目的:评估超声造影(contrast-enhanced ultrasound,CEUS)肝脏影像报告和数据系统(Liver Imaging Reporting and Data System,LI-RADS)分类中的LR-M标准鉴别肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)与低分化肝细胞癌(hepatocell...目的:评估超声造影(contrast-enhanced ultrasound,CEUS)肝脏影像报告和数据系统(Liver Imaging Reporting and Data System,LI-RADS)分类中的LR-M标准鉴别肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)与低分化肝细胞癌(hepatocellular carcinoma,HCC)的诊断效能。方法:回顾并分析2019年1月—2023年12月经病理学检查确诊的ICC患者和低分化HCC患者,所有患者均在治疗前接受了CEUS检查。对比两组患者的常规超声特征、CEUS特征及CEUSLI-RADS分类。根据病灶最大直径分为≤5cm、5~10cm及>10 cm 3个亚组,进行CEUS LI-RADS中LR-M类别诊断效能的亚组分析。CEUSLI-RADS类别根据2017版CEUSLI-RADS进行分类。采用受试者工作特征曲线分析LR-M的诊断性能。结果:共纳入50例ICC和50例低分化HCC患者。24例(48.0%)ICC患者和10例(20.0%)低分化HCC患者病灶位于左肝(P=0.003)。23例(46.0%)ICC患者和1例(2.0%)低分化HCC患者出现胆管扩张或胆管结石(P<0.001)。31例(62.0%)ICC患者和1例(2.0%)低分化HCC患者病灶在动脉期呈现出典型的边缘性、不规则环状增强型(P<0.001)。34例(68.0%)ICC患者和3例(6.0%)低分化HCC患者在门脉期或延迟期出现显著廓清(P<0.001)。ICC和低分化HCC平均廓清时间分别为34.45 s和74.08 s(P<0.001)。LR-M的总体曲线下面积(area under curve,AUC)、灵敏度、特异度分别为0.730、94.00%及52.00%,在≤5 cm、5~10 cm及>10 cm 3个亚组中AUC分别为0.746、0.667及0.833。结论:LR-M分类在识别ICC方面具有高灵敏度,但其特异度有待提升。当病灶大小>10 cm时,LR-M分类准确度显著增加。当病灶大小≤5 cm或>10 cm时,LR-M鉴别ICC和低分化HCC的特异度显著提升。展开更多
目的:总结结直肠癌与中医体质间相关性的研究及现状,探讨结直肠癌在中医理论体系下的体质分布特征,以期为临床实践采用中医药预防结直肠癌提供基于证据的医学支持。方法:计算机检索中国知网、万方数据库、维普数据库、PubMed、Web of Sc...目的:总结结直肠癌与中医体质间相关性的研究及现状,探讨结直肠癌在中医理论体系下的体质分布特征,以期为临床实践采用中医药预防结直肠癌提供基于证据的医学支持。方法:计算机检索中国知网、万方数据库、维普数据库、PubMed、Web of Science、EMbase等数据库,整理、汇总结直肠癌与中医体质相关的文献,检索时限为建库至2024年7月20日。采用RevMan 5.4、Stata 15.0软件进行Meta分析。结果:共纳入11篇文献,涉及病人2349例。横断面研究的合并结果显示,结直肠癌病人主要体质类型分别为阳虚质(18%)、湿热质(17%)、气虚质(14%)、痰湿质(12%)。病例-对照研究的Meta分析结果显示,气虚质在结直肠癌人群的比例是普通人群的1.83倍,差异有统计学意义(P<0.05),其余体质类型则差异无统计学意义。结论:现有证据表明,结直肠癌病人主要的体质类型包括阳虚质、湿热质、气虚质和痰湿质,其中以阳虚质最为常见,而气虚质可能是导致结直肠癌发生的一个重要风险因素。展开更多
Objective:Neoadjuvant immunotherapy has demonstrated favorable efficacy in patients with resectable non-small cell lung cancer(NSCLC).However,its clinical application remains limited by the lack of reliable and non-in...Objective:Neoadjuvant immunotherapy has demonstrated favorable efficacy in patients with resectable non-small cell lung cancer(NSCLC).However,its clinical application remains limited by the lack of reliable and non-invasive biomarkers.Although existing histological biomarkers such as programmed death-ligand 1(PD-L1)and tumor mutation burden(TMB)can be used for reference,they rely on invasive sampling and are susceptible to tumor heterogeneity.This study evaluated a series of peripheral blood inflammation-related indicators,including neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and interleukin-6(IL-6),to explore their potential as non-invasive predictive and prognostic biomarkers for NSCLC.Furthermore,a prediction model based on the above indicators was constructed to provide a practical and feasible tool for optimizing individualized clinical management in patients with resectable NSCLC.Methods:A retrospective analysis was conducted on 144 patients with resectable(stageⅠB-ⅢB)NSCLC who underwent surgery after receiving neoadjuvant immunotherapy combined with chemotherapy at the Second Xiangya Hospital,Central South University,between 2019 and 2022.Peripheral blood-related indicators at baseline and before surgery were collected.Clinical data that might influence treatment efficacy were also recorded,including age,sex,body mass index,smoking history,pathological type,clinical stage,and use of immune checkpoint inhibitors.The relationships between peripheral blood inflammatory indicators(NLR,LMR,PLR,SII,and IL-6)and objective response rate(ORR),pathological complete response(pCR),major pathological response(MPR),and disease-free survival(DFS)were analyzed.Receiver operating characteristic(ROC)curves were used to determine optimal cutoff values for each indicator.A