BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study...BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study aims to investigate the application value of a combined machine learning(ML)based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis(MLM).AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer.METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023.All participants were randomly assigned to the training or validation queue in a 7:3 ratio.We first apply generalized linear regression model(GLRM)and random forest model(RFM)algorithm to construct an MLM prediction model in the training queue,and evaluate the discriminative power of the MLM prediction model using area under curve(AUC)and decision curve analysis(DCA).Then,the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups.RESULTS Among the 301 patients included in the study,16.28%were ultimately diagnosed with MLM through pathological examination.Multivariate analysis showed that carcinoembryonic antigen,and magnetic resonance imaging radiomics were independent predictors of MLM.Then,the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation.The prediction performance of GLRM in the training and validation queue was 0.765[95%confidence interval(CI):0.710-0.820]and 0.767(95%CI:0.712-0.822),respectively.Compared with GLRM,RFM achieved superior performance with AUC of 0.919(95%CI:0.868-0.970)and 0.901(95%CI:0.850-0.952)in the training and validation queue,respectively.The DCA indicated that the predictive ability and net profit of clinical RFM were improved.CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models,the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.展开更多
BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine...BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine risk factors for the metachronous occurrence of early gastric cancer(EGC)in elderly individuals.METHODS This retrospective cohort study comprised 653 elderly patients(aged≥65 years)who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital.Comprehensive analyses were conducted to compare lifestyle habits,comorbidities,and Helicobacter pylori(H.pylori)infections as potential indicators.RESULTS During a median follow-up of 38 months,46 patients(7.0%,20.46/1000 person-years)developed MGC in the elderly cohort.The cumulative incidences of MGC at 2,3,and 5 years were 3.3%,5.3%,and 11.5%,respectively.In multivariate Cox regression analyses,the independent risk factors for MGC included metabolic dysfunctionassociated steatotic liver disease(MASLD)[hazard ratio(HR)=2.44,95%confidence interval(CI):1.15-5.17],persistent H.pylori infection(HR=10.38,95%CI:3.36-32.07),severe mucosal atrophy(HR=2.71,95%CI:1.45-5.08),and pathological differentiation of EGC(well/moderately differentiated vs poorly differentiated:HR=10.18,95%CI:1.30-79.65).Based on these risk factors,a risk stratification system was developed to categorize individuals into low(0-1 point),intermediate(2-3 points),and high(4-8 points)risk categories for MGC,with cumulative incidence rates of 12.3%,21.6%,and 45%,respectively.CONCLUSION Among elderly individuals,MASLD,persistent H.pylori infection,severe mucosal atrophy,and well/moderately differentiated EGC were associated with an increased risk of MGC.Elderly patients are recommended to adopt healthy lifestyle practices,and undergo regular endoscopic screening and H.pylori testing after curative ESD for EGC.展开更多
Rectal cancer is a major global health concern,and metachronous liver metastasis(MLM)significantly worsens patient prognosis.Advances in imaging and machine learning have led to the development of radiomics models,par...Rectal cancer is a major global health concern,and metachronous liver metastasis(MLM)significantly worsens patient prognosis.Advances in imaging and machine learning have led to the development of radiomics models,particularly those utilizing multiparametric magnetic resonance imaging,which are highly valuable in predicting MLM.These models analyze imaging features to provide insights that can aid clinical decision-making and potentially improve treatment outcomes and survival rates.However,realizing the full potential of radiomics models faces challenges in terms of accuracy,generalizability,and data depen-dency.This editorial comments on a study regarding radiomics prediction models for rectal cancer MLM published recently in the World Journal of Gastrointestinal Oncology,discusses the progress,challenges,and strategies for diagnostic models of MLM in rectal cancer,and proposes directions for future research.展开更多
BACKGROUND Metachronous multiple esophageal squamous cell carcinomas(ESCCs)may occur in some patients after endoscopic resection.Multiple dysplastic lesions in the esophagus increase risk of multiple squamous cell car...BACKGROUND Metachronous multiple esophageal squamous cell carcinomas(ESCCs)may occur in some patients after endoscopic resection.Multiple dysplastic lesions in the esophagus increase risk of multiple squamous cell carcinomas(SCCs).Endoscopic imaging technology such as narrow band imaging(NBI),can detect early SCC.Lugol chromoendoscopy is also the conventional standard technique for detecting superficial ESCC.However,little is known about the interval from the first SCC to the metachronous SCC.Effective methods to prevent multiple metachronous SCCs are needed in survivors of esophageal SCC.CASE SUMMARY A 56-year-old man showed a slightly elevated reddish area in the middle thoracic esophagus at 30 cm from the incisors on gastroscopy for routine examination.Esophageal mucosa lesion was about 2.5 cm.NBI and magnifying gastroscopy confirmed intra-epithelial papillary loop type B-1 according to the Japan Esophageal Society Classification.Lugol chromoendoscopy was used to evaluate the dysplastic squamous epithelium in the esophagus.Biopsy pathology revealed severe dysplastic squamous epithelium.Computed tomography showed no lymph node metastasis.His complete blood test and tumor markers were within reference values.He had no history of alcohol consumption and smoking.Mucosal lesion was dissected by endoscopic submucosal dissection(ESD).Postoperative pathological results showed moderately differentiated squamous carcinoma.No cancer thrombus was seen in the vasculature,and the surrounding cut edge was not involved.The patient underwent radiotherapy within 2 months after ESD.The multiple Lugol-voiding lesions disappeared,and enhanced chest computed tomography revealed no lymph node metastasis.CONCLUSION This is the first case of multiple dysplastic lesions of esophagus cured by radiotherapy.Radiotherapy after minimally invasive endoscopic treatment might be a safe and effective optional therapeutic strategy to prevent metachronous multiple esophageal SCCs.展开更多
