BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and ...BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and third for mortality.Knowledge of the invasive depth of the tumor is vital to treatment decisions.AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography(DCEUS)for preoperative T staging in patients with GC by comparing with multi-detector computed tomography(MDCT).METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023.Patients underwent DCEUS,including ultrasonography(US)and intravenous contrast-enhanced ultrasonography(CEUS),and MDCT examinations for the assessment of preoperative T staging.Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual.The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.RESULTS A total of 229 patients with GC(80 T1,33 T2,59 T3 and 57 T4)were included.Overall accuracies were 86.9%for DCEUS and 61.1%for MDCT(P<0.001).DCEUS was superior to MDCT for T1(92.5%vs 70.0%,P<0.001),T2(72.7%vs 51.5%,P=0.041),T3(86.4%vs 45.8%,P<0.001)and T4(87.7%vs 70.2%,P=0.022)staging of GC.CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT,and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.展开更多
BACKGROUND Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer(CRC).Low-keV virtual monoenergetic images(VMIs)have been shown to enhance lesion conspicuity.Th...BACKGROUND Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer(CRC).Low-keV virtual monoenergetic images(VMIs)have been shown to enhance lesion conspicuity.This study aimed to assess the diagnostic value of dual-layer spectral computed tomography(CT)-derived VMIs,in combination with multiplanar reformation(MPR)and evaluation of peritumoral fat stranding(PFS),for improving the accuracy of T staging in CRC.AIM To assess the diagnostic performance of dual-layer spectral CT(DLSCT)VMIs,particularly at low energy levels,and their integration with personalized MPR for preoperative T staging of CRC.METHODS In this retrospective study,157 patients with pathologically confirmed CRC(mean age:63.5±12.1 years)underwent DLSCT within 1 week before surgery.VMIs ranging from 40 keV to 70 keV(at 10 keV intervals)and conventional polyenergetic images(PEIs)were reconstructed.Objective image quality parameters,including image noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR),were quantified,alongside subjective image quality scores using a 5-point Likert scale.Interobserver agreement was evaluated usingκstatistics.Taking histopathology as the reference standard,the diagnostic accuracy of T staging(T1-2 vs T3-4)was compared across PEIs and VMIs,both with and without MPR and PFS.RESULTS Low-keV VMIs(40-70 keV)demonstrated significantly higher SNR and CNR than PEIs(all P<0.001).Notably,40-keV VMIs achieved noise levels comparable to PEIs(8.17±3.63 vs 8.53±2.90;P=0.673).Subjective image quality peaked at 40-50 keV VMIs(Likert scores 4.85-4.88 vs 3.97 for PEIs;P<0.001),supported by excellent interobserver agreement(κ=0.812-0.913).The combination of 40-50 keV VMIs with MPR yielded the highest T staging accuracy(94.27%)compared to axial PEIs(70.7%),with a sensitivity and specificity of 83.87%and 96.83%,respectively(Youden index=0.81;P<0.05).While PFS enhanced staging accuracy on PEIs(up to 77.07%with MPR),it provided no significant additional benefit for VMIs.CONCLUSION DLSCT VMIs at 40-50 keV significantly enhanced image quality and improved preoperative T staging accuracy of CRC when combined with MPR.These findings underscored the clinical value of low-keV spectral imaging in tailoring individualized treatment strategies.展开更多
BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evalu...BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evaluate the predictive value of dynamic contrast-enhanced-magnetic resonance imaging(DCE-MRI)parameters and serum biomarkers[carbohydrate antigen(CA)19-9,CA125]for determining T stage and differentiation grade in rectal cancer.METHODS We conducted a retrospective review of clinical data from 126 patients who were pathologically diagnosed with rectal cancer between January 2021 to June 2024.Each patient underwent DCE-MRI scans and serum tests for CA19-9 and CA125.Receiver operating characteristic curves were utilized to assess the diagnostic value of DCE-MRI parameters,including volume transfer constant(Ktrans),rate constant(Kep),and volume fraction of extravascular extracellular space(Ve),as well as serum biomarkers for staging and grading rectal cancer.The DeLong test algorithm was employed to evaluate differences in diagnostic performance among the various indicators.RESULTS There were statistically higher levels of Ktrans,Ve,CA19-9,and CA125 serum concentrations of patients with advanced T stages and on poorly differentiated tumors than that in patients with low stages and moderate to high differentiation(P<0.05).Combined use of Ktrans and Ve for T stage diagnosis showed an area under the curve(AUC)of 0.892[95%confidence interval(CI):0.832-0.952],which increased to 0.923(95%CI:0.865-0.981)when combined with serum biomarkers.For grades differentiation,the combined DCE-MRI parameters had an AUC of 0.883(95%CI:0.821-0.945),which rose to 0.912(95%CI:0.855-0.969)when combined with serum markers.According to the Delong test,the combined diagnostic method performed better than a single diagnostic method(P<0.05).CONCLUSION The combined application of DCE-MRI functional parameters and serum tumor markers can significantly improve the diagnostic accuracy of T staging and differentiation degree of rectal cancer,providing a new approach to improve the preoperative assessment system of rectal cancer.This combined diagnostic model has important clinical application value,but further validation is needed through large-scale multicenter studies.展开更多
BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomogra...BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.展开更多
BACKGROUND Accurate identification of tumor invasion depth and lymph node(LN)involve-ment in patients with colon cancer(CC)is critical for guiding treatment strategies.However,the preoperative prediction of tumor inva...BACKGROUND Accurate identification of tumor invasion depth and lymph node(LN)involve-ment in patients with colon cancer(CC)is critical for guiding treatment strategies.However,the preoperative prediction of tumor invasion depth and LN metastasis in CC remains challenging.As the intestinal tumor develops,the fat density in the mesentery increases.METHODS Patients,who were diagnosed with CC and underwent surgery,were included and divided into the training and validation cohorts.CT-T values of the mesen-tery were extracted from the CT images.Cutoff points were determined using the receiver operating characteristic(ROC)curve,and the area under the ROC curve was employed to assess the performance of the CT-T value for tumor invasion depth and LN status prediction.RESULTS Cutoff values of 11.83 and 17.17 were identified to discriminate T1/2 vs T3/4 and N0 vs N1/2,respectively.With a cutoff CT-T value of 11.83,the total diagnostic accuracy for T stage was 83.1%(81.5%for the training cohort and 86.2%for the validation cohort).With a cutoff CT-T value of 17.17,the total diagnostic accuracy for N stage was 77.3%(75.8%for the training cohort and 80.1%for the validation cohort),which was higher than that of CT-reported LN metastasis.CONCLUSION In this study,we explored an efficient method for predicting preoperative T and N stages using the tumor-contributed CT value of the mesentery in CC,which displayed superior predictive accuracy.展开更多
BACKGROUND Rectal cancer is one of the common digestive system malignant tumors around the world.Its early diagnosis and staging are crucial for rectal cancer treatment and prognosis.In recent years,tumor markers have...BACKGROUND Rectal cancer is one of the common digestive system malignant tumors around the world.Its early diagnosis and staging are crucial for rectal cancer treatment and prognosis.In recent years,tumor markers have gradually received attention in early screening,treatment monitoring and prognostic evaluation of cancer,but their predictive role in rectal cancer staging and differentiation is still unclear.AIM To assess the prognostic value of tumor markers alpha-fetoprotein(AFP)cancer antigen 72-4(CA72-4),carbohydrate antigen 19-9(CA19-9),and carcinoembryonic antigen(CEA),alongside multimodal magnetic resonance imaging(MRI),for staging and differentiating rectal cancer in patients.METHODS This study retrospectively analyzed 167 patients with rectal cancer who were treated at our institution from January 2020 to December 2024.Each patient underwent serological testing and multimodal MRI for diagnosis.Histopathological examination after surgical resection or imaging based on follow-up was used as the gold standard.According to the T stage and differentiation degree,patients were divided into low stage group(T1-T2)and high stage group(T3-T4).In addition,they were divided into low-differentiation groups and high-differentiation groups according to their differentiation degree.We compared the accuracy,sensitivity and specificity of tumor marker levels and MRI in rectal cancer stage and differentiation.RESULTS The study's findings indicate that in the context of rectal cancer T staging,there is substantial concordance between MRI and clinicopathological assessments,with a Kappa coefficient of 0.789(P<0.001).Similarly,for various degrees of tumor differentiation,MRI and clinicopathological evaluations demonstrated substantial agreement,with a Kappa coefficient of 0.651(P<0.001).Notably,the concentrations of tumor markers CA19-9,CA72-4,CEA,and AFP were significantly elevated in the T3-T4 stage compared to the T1-T2 stage.Furthermore,these markers were significantly higher in the low-differentiation group compared to the high-differentiation group(P<0.05).The combined use of tumor markers and MRI for preoperative T staging of rectal cancer yielded a diagnostic sensitivity of 93.7%and a specificity of 94.6%,as evidenced by the receiver operating characteristic analysis,with an area under the curve of 0.947.For tumor differentiation,the diagnostic sensitivity and specificity were 93.6%and 97.1%,respectively,with an area under the curve of 0.978(95%confidence interval:0.946-1.000),surpassing the accuracy of individual detection methods.CONCLUSION The CA19-9,CA72-4,CEA and AFP tumor markers combined with multimodal MRI have high sensitivity and specificity in diagnosing rectal cancer stage and differentiation.Their diagnostic efficacy is significantly better than that of single tests,which can effectively improve the predictive ability of rectal cancer stage and differentiation,provide a more reliable diagnostic reference for clinical practice,and have important clinical significance.展开更多
