pravettoni
Despite the advancements in oncological medicine and research, cancer remains the second leading cause of death in Europe with Central and Eastern European countries, such as Slovakia and Croatia, showing the highest mortality rates and disparities in access to appropriate and comprehensive cancer care. Therefore, the primary aim of the current study is to investigate cancer patients’ perspectives and experiences to understand the possible underlying reasons for cancer disparities.Croatian cancer patients (n=15) and Slovak patients (n=11) were recruited through social media platforms, patients’ organisations, and hospital websites and offered participation in online focus group discussions on perceived disparities, barriers or malfunctioning during and after their cancer journey. Transcripts of video and audio recordings of the interviews were translated and analysed using Thematic analysis.Six Croatian and five Slovak themes emerged from the focus group discussions highlighting encountered barriers and perceived disparities, as well as suggestions or unmet needs. Most of the themes are common to both groups, such as the lack of information and use of the internet, and the taboos regarding cancer or psycho-oncological support. However, some themes are specific to each group, for instance, Slovak cancer patients remarked the fact that they do not mind travelling to get treatment as long as they can be treated in the west of Slovakia, while Croatian patients highlighted the need for more information after the illness and the socioeconomic impact deriving from a cancer diagnosis.Urgent intervention is needed in addressing disparities in Central and Eastern Europe. Present results could inform dedicated guidelines or better resource allocation strategies to reduce disparities in cancer care and promote inclusive healthcare.
尽管肿瘤医学和研究取得了进步,但癌症仍是欧洲第二大死因,斯洛伐克和克罗地亚等中东欧国家的死亡率最高,在获得适当和全面的癌症护理方面也存在差异。克罗地亚癌症患者(15 人)和斯洛伐克癌症患者(11 人)通过社交媒体平台、患者组织和医院网站被招募,并参加了在线焦点小组讨论,讨论他们在癌症治疗过程中和治疗后感知到的差异、障碍或故障。焦点小组讨论中出现了六个克罗地亚主题和五个斯洛伐克主题,强调了遇到的障碍和感知到的差异,以及建议或未满足的需求。大部分主题是两个群体共有的,例如缺乏信息和互联网的使用,以及有关癌症或肿瘤心理支持的禁忌。然而,有些主题是每个群体所特有的,例如,斯洛伐克癌症患者表示,只要能在斯洛伐克西部接受治疗,他们并不介意长途跋涉去接受治疗;而克罗地亚患者则强调,在患病后需要获得更多信息,以及癌症诊断对社会经济的影响。目前的研究结果可以为专门的指南或更好的资源分配战略提供参考,以减少癌症治疗中的差异,促进包容性医疗保健。
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引用次数: 0
Treatment accuracy of standard linear accelerator-based prostate SBRT: the delivered dose assessment of patients treated within two major clinical trials using an in-house position monitoring system 基于标准直线加速器的前列腺 SBRT 的治疗精确度:使用内部位置监测系统对两项主要临床试验中接受治疗的患者进行剂量评估
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1372968
Sankar Arumugam, T. Young, Catherine Jones, David Pryor, M. Sidhom
The purpose of this study was to assess the dosimetric improvements achieved in prostate stereotactic body radiotherapy (SBRT) treatment within the PROMETHEUS and NINJA trials using an in-house real-time position monitoring system, SeedTracker.This study considered a total of 127 prostate SBRT patients treated in the PROMETHEUS (ACTRN12615000223538) and NINJA (ACTRN12618001806257) clinical trials. The SeedTracker position monitoring system was utilized for real-time position monitoring with a 3-mm position tolerance. The doses delivered to the clinical target volume (CTV), rectum, and bladder were assessed by incorporating the actual target position during treatment. The dose that would have been delivered without monitoring was also assessed by incorporating the observed position deviations.Treatment with position corrections resulted in a mean (range) CTV D99 difference of −0.3 (−1.0 to 0.0) Gy between the planned and delivered dose. Without corrections, this difference would have been −0.6 (−3.7 to 0.0) Gy. Not correcting for position deviations resulted in a statistically significant difference between the planned and delivered CTV D99 (p < 0.05). The mean (range) dose difference between the planned and delivered D2cc of the rectum and bladder for treatment with position corrections was −0.1 (−3.7 to 4.7) Gy and −0.1 (−1.7 to 0.5) Gy, respectively. Without corrections, these differences would have been −0.6 (−6.1 to 4.7) Gy and −0.2 (−2.5 to 0.9) Gy.SeedTracker improved clinical dose volume compliance in prostate SBRT. Without monitoring and corrections, delivered dose would significantly differ from the planned dose.