prediction model for the efficacy of neoadjuvant immunotherapy in NSCLC was constructed using least absolute shrinkage and selection operator(LASSO)regression combined with a multivariate Cox proportional hazards model.Results:The median age of included patients was 58 years,and 91.0%(131/144)were male.Among pathological types,squamous cell carcinoma accounted for 74.3%(107/144),adenocarcinoma for 22.9%(33/144),and other types for 4 cases.The overall ORR,pCR,and MPR rates were 69.2%,42.4%,and 61.5%,respectively.Univariate analysis showed that patients with squamous cell carcinoma had significantly higher ORR(P=0.007),pCR(P=0.027),and MPR(P=0.019).Lower baseline LMR was associated with a higher ORR.Elevated baseline PLR was significantly associated with pCR(P=0.014)and MPR(P=0.043).Increased baseline SII(P=0.015)and IL-6(P=0.043)were associated with higher MPR rates.Multivariate analysis showed that squamous cell carcinoma was an independent predictor of MPR(OR=7.34,95%CI 1.02 to 52.51,P=0.047),and lower baseline LMR was an independent predictor of ORR in NSCLC(OR=0.21,95%CI 0.05 to 0.92,cutoff value 3.12;P=0.04).Further survival analysis indicated that low baseline NLR(HR=0.363,P=0.014),low preoperative LMR(HR=0.260,P=0.018),and high preoperative SII(HR=0.278,P=0.003)significantly reduced the risk of DFS.A prediction model including 9 factors(age,pathological type,baseline NLR,baseline neutrophils,baseline IL-6,baseline monocytes,preoperative lymphocytes,preoperative SII,and preoperative LMR)was established for predicting the efficacy of neoadjuvant immunotherapy in NSCLC,with an AUC of 0.818.Conclusion:Neoadjuvant immunotherapy demonstrates favorable clinical efficacy in patients with NSCLC,particularly in those with squamous cell carcinoma.Meanwhile,peripheral blood inflammation-related indicators may serve as important biomarkers for predicting the efficacy and prognosis of neoadjuvant immunotherapy in NSCLC.展开更多
文摘目的:评估超声造影(contrast-enhanced ultrasound,CEUS)肝脏影像报告和数据系统(Liver Imaging Reporting and Data System,LI-RADS)分类中的LR-M标准鉴别肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)与低分化肝细胞癌(hepatocellular carcinoma,HCC)的诊断效能。方法:回顾并分析2019年1月—2023年12月经病理学检查确诊的ICC患者和低分化HCC患者,所有患者均在治疗前接受了CEUS检查。对比两组患者的常规超声特征、CEUS特征及CEUSLI-RADS分类。根据病灶最大直径分为≤5cm、5~10cm及>10 cm 3个亚组,进行CEUS LI-RADS中LR-M类别诊断效能的亚组分析。CEUSLI-RADS类别根据2017版CEUSLI-RADS进行分类。采用受试者工作特征曲线分析LR-M的诊断性能。结果:共纳入50例ICC和50例低分化HCC患者。24例(48.0%)ICC患者和10例(20.0%)低分化HCC患者病灶位于左肝(P=0.003)。23例(46.0%)ICC患者和1例(2.0%)低分化HCC患者出现胆管扩张或胆管结石(P<0.001)。31例(62.0%)ICC患者和1例(2.0%)低分化HCC患者病灶在动脉期呈现出典型的边缘性、不规则环状增强型(P<0.001)。34例(68.0%)ICC患者和3例(6.0%)低分化HCC患者在门脉期或延迟期出现显著廓清(P<0.001)。ICC和低分化HCC平均廓清时间分别为34.45 s和74.08 s(P<0.001)。LR-M的总体曲线下面积(area under curve,AUC)、灵敏度、特异度分别为0.730、94.00%及52.00%,在≤5 cm、5~10 cm及>10 cm 3个亚组中AUC分别为0.746、0.667及0.833。结论:LR-M分类在识别ICC方面具有高灵敏度,但其特异度有待提升。当病灶大小>10 cm时,LR-M分类准确度显著增加。当病灶大小≤5 cm或>10 cm时,LR-M鉴别ICC和低分化HCC的特异度显著提升。
文摘目的:总结结直肠癌与中医体质间相关性的研究及现状,探讨结直肠癌在中医理论体系下的体质分布特征,以期为临床实践采用中医药预防结直肠癌提供基于证据的医学支持。方法:计算机检索中国知网、万方数据库、维普数据库、PubMed、Web of Science、EMbase等数据库,整理、汇总结直肠癌与中医体质相关的文献,检索时限为建库至2024年7月20日。采用RevMan 5.4、Stata 15.0软件进行Meta分析。结果:共纳入11篇文献,涉及病人2349例。横断面研究的合并结果显示,结直肠癌病人主要体质类型分别为阳虚质(18%)、湿热质(17%)、气虚质(14%)、痰湿质(12%)。病例-对照研究的Meta分析结果显示,气虚质在结直肠癌人群的比例是普通人群的1.83倍,差异有统计学意义(P<0.05),其余体质类型则差异无统计学意义。结论:现有证据表明,结直肠癌病人主要的体质类型包括阳虚质、湿热质、气虚质和痰湿质,其中以阳虚质最为常见,而气虚质可能是导致结直肠癌发生的一个重要风险因素。
基金supported by the Key Scientific Research Project of the Hunan Provincial Department of Science and Technology(2024PT5102)the Outstanding Youth Program under the Scientific Research Project of the Hunan Provincial Department of Education(23B0011)+1 种基金the Wu Jieping Medical Foundation(320.6750.2023-05-39)the Postgraduate Innovative Project of Central South University(2024XQLH151),China.