BACKGROUND The effect of the number of lymph node dissections(LNDs)during radical resection for colorectal cancer(CRC)on overall survival(OS)remains controver-sial.AIM To investigate the association between the number...BACKGROUND The effect of the number of lymph node dissections(LNDs)during radical resection for colorectal cancer(CRC)on overall survival(OS)remains controver-sial.AIM To investigate the association between the number of LNDs and OS in patients with tumor node metastasis(TNM)stage Ⅰ–Ⅱ CRC undergoing radical resection.METHODS Patients who underwent radical resection for CRC at a single-center hospital between January 2011 and December 2021 were retrospectively analyzed.Cox regression analyses were performed to identify the independent predictors of OS at different T stages.RESULTS A total of 2850 patients who underwent laparoscopic radical resection for CRC were enrolled.At stage T1,age[P<0.01,hazard ratio(HR)=1.075,95%confidence interval(CI):1.019-1.134]and tumour size(P=0.021,HR=3.635,95%CI:1.210-10.917)were independent risk factors for OS.At stage T2,age(P<0.01,HR=1.064,95%CI:1.032-1.098)and overall complications(P=0.012,HR=2.297,95%CI:1.200-4.397)were independent risk factors for OS.At stage T3,only age(P<0.01,HR=1.047,95%CI:1.027-1.066)was an independent risk factor for OS.At stage T4,age(P<0.01,HR=1.057,95%CI:1.039-1.075)and body mass index(P=0.034,HR=0.941,95%CI:0.890-0.995)were independent risk factors for OS.However,there was no association between LNDs and OS in stages Ⅰ and Ⅱ.CONCLUSION The number of LDNs did not affect the survival of patients with TNM stages Ⅰ and Ⅱ CRC.Therefore,insufficient LNDs should not be a cause for alarm during the surgery.展开更多
The number of lymph nodes(LNs)dissected during surgery has become an interesting topic.Simple intuition always leads us to believe that dissecting more LNs will result in more accurate pathological staging and assuran...The number of lymph nodes(LNs)dissected during surgery has become an interesting topic.Simple intuition always leads us to believe that dissecting more LNs will result in more accurate pathological staging and assurance of surgical quality.However,when the number of LNs dissected reaches a certain threshold,the patient’s prognosis does not continue to improve as the number of dissected nodes increases.Instead,an increase in the number of dissected LNs may be accompanied by a higher incidence of complications.Currently,there are only less than 40%of colorectal cancer patients undergoing adequate LN evaluation.Therefore,obtaining a sufficient number of LNs in clinical practice is extremely challenging.How to further address the insufficiency of LN dissection due to various reasons,which results in concerns of surgeons about patient prognosis,is currently a critical focus.展开更多
Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of pa...Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.展开更多
Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with ...Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with comparison of cT3 substage.Methods:This was a retrospective,multicenter cohort study including cT3 rectal cancer patients undergoing neoadjuvant chemoradiotherapy followed by radical surgery from January 2013 to September 2014.DMRF and cT3 substage were evaluated from baseline MRI.The cutoff of DMRF was determined by disease progression.Multivariate cox regression was used to test the prognostic values of baseline variables.Results:A total of 804 patients were included,of which 226(28.1%)developed progression.A DMRF cutoff of7 mm was chosen.DMRF category,the clock position of the deepest position of tumor invasion(CDTI)and extramural venous invasion(EMVI)were independent predictors for disease progression,and hazard ratios(HRs)were 0.26[95%confidence interval(95%CI),0.13-0.56],1.88(95%CI,1.33-2.65)and 1.57(95%CI,1.13-2.18),respectively.cT3 substage was not a predictor for disease progression.Conclusions:The measurement of DMRF value on baseline MRI can better distinguish cT3 rectal cancer prognosis rather than cT3 substage,and was recommended in clinical evaluation.展开更多
BACKGROUND With the development of laparoscopic techniques,gallbladder cancer(GBC)is no longer a contraindication to laparoscopic surgery(LS).Although LS is recommended for stage T1 GBC,the value of LS for stage T2 GB...BACKGROUND With the development of laparoscopic techniques,gallbladder cancer(GBC)is no longer a contraindication to laparoscopic surgery(LS).Although LS is recommended for stage T1 GBC,the value of LS for stage T2 GBC is still controversial.AIM To evaluate the short-and long-term outcomes of LS in comparison to those of open surgery(OS)for stage T2 GBC.METHODS We searched the PubMed,Embase,Cochrane Library,Ovid,Google Scholar,and Web of Science databases for published studies comparing the efficacy of LS and OS in the treatment of stage T2 GBC,with a cutoff date of September 2022.The Stata 15 statistical software was used for analysis.Relative risk(RR)and weighted mean difference(WMD)were calculated to assess binary and continuous outcome indicators,respectively.Begg’s test and Egger’s test were used for detecting publication bias.RESULTS A total of five studies were included,with a total of 297 patients,153 in the LS group and 144 in the OS group.Meta-analysis results showed that the LS group was better than the OS group in terms of operative time[WMD=-41.29,95%confidence interval(CI):-75.66 to-6.92,P=0.02],estimated blood loss(WMD=-261.96,95%CI:-472.60 to-51.31,P=0.01),and hospital stay(WMD=-5.67,95%CI:-8.53 to-2.81,P=0.0001),whereas there was no significant difference between the two groups in terms of blood transfusion(RR=0.60,95%CI:0.31-1.15,P=0.13),complications(RR=0.72,95%CI:0.39-1.33,P=0.29),number of lymph nodes retrieved(WMD=–1.71,95%CI:-4.27 to-0.84,P=0.19),recurrence(RR=0.41,95%CI:0.06-2.84,P=0.36),3-year and 5-year overall survival(RR=0.99,95%CI:0.82-1.18,P=0.89 and RR=1.02,95%CI:0.68-1.53,P=0.92;respectively),and 3-year and 5-year disease-free survival(RR=1.01,95%CI:0.84-1.21,P=0.93 and RR=1.15,95%CI:0.90-1.46,P=0.26;respectively).CONCLUSION The long-term outcomes of LS for T2 GBC are similar to those of OS,but LS is superior to OS in terms of operative time,intraoperative bleeding,and postoperative hospital stay.Nevertheless,these findings should be validated via high-quality randomized controlled trials and longer follow-ups.展开更多
BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC...BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.展开更多
BACKGROUND Esophageal carcinosarcoma(ECS) is a rare biphasic tumor and a type of esophageal malignancy,which presents as protruding or elevated lesions.ECS patients are often not hospitalized until they have severe dy...BACKGROUND Esophageal carcinosarcoma(ECS) is a rare biphasic tumor and a type of esophageal malignancy,which presents as protruding or elevated lesions.ECS patients are often not hospitalized until they have severe dysphagia.ECS is easily misdiagnosed as a benign tumor due to its atypical characteristics under endoscopy.With the popularization of endoscopic treatment,these patients are often referred to endoscopic treatment,such as endoscopic submucosal dissection(ESD).However,there is a lack of consensus on the endoscopic features and therapies for ECS.Here,we report a case of ECS and discuss the value of endoscopic diagnosis and therapeutic strategies.CASE SUMMARY A 63-year-old man was admitted to the hospital with dysphagia.During the endoscopic examination,an elevated lesion was found with an erosive and hyperemic surface covered with white pseudomembranous inflammation.Endoscopic ultrasonography(EUS),biopsies,and enhanced thoracic computed tomography were performed,suggesting that it was a benign lesion and located within the submucosal layer.This lesion was diagnosed as a fibrovascular polyp with a Paris classification of 0-Ip.The patient was then referred to ESD treatment.However,the post-ESD pathological and immunohistochemical study showed that this lesion was ECS with a vertical positive margin(T1b stage),indicating that we made a misdiagnosis and achieved a noncurative resection.Due to the potential tumor residue,additional open surgery was performed at the patient’s request.In the postoperative pathological study,no tumor remnants or metastases were discovered.The patient was followed for 1 year and had no recurrence.CONCLUSION ECS can be misdiagnosed at the initial endoscopy.EUS can help to identify the tumor stage.Patients with T1b stage ECS cannot be routinely referred to ESD treatment due to the high risk of metastasis and recurrence rate.展开更多
Objective: There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer. We evaluated the survival benefit of resection in this group of patients. Methods: We retr...Objective: There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer. We evaluated the survival benefit of resection in this group of patients. Methods: We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection (n = 49) with patients with non-curative resection (n = 113) from 1980 to 2000. Results: Curative resection was performed in 49 (30.2%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 9.3% and the median survival time was 12 months for all 162 registered patients. The 5-year survival rates in patients after curative and non-curative resection were 14.3% vs 7.1% respectively. These values differed considerably between the two groups (P = 0.033). Operative type and curability were independent statistically significant prognostic parameters. Conclusion: Curability was an independent prognostic factor among all registered patients. Patients with T4 gastric carcinoma might be benefited from curative resection.展开更多
OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder c...OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder carcinoma. METHODS Fifty-eight stage T4 bladder carcinoma patients were selected. The patients were grouped to the TAI group and the TAE group. The main symptom of hemorrhage was gross hematuria. None of the patients in our study could receive trunk embolization. The infusion plan was oxaliplatin （100 mg/m2） and epirubicin （EPI 50mg/m2）. Embolization was done with coils or strips of gelatin sponge. The duration of gross hematuria was observed. Routine urinalysis and routine blood examination were performed. EORTC QLQ-C30 was used to evaluate the quality of life before and after treatment. RESULTS Gross hematuria and hematuria by light microscope in all patients were reviewed. Resolution time of gross hematuria in the TAI group was 6.7 ± 1.8 days and that in the TAE group was 3.5 ± 0.7 days. The changes in routine urianlysis, routine blood examination and EORTC QLQ-C30 are shown in Figs.l-3. Gross hematuria disappeared in both groups within 7 days after treatment, but the time for the gross hematuria to resolve in the TAE group was much less than that in TAI group （t = 2.51, P 〈 0.01）, and there were no significant differences in the 7th and 21st day between the 2 groups. On the 90th day, the number of erythrocytes in the urine was near 30, close to gross hematuria. The EORTC QLQ-C30 scores decreased after interventional therapy in both groups, which means that quality of life was increased, but there were no significant differences between the 2 groups. CONCLUSION Selective internal iliac artery infusion and selective internal iliac artery embolization are safe, and, in our study, therapeutic efficacy was satisfactory in treating unremitting gross hematuria of stage T4 bladder carcinoma in patients who could not receive trunk embolization. TAE can stop gross hematuria in the short term, but it can be used just once and the long-term therapeutic effect is not satisfactory. TAI had a therapeutic effect similar to TAE, but for a shorter duration, and TAI can be performed multiple times. TAI is one of the facultative treatments for treating gross hematuria of stage T4 bladder carcinoma.展开更多
基金This study was reviewed and approved by the Ethics Committee of Sun Yat-sen University Cancer Center(Approval No.B2023-219-03).