本研究的目的是评估在 PROMETHEUS 和 NINJA 试验中使用内部实时位置监测系统 SeedTracker 对前列腺立体定向体放射治疗 (SBRT) 所取得的剂量学改进。本研究考虑了在 PROMETHEUS (ACTRN12615000223538) 和 NINJA (ACTRN12618001806257) 临床试验中接受治疗的 127 例前列腺 SBRT 患者。SeedTracker 位置监测系统用于实时位置监测,位置误差为 3 毫米。通过结合治疗过程中的实际靶点位置,对临床靶体积(CTV)、直肠和膀胱的剂量进行了评估。在进行位置校正治疗后,计划剂量和实际剂量之间的 CTV D99 平均值(范围)差异为 -0.3(-1.0 至 0.0)Gy。如果不进行校正,这一差异将为-0.6(-3.7 至 0.0)Gy。如果不对位置偏差进行校正,则计划的 CTV D99 剂量与投放的 CTV D99 剂量之间的差异具有统计学意义(P < 0.05)。位置校正后,直肠和膀胱的计划 D2cc 剂量与交付 D2cc 剂量之间的平均(范围)差异分别为-0.1(-3.7 至 4.7)Gy 和-0.1(-1.7 至 0.5)Gy。如果没有校正,这些差异将分别为-0.6(-6.1 到 4.7)Gy 和-0.2(-2.5 到 0.9)Gy。如果不进行监测和校正,投放剂量将与计划剂量相差甚远。
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引用次数: 0
Frequency of pathogenic germline variants in pediatric medulloblastoma survivors 小儿髓母细胞瘤幸存者中致病基因变异的频率
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1441958
Donald Rees, D. Gianferante, Jung Kim, Theodora Stavrou, Gregory Reaman, Y. Sapkota, M. Gramatges, Lindsay M. Morton, Melissa M. Hudson, Gregory T. Armstrong, Neal D. Freedman, Wen-Yi Huang, W. Diver, Adriana Lori, Wen Luo, B. Hicks, Jia Liu, Amy A. Hutchinson, Alisa M. Goldstein, L. Mirabello
Medulloblastoma is the most common malignant brain tumor in children. Most cases are sporadic, but well characterized germline alterations in APC, ELP1, GPR161, PTCH1, SUFU, and TP53 predispose to medulloblastoma. However, knowledge about pathogenic/likely pathogenic (P/LP) variants that predispose to medulloblastoma vary based on genes evaluated, patient demographics, and pathogenicity definitions.Germline exome sequencing was conducted on 160 childhood survivors of medulloblastoma. Analyses focused on rare variants in 239 known cancer susceptibility genes (CSGs). P/LP variants were identified using ClinVar and InterVar. Variants of unknown significance in known medulloblastoma predisposing genes (APC, ELP1, GPR161, PTCH1, SUFU, TP53) were further classified for loss of function variants. We compared the frequency of P/LP variants in cases to that in 1,259 cancer-free adult controls.Twenty cases (12.5%) had a P/LP variant in an autosomal dominant CSG versus 5% in controls (p=1.0 x10-3), and 10 (6.3%) of these were P/LP variants in a known medulloblastoma gene, significantly greater than 0.2% observed in controls (p=1.4x10-8). The CSGs with the most P/LP variants in cases, and significantly higher than controls, were ELP1 (p=3.0x10-4) and SUFU (p=1.4x10-3).Approximately one in eight pediatric medulloblastoma survivors had an autosomal dominant P/LP CSG variant. We confirm several known associated genes and identify novel genes that may be important in medulloblastoma.