BACKGROUND Multiple primary carcinoma(MPC)refers to two or more types of primary malignant tumors occurring simultaneously or sequentially in the same patient.Breast cancer is one of the most common malignant tumors a...BACKGROUND Multiple primary carcinoma(MPC)refers to two or more types of primary malignant tumors occurring simultaneously or sequentially in the same patient.Breast cancer is one of the most common malignant tumors affecting women.On the other hand,diffuse large B-cell lymphoma(DLBCL)is the most frequent form of non-Hodgkin’s lymphoma(NHL).In clinical practice,the simultaneous existence of metachronous primary breast cancer and lymphoma is rare.In this case,we highlight the significance of multidisciplinary management and advanced imaging techniques in the early identification and treatment of MPC cases.CASE SUMMARY In this study,we report a case of a 40-year-old female who was diagnosed with invasive ductal carcinoma of the breast(T3N1M0 stage IIIA LuminalB type)as the first primary cancer and DLBCL(stage IIIA)as the second primary cancer.The patient underwent the modified radical mastectomy for left breast cancer and received Rituximab,cyclophospha-mide,hydroxydaunorubicin,Oncovin(vincristine)and prednisolone regimen chemotherapy treatment for DLBCL.As of now,the patient is in stable condition.The successful diagnosis of the present patient highlights the need for multidisciplinary management and adoption of advanced imaging techniques to identify the second primary cancer,especially NHL.CONCLUSION Accurate diagnosis and management of metachronous MPC requires an interdisciplinary team and selection of an appropriate treatment plan.展开更多
AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric ...AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.展开更多
Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased ...Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased in Japan and Korea,where H.pylori infection and gastric cancer are highly prevalent.Early intestinal-type gastric cancer without concomitant lymph node metastasis is usually treated by endoscopic resection.Secondary metachronous gastric cancers often develop because atrophic mucosa left untreated after endoscopic treatment confers a high risk of gastric cancer.The efficacy of H.pylori eradication for the prevention of metachronous gastric cancer remains controversial.However,in patients who undergo endoscopic resection of early gastric cancer,H.pylori eradication is recommended to suppress or delay metachronous gastric cancer.Careful and regularly scheduled endoscopy should be performed to detect minute metachronous gastric cancer after endoscopic resection.展开更多
To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD). METHODSA total of 352 patients underwent ESD for early GC at NTT ...To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD). METHODSA total of 352 patients underwent ESD for early GC at NTT West Osaka Hospital between June 2006 and February 2016. Exclusion criteria were as follows: Remnant stomach, unknown Helicobacter pylori status, and endoscopic observation of the whole stomach outside our hospital. We analyzed data from 192 patients comprising 109 patients with solitary GC (Group A) and 83 with metachronous and synchronous GC (Group B). We retrospectively investigated the clinicopathological and endoscopic characteristics, and endoscopic risk score as predictive markers for GC. RESULTSThe median age of Group B [72 years (interquartile range 63-78)] was significantly higher than that of Group A [66 years (interquartile range 61-74), respectively, P = 0.0009]. The prevalence of intestinal metaplasia in Group B tended to be higher than that in Group A (57.8% vs 45.0%, P = 0.08). The prevalence of gastric xanthoma (GX) in Group B was significantly higher than that in Group A (54.2% vs 32.1%, P = 0.003). The atrophy score in Group B was significantly higher than that in Group A (P = 0.005). Multivariate analysis revealed that higher age and the presence of GX were independently related to metachronous and synchronous GC [OR = 1.04 (1.01-1.08), P = 0.02; and OR = 2.11 (1.14-3.99), P = 0.02, respectively]. CONCLUSIONThe presence of GX is a useful predictive marker for metachronous and synchronous GC.展开更多
The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and variet...The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.展开更多
rarely has a solitary, metachronous bilateral adrenal metastasis of colorectal cancer been reported. We depict a 41-year-old man who underwent sigmoid colon cancer radical surgery followed by adjuvant chemotherapy for...rarely has a solitary, metachronous bilateral adrenal metastasis of colorectal cancer been reported. We depict a 41-year-old man who underwent sigmoid colon cancer radical surgery followed by adjuvant chemotherapy for alocally ulcerative sigmoid adenocarcinoma with metachronous bilateral adrenal metastasis revealed by a computed tomography scan. histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. the level of serum carcinoembryonic antigen had indicative significance for the presence of adrenal metastasis in the reported series. We performed a literature analysis related to this pathological characteristic and attach importance to consistent, vigilant radiological surveillance of the adrenal glands in the patients' follow up for colorectal cancer with or without subsequent adrenal metastasis.展开更多
BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous...BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.METHODS From October 2010 to August 2021,patients with DPGCC were retrospectively reviewed.The patients with DPGCC were divided into two groups(synchronous and metachronous).We compared the overall survival(OS)between the groups using Kaplan-Meier survival methods.Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.RESULTS Of the 76 patients with DPGCC,46 and 30 had synchronous and metachronous cancers,respectively.The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers(28.3%vs 3.3%,P=0.015).The majority of the second primary cancers had occurred within 5 years.Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers(P=0.010).The patients who had undergone gastrectomy(P<0.001)or CRC resection(P<0.001)had a better prognosis than those who had not.In the multivariate analysis,synchronous cancer[hazard ratio(HR)=6.8,95%confidence interval(95%CI):2.0-22.7,(P=0.002)]and stage III-IV gastric cancer(GC)[HR=10.0,95%CI:3.4-29.5,(P<0.001)]were risk prognostic factor for OS,while patients who underwent gastrectomy was a protective prognostic factor for OS[HR=0.2,95%CI:0.1-0.6,P=0.002].CONCLUSION Regular surveillance for metachronous cancer is necessary during postoperative follow-up.Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC.The prognosis appears to be influenced by the stage of GC rather than the stage of CRC.Patients with synchronous cancer have a worse prognosis,and its treatment strategy is worth further exploration.展开更多
A 72-year-old male with an early stage "node-negative" sigmoid colon cancer developed 2 separate "node-negative" early stage colon cancers during a subsequent colonoscopy surveillance regimen, the ...A 72-year-old male with an early stage "node-negative" sigmoid colon cancer developed 2 separate "node-negative" early stage colon cancers during a subsequent colonoscopy surveillance regimen, the first in the descending colon 7 years later, and the second in the cecum almost 14 years after the first cancer was resected. After the initial symptomatic cancer, all subsequent neoplastic disease, including malignant cancers were completely asymptomatic. This entity, multiple primary cancers, likely reflected the use of a colonoscopic surveillance regimen.展开更多
A 77-year-old woman complained of epigastralgia,and a tumor(5 cm in diameter)of the gallbladder neck was detected by image analysis.Following cholecystectomy,the tumor was pathologically diagnosed as intraductal papil...A 77-year-old woman complained of epigastralgia,and a tumor(5 cm in diameter)of the gallbladder neck was detected by image analysis.Following cholecystectomy,the tumor was pathologically diagnosed as intraductal papillary neoplasm(IPN),gastric type,with associated invasive carcinoma.About 10 mo later,intraluminal multiple masses(3 foci,up to 1.8 cm)were noted in the extrahepatic bile duct,and the resected specimen showed that all tumors had similar gross and microscopic features as seen in gallbladder IPN without invasion,and they were synchronous multiple lesions.This case showed a papillary tumor of the gallbladder of gastric phenotype,and confirmed that the gallbladder is a target of IPN in addition to the bile ducts.展开更多
Extrahepatic bile duct(EHBD)cancer may occur metachronously,and these cancers are resectable with a favorable prognosis.We aimed to identify the pattern of metachronous EHBD cancer.We classified the cases of metachron...Extrahepatic bile duct(EHBD)cancer may occur metachronously,and these cancers are resectable with a favorable prognosis.We aimed to identify the pattern of metachronous EHBD cancer.We classified the cases of metachronous EHBD cancer reported in the literature thus far and investigated two new cases of metachronous EHBD cancer.A 70-year-old female underwent R0 bile duct resection for a type 1 Klatskin tumor(pT-1N0M0).A 70-year-old male patient underwent R0 bile duct resection for a middle bile duct cancer(pT2N1M0).Imaging studies of both patients taken at 14 and 24mo after first surgery respectively revealed a metachronous cholangiocarcinoma that required pancreaticoduodenectomy(PD).Histopathology of the both tumors after PD revealed cholangiocarcinoma invading the pancreas(pT3N0M0).Both patients have been free from recurrence for 6 years and 16 mo respectively after the second surgery.Through a review of the literature on these cases,we classified the pattern of metachronous EHBD cancer according to the site of de novo neoplasia.The proximal remnant bile duct was most commonly involved.Metachronous EHBD cancer should be distinguished from an unresectable recurrent tumor.Classifying metachronous EHBD cancer may be helpful in identifying rare metachronous tumors.展开更多
AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic duct...AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma(PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data(age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival(DFS) from pancreas resection until metastases onset and overall survival(OS) were calculated. Wilcoxon test, χ~2 test and survival functions computed by the KaplanMeier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A P-value of less than 0.05 was considered statistically significant.RESULTS Metachronous pulmonary metastases were observed in 20(16.9%) and were operable in 3(2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases(oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases.CONCLUSION Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.展开更多
BACKGROUND Isolated splenic metastasis is a rare clinical entity.Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachrono...BACKGROUND Isolated splenic metastasis is a rare clinical entity.Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachronous splenic metastasis are exceedingly rare.CASE SUMMARY We report a colon cancer patient who underwent laparoscopic radical colon resection 14 mo previously,and subsequently underwent a second local resection due to local recurrence detected by elevated serum carcinoembryonic antigen(CEA)and positron emission tomography(PET).However,multiple metastases in the spleen were found 7 mo later by elevated serum CEA and PET-magnetic resonance imaging.Then the patient underwent total laparoscopic splenectomy.Local tumor recurrence and splenic metastasis from colorectal cancer(CRC)were found by postoperative pathology.Genetic analysis of these recurrent and metastatic tissues showed KRAS exon2,APC exon16 and TP53 exon6 missense mutations,but no mutations of NRAS,KRAF,EGFR,ERBB2,MET,MLH1,MSH2 and MSH6 were detected.Chemotherapy and target therapy were administered after multiple disciplinary team(MDT)consultation,and no tumor recurrence has been observed to date.We also reviewed the literature by conducting a search of the PubMed database using the following key words:CRC,splenic metastasis,isolated,and review.We identified 34 relevant papers,which included 28 cases of metachronous metastasis and 6 cases of simultaneous metastasis.CONCLUSION Close monitoring of serum CEA levels is crucial for the detection of isolated splenic metastases after colon surgery.In terms of overall survival and progression-free survival,MDT plays an important role in the entire process of disease management.展开更多
