The Barcelona Clinic Liver Cancer(BCLC)system was proposed in 1999 with the intent to improve a therapeutic algorithm for the management of patients with hepatocellular carcinoma(HCC)[1].Both the European and the Amer...The Barcelona Clinic Liver Cancer(BCLC)system was proposed in 1999 with the intent to improve a therapeutic algorithm for the management of patients with hepatocellular carcinoma(HCC)[1].Both the European and the American Guidelines on the Treatment of HCC have endorsed the BCLC as the standard staging algorithm with prognostic and therapeutic implications[2,3].The BCLC staging system stratifies HCC patients into five stages(0,A,B,C and D).According to the algorithm,liver transplantation(LT)is indicated only in patients in the stages BCLC 0 and A,special situations provided.展开更多
Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of e...Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.展开更多
BACKGROUND Gastric cancer(GC)is a prevalent malignancy with a substantial health burden and high mortality rate,despite advances in prevention,early detection,and treatment.Compared with the global average,Asia,notabl...BACKGROUND Gastric cancer(GC)is a prevalent malignancy with a substantial health burden and high mortality rate,despite advances in prevention,early detection,and treatment.Compared with the global average,Asia,notably China,reports disproportionately high GC incidences.The disease often progresses asymptoma-tically in the early stages,leading to delayed diagnosis and compromised out-comes.Thus,it is crucial to identify early diagnostic biomarkers and enhance treatment strategies to improve patient outcomes and reduce mortality.METHODS Retrospectively analyzed the clinical data of 148 patients with GC treated at the Civil Aviation Shanghai Hospital between December 2022 and December 2023.The associations of coagulation indices-partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen,fibrinogen degradation products(FDP),fasting blood glucose,and D-dimer(D-D)with TNM stage and distant metastasis were examined.RESULTS Prolongation of APTT,PT,and TT was significantly correlated with the GC TNM stage.Hence,abnormal coagulation system activation was closely related to disease progression.Elevated FDP and D-D were significantly associated with distant metastasis in GC(P<0.05),suggesting that increased fibrinolytic activity contributes to increased metastatic risk.CONCLUSION Our Results reveal coagulation indices,FDPs as GC biomarkers,reflecting abnormal coagulation/fibrinolysis,aiding disease progression,metastasis prediction,and helping clinicians assess thrombotic risk for early intervention and personalized treatment plans.展开更多
BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrason...BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.展开更多
Background:Primary small cell carcinoma of the oesophagus(PSCCE)is a gastrointestinal tumour of rare onset.The current study was to investigate the role of a novel risk stratification system(RSS)for PSCCE.Methods:The ...Background:Primary small cell carcinoma of the oesophagus(PSCCE)is a gastrointestinal tumour of rare onset.The current study was to investigate the role of a novel risk stratification system(RSS)for PSCCE.Methods:The study included patients with PSCCE attending any of five medical institutions in China in 2008-2021,four of which served as a training set(n=422)for construction of the RSS while the other served as a separate cohort(n=256)for validation of the model.The RSS was established based on covariates associated with overall survival(OS)with a two-sided P-value of<0.05 in multivariable regression.Survival discrimination of RSS was assessed.Results:In the training cohort,multivariate regression analysis revealed age,Eastern Cooperative Oncology Group score,and initial lymph node metastasis to be independent prognostic factors for OS in non-distant metastatic PESCC;concurrent hepatic metastasis was the only significant predictor of distant metastatic PESCC.Accordingly,the RSS was developed and could classify patients into four subgroups:low-risk localized disease(LLD,defined as non-distant metastasis PESCC without risk factors,n=58);high-risk localized disease(HLD,defined as non-distant metastasis PESCC with≥1 risk factor,n=199);low-risk metastatic disease(LMD,defined as metastatic PESCC without concomitant liver metastases,n=103);and high-risk metastatic disease(HMD,definded as metastatic disease with synchronous liver metastases,n=63).Three-year OS rates were 52.5%,29.5%,14.4%,and 5.7%for LLD,HLD,LMD,and HMD,respectively.When compared with the tumor-node-metastasis(TNM)system,RSS showed a consistently superior ability to predict OS in both the training and validation cohorts.Conclusion:The RSS is a reliable stratification model that could be used to optimize treatment for PESCC.展开更多