髓母细胞瘤是儿童最常见的恶性脑肿瘤。大多数病例为散发性,但 APC、ELP1、GPR161、PTCH1、SUFU 和 TP53 的种系变异特征明确,易导致髓母细胞瘤。然而,根据所评估的基因、患者人口统计学和致病性定义的不同,对易诱发髓母细胞瘤的致病性/可能致病性(P/LP)变异的了解也不尽相同。分析的重点是239个已知癌症易感基因(CSG)中的罕见变异。使用 ClinVar 和 InterVar 鉴定了 P/LP 变异。对已知髓母细胞瘤易感基因(APC、ELP1、GPR161、PTCH1、SUFU、TP53)中意义不明的变异进行了进一步的功能缺失变异分类。我们将病例中的P/LP变异频率与1,259例无癌症成人对照中的P/LP变异频率进行了比较。20例病例(12.5%)的常染色体显性CSG中存在P/LP变异,而对照中只有5%(p=1.0 x10-3),其中10例(6.3%)是已知髓母细胞瘤基因中的P/LP变异,明显高于对照中的0.2%(p=1.4x10-8)。病例中P/LP变异最多且明显高于对照组的CSG是ELP1(p=3.0x10-4)和SUFU(p=1.4x10-3)。我们证实了几个已知的相关基因,并发现了可能对髓母细胞瘤很重要的新基因。
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引用次数: 0
Unveiling the synergetic benefits of the tunneling technique using stapler tractor in precise resection of lung segments: a retrospective cohort study 揭示隧道技术与订书机牵引器在精确切除肺段中的协同优势:一项回顾性队列研究
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1417871
Jian Zhu, Cheng-Hao Fu, Liang Chen, Quan Zhu, Shu-Sheng Zhu, Jianan Zheng, Wei Liao, Kun Li, Wei Wen
Tunneling technique has shown preliminary promise in lung segmentectomy which requires the use of staplers in specific procedures. However, the obstacle when staples pass is the most obvious factor hindering the implementation and development of this technique. This study investigated whether the obstacle of the technology could be addressed by using an innovative self-designed stapler tractor and analyzed the combined and respective advantages of them.The clinical data of patients with lung nodules located near anatomical sites with potential tunnel creation treated by segmentectomy were analyzed in this retrospective case-control study. The data were divided into four groups according to four distinct surgical strategies: In Group A, the tunneling technique was performed with a stapler tractor; in Group B, the tunneling technique was performed without a stapler tractor; in Group C, didn’t perform the tunneling technique but using stapler tractor in a normal approach; and in Group D, neither performed the technique nor used the stapler tractor. The general linear data, operation times, intraoperative adverse events, postoperative recovery and complications were compared.Compared with other groups, Group A exhibited the best surgical outcomes in comprehensive aspects. Separately, the tunnel groups (Group A&B) had better outcomes in the macro implementation of operation, including resection margin, the number of sampled intrapulmonary lymph nodes and resected subsegments, while the staple tractor groups (Group A&C) performed better on details of the procedure, including operation time, conversion to thoracotomy, and intraoperative bleeding (p < 0.05). Both of them were beneficial for shorter hospital stay, and the tunnel group was more advantageous.The tunneling technique is an advanced and beneficial surgical strategy for performing precise resection of lung segments while a stapler tractor can promote and facilitate it as a supplementary instrument. They show more combined benefits in effectively minimizing the occurrence of erroneous injuries and enhancing the operational efficacy.
隧道技术已在肺段切除术中显示出初步前景,在特定手术中需要使用订书机。然而,钉书针通过时的障碍是阻碍该技术实施和发展的最明显因素。这项回顾性病例对照研究分析了通过肺段切除术治疗的肺结节患者的临床数据,这些患者位于可能形成隧道的解剖部位附近。根据四种不同的手术策略,数据被分为四组:在 A 组中,使用订书机牵引器实施隧道技术;在 B 组中,不使用订书机牵引器实施隧道技术;在 C 组中,不实施隧道技术,但在正常方法中使用订书机牵引器;在 D 组中,既不实施隧道技术,也不使用订书机牵引器。与其他各组相比,A 组的手术效果最好。另外,隧道组(A 组和 B 组)在手术的宏观实施方面,包括切除边缘、取样的肺内淋巴结数量和切除的亚段等方面效果更好,而钉牵引组(A 组和 C 组)在手术细节方面,包括手术时间、转为开胸手术和术中出血等方面表现更好(P < 0.05)。隧道技术是精确切除肺段的一种先进而有效的手术策略,而订书机牵引器作为一种辅助器械可以促进和推动隧道技术的发展。它们在有效减少误伤发生和提高手术疗效方面显示出更多的综合优势。
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引用次数: 0
Construction of a risk prediction model for lung infection after chemotherapy in lung cancer patients based on the machine learning algorithm 基于机器学习算法构建肺癌患者化疗后肺部感染风险预测模型
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1403392
Tao Sun, Jun Liu, Houqin Yuan, Xin Li, Hui Yan