文摘Objective:Neoadjuvant immunotherapy has demonstrated favorable efficacy in patients with resectable non-small cell lung cancer(NSCLC).However,its clinical application remains limited by the lack of reliable and non-invasive biomarkers.Although existing histological biomarkers such as programmed death-ligand 1(PD-L1)and tumor mutation burden(TMB)can be used for reference,they rely on invasive sampling and are susceptible to tumor heterogeneity.This study evaluated a series of peripheral blood inflammation-related indicators,including neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and interleukin-6(IL-6),to explore their potential as non-invasive predictive and prognostic biomarkers for NSCLC.Furthermore,a prediction model based on the above indicators was constructed to provide a practical and feasible tool for optimizing individualized clinical management in patients with resectable NSCLC.Methods:A retrospective analysis was conducted on 144 patients with resectable(stageⅠB-ⅢB)NSCLC who underwent surgery after receiving neoadjuvant immunotherapy combined with chemotherapy at the Second Xiangya Hospital,Central South University,between 2019 and 2022.Peripheral blood-related indicators at baseline and before surgery were collected.Clinical data that might influence treatment efficacy were also recorded,including age,sex,body mass index,smoking history,pathological type,clinical stage,and use of immune checkpoint inhibitors.The relationships between peripheral blood inflammatory indicators(NLR,LMR,PLR,SII,and IL-6)and objective response rate(ORR),pathological complete response(pCR),major pathological response(MPR),and disease-free survival(DFS)were analyzed.Receiver operating characteristic(ROC)curves were used to determine optimal cutoff values for each indicator.A prediction model for the efficacy of neoadjuvant immunotherapy in NSCLC was constructed using least absolute shrinkage and selection operator(LASSO)regression combined with a multivariate Cox proportional hazards model.Results:The median age of included patients was 58 years,and 91.0%(131/144)were male.Among pathological types,squamous cell carcinoma accounted for 74.3%(107/144),adenocarcinoma for 22.9%(33/144),and other types for 4 cases.The overall ORR,pCR,and MPR rates were 69.2%,42.4%,and 61.5%,respectively.Univariate analysis showed that patients with squamous cell carcinoma had significantly higher ORR(P=0.007),pCR(P=0.027),and MPR(P=0.019).Lower baseline LMR was associated with a higher ORR.Elevated baseline PLR was significantly associated with pCR(P=0.014)and MPR(P=0.043).Increased baseline SII(P=0.015)and IL-6(P=0.043)were associated with higher MPR rates.Multivariate analysis showed that squamous cell carcinoma was an independent predictor of MPR(OR=7.34,95%CI 1.02 to 52.51,P=0.047),and lower baseline LMR was an independent predictor of ORR in NSCLC(OR=0.21,95%CI 0.05 to 0.92,cutoff value 3.12;P=0.04).Further survival analysis indicated that low baseline NLR(HR=0.363,P=0.014),low preoperative LMR(HR=0.260,P=0.018),and high preoperative SII(HR=0.278,P=0.003)significantly reduced the risk of DFS.A prediction model including 9 factors(age,pathological type,baseline NLR,baseline neutrophils,baseline IL-6,baseline monocytes,preoperative lymphocytes,preoperative SII,and preoperative LMR)was established for predicting the efficacy of neoadjuvant immunotherapy in NSCLC,with an AUC of 0.818.Conclusion:Neoadjuvant immunotherapy demonstrates favorable clinical efficacy in patients with NSCLC,particularly in those with squamous cell carcinoma.Meanwhile,peripheral blood inflammation-related indicators may serve as important biomarkers for predicting the efficacy and prognosis of neoadjuvant immunotherapy in NSCLC.
