AIM To assess the accuracy of shear wave elastography(SWE)alone and in combination with aminotransferase platelet ratio index(APRI)score in the staging of liver fibrosis.METHODS A multicenter prospective study was con...AIM To assess the accuracy of shear wave elastography(SWE)alone and in combination with aminotransferase platelet ratio index(APRI)score in the staging of liver fibrosis.METHODS A multicenter prospective study was conducted to assess the accuracy of SWE(medians)and APRI to predict biopsy results.The analysis focused on distinguishing the different stages of liver disease,namely,F0 from F1-4,F0-1 from F2-4,F0-2 from F3-4 and F0-3 from F4;F0-F1 from F2-F4 being of primary interest.The area under the receiver operating characteristic(AUROC)curve was computed using logistic regression model.The role of age,gender and steatosis was also assessed.RESULTS SWE alone accurately distinguished F0-1 from F2-4 with a high probability.The AUROC using SWE alone was 0.91 compared to 0.78 for using the APRI score alone.The APRI score,when used in conjunction with SWE,did not make a significant contribution to the AUROC.SWE and steatosis were the only significant predictors that differentiated F0-1 from F2-4 with an AUROC of 0.944.CONCLUSION Our study validates the use of SWE in the diagnosis and staging of liver fibrosis.Furthermore,the probability of a correct diagnosis is significantly enhanced with the addition of steatosis as a prognostic factor.展开更多
AIM: To investigate the prognostic significance of the primary site of disease for small bowel carcinoid(SBC) using a population-based analysis.METHODS: The Surveillance,Epidemiology and End Results(SEER) database was...AIM: To investigate the prognostic significance of the primary site of disease for small bowel carcinoid(SBC) using a population-based analysis.METHODS: The Surveillance,Epidemiology and End Results(SEER) database was queried for histologically confirmed SBC between the years 1988 and 2009.Overall survival(OS) and disease-specific survival(DSS) were analyzed using the Kaplan-Meier method and compared using Log rank testing.Log rank and multivariate Cox regression analyses were used to identify predictors of survival using age,year of diagnosis,race,gender,tumor histology/size/location,tumor-node-metastasis stage,number of lymph nodes(LNs) examined and percent of LNs with metastases.RESULTS: Of the 3763 patients,51.2% were male with a mean age of 62.13 years.Median follow-up was 50 mo.The 10-year OS and DSS for duodenal primaries were significantly better when compared to jejunal and ileal primaries(P = 0.02 and 【 0.0001,respectively).On multivariate Cox regression analysis,after adjusting for multiple factors,primary site location was not a significant predictor of survival(P = 0.752 for OS and P = 0.966 DSS) while age,number of primaries,number of LNs examined,T-stage and M-stage were independent predictors of survival.CONCLUSION: This 21-year,population-based study of SBC challenges the concept that location of the primary lesion alone is a significant predictor of survival.展开更多
基金the Aga Khan United States Research funding body and research support team for funding this study
文摘AIM To assess the accuracy of shear wave elastography(SWE)alone and in combination with aminotransferase platelet ratio index(APRI)score in the staging of liver fibrosis.METHODS A multicenter prospective study was conducted to assess the accuracy of SWE(medians)and APRI to predict biopsy results.The analysis focused on distinguishing the different stages of liver disease,namely,F0 from F1-4,F0-1 from F2-4,F0-2 from F3-4 and F0-3 from F4;F0-F1 from F2-F4 being of primary interest.The area under the receiver operating characteristic(AUROC)curve was computed using logistic regression model.The role of age,gender and steatosis was also assessed.RESULTS SWE alone accurately distinguished F0-1 from F2-4 with a high probability.The AUROC using SWE alone was 0.91 compared to 0.78 for using the APRI score alone.The APRI score,when used in conjunction with SWE,did not make a significant contribution to the AUROC.SWE and steatosis were the only significant predictors that differentiated F0-1 from F2-4 with an AUROC of 0.944.CONCLUSION Our study validates the use of SWE in the diagnosis and staging of liver fibrosis.Furthermore,the probability of a correct diagnosis is significantly enhanced with the addition of steatosis as a prognostic factor.
基金Supported by Cedars-Sinai Medical Center Department of Surgical Oncologyby Fellowship Funding from the WilliamRandolph Hearst Foundation(San Francisco,CA)(Dr.Hari DM)the Harold McAlister Charitable Foundation(Los Angeles,CA)(Dr.Leung AM)
文摘AIM: To investigate the prognostic significance of the primary site of disease for small bowel carcinoid(SBC) using a population-based analysis.METHODS: The Surveillance,Epidemiology and End Results(SEER) database was queried for histologically confirmed SBC between the years 1988 and 2009.Overall survival(OS) and disease-specific survival(DSS) were analyzed using the Kaplan-Meier method and compared using Log rank testing.Log rank and multivariate Cox regression analyses were used to identify predictors of survival using age,year of diagnosis,race,gender,tumor histology/size/location,tumor-node-metastasis stage,number of lymph nodes(LNs) examined and percent of LNs with metastases.RESULTS: Of the 3763 patients,51.2% were male with a mean age of 62.13 years.Median follow-up was 50 mo.The 10-year OS and DSS for duodenal primaries were significantly better when compared to jejunal and ileal primaries(P = 0.02 and 【 0.0001,respectively).On multivariate Cox regression analysis,after adjusting for multiple factors,primary site location was not a significant predictor of survival(P = 0.752 for OS and P = 0.966 DSS) while age,number of primaries,number of LNs examined,T-stage and M-stage were independent predictors of survival.CONCLUSION: This 21-year,population-based study of SBC challenges the concept that location of the primary lesion alone is a significant predictor of survival.