The objective of this study was to create and validate a machine learning (ML)-based model for predicting the likelihood of lung infections following chemotherapy in patients with lung cancer.A retrospective study was conducted on a cohort of 502 lung cancer patients undergoing chemotherapy. Data on age, Body Mass Index (BMI), underlying disease, chemotherapy cycle, number of hospitalizations, and various blood test results were collected from medical records. We used the Synthetic Minority Oversampling Technique (SMOTE) to handle unbalanced data. Feature screening was performed using the Boruta algorithm and The Least Absolute Shrinkage and Selection Operator (LASSO). Subsequently, six ML algorithms, namely Logistic Regression (LR), Random Forest (RF), Gaussian Naive Bayes (GNB), Multi-layer Perceptron (MLP), Support Vector Machine (SVM), and K-Nearest Neighbors (KNN) were employed to train and develop an ML model using a 10-fold cross-validation methodology. The model’s performance was evaluated through various metrics, including the area under the receiver operating characteristic curve (ROC), accuracy, sensitivity, specificity, F1 score, calibration curve, decision curves, clinical impact curve, and confusion matrix. In addition, model interpretation was performed by the Shapley Additive Explanations (SHAP) analysis to clarify the importance of each feature of the model and its decision basis. Finally, we constructed nomograms to make the predictive model results more readable.The integration of Boruta and LASSO methodologies identified Gender, Smoke, Drink, Chemotherapy cycles, pleural effusion (PE), Neutrophil-lymphocyte count ratio (NLR), Neutrophil-monocyte count ratio (NMR), Lymphocytes (LYM) and Neutrophil (NEUT) as significant predictors. The LR model demonstrated superior performance compared to alternative ML algorithms, achieving an accuracy of 81.80%, a sensitivity of 81.1%, a specificity of 82.5%, an F1 score of 81.6%, and an AUC of 0.888(95%CI(0.863-0.911)). Furthermore, the SHAP method identified Chemotherapy cycles and Smoke as the primary decision factors influencing the ML model’s predictions. Finally, this study successfully constructed interactive nomograms and dynamic nomograms.The ML algorithm, combining demographic and clinical factors, accurately predicted post-chemotherapy lung infections in cancer patients. The LR model performed well, potentially improving early detection and treatment in clinical practice.
本研究的目的是创建并验证一个基于机器学习(ML)的模型,用于预测肺癌患者化疗后肺部感染的可能性。我们从病历中收集了有关年龄、体重指数(BMI)、基础疾病、化疗周期、住院次数和各种血液检测结果的数据。我们使用合成少数群体过度取样技术(SMOTE)来处理不平衡数据。我们使用 Boruta 算法和最小绝对收缩和选择操作器(LASSO)进行了特征筛选。随后,采用六种 ML 算法,即逻辑回归 (LR)、随机森林 (RF)、高斯直觉贝叶斯 (GNB)、多层感知器 (MLP)、支持向量机 (SVM) 和 K-Nearest Neighbors (KNN),使用 10 倍交叉验证方法来训练和开发 ML 模型。模型的性能通过各种指标进行评估,包括接收者操作特征曲线下面积(ROC)、准确性、灵敏度、特异性、F1 分数、校准曲线、决策曲线、临床影响曲线和混淆矩阵。此外,我们还通过夏普利相加解释(SHAP)分析法对模型进行了解释,以明确模型每个特征的重要性及其决策依据。通过整合 Boruta 和 LASSO 方法,我们发现性别、吸烟、饮酒、化疗周期、胸腔积液(PE)、中性粒细胞-淋巴细胞计数比(NLR)、中性粒细胞-单核细胞计数比(NMR)、淋巴细胞(LYM)和中性粒细胞(NEUT)是重要的预测因子。与其他 ML 算法相比,LR 模型表现出更优越的性能,准确率为 81.80%,灵敏度为 81.1%,特异性为 82.5%,F1 得分为 81.6%,AUC 为 0.888(95%CI(0.863-0.911))。此外,SHAP 方法还发现化疗周期和烟雾是影响 ML 模型预测结果的主要决策因素。最后,本研究成功构建了交互式提名图和动态提名图。ML算法结合人口统计学和临床因素,准确预测了癌症患者化疗后的肺部感染。LR模型表现良好,有望改善临床实践中的早期检测和治疗。
{"title":"Construction of a risk prediction model for lung infection after chemotherapy in lung cancer patients based on the machine learning algorithm","authors":"Tao Sun, Jun Liu, Houqin Yuan, Xin Li, Hui Yan","doi":"10.3389/fonc.2024.1403392","DOIUrl":"https://doi.org/10.3389/fonc.2024.1403392","url":null,"abstract":"The objective of this study was to create and validate a machine learning (ML)-based model for predicting the likelihood of lung infections following chemotherapy in patients with lung cancer.A retrospective study was conducted on a cohort of 502 lung cancer patients undergoing chemotherapy. Data on age, Body Mass Index (BMI), underlying disease, chemotherapy cycle, number of hospitalizations, and various blood test results were collected