文摘BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and third for mortality.Knowledge of the invasive depth of the tumor is vital to treatment decisions.AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography(DCEUS)for preoperative T staging in patients with GC by comparing with multi-detector computed tomography(MDCT).METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023.Patients underwent DCEUS,including ultrasonography(US)and intravenous contrast-enhanced ultrasonography(CEUS),and MDCT examinations for the assessment of preoperative T staging.Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual.The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.RESULTS A total of 229 patients with GC(80 T1,33 T2,59 T3 and 57 T4)were included.Overall accuracies were 86.9%for DCEUS and 61.1%for MDCT(P<0.001).DCEUS was superior to MDCT for T1(92.5%vs 70.0%,P<0.001),T2(72.7%vs 51.5%,P=0.041),T3(86.4%vs 45.8%,P<0.001)and T4(87.7%vs 70.2%,P=0.022)staging of GC.CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT,and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.
基金Supported by Jiangsu Province 333 Talent Key Industry Field Talent Project,No.[2022]21Key Scientific Research Program of Jiangsu Provincial Health Committee,No.ZD2021059+2 种基金Nantong Key Laboratory Project,No.[2020]163The Project of Nantong City Health Committee,No.MS2023027Young Medical Talents Fund of Health and Family Planning Commission of Nantong,No.QA2019006 and No.QNZ2023027.
文摘BACKGROUND Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer(CRC).Low-keV virtual monoenergetic images(VMIs)have been shown to enhance lesion conspicuity.This study aimed to assess the diagnostic value of dual-layer spectral computed tomography(CT)-derived VMIs,in combination with multiplanar reformation(MPR)and evaluation of peritumoral fat stranding(PFS),for improving the accuracy of T staging in CRC.AIM To assess the diagnostic performance of dual-layer spectral CT(DLSCT)VMIs,particularly at low energy levels,and their integration with personalized MPR for preoperative T staging of CRC.METHODS In this retrospective study,157 patients with pathologically confirmed CRC(mean age:63.5±12.1 years)underwent DLSCT within 1 week before surgery.VMIs ranging from 40 keV to 70 keV(at 10 keV intervals)and conventional polyenergetic images(PEIs)were reconstructed.Objective image quality parameters,including image noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR),were quantified,alongside subjective image quality scores using a 5-point Likert scale.Interobserver agreement was evaluated usingκstatistics.Taking histopathology as the reference standard,the diagnostic accuracy of T staging(T1-2 vs T3-4)was compared across PEIs and VMIs,both with and without MPR and PFS.RESULTS Low-keV VMIs(40-70 keV)demonstrated significantly higher SNR and CNR than PEIs(all P<0.001).Notably,40-keV VMIs achieved noise levels comparable to PEIs(8.17±3.63 vs 8.53±2.90;P=0.673).Subjective image quality peaked at 40-50 keV VMIs(Likert scores 4.85-4.88 vs 3.97 for PEIs;P<0.001),supported by excellent interobserver agreement(κ=0.812-0.913).The combination of 40-50 keV VMIs with MPR yielded the highest T staging accuracy(94.27%)compared to axial PEIs(70.7%),with a sensitivity and specificity of 83.87%and 96.83%,respectively(Youden index=0.81;P<0.05).While PFS enhanced staging accuracy on PEIs(up to 77.07%with MPR),it provided no significant additional benefit for VMIs.CONCLUSION DLSCT VMIs at 40-50 keV significantly enhanced image quality and improved preoperative T staging accuracy of CRC when combined with MPR.These findings underscored the clinical value of low-keV spectral imaging in tailoring individualized treatment strategies.
文摘BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evaluate the predictive value of dynamic contrast-enhanced-magnetic resonance imaging(DCE-MRI)parameters and serum biomarkers[carbohydrate antigen(CA)19-9,CA125]for determining T stage and differentiation grade in rectal cancer.METHODS We conducted a retrospective review of clinical data from 126 patients who were pathologically diagnosed with rectal cancer between January 2021 to June 2024.Each patient underwent DCE-MRI scans and serum tests for CA19-9 and CA125.Receiver operating characteristic curves were utilized to assess the diagnostic value of DCE-MRI parameters,including volume transfer constant(Ktrans),rate constant(Kep),and volume fraction of extravascular extracellular space(Ve),as well as serum biomarkers for staging and grading rectal cancer.The DeLong test algorithm was employed to evaluate differences in diagnostic performance among the various indicators.RESULTS There were statistically higher levels of Ktrans,Ve,CA19-9,and CA125 serum concentrations of patients with advanced T stages and on poorly differentiated tumors than that in patients with low stages and moderate to high differentiation(P<0.05).Combined use of Ktrans and Ve for T stage diagnosis showed an area under the curve(AUC)of 0.892[95%confidence interval(CI):0.832-0.952],which increased to 0.923(95%CI:0.865-0.981)when combined with serum biomarkers.For grades differentiation,the combined DCE-MRI parameters had an AUC of 0.883(95%CI:0.821-0.945),which rose to 0.912(95%CI:0.855-0.969)when combined with serum markers.According to the Delong test,the combined diagnostic method performed better than a single diagnostic method(P<0.05).CONCLUSION The combined application of DCE-MRI functional parameters and serum tumor markers can significantly improve the diagnostic accuracy of T staging and differentiation degree of rectal cancer,providing a new approach to improve the preoperative assessment system of rectal cancer.This combined diagnostic model has important clinical application value,but further validation is needed through large-scale multicenter studies.