BACKGROUND Squamous cell carcinoma(SCC)in pancreas and stomach is a rare histologic subtype with aggressive behavior,poor prognosis,and no standardized therapy.Pancreatic SCC or gastric SCC has been previously reporte...BACKGROUND Squamous cell carcinoma(SCC)in pancreas and stomach is a rare histologic subtype with aggressive behavior,poor prognosis,and no standardized therapy.Pancreatic SCC or gastric SCC has been previously reported.However,case of SCC occurring in both the pancreas and the stomach has not been reported yet.CASE SUMMARY A 75-year-old female with prior history of hypertension and diabetes mellitus visited our hospital with complaint of abdominal pain that started three months ago.Computed tomography(CT)scan of the abdomen showed 3.3 cm mass at the distal pancreas.She received surgical resection which was histologically found to be SCC of the pancreas with clear resection margins.After she was discharged,she no longer visited the hospital.Three years later,she was referred to our hospital after showing abnormal findings on a gastroscopy performed at another hospital.Gastroscopy revealed a single,2cm sized,ill-defined irregular flat and hyperemic mass at high body.Histologic finding of the mass was SCC.CT scan and positive emission tomography CT showed metastatic lesions to the liver and the peritoneum.She received combination chemotherapy with capecitabine and oxaliplatin.However,she passed away 6 mo after diagnosis of gastric SCC.CONCLUSION To the best of our knowledge,this is the first case of metachronous SCC of stomach occurring after diagnosis of pancreatic SCC.展开更多
BACKGROUND Peritoneal metastasis(PM)after primary surgery for colorectal cancer(CRC)has the worst prognosis.Prediction and early detection of metachronous PM(m-PM)have an important role in improving postoperative prog...BACKGROUND Peritoneal metastasis(PM)after primary surgery for colorectal cancer(CRC)has the worst prognosis.Prediction and early detection of metachronous PM(m-PM)have an important role in improving postoperative prognosis of CRC.However,commonly used imaging methods have limited sensitivity to detect PM early.We aimed to establish a nomogram model to evaluate the individual probability of m-PM to facilitate early interventions for high-risk patients.AIM To establish and validate a nomogram model for predicting the occurrence of m-PM in CRC within 3 years after surgery.METHODS We used the clinical data of 878 patients at the Second Hospital of Jilin University,between January 1,2014 and January 31,2019.The patients were randomly divided into training and validation cohorts at a ratio of 2:1.The least absolute shrinkage and selection operator(LASSO)regression was performed to identify the variables with nonzero coefficients to predict the risk of m-PM.Multivariate logistic regression was used to verify the selected variables and to develop the predictive nomogram model.Harrell’s concordance index,receiver operating characteristic curve,Brier score,and decision curve analysis(DCA)were used to evaluate discrimination,distinctiveness,validity,and clinical utility of this nomogram model.The model was verified internally using bootstrapping method and verified externally using validation cohort.RESULTS LASSO regression analysis identified six potential risk factors with nonzero coefficients.Multivariate logistic regression confirmed the risk factors to be independent.Based on the results of two regression analyses,a nomogram model was established.The nomogram included six predictors:Tumor site,histological type,pathological T stage,carbohydrate antigen 125,v-raf murine sarcoma viral oncogene homolog B mutation and microsatellite instability status.The model achieved good predictive accuracy on both the training and validation datasets.The C-index,area under the curve,and Brier scores were 0.796,0.796[95%confidence interval(CI)0.735-0.856],and 0.081 for the training cohort and 0.782,0.782(95%CI 0.690-0.874),and 0.089 for the validation cohort,respectively.DCA showed that when the threshold probability was between 0.01 and 0.90,using this model to predict m-PM achieved a net clinical benefit.CONCLUSION We have established and validated a nomogram model to predict m-PM in patients undergoing curative surgery,which shows good discrimination and high accuracy.展开更多
To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatme...To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatment of difficult liver colorectal metastases （CRM） and right-lung CRM, reporting their experience in a cohort of 11 patients.展开更多
文摘BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study aims to investigate the application value of a combined machine learning(ML)based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis(MLM).AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer.METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023.All participants were randomly assigned to the training or validation queue in a 7:3 ratio.We first apply generalized linear regression model(GLRM)and random forest model(RFM)algorithm to construct an MLM prediction model in the training queue,and evaluate the discriminative power of the MLM prediction model using area under curve(AUC)and decision curve analysis(DCA).Then,the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups.RESULTS Among the 301 patients included in the study,16.28%were ultimately diagnosed with MLM through pathological examination.Multivariate analysis showed that carcinoembryonic antigen,and magnetic resonance imaging radiomics were independent predictors of MLM.Then,the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation.The prediction performance of GLRM in the training and validation queue was 0.765[95%confidence interval(CI):0.710-0.820]and 0.767(95%CI:0.712-0.822),respectively.Compared with GLRM,RFM achieved superior performance with AUC of 0.919(95%CI:0.868-0.970)and 0.901(95%CI:0.850-0.952)in the training and validation queue,respectively.The DCA indicated that the predictive ability and net profit of clinical RFM were improved.CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models,the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.