from medical records. We used the Synthetic Minority Oversampling Technique (SMOTE) to handle unbalanced data. Feature screening was performed using the Boruta algorithm and The Least Absolute Shrinkage and Selection Operator (LASSO). Subsequently, six ML algorithms, namely Logistic Regression (LR), Random Forest (RF), Gaussian Naive Bayes (GNB), Multi-layer Perceptron (MLP), Support Vector Machine (SVM), and K-Nearest Neighbors (KNN) were employed to train and develop an ML model using a 10-fold cross-validation methodology. The model’s performance was evaluated through various metrics, including the area under the receiver operating characteristic curve (ROC), accuracy, sensitivity, specificity, F1 score, calibration curve, decision curves, clinical impact curve, and confusion matrix. In addition, model interpretation was performed by the Shapley Additive Explanations (SHAP) analysis to clarify the importance of each feature of the model and its decision basis. Finally, we constructed nomograms to make the predictive model results more readable.The integration of Boruta and LASSO methodologies identified Gender, Smoke, Drink, Chemotherapy cycles, pleural effusion (PE), Neutrophil-lymphocyte count ratio (NLR), Neutrophil-monocyte count ratio (NMR), Lymphocytes (LYM) and Neutrophil (NEUT) as significant predictors. The LR model demonstrated superior performance compared to alternative ML algorithms, achieving an accuracy of 81.80%, a sensitivity of 81.1%, a specificity of 82.5%, an F1 score of 81.6%, and an AUC of 0.888(95%CI(0.863-0.911)). Furthermore, the SHAP method identified Chemotherapy cycles and Smoke as the primary decision factors influencing the ML model’s predictions. Finally, this study successfully constructed interactive nomograms and dynamic nomograms.The ML algorithm, combining demographic and clinical factors, accurately predicted post-chemotherapy lung infections in cancer patients. The LR model performed well, potentially improving early detection and treatment in clinical practice.","PeriodicalId":507440,"journal":{"name":"Frontiers in Oncology","volume":"64 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intravoxel incoherent motion and enhanced T2*-weighted angiography for preoperative prediction of microvascular invasion in hepatocellular carcinoma 用于术前预测肝细胞癌微血管侵犯的体细胞内非相干运动和增强型 T2* 加权血管造影术
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1389769
Xue Ren, Ying Zhao, Nan Wang, Jiahui Liu, Shuo Zhang, Mingrui Zhuang, Hongkai Wang, Jixiang Wang, Yindi Zhang, Qingwei Song, Ailian Liu
To investigate the value of the combined application of intravoxel incoherent motion (IVIM) and enhanced T2*-weighted angiography (ESWAN) for preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC).76 patients with pathologically confirmed HCC were retrospectively enrolled and divided into the MVI-positive group (n=26) and MVI-negative group (n=50). Conventional MRI, IVIM, and ESWAN sequences were performed. Three region of interests (ROIs) were placed on the maximum axial slice of the lesion on D, D*, and f maps derived from IVIM sequence, and R2* map derived from ESWAN sequence, and intratumoral susceptibility signal (ITSS) from the phase map derived from ESWAN sequence was also automatically measured. Receiver operating characteristic (ROC) curves were drawn to evaluate the ability for predicting MVI. Univariate and multivariate logistic regression were used to screen independent risk predictors in clinical and imaging information. The Delong’s test was used to compare the differences between the area under curves (AUCs).The D and D* values of MVI-negative group were significantly higher than those of MVI-positive group (P=0.038, and P=0.023), which in MVI-negative group were 0.892×10-3 (0.760×10-3, 1.303×10-3) mm2/s and 0.055 (0.025, 0.100) mm2/s, and in MVI-positive group were 0.591×10-3 (0.372×10-3, 0.824×10-3) mm2/s and 0.028 (0.006, 0.050)mm2/s, respectively. The