文摘BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.
基金Supported by National Natural Science Foundation of China,No.82303785and Medical Scientific Research Foundation of Guangdong Province,No.A2024096.
文摘BACKGROUND Accurate identification of tumor invasion depth and lymph node(LN)involve-ment in patients with colon cancer(CC)is critical for guiding treatment strategies.However,the preoperative prediction of tumor invasion depth and LN metastasis in CC remains challenging.As the intestinal tumor develops,the fat density in the mesentery increases.METHODS Patients,who were diagnosed with CC and underwent surgery,were included and divided into the training and validation cohorts.CT-T values of the mesen-tery were extracted from the CT images.Cutoff points were determined using the receiver operating characteristic(ROC)curve,and the area under the ROC curve was employed to assess the performance of the CT-T value for tumor invasion depth and LN status prediction.RESULTS Cutoff values of 11.83 and 17.17 were identified to discriminate T1/2 vs T3/4 and N0 vs N1/2,respectively.With a cutoff CT-T value of 11.83,the total diagnostic accuracy for T stage was 83.1%(81.5%for the training cohort and 86.2%for the validation cohort).With a cutoff CT-T value of 17.17,the total diagnostic accuracy for N stage was 77.3%(75.8%for the training cohort and 80.1%for the validation cohort),which was higher than that of CT-reported LN metastasis.CONCLUSION In this study,we explored an efficient method for predicting preoperative T and N stages using the tumor-contributed CT value of the mesentery in CC,which displayed superior predictive accuracy.
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LTGY24H160006Jiaxing Medical Key Discipline,No.2023-ZC-015.
文摘BACKGROUND Rectal cancer is one of the common digestive system malignant tumors around the world.Its early diagnosis and staging are crucial for rectal cancer treatment and prognosis.In recent years,tumor markers have gradually received attention in early screening,treatment monitoring and prognostic evaluation of cancer,but their predictive role in rectal cancer staging and differentiation is still unclear.AIM To assess the prognostic value of tumor markers alpha-fetoprotein(AFP)cancer antigen 72-4(CA72-4),carbohydrate antigen 19-9(CA19-9),and carcinoembryonic antigen(CEA),alongside multimodal magnetic resonance imaging(MRI),for staging and differentiating rectal cancer in patients.METHODS This study retrospectively analyzed 167 patients with rectal cancer who were treated at our institution from January 2020 to December 2024.Each patient underwent serological testing and multimodal MRI for diagnosis.Histopathological examination after surgical resection or imaging based on follow-up was used as the gold standard.According to the T stage and differentiation degree,patients were divided into low stage group(T1-T2)and high stage group(T3-T4).In addition,they were divided into low-differentiation groups and high-differentiation groups according to their differentiation degree.We compared the accuracy,sensitivity and specificity of tumor marker levels and MRI in rectal cancer stage and differentiation.RESULTS The study's findings indicate that in the context of rectal cancer T staging,there is substantial concordance between MRI and clinicopathological assessments,with a Kappa coefficient of 0.789(P<0.001).Similarly,for various degrees of tumor differentiation,MRI and clinicopathological evaluations demonstrated substantial agreement,with a Kappa coefficient of 0.651(P<0.001).Notably,the concentrations of tumor markers CA19-9,CA72-4,CEA,and AFP were significantly elevated in the T3-T4 stage compared to the T1-T2 stage.Furthermore,these markers were significantly higher in the low-differentiation group compared to the high-differentiation group(P<0.05).The combined use of tumor markers and MRI for preoperative T staging of rectal cancer yielded a diagnostic sensitivity of 93.7%and a specificity of 94.6%,as evidenced by the receiver operating characteristic analysis,with an area under the curve of 0.947.For tumor differentiation,the diagnostic sensitivity and specificity were 93.6%and 97.1%,respectively,with an area under the curve of 0.978(95%confidence interval:0.946-1.000),surpassing the accuracy of individual detection methods.CONCLUSION The CA19-9,CA72-4,CEA and AFP tumor markers combined with multimodal MRI have high sensitivity and specificity in diagnosing rectal cancer stage and differentiation.Their diagnostic efficacy is significantly better than that of single tests,which can effectively improve the predictive ability of rectal cancer stage and differentiation,provide a more reliable diagnostic reference for clinical practice,and have important clinical significance.
基金Chongqing Medical University Future Medical Youth Innovation Team Development Support Program,No.03030299QCW0007.