基金Supported by the National Natural Science Foundation of China,No.81572338 and No.82170548C-class-sponsored research project of the Jiangsu Provincial Six Talent Peaks,No.WSN-078+2 种基金Jiangsu Province“333 High-level Talents Training Project”,No.2016-III-0126the Jiangsu Provincial Key Research and Development Program,No.BE2021601the Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_1037.
文摘BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine risk factors for the metachronous occurrence of early gastric cancer(EGC)in elderly individuals.METHODS This retrospective cohort study comprised 653 elderly patients(aged≥65 years)who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital.Comprehensive analyses were conducted to compare lifestyle habits,comorbidities,and Helicobacter pylori(H.pylori)infections as potential indicators.RESULTS During a median follow-up of 38 months,46 patients(7.0%,20.46/1000 person-years)developed MGC in the elderly cohort.The cumulative incidences of MGC at 2,3,and 5 years were 3.3%,5.3%,and 11.5%,respectively.In multivariate Cox regression analyses,the independent risk factors for MGC included metabolic dysfunctionassociated steatotic liver disease(MASLD)[hazard ratio(HR)=2.44,95%confidence interval(CI):1.15-5.17],persistent H.pylori infection(HR=10.38,95%CI:3.36-32.07),severe mucosal atrophy(HR=2.71,95%CI:1.45-5.08),and pathological differentiation of EGC(well/moderately differentiated vs poorly differentiated:HR=10.18,95%CI:1.30-79.65).Based on these risk factors,a risk stratification system was developed to categorize individuals into low(0-1 point),intermediate(2-3 points),and high(4-8 points)risk categories for MGC,with cumulative incidence rates of 12.3%,21.6%,and 45%,respectively.CONCLUSION Among elderly individuals,MASLD,persistent H.pylori infection,severe mucosal atrophy,and well/moderately differentiated EGC were associated with an increased risk of MGC.Elderly patients are recommended to adopt healthy lifestyle practices,and undergo regular endoscopic screening and H.pylori testing after curative ESD for EGC.
文摘Rectal cancer is a major global health concern,and metachronous liver metastasis(MLM)significantly worsens patient prognosis.Advances in imaging and machine learning have led to the development of radiomics models,particularly those utilizing multiparametric magnetic resonance imaging,which are highly valuable in predicting MLM.These models analyze imaging features to provide insights that can aid clinical decision-making and potentially improve treatment outcomes and survival rates.However,realizing the full potential of radiomics models faces challenges in terms of accuracy,generalizability,and data depen-dency.This editorial comments on a study regarding radiomics prediction models for rectal cancer MLM published recently in the World Journal of Gastrointestinal Oncology,discusses the progress,challenges,and strategies for diagnostic models of MLM in rectal cancer,and proposes directions for future research.
基金Supported by Jinhua City Science and Technology Plan Projects,No.2022-4-145.
文摘BACKGROUND Metachronous multiple esophageal squamous cell carcinomas(ESCCs)may occur in some patients after endoscopic resection.Multiple dysplastic lesions in the esophagus increase risk of multiple squamous cell carcinomas(SCCs).Endoscopic imaging technology such as narrow band imaging(NBI),can detect early SCC.Lugol chromoendoscopy is also the conventional standard technique for detecting superficial ESCC.However,little is known about the interval from the first SCC to the metachronous SCC.Effective methods to prevent multiple metachronous SCCs are needed in survivors of esophageal SCC.CASE SUMMARY A 56-year-old man showed a slightly elevated reddish area in the middle thoracic esophagus at 30 cm from the incisors on gastroscopy for routine examination.Esophageal mucosa lesion was about 2.5 cm.NBI and magnifying gastroscopy confirmed intra-epithelial papillary loop type B-1 according to the Japan Esophageal Society Classification.Lugol chromoendoscopy was used to evaluate the dysplastic squamous epithelium in the esophagus.Biopsy pathology revealed severe dysplastic squamous epithelium.Computed tomography showed no lymph node metastasis.His complete blood test and tumor markers were within reference values.He had no history of alcohol consumption and smoking.Mucosal lesion was dissected by endoscopic submucosal dissection(ESD).Postoperative pathological results showed moderately differentiated squamous carcinoma.No cancer thrombus was seen in the vasculature,and the surrounding cut edge was not involved.The patient underwent radiotherapy within 2 months after ESD.The multiple Lugol-voiding lesions disappeared,and enhanced chest computed tomography revealed no lymph node metastasis.CONCLUSION This is the first case of multiple dysplastic lesions of esophagus cured by radiotherapy.Radiotherapy after minimally invasive endoscopic treatment might be a safe and effective optional therapeutic strategy to prevent metachronous multiple esophageal SCCs.
