BACKGROUND Data comparing the outcomes of hepatocellular carcinoma(HCC)ablation by multibipolar radiofrequency ablation(mbp-RFA)and microwave ablation(MWA)are lacking.This study compares safety and efficacy of the two...BACKGROUND Data comparing the outcomes of hepatocellular carcinoma(HCC)ablation by multibipolar radiofrequency ablation(mbp-RFA)and microwave ablation(MWA)are lacking.This study compares safety and efficacy of the two techniques in treatment-naive HCC.AIM To compare the risk of local tumor progression(LTP)according to the technique;secondary endpoints included technique efficacy rate at one-month,overall survival and major complication rate.METHODS A bi-institutional retrospective analysis of patients undergoing treatment-naive HCC ablation by either technique was performed.Inverse probability of treatment weighting was used to compare the two groups.Mixed effects multivariate Cox regression was applied to identify risk factors for LTP.RESULTS A total of 362 patients(mean age,66.1±6.2 years,308 men)were included,of which 242(323 tumors)treated by mbp-RFA and 120(168 tumors)by MWA.After a median follow-up of 27 months,cumulative LTP was 11.4%after mbp-RFA and 25.2%after MWA.Independent risk factors for LTP at multivariate analysis were MWA(hazard ratio=2.85,P<0.001)and tumor size(hazard ratio=1.08,P<0.001).Two-year LTP-free survival was higher after mbp-RFA than MWA regardless of size(<3 cm:96%vs 87.1%,P<0.01;≥3 cm:87.5%vs 74%,P=0.04).Technique efficacy rate was higher after mbp-RFA(94.1%vs 87.5%,P=0.01).No difference was observed in major complication rate(9.5%vs 7.5%,P=0.59),nor 5-year overall survival(63.6%vs 58.3%,P=0.33).CONCLUSION Mbp-RFA leads to better local tumor control of treatment-naïve HCC than MWA regardless of tumor size and has better primary efficacy,while maintaining a comparable safety profile.展开更多
BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically...BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically experience a poor prognosis,highlighting an urgent need to explore novel treatment approaches.This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors(ICIs)in the treatment of EC patients with liver metastases.Furthermore,prognostic factors influencing outcomes in this patient population were identified.AIM To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors.METHODS This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024.Patients receiving CMT were compared with those receiving CMT+ICI.Analyzed variables included clinicopathological features,treatment history,characteristics of metastasis,systemic and local treatments,overall survival(OS),and treatment-related adverse events(TRAEs).Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models.Finally,efficacy outcomes and TRAE profiles were compared between the two groups.RESULTS A significant difference in median OS was identified between the two groups(10.8 months in the CMT group vs 20.8 months in the CMT+ICI group,P=0.004).The CMT+ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months(P<0.001).Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate.Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases:Karnofsky Performance Status score≥70,receipt of local therapy for liver metastases,and the number of cycles of CMT and immunotherapy received.Furthermore,the incidence of TRAEs did not significantly differ between the CMT+ICI and CMT groups.CONCLUSION For EC patients with liver metastases,the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone,while maintaining manageable TRAEs.展开更多
文摘现有的基于深度学习的医学图像分割方法,大多是利用大量的训练数据拟合检测网络,以获得优异的检测性能。这些方法往往需要较大的模型参数,导致检测实时性较差。为此,提出了基于局部上下文引导特征深度融合轻量级医学分割网络(local context guided feature deep fusion lightweight medical segmentation network,LCGML-net)。LCGML-net通过精确的特征选择与特征融合来减少模型拟合所需的参数数量,从而在保证检测精度的同时实现更小的模型参数。在特征提取阶段和映射阶段,分别通过提取和融合目标的多层次多尺度局部上下文特征来丰富特征表达和精准分割。在STARE、CHASEDB1和KITS19等多个基准数据集上开展的实验证明,与其他方法相比,所提出的LCGML-net具有最佳的检测性能和最小的模型参数。
文摘BACKGROUND Data comparing the outcomes of hepatocellular carcinoma(HCC)ablation by multibipolar radiofrequency ablation(mbp-RFA)and microwave ablation(MWA)are lacking.This study compares safety and efficacy of the two techniques in treatment-naive HCC.AIM To compare the risk of local tumor progression(LTP)according to the technique;secondary endpoints included technique efficacy rate at one-month,overall survival and major complication rate.METHODS A bi-institutional retrospective analysis of patients undergoing treatment-naive HCC ablation by either technique was performed.Inverse probability of treatment weighting was used to compare the two groups.Mixed effects multivariate Cox regression was applied to identify risk factors for LTP.RESULTS A total of 362 patients(mean age,66.1±6.2 years,308 men)were included,of which 242(323 tumors)treated by mbp-RFA and 120(168 tumors)by MWA.After a median follow-up of 27 months,cumulative LTP was 11.4%after mbp-RFA and 25.2%after MWA.Independent risk factors for LTP at multivariate analysis were MWA(hazard ratio=2.85,P<0.001)and tumor size(hazard ratio=1.08,P<0.001).Two-year LTP-free survival was higher after mbp-RFA than MWA regardless of size(<3 cm:96%vs 87.1%,P<0.01;≥3 cm:87.5%vs 74%,P=0.04).Technique efficacy rate was higher after mbp-RFA(94.1%vs 87.5%,P=0.01).No difference was observed in major complication rate(9.5%vs 7.5%,P=0.59),nor 5-year overall survival(63.6%vs 58.3%,P=0.33).CONCLUSION Mbp-RFA leads to better local tumor control of treatment-naïve HCC than MWA regardless of tumor size and has better primary efficacy,while maintaining a comparable safety profile.
基金Supported by National Natural Science Foundation of China,No.82303672Zhejiang Provincial Health Commission and Zhejiang Provincial Administration of Traditional Chinese Medicine through the Targeted Project for Medical and Health Research,No.2025ZL017and China Primary Health Care Foundation,No.ZLMY20240311001ZJ.
文摘BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically experience a poor prognosis,highlighting an urgent need to explore novel treatment approaches.This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors(ICIs)in the treatment of EC patients with liver metastases.Furthermore,prognostic factors influencing outcomes in this patient population were identified.AIM To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors.METHODS This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024.Patients receiving CMT were compared with those receiving CMT+ICI.Analyzed variables included clinicopathological features,treatment history,characteristics of metastasis,systemic and local treatments,overall survival(OS),and treatment-related adverse events(TRAEs).Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models.Finally,efficacy outcomes and TRAE profiles were compared between the two groups.RESULTS A significant difference in median OS was identified between the two groups(10.8 months in the CMT group vs 20.8 months in the CMT+ICI group,P=0.004).The CMT+ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months(P<0.001).Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate.Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases:Karnofsky Performance Status score≥70,receipt of local therapy for liver metastases,and the number of cycles of CMT and immunotherapy received.Furthermore,the incidence of TRAEs did not significantly differ between the CMT+ICI and CMT groups.CONCLUSION For EC patients with liver metastases,the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone,while maintaining manageable TRAEs.