R2* and ITSS values of MVI-negative group were significantly lower than those of MVI-positive group (P=0.034, and P=0.005), which in MVI-negative group were 29.290 (23.117, 35.228) Hz and 0.146 (0.086, 0.236), and in MVI-positive group were 43.696 (34.914, 58.083) Hz and 0.199 (0.155, 0.245), respectively. After univariate and multivariate analyses, only AFP (odds ratio, 0.183; 95% CI, 0.041–0.823; P = 0.027) was the independent risk factor for predicting the status of MVI. The AUCs of AFP, D, D*, R2*, and ITSS for prediction of MVI were 0.652, 0.739, 0.707, 0.798, and 0.657, respectively. The AUCs of IVIM (D+D*), ESWAN (R2*+ITSS), and combination (D+D*+R2*+ITSS) for predicting MVI were 0.772, 0.800, and, 0.855, respectively. When IVIM combined with ESWAN, the performance was improved with a sensitivity of 73.1% and a specificity of 92.0% (cut-off value: 0.502) and the AUC was significantly higher than AFP (P=0.001), D (P=0.038), D* (P=0.023), R2* (P=0.034), and ITSS (P=0.005).The IVIM and ESWAN parameters showed good efficacy in prediction of MVI in patients with HCC. The combination of IVIM and ESWAN may be useful for noninvasive prediction of MVI before clinical operation.
研究联合应用体细胞内非相干运动(IVIM)和增强 T2* 加权血管造影(ESWAN)对肝细胞癌(HCC)微血管侵犯(MVI)进行术前预测的价值。回顾性纳入 76 例病理确诊的 HCC 患者,将其分为 MVI 阳性组(26 例)和 MVI 阴性组(50 例)。进行了常规 MRI、IVIM 和 ESWAN 序列检查。在 IVIM 序列得出的 D、D* 和 f 图以及 ESWAN 序列得出的 R2* 图上,病变的最大轴切片上放置了三个感兴趣区(ROI),并自动测量了 ESWAN 序列得出的相位图上的瘤内易感信号(ITSS)。绘制接收者操作特征(ROC)曲线以评估预测 MVI 的能力。采用单变量和多变量逻辑回归筛选临床和成像信息中的独立风险预测因子。MVI阴性组的D值和D*值明显高于MVI阳性组(P=0.038,P=0.023),其中 MVI 阴性组分别为 0.892×10-3 (0.760×10-3, 1.303×10-3) mm2/s 和 0.055 (0.025, 0.100) mm2/s,MVI 阳性组分别为 0.591×10-3 (0.372×10-3, 0.824×10-3) mm2/s 和 0.028 (0.006, 0.050)mm2/s。MVI阴性组的R2*和ITSS值明显低于MVI阳性组(P=0.034,P=0.005),MVI阴性组分别为29.290(23.117,35.228)Hz和0.146(0.086,0.236),MVI阳性组分别为43.696(34.914,58.083)Hz和0.199(0.155,0.245)。经过单变量和多变量分析,只有 AFP(几率比 0.183;95% CI,0.041-0.823;P = 0.027)是预测 MVI 状态的独立风险因素。AFP、D、D*、R2* 和 ITSS 预测 MVI 的 AUC 分别为 0.652、0.739、0.707、0.798 和 0.657。IVIM(D+D*)、ESWAN(R2*+ITSS)和组合(D+D*+R2*+ITSS)预测 MVI 的 AUC 分别为 0.772、0.800 和 0.855。当 IVIM 与 ESWAN 联用时,灵敏度为 73.1%,特异度为 92.0%(临界值:0.502),AUC 明显高于 AFP(P=0.001)、D(P=0.038)、D*(P=0.023)、R2*(P=0.034)和 ITSS(P=0.005)。IVIM和ESWAN参数对预测HCC患者的MVI有很好的效果。IVIM和ESWAN的组合可能有助于在临床手术前对MVI进行无创预测。
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引用次数: 0
Long segment ureterectomy with tapered demucosalized ileum replacement of ureter for ureteral cancer: a case report and literature review 输尿管癌的长段输尿管切除术与锥形去粘膜回肠替代输尿管:病例报告与文献综述
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1426003
Zhifei Xie, Mingwen Liu, Shulian Chen, Wen Tang, Guobiao Liang, Jingyu Xu, Ze-Ju Zhao
Radical nephroureterectomy (RNU) with bladder sleeve resection is currently the gold standard for the treatment of high-risk ureteral cancer. However, in certain special cases, such as bilateral upper tract urothelial carcinoma(UTUC), isolated and chronic kidney disease, and low-risk UTUC, kidney sparing surgery(KSS) may represent a viable alternative, though it remains highly challenging. The current KSS options for ureteral cancer include endoscopic treatment, segmental ureterectomy, total ureterectomy combined with kidney autotransplantation and nephrostomy. These methods are associated with significant disadvantages, such as a high risk of recurrence and vascular-related complications. On the basis of previous studies, we creatively proposed a surgical method of long segment ureterectomy with tapered demucosalized ileum(TDI) replacement of the ureter for ureteral cancer, and successfully performed this operation on a patient with ureteral cancer. The follow-up results showed that this surgical method provides good tumor control while preserving the patient’s renal function and improves the inherent defect of the ileal replacement of the ureter, which is a feasible choice for patients with ureteral cancer and kidney preservation.