文摘BACKGROUND Multiple primary carcinoma(MPC)refers to two or more types of primary malignant tumors occurring simultaneously or sequentially in the same patient.Breast cancer is one of the most common malignant tumors affecting women.On the other hand,diffuse large B-cell lymphoma(DLBCL)is the most frequent form of non-Hodgkin’s lymphoma(NHL).In clinical practice,the simultaneous existence of metachronous primary breast cancer and lymphoma is rare.In this case,we highlight the significance of multidisciplinary management and advanced imaging techniques in the early identification and treatment of MPC cases.CASE SUMMARY In this study,we report a case of a 40-year-old female who was diagnosed with invasive ductal carcinoma of the breast(T3N1M0 stage IIIA LuminalB type)as the first primary cancer and DLBCL(stage IIIA)as the second primary cancer.The patient underwent the modified radical mastectomy for left breast cancer and received Rituximab,cyclophospha-mide,hydroxydaunorubicin,Oncovin(vincristine)and prednisolone regimen chemotherapy treatment for DLBCL.As of now,the patient is in stable condition.The successful diagnosis of the present patient highlights the need for multidisciplinary management and adoption of advanced imaging techniques to identify the second primary cancer,especially NHL.CONCLUSION Accurate diagnosis and management of metachronous MPC requires an interdisciplinary team and selection of an appropriate treatment plan.
基金Supported by the 2015 Yeungnam University Research Grant
文摘AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.
文摘Helicobacter pylori(H.pylori)plays an important role in gastric carcinogenesis,as the majority of gastric cancers develop from H.pylori-infected gastric mucosa.The rate of early gastric cancer diagnosis has increased in Japan and Korea,where H.pylori infection and gastric cancer are highly prevalent.Early intestinal-type gastric cancer without concomitant lymph node metastasis is usually treated by endoscopic resection.Secondary metachronous gastric cancers often develop because atrophic mucosa left untreated after endoscopic treatment confers a high risk of gastric cancer.The efficacy of H.pylori eradication for the prevention of metachronous gastric cancer remains controversial.However,in patients who undergo endoscopic resection of early gastric cancer,H.pylori eradication is recommended to suppress or delay metachronous gastric cancer.Careful and regularly scheduled endoscopy should be performed to detect minute metachronous gastric cancer after endoscopic resection.
文摘To investigate predictive markers for metachronous and synchronous gastric cancer (GC), which can develop after endoscopic submucosal dissection (ESD). METHODSA total of 352 patients underwent ESD for early GC at NTT West Osaka Hospital between June 2006 and February 2016. Exclusion criteria were as follows: Remnant stomach, unknown Helicobacter pylori status, and endoscopic observation of the whole stomach outside our hospital. We analyzed data from 192 patients comprising 109 patients with solitary GC (Group A) and 83 with metachronous and synchronous GC (Group B). We retrospectively investigated the clinicopathological and endoscopic characteristics, and endoscopic risk score as predictive markers for GC. RESULTSThe median age of Group B [72 years (interquartile range 63-78)] was significantly higher than that of Group A [66 years (interquartile range 61-74), respectively, P = 0.0009]. The prevalence of intestinal metaplasia in Group B tended to be higher than that in Group A (57.8% vs 45.0%, P = 0.08). The prevalence of gastric xanthoma (GX) in Group B was significantly higher than that in Group A (54.2% vs 32.1%, P = 0.003). The atrophy score in Group B was significantly higher than that in Group A (P = 0.005). Multivariate analysis revealed that higher age and the presence of GX were independently related to metachronous and synchronous GC [OR = 1.04 (1.01-1.08), P = 0.02; and OR = 2.11 (1.14-3.99), P = 0.02, respectively]. CONCLUSIONThe presence of GX is a useful predictive marker for metachronous and synchronous GC.
文摘The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.
基金Supported by Grants from The Natural Science Foundation of Guangdong,No.S2013010015528
文摘rarely has a solitary, metachronous bilateral adrenal metastasis of colorectal cancer been reported. We depict a 41-year-old man who underwent sigmoid colon cancer radical surgery followed by adjuvant chemotherapy for alocally ulcerative sigmoid adenocarcinoma with metachronous bilateral adrenal metastasis revealed by a computed tomography scan. histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. the level of serum carcinoembryonic antigen had indicative significance for the presence of adrenal metastasis in the reported series. We performed a literature analysis related to this pathological characteristic and attach importance to consistent, vigilant radiological surveillance of the adrenal glands in the patients' follow up for colorectal cancer with or without subsequent adrenal metastasis.