文摘BACKGROUND The effect of the number of lymph node dissections(LNDs)during radical resection for colorectal cancer(CRC)on overall survival(OS)remains controver-sial.AIM To investigate the association between the number of LNDs and OS in patients with tumor node metastasis(TNM)stage Ⅰ–Ⅱ CRC undergoing radical resection.METHODS Patients who underwent radical resection for CRC at a single-center hospital between January 2011 and December 2021 were retrospectively analyzed.Cox regression analyses were performed to identify the independent predictors of OS at different T stages.RESULTS A total of 2850 patients who underwent laparoscopic radical resection for CRC were enrolled.At stage T1,age[P<0.01,hazard ratio(HR)=1.075,95%confidence interval(CI):1.019-1.134]and tumour size(P=0.021,HR=3.635,95%CI:1.210-10.917)were independent risk factors for OS.At stage T2,age(P<0.01,HR=1.064,95%CI:1.032-1.098)and overall complications(P=0.012,HR=2.297,95%CI:1.200-4.397)were independent risk factors for OS.At stage T3,only age(P<0.01,HR=1.047,95%CI:1.027-1.066)was an independent risk factor for OS.At stage T4,age(P<0.01,HR=1.057,95%CI:1.039-1.075)and body mass index(P=0.034,HR=0.941,95%CI:0.890-0.995)were independent risk factors for OS.However,there was no association between LNDs and OS in stages Ⅰ and Ⅱ.CONCLUSION The number of LDNs did not affect the survival of patients with TNM stages Ⅰ and Ⅱ CRC.Therefore,insufficient LNDs should not be a cause for alarm during the surgery.
文摘The number of lymph nodes(LNs)dissected during surgery has become an interesting topic.Simple intuition always leads us to believe that dissecting more LNs will result in more accurate pathological staging and assurance of surgical quality.However,when the number of LNs dissected reaches a certain threshold,the patient’s prognosis does not continue to improve as the number of dissected nodes increases.Instead,an increase in the number of dissected LNs may be accompanied by a higher incidence of complications.Currently,there are only less than 40%of colorectal cancer patients undergoing adequate LN evaluation.Therefore,obtaining a sufficient number of LNs in clinical practice is extremely challenging.How to further address the insufficiency of LN dissection due to various reasons,which results in concerns of surgeons about patient prognosis,is currently a critical focus.
文摘Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.
基金supported by the National Natural Science Foundation of China(No.82071881,91959116,81971584)National Key R&D Program of China(No.2019YFC0117705)+3 种基金Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(No.ZYLX201803)Beijing Hospitals Authority Ascent Plan(No.DFL20191103)Capital’s Funds for Health Improvement and Research(No.2020-1-2151)Beijing Natural Science Foundation(No.Z200015,Z180001)。
文摘Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with comparison of cT3 substage.Methods:This was a retrospective,multicenter cohort study including cT3 rectal cancer patients undergoing neoadjuvant chemoradiotherapy followed by radical surgery from January 2013 to September 2014.DMRF and cT3 substage were evaluated from baseline MRI.The cutoff of DMRF was determined by disease progression.Multivariate cox regression was used to test the prognostic values of baseline variables.Results:A total of 804 patients were included,of which 226(28.1%)developed progression.A DMRF cutoff of7 mm was chosen.DMRF category,the clock position of the deepest position of tumor invasion(CDTI)and extramural venous invasion(EMVI)were independent predictors for disease progression,and hazard ratios(HRs)were 0.26[95%confidence interval(95%CI),0.13-0.56],1.88(95%CI,1.33-2.65)and 1.57(95%CI,1.13-2.18),respectively.cT3 substage was not a predictor for disease progression.Conclusions:The measurement of DMRF value on baseline MRI can better distinguish cT3 rectal cancer prognosis rather than cT3 substage,and was recommended in clinical evaluation.
基金Supported by Shenzhen High-Level Hospital Construction FundSanming Project of Medicine in Shenzhen,No. SZSM202011010。
文摘BACKGROUND With the development of laparoscopic techniques,gallbladder cancer(GBC)is no longer a contraindication to laparoscopic surgery(LS).Although LS is recommended for stage T1 GBC,the value of LS for stage T2 GBC is still controversial.AIM To evaluate the short-and long-term outcomes of LS in comparison to those of open surgery(OS)for stage T2 GBC.METHODS We searched the PubMed,Embase,Cochrane Library,Ovid,Google Scholar,and Web of Science databases for published studies comparing the efficacy of LS and OS in the treatment of stage T2 GBC,with a cutoff date of September 2022.The Stata 15 statistical software was used for analysis.Relative risk(RR)and weighted mean difference(WMD)were calculated to assess binary and continuous outcome indicators,respectively.Begg’s test and Egger’s test were used for detecting publication bias.RESULTS A total of five studies were included,with a total of 297 patients,153 in the LS group and 144 in the OS group.Meta-analysis results showed that the LS group was better than the OS group in terms of operative time[WMD=-41.29,95%confidence interval(CI):-75.66 to-6.92,P=0.02],estimated blood loss(WMD=-261.96,95%CI:-472.60 to-51.31,P=0.01),and hospital stay(WMD=-5.67,95%CI:-8.53 to-2.81,P=0.0001),whereas there was no significant difference between the two groups in terms of blood transfusion(RR=0.60,95%CI:0.31-1.15,P=0.13),complications(RR=0.72,95%CI:0.39-1.33,P=0.29),number of lymph nodes retrieved(WMD=–1.71,95%CI:-4.27 to-0.84,P=0.19),recurrence(RR=0.41,95%CI:0.06-2.84,P=0.36),3-year and 5-year overall survival(RR=0.99,95%CI:0.82-1.18,P=0.89 and RR=1.02,95%CI:0.68-1.53,P=0.92;respectively),and 3-year and 5-year disease-free survival(RR=1.01,95%CI:0.84-1.21,P=0.93 and RR=1.15,95%CI:0.90-1.46,P=0.26;respectively).CONCLUSION The long-term outcomes of LS for T2 GBC are similar to those of OS,but LS is superior to OS in terms of operative time,intraoperative bleeding,and postoperative hospital stay.Nevertheless,these findings should be validated via high-quality randomized controlled trials and longer follow-ups.