Accurate cancer staging is the foundation of precision oncology and guides prognosis prediction and therapeutic decision-making. The conjoint TNM System by the American Joint Committee on Cancer (AJCC) and the Interna...Accurate cancer staging is the foundation of precision oncology and guides prognosis prediction and therapeutic decision-making. The conjoint TNM System by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) has served as the global standard for tumor classification since inception.展开更多
Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently t...Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently the only definitive treatment;however,the subtle emergence of symptoms often leads to a diagnosis at an advanced stage,with merely 10%-15%of patients being eligible for surgical intervention.The primary obstacle to achieving a potential radical resection is the presence of distant metastatic disease or invasion of adjacent major vascular structures.This review aims to highlight the critical role of endoscopic ultrasound in the diagnosis and staging of pancreatic tumors.We systematically searched PubMed,MEDLINE and Web of Science by using‘pancreatic cancer’and‘endoscopic ultrasonography’as keywords.Relevant studies were reviewed and analyzed.Endoscopic ultrasonography(EUS)is efficient in the diagnosis and staging of pancreatic cancer,past studies reported the accuracy of EUS is 63%to 94%for T-staging and 44%to 82%for N-staging but there are still limitations that need to be comprehensively applied with other diagnostic methods to evaluation of distant metastasis for surgical resectability.Our review aims to reveal the value for the staging of pancreatic cancer.展开更多
This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limit...This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limitations in dataset diversity,and the need for explainable artificial intelligence to enhance adoption in pathology and personalized treatment.展开更多
BACKGROUND Esophageal cancer(EC)is one of the most prevalent malignant gastrointestinal tumors;accurate prediction of EC staging has high significance before treatment.AIM To explore a rational radiomic approach for p...BACKGROUND Esophageal cancer(EC)is one of the most prevalent malignant gastrointestinal tumors;accurate prediction of EC staging has high significance before treatment.AIM To explore a rational radiomic approach for predicting preoperative staging of EC based on magnetic resonance imaging(MRI).METHODS This retrospective study included 210 patients with pathologically confirmed EC,randomly divided into a primary cohort(n=147)and a validation cohort(n=63)in a ratio of 7:3.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI)and gadolinium contrast-enhanced T1-weighted imaging(T1WI)-Gd images.Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Then a logistic regression model was built to predict the EC stages.The diagnostic performance of the radiomics model for discriminating between stages Ⅰ-Ⅱ and Ⅲ-Ⅳ was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 214 radiomics features were extracted.Following feature dimension reduction,the T1WI and T2WI sequences were retained,and 14 features from the T1WI sequence and 3 features from the T2WI sequence were selected to construct radiomics signatures.The radiomics signature combining T2WI with T1WI-Gd demonstrated superior discrimination of stages in the validation cohort(AUC:0.851;SEN:0.697;SPE:0.793),which outperformed single-sequence models(AUC:0.779,0.844;SEN:0.667,0.636;SPE:0.8,0.8).CONCLUSION MRI-based radiomics signatures could identify EC stages before treatment,which could serve as a noninvasive and quantitative approach aiding personalized treatment planning.展开更多
BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer fol...BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer follows a sequence from esophagitis to non-dysplastic Barrett’s esophagus,dysplastic Barrett’s esophagus,and eventually esophageal adenocarcinoma(EAC).This study explored the application of deep learning technology in the precise diagnosis of pathological classification and staging of EAC to enhance diagnostic accuracy and efficiency.AIM To explore the application of deep learning models,particularly Wave-Vision Transformer(Wave-ViT),in the pathological classification and staging of esophageal cancer to enhance diagnostic accuracy and efficiency.METHODS We applied several deep learning models,including multi-layer perceptron,residual network,transformer,and Wave-ViT,to a dataset of clinically validated esophageal pathology images.The models were trained to identify pathological features and assist in the classification and staging of different stages of esophageal cancer.The models were compared based on accuracy,computational complexity,and efficiency.RESULTS The Wave-ViT model demonstrated the highest accuracy at 88.97%,surpassing the transformer(87.65%),residual network(85.44%),and multi-layer perceptron(81.17%).Additionally,Wave-ViT exhibited low computational complexity with significantly reduced parameter size,making it highly efficient for real-time clinical applications.CONCLUSION Deep learning technology,particularly the Frequency-Domain Transformer model,shows promise in improving the precision of pathological classification and staging of EAC.The application of the Frequency-Domain Transformer model enhances the automation of the diagnostic process and may support early detection and treatment of EAC.Future research may further explore the potential of this model in broader medical image analysis applications,particularly in the field of precision medicine.展开更多
BACKGROUND Transabdominal ultrasound after the oral administration of an echoic cellulosebased gastric ultrasound contrast agent has recently been suggested to be effective in T staging of gastric cancer(GC).AIM To ex...BACKGROUND Transabdominal ultrasound after the oral administration of an echoic cellulosebased gastric ultrasound contrast agent has recently been suggested to be effective in T staging of gastric cancer(GC).AIM To explore the clinical characteristics and transabdominal features associated with T3-T4 staging of GC.METHODS In total,113 patients who underwent transabdominal ultrasonography and had confirmed GC based on surgical pathology were included.Variables including clinical characteristics[age,body mass index,gender,clinical features,pathological type,histologic type,Lauren type,carcinoembryonic antigen(CEA),and CA19-9]and transabdominal ultrasound features(thickness and length of lesion,presence of angle sign,presence of ulcer,and lesion location)were recorded.Univariate and multivariable logistic regression analyses were performed to identify the factors associated with T3-T4 staging.RESULTS Ninety-two patients were T3-T4 staging and 21 were T1-T2 staging.Univariate analysis revealed that the thickness of gastric lesions(1.6±0.6 cm vs 1.0±0.4 cm,P<0.001),length of gastric lesions(5.7±2.2 cm vs 2.9±1.0 cm,P<0.001),presence of angle sign(92.4%vs 19.0%,P<0.001),elevated CEA(36.9%vs 0%,P<0.001)and elevated CA19-9(27.2%vs 14.3%,P=0.034)were statistically significant between the two groups.Multivariable logistic regression analysis revealed that the length of gastric lesions[odds ratio(OR)=2.373,95%confidence interval(95%CI):1.281-4.396,P=0.006]and presence of angle sign(OR=31.083,95%CI:4.449-217.164,P<0.001)were independent factors associated with T3-T4 staging.A receiver operating characteristic curve was plotted,and the area under the curve was 0.950(95%CI:0.906-0.994,P<0.001).CONCLUSION Transabdominal ultrasound features,including an angle sign and lesion length,help identify T3-T4 staging.展开更多
The authors regret that the scientific names of some species mentioned in the paper were incorrectly presented.The incorrect sci-entific names,their locations in the paper,correct spellings and refer-ences,are listed ...The authors regret that the scientific names of some species mentioned in the paper were incorrectly presented.The incorrect sci-entific names,their locations in the paper,correct spellings and refer-ences,are listed below.展开更多