基金Supported by National Natural Science Foundation of China,No.82070684the Fundamental and Applied Basic Research Program of Guangdong Province,No.2020B151502005+3 种基金the Bethune Aixikang Distinguished Surgical Fund project,No.HZB-20190528-5China international medical foundation,No.Z-2017-24-2110the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases,No.2020B1111170004the National Key Clinical Discipline.
文摘BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.METHODS From October 2010 to August 2021,patients with DPGCC were retrospectively reviewed.The patients with DPGCC were divided into two groups(synchronous and metachronous).We compared the overall survival(OS)between the groups using Kaplan-Meier survival methods.Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.RESULTS Of the 76 patients with DPGCC,46 and 30 had synchronous and metachronous cancers,respectively.The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers(28.3%vs 3.3%,P=0.015).The majority of the second primary cancers had occurred within 5 years.Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers(P=0.010).The patients who had undergone gastrectomy(P<0.001)or CRC resection(P<0.001)had a better prognosis than those who had not.In the multivariate analysis,synchronous cancer[hazard ratio(HR)=6.8,95%confidence interval(95%CI):2.0-22.7,(P=0.002)]and stage III-IV gastric cancer(GC)[HR=10.0,95%CI:3.4-29.5,(P<0.001)]were risk prognostic factor for OS,while patients who underwent gastrectomy was a protective prognostic factor for OS[HR=0.2,95%CI:0.1-0.6,P=0.002].CONCLUSION Regular surveillance for metachronous cancer is necessary during postoperative follow-up.Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC.The prognosis appears to be influenced by the stage of GC rather than the stage of CRC.Patients with synchronous cancer have a worse prognosis,and its treatment strategy is worth further exploration.
文摘A 72-year-old male with an early stage "node-negative" sigmoid colon cancer developed 2 separate "node-negative" early stage colon cancers during a subsequent colonoscopy surveillance regimen, the first in the descending colon 7 years later, and the second in the cecum almost 14 years after the first cancer was resected. After the initial symptomatic cancer, all subsequent neoplastic disease, including malignant cancers were completely asymptomatic. This entity, multiple primary cancers, likely reflected the use of a colonoscopic surveillance regimen.
文摘A 77-year-old woman complained of epigastralgia,and a tumor(5 cm in diameter)of the gallbladder neck was detected by image analysis.Following cholecystectomy,the tumor was pathologically diagnosed as intraductal papillary neoplasm(IPN),gastric type,with associated invasive carcinoma.About 10 mo later,intraluminal multiple masses(3 foci,up to 1.8 cm)were noted in the extrahepatic bile duct,and the resected specimen showed that all tumors had similar gross and microscopic features as seen in gallbladder IPN without invasion,and they were synchronous multiple lesions.This case showed a papillary tumor of the gallbladder of gastric phenotype,and confirmed that the gallbladder is a target of IPN in addition to the bile ducts.
基金Supported by Kyungpook National University Research Fund,2013
文摘Extrahepatic bile duct(EHBD)cancer may occur metachronously,and these cancers are resectable with a favorable prognosis.We aimed to identify the pattern of metachronous EHBD cancer.We classified the cases of metachronous EHBD cancer reported in the literature thus far and investigated two new cases of metachronous EHBD cancer.A 70-year-old female underwent R0 bile duct resection for a type 1 Klatskin tumor(pT-1N0M0).A 70-year-old male patient underwent R0 bile duct resection for a middle bile duct cancer(pT2N1M0).Imaging studies of both patients taken at 14 and 24mo after first surgery respectively revealed a metachronous cholangiocarcinoma that required pancreaticoduodenectomy(PD).Histopathology of the both tumors after PD revealed cholangiocarcinoma invading the pancreas(pT3N0M0).Both patients have been free from recurrence for 6 years and 16 mo respectively after the second surgery.Through a review of the literature on these cases,we classified the pattern of metachronous EHBD cancer according to the site of de novo neoplasia.The proximal remnant bile duct was most commonly involved.Metachronous EHBD cancer should be distinguished from an unresectable recurrent tumor.Classifying metachronous EHBD cancer may be helpful in identifying rare metachronous tumors.
基金Supported by the Ministry of Health of the Czech Republic,no.16-28375A to Mohelnikova-Duchonova B
文摘AIM To analyze pancreatic cancer patients who developed metachronous pulmonary metastases(MPM) as a first site of recurrence after the curative-intent surgery.METHODS One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma(PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data(age, sex, grade, primary tumor location, p TNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival(DFS) from pancreas resection until metastases onset and overall survival(OS) were calculated. Wilcoxon test, χ~2 test and survival functions computed by the KaplanMeier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A P-value of less than 0.05 was considered statistically significant.RESULTS Metachronous pulmonary metastases were observed in 20(16.9%) and were operable in 3(2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases(oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases.CONCLUSION Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.