文摘BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.
文摘BACKGROUND Esophageal carcinosarcoma(ECS) is a rare biphasic tumor and a type of esophageal malignancy,which presents as protruding or elevated lesions.ECS patients are often not hospitalized until they have severe dysphagia.ECS is easily misdiagnosed as a benign tumor due to its atypical characteristics under endoscopy.With the popularization of endoscopic treatment,these patients are often referred to endoscopic treatment,such as endoscopic submucosal dissection(ESD).However,there is a lack of consensus on the endoscopic features and therapies for ECS.Here,we report a case of ECS and discuss the value of endoscopic diagnosis and therapeutic strategies.CASE SUMMARY A 63-year-old man was admitted to the hospital with dysphagia.During the endoscopic examination,an elevated lesion was found with an erosive and hyperemic surface covered with white pseudomembranous inflammation.Endoscopic ultrasonography(EUS),biopsies,and enhanced thoracic computed tomography were performed,suggesting that it was a benign lesion and located within the submucosal layer.This lesion was diagnosed as a fibrovascular polyp with a Paris classification of 0-Ip.The patient was then referred to ESD treatment.However,the post-ESD pathological and immunohistochemical study showed that this lesion was ECS with a vertical positive margin(T1b stage),indicating that we made a misdiagnosis and achieved a noncurative resection.Due to the potential tumor residue,additional open surgery was performed at the patient’s request.In the postoperative pathological study,no tumor remnants or metastases were discovered.The patient was followed for 1 year and had no recurrence.CONCLUSION ECS can be misdiagnosed at the initial endoscopy.EUS can help to identify the tumor stage.Patients with T1b stage ECS cannot be routinely referred to ESD treatment due to the high risk of metastasis and recurrence rate.
文摘Objective: There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer. We evaluated the survival benefit of resection in this group of patients. Methods: We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection (n = 49) with patients with non-curative resection (n = 113) from 1980 to 2000. Results: Curative resection was performed in 49 (30.2%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 9.3% and the median survival time was 12 months for all 162 registered patients. The 5-year survival rates in patients after curative and non-curative resection were 14.3% vs 7.1% respectively. These values differed considerably between the two groups (P = 0.033). Operative type and curability were independent statistically significant prognostic parameters. Conclusion: Curability was an independent prognostic factor among all registered patients. Patients with T4 gastric carcinoma might be benefited from curative resection.
文摘OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder carcinoma. METHODS Fifty-eight stage T4 bladder carcinoma patients were selected. The patients were grouped to the TAI group and the TAE group. The main symptom of hemorrhage was gross hematuria. None of the patients in our study could receive trunk embolization. The infusion plan was oxaliplatin （100 mg/m2） and epirubicin （EPI 50mg/m2）. Embolization was done with coils or strips of gelatin sponge. The duration of gross hematuria was observed. Routine urinalysis and routine blood examination were performed. EORTC QLQ-C30 was used to evaluate the quality of life before and after treatment. RESULTS Gross hematuria and hematuria by light microscope in all patients were reviewed. Resolution time of gross hematuria in the TAI group was 6.7 ± 1.8 days and that in the TAE group was 3.5 ± 0.7 days. The changes in routine urianlysis, routine blood examination and EORTC QLQ-C30 are shown in Figs.l-3. Gross hematuria disappeared in both groups within 7 days after treatment, but the time for the gross hematuria to resolve in the TAE group was much less than that in TAI group （t = 2.51, P 〈 0.01）, and there were no significant differences in the 7th and 21st day between the 2 groups. On the 90th day, the number of erythrocytes in the urine was near 30, close to gross hematuria. The EORTC QLQ-C30 scores decreased after interventional therapy in both groups, which means that quality of life was increased, but there were no significant differences between the 2 groups. CONCLUSION Selective internal iliac artery infusion and selective internal iliac artery embolization are safe, and, in our study, therapeutic efficacy was satisfactory in treating unremitting gross hematuria of stage T4 bladder carcinoma in patients who could not receive trunk embolization. TAE can stop gross hematuria in the short term, but it can be used just once and the long-term therapeutic effect is not satisfactory. TAI had a therapeutic effect similar to TAE, but for a shorter duration, and TAI can be performed multiple times. TAI is one of the facultative treatments for treating gross hematuria of stage T4 bladder carcinoma.