BACKGROUND The prognosis of gastric cancer(GC)patients is poor,and an accurate prognostic staging system would help assess patients'prognostic status before treatment and determine appropriate treatment strategies...BACKGROUND The prognosis of gastric cancer(GC)patients is poor,and an accurate prognostic staging system would help assess patients'prognostic status before treatment and determine appropriate treatment strategies.AIM To develop positive lymph node ratio(LNR)and machine learning(ML)-based staging systems for GC patients with varying differentiation.METHODS This multicenter retrospective cohort study included 11772 GC patients,with 5612 in the training set(Harbin Medical University Cancer Hospital)and 6160 in the validation set(Surveillance,Epidemiology,and End Results Program database).X-tile software identified optimal cutoff values for the positive LNR,and five ML models were developed using pT and LNR staging.Risk scores were divided into seven stages,constructing new staging systems tailored to different tumor differentiation levels.RESULTS In both the training and validation sets,regardless of the tumor differentiation level,LNR staging demonstrated superior prognostic stratification compared to pN.Extreme Gradient Boosting exhibited better predictive performance than the other four models.Compared to tumor node metastasis staging,the new staging systems,developed for patients with different degrees of differentiation,showed significantly better predictive performance.CONCLUSION The new positive lymph nodes ratio staging and integrated staging systems constructed for GC patients with different differentiation grades exhibited better prognostic stratification capabilities.展开更多
BACKGROUND Whole-body magnetic resonance imaging(wbMRI)allows general assessment of systemic cancers including lymphomas without radiation burden.AIM To evaluate the diagnostic performance of wbMRI in the staging of d...BACKGROUND Whole-body magnetic resonance imaging(wbMRI)allows general assessment of systemic cancers including lymphomas without radiation burden.AIM To evaluate the diagnostic performance of wbMRI in the staging of diffuse large B-cell lymphoma(DLBCL),determine the value of individual MRI sequences,and assess patients’concerns with wbMRI.METHODS In this single-center prospective study,adult patients newly diagnosed with systemic DLBCL underwent wbMRI on a 3T scanner[diffusion weighted images with background suppression(DWIBS),T2,short tau inversion recovery(STIR),contrast-enhanced T1]and fluorodeoxyglucose(18F-FDG)positron emission tomo-graphy/computed tomography(PET/CT)(reference standard).The involvement of 12 nodal regions and extranodal sites was evaluated on wbMRI and PET/CT.The utility of wbMRI sequences was rated on a five-point scale(0=not useful,4=very useful).Patients received a questionnaire regarding wbMRI.RESULTS Of 60 eligible patients,14(23%)were enrolled and completed the study.The sensitivity of wbMRI in the nodal involvement(182 nodal sites)was 0.84,with 0.99 specificity,positive predictive value of 0.96,negative predictive value of 0.97,and 0.97 accuracy.PET/CT and wbMRI were concordant both in extranodal involvement(13 instances)and staging(κ=1.0).The mean scores of the utility of MRI sequences were 3.71±0.73 for DWIBS,2.64±0.84 for T1,2.14±0.77 for STIR,and 1.29±0.73 for T2(P<0.0001).Patients were mostly concerned about the enclosed environment and duration of the MRI examination(27%of patients).CONCLUSION The wbMRI exhibited excellent sensitivity and specificity in staging DLBCL.DWIBS and contrast-enhanced T1 were rated as the most useful sequences.Patients were less willing to undergo wbMRI as a second examination parallel to PET/CT,especially owing to the long duration and the enclosed environment.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
In this editorial,we comment on the article by Lambert et al,published in the recent issue of the World Journal of Radiology.The focus of the editorial is to explore the advancements in whole-body magnetic resonance i...In this editorial,we comment on the article by Lambert et al,published in the recent issue of the World Journal of Radiology.The focus of the editorial is to explore the advancements in whole-body magnetic resonance imaging(WB-MRI)techno-logy,its current clinical applications,and the challenges that must be addressed to fully realize its potential in oncological imaging.WB-MRI has emerged as a pivotal tool in oncological imaging,offering comprehensive disease assessment without ionizing radiation.Its applications span the detection of bone metastases,evaluation of hematologic