文摘BACKGROUND Isolated splenic metastasis is a rare clinical entity.Multiple metastases in the spleen after radical colon resection in a patient who subsequently underwent a second local resection for isolated metachronous splenic metastasis are exceedingly rare.CASE SUMMARY We report a colon cancer patient who underwent laparoscopic radical colon resection 14 mo previously,and subsequently underwent a second local resection due to local recurrence detected by elevated serum carcinoembryonic antigen(CEA)and positron emission tomography(PET).However,multiple metastases in the spleen were found 7 mo later by elevated serum CEA and PET-magnetic resonance imaging.Then the patient underwent total laparoscopic splenectomy.Local tumor recurrence and splenic metastasis from colorectal cancer(CRC)were found by postoperative pathology.Genetic analysis of these recurrent and metastatic tissues showed KRAS exon2,APC exon16 and TP53 exon6 missense mutations,but no mutations of NRAS,KRAF,EGFR,ERBB2,MET,MLH1,MSH2 and MSH6 were detected.Chemotherapy and target therapy were administered after multiple disciplinary team(MDT)consultation,and no tumor recurrence has been observed to date.We also reviewed the literature by conducting a search of the PubMed database using the following key words:CRC,splenic metastasis,isolated,and review.We identified 34 relevant papers,which included 28 cases of metachronous metastasis and 6 cases of simultaneous metastasis.CONCLUSION Close monitoring of serum CEA levels is crucial for the detection of isolated splenic metastases after colon surgery.In terms of overall survival and progression-free survival,MDT plays an important role in the entire process of disease management.
文摘BACKGROUND Squamous cell carcinoma(SCC)in pancreas and stomach is a rare histologic subtype with aggressive behavior,poor prognosis,and no standardized therapy.Pancreatic SCC or gastric SCC has been previously reported.However,case of SCC occurring in both the pancreas and the stomach has not been reported yet.CASE SUMMARY A 75-year-old female with prior history of hypertension and diabetes mellitus visited our hospital with complaint of abdominal pain that started three months ago.Computed tomography(CT)scan of the abdomen showed 3.3 cm mass at the distal pancreas.She received surgical resection which was histologically found to be SCC of the pancreas with clear resection margins.After she was discharged,she no longer visited the hospital.Three years later,she was referred to our hospital after showing abnormal findings on a gastroscopy performed at another hospital.Gastroscopy revealed a single,2cm sized,ill-defined irregular flat and hyperemic mass at high body.Histologic finding of the mass was SCC.CT scan and positive emission tomography CT showed metastatic lesions to the liver and the peritoneum.She received combination chemotherapy with capecitabine and oxaliplatin.However,she passed away 6 mo after diagnosis of gastric SCC.CONCLUSION To the best of our knowledge,this is the first case of metachronous SCC of stomach occurring after diagnosis of pancreatic SCC.
基金Supported by the Science and Technology Development Project of Jilin Province,No.2020SCZT079.
文摘BACKGROUND Peritoneal metastasis(PM)after primary surgery for colorectal cancer(CRC)has the worst prognosis.Prediction and early detection of metachronous PM(m-PM)have an important role in improving postoperative prognosis of CRC.However,commonly used imaging methods have limited sensitivity to detect PM early.We aimed to establish a nomogram model to evaluate the individual probability of m-PM to facilitate early interventions for high-risk patients.AIM To establish and validate a nomogram model for predicting the occurrence of m-PM in CRC within 3 years after surgery.METHODS We used the clinical data of 878 patients at the Second Hospital of Jilin University,between January 1,2014 and January 31,2019.The patients were randomly divided into training and validation cohorts at a ratio of 2:1.The least absolute shrinkage and selection operator(LASSO)regression was performed to identify the variables with nonzero coefficients to predict the risk of m-PM.Multivariate logistic regression was used to verify the selected variables and to develop the predictive nomogram model.Harrell’s concordance index,receiver operating characteristic curve,Brier score,and decision curve analysis(DCA)were used to evaluate discrimination,distinctiveness,validity,and clinical utility of this nomogram model.The model was verified internally using bootstrapping method and verified externally using validation cohort.RESULTS LASSO regression analysis identified six potential risk factors with nonzero coefficients.Multivariate logistic regression confirmed the risk factors to be independent.Based on the results of two regression analyses,a nomogram model was established.The nomogram included six predictors:Tumor site,histological type,pathological T stage,carbohydrate antigen 125,v-raf murine sarcoma viral oncogene homolog B mutation and microsatellite instability status.The model achieved good predictive accuracy on both the training and validation datasets.The C-index,area under the curve,and Brier scores were 0.796,0.796[95%confidence interval(CI)0.735-0.856],and 0.081 for the training cohort and 0.782,0.782(95%CI 0.690-0.874),and 0.089 for the validation cohort,respectively.DCA showed that when the threshold probability was between 0.01 and 0.90,using this model to predict m-PM achieved a net clinical benefit.CONCLUSION We have established and validated a nomogram model to predict m-PM in patients undergoing curative surgery,which shows good discrimination and high accuracy.
文摘To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatment of difficult liver colorectal metastases （CRM） and right-lung CRM, reporting their experience in a cohort of 11 patients.