目前,根治性肾切除术(RNU)加膀胱袖状切除术是治疗高危输尿管癌的金标准。然而,在某些特殊病例中,如双侧上尿路输尿管癌(UTUC)、孤立性慢性肾病和低风险UTUC,保肾手术(KSS)可能是一种可行的替代方案,尽管它仍具有很高的挑战性。目前输尿管癌的 KSS 选择包括内窥镜治疗、节段性输尿管切除术、全输尿管切除术联合肾脏自体移植术和肾造瘘术。这些方法都有很大的缺点,如复发风险高和血管相关并发症。在前人研究的基础上,我们创造性地提出了输尿管癌长段输尿管切除联合锥形去粘膜回肠(TDI)置换输尿管的手术方法,并成功为一名输尿管癌患者实施了该手术。随访结果显示,该手术方法在保留患者肾功能的同时,肿瘤控制效果良好,改善了回肠替代输尿管的固有缺陷,是输尿管癌患者保留肾脏的可行选择。
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引用次数: 0
Application of λ esophagojejunostomy in total gastrectomy under laparoscopy: a modified technique for post-gastrectomy reconstruction 腹腔镜下全胃切除术中λ食管空肠吻合术的应用:胃切除术后重建的改良技术
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1335297
Langbiao Liu, Guo-Tian Ruan, Ya-Dong Wu, Lei Niu, Jun Cai
Common gastrectomy methods can significantly affect patients’ postoperative quality of life. This study investigated the safety, feasibility, and short-term efficacy of λ-type esophagojejunostomy in total gastrectomy under total laparoscopy.We retrospectively analyzed the clinical and follow-up data of 50 patients with adenocarcinoma of the gastric/gastroesophageal junction who underwent total laparoscopic radical gastrectomy with λ-type esophagojejunostomy at the Beijing Friendship Hospital from January 2021 to July 2022. Data are reported as mean ± standard deviation.Patients comprised 27 males and 23 females, aged 42 to 76 (60.9 ± 5.6) years. There were 26 cases of gastroesophageal junction adenocarcinoma (16 Siewert type II and 10 Siewert type III) and 24 cases of adenocarcinoma of the proximal gastric body. All patients underwent radical total gastrectomy and D2 lymph node dissection with λ-type esophagojejunostomy for digestive tract reconstruction under total laparoscopy. The total operation time was 235–295 (249.4 ± 48.5) min, digestive tract reconstruction time was (48.2 ± 23.2) min, intraoperative blood loss was (63.4 ± 48.4) mL, recovery time of exhaust was (3.1 ± 2.2) d, first drinking or eating time was (4.1 ± 2.1) d, and hospital stay was (9.3 ± 4.4) d. Three patients had postoperative complications, including one with duodenal remnant leakage combined with abdominal infection. Anastomotic bleeding and postoperative inflammatory intestinal obstruction occurred in one patient each, all of whom were cured by conservative treatment. The Nutritional Risk Index of the whole group was 53.5 ± 8.4 preoperatively, 47.3 ± 5.6 one week postoperatively, 50.3 ± 5.6 six months postoperatively, and 52.4 ± 4.2 at 12 months postoperatively. Roux-en-Y stasis syndrome and bile reflux esophagitis occurred in one patient each (2.0%). There were no occurrences of recanalization of the closed end of the afferent loop of the esophagojejunostomy anastomosis, anastomotic stricture or obstruction, or tumor recurrence.λ-type esophagojejunostomy is safe and feasible for digestive tract reconstruction after total laparoscopic radical gastrectomy. This digestive tract reconstruction method not only maintains intestinal continuity but also simplifies surgical procedures, allowing patients to recover quickly with an excellent short-term effect.
普通的胃切除术方法会严重影响患者的术后生活质量。我们回顾性分析了2021年1月至2022年7月在北京友谊医院接受全腹腔镜根治性胃切除术并行λ型食管空肠吻合术的50例胃/胃食管交界处腺癌患者的临床和随访数据。患者中有 27 名男性和 23 名女性,年龄在 42 岁至 76 岁之间(60.9±5.6)。其中胃食管连接部腺癌 26 例(16 例为 Siewert II 型,10 例为 Siewert III 型),胃体近端腺癌 24 例。所有患者均在全腹腔镜下接受了根治性全胃切除术、D2淋巴结清扫术和λ型食管空肠吻合术,以重建消化道。手术总时间为 235-295 (249.4 ± 48.5) min,消化道重建时间为 (48.2 ± 23.2) min,术中失血量为 (63.4 ± 48.4) mL,排气恢复时间为 (3.1 ± 2.2) d,首次饮水或进食时间为 (4.1 ± 2.1) d,住院时间为 (9.3 ± 4.4) d。吻合口出血和术后炎性肠梗阻各发生 1 例,均经保守治疗治愈。全组患者的营养风险指数为术前 53.5 ± 8.4,术后一周 47.3 ± 5.6,术后六个月 50.3 ± 5.6,术后 12 个月 52.4 ± 4.2。Roux-en-Y瘀血综合征和胆汁反流性食管炎各有一名患者发生(2.0%)。λ型食管空肠吻合术在全腹腔镜根治性胃切除术后的消化道重建中是安全可行的。这种消化道重建方法不仅保持了肠道的连续性,而且简化了手术程序,使患者能够快速康复,短期效果极佳。
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引用次数: 0
Urinary mRNA-based biomarkers for non-muscle-invasive bladder cancer: a mini-review 基于尿 mRNA 的非肌层浸润性膀胱癌生物标记物:微型综述
Pub Date : 2024-08-09 DOI: 10.3389/fonc.2024.1441883
Karoline Brito Caetano Andrade Coelho, D.K. Wosniaki, A. Marin, Laura Fabris, Rodolfo Borges dos Reis, M. N. Aoki, D. Zanette
Bladder cancer (BC) is the second most common type of cancer of the urinary system. Approximately 75% of the cases are non-muscle invasive bladder cancer (NMIBC), which has a high recurrence and progression rate. Current diagnosis and surveillance methods present challenges, including risks to the patients. For this reason, urinary biomarkers have been proposed as alternatives to the methods. The goal of this mini-review is to describe urinary mRNA-based biomarkers available in current literature for NMIBC tumors, using the PubMed database. The search included the following keywords: “biomarkers” AND “bladder cancer” AND “urine” and “RNA” and “non-muscle”. The search yielded 11 original researchers utilizing mRNA-based urinary biomarkers. Although there is a wide variety of biomarkers described, the cohorts of the studies were not exclusively NMIBC, which is the subtype of BC that would mostly benefit from the introduction of a good follow-up biomarker, highlighting the need for randomized interventional trials for NMIBC.
膀胱癌(BC)是泌尿系统癌症中第二大常见类型。约 75% 的病例为非肌层浸润性膀胱癌 (NMIBC),其复发率和进展率都很高。目前的诊断和监测方法面临挑战,包括对患者的风险。因此,人们提出了尿液生物标志物作为这些方法的替代品。这篇微型综述的目的是利用 PubMed 数据库,描述目前文献中可用于 NMIBC 肿瘤的基于尿 mRNA 的生物标记物。搜索包括以下关键词:"生物标记物"、"膀胱癌"、"尿液"、"RNA "和 "非肌肉"。搜索结果显示,有 11 位研究人员利用了基于 mRNA 的尿液生物标记物。虽然描述的生物标志物种类繁多,但研究的队列并不完全是 NMIBC,而 NMIBC 是膀胱癌的一个亚型,引入良好的随访生物标志物将使该亚型受益匪浅,这凸显了针对 NMIBC 进行随机干预试验的必要性。
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引用次数: 0
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Frontiers in Oncology
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