malignancies,and staging of a wide range of cancers,including lymphoma,prostate,and breast cancers.Advanced techniques such as diffusion-weighted imaging have enhanced its diagnostic performance by pro-viding superior lesion-to-background contrast and quantitative metrics.Despite its diagnostic strengths,WB-MRI faces challenges in standardization,patient acceptance,and integration into clinical workflows.Variability in acquisition pro-tocols,hardware differences,and patient-related factors,such as anxiety and motion artifacts,have limited widespread adoption.Emerging guidelines like MET-RADS-P and ONCO-RADS aim to address these issues by promoting stan-dardized protocols tailored to specific clinical needs.This editorial explores the advancements in WB-MRI technology,its current clinical applications,and the barriers that must be overcome to maximize its utility.By addressing these cha-llenges and embracing standardization,WB-MRI holds the potential to redefine the landscape of oncological imaging,aligning diagnostic precision with modern treatment goals of reducing long-term patient risk.展开更多
BACKGROUND Cutaneous melanoma is an aggressive skin cancer with high metastatic potential.Accurate staging is critical to guide therapeutic strategies and improve prognosis.Whole-body magnetic resonance imaging(WB-MRI...BACKGROUND Cutaneous melanoma is an aggressive skin cancer with high metastatic potential.Accurate staging is critical to guide therapeutic strategies and improve prognosis.Whole-body magnetic resonance imaging(WB-MRI),particularly when combined with diffusion-weighted imaging(DWI),has emerged as promising tool for comprehensive,radiation-free assessment of metastatic spread.AIM To systematically review the diagnostic performance and clinical utility of WBMRI in the staging and restaging of cutaneous melanoma,with comparison to conventional imaging modalities such as computed tomography(CT)and positron emission tomography/CT(PET/CT).METHODS A systematic literature review was conducted using PubMed,Embase,Scopus and Web of Science databases for studies published in the last 10 years.Inclusion criteria focused on comparative diagnostic accuracy studies of WB-MRI vs CT and PET/CT for melanoma staging.The methodological quality of the studies was appraised using the QUADAS-2 tool.RESULTS Sixteen studies involving over 700 patients met the inclusion criteria.WB-MRI showed high sensitivity(73%-90%)and specificity(up to 98%)in detecting metastases,particularly in bone,liver and soft tissue.DWI enhanced lesion detection,and WB-MRI often influenced clinical management decisions.However,CT outperformed WB-MRI in identifying small pulmonary nodules.AI-assisted analysis and contrastenhanced sequences further improved diagnostic confidence.CONCLUSION WB-MRI represents a robust imaging modality for staging cutaneous melanoma,offering superior soft-tissue contrast and functional imaging without ionizing radiation.Its strengths lie in detecting bone,liver and brain metastases.Challenges include limited lung lesion detection,cost,and availability.Advances in artificial intelligence,Hybrid PET/MRY systems,and radiomics are poised to expand WB-MRI’s role in personalized melanoma management.展开更多
BACKGROUND Existing assessment systems for chronic hepatitis B(CHB)-associated liver fibrosis(LF)exhibit insufficient accuracy,thereby requiring further improvements.AIM To investigate the association of LF staging wi...BACKGROUND Existing assessment systems for chronic hepatitis B(CHB)-associated liver fibrosis(LF)exhibit insufficient accuracy,thereby requiring further improvements.AIM To investigate the association of LF staging with hepatitis B core antibody(HBcAb),hepatitis B virus DNA(HBV-DNA),and hepatitis B surface antigen(HBsAg)in patients with CHB.METHODS We selected 120 patients with CHB receiving treatment in Hangzhou Linping District First People’s Hospital from January 2020 to June 2024.Participants were allocated into the mild(F0-F1,n=52)and moderate-to-severe groups(F2-F4,n=68)following the rigorous LF staging criteria.HBcAb,HBV-DNA,and HBsAg concentrations were measured.Pearson correlations were employed to examine the correlations of HBcAb with HBV-DNA and HBsAg,whereas Spearman correlation analysis was conducted to identify the associations of the three with LF staging.Receiver operating characteristic(ROC)curves were further used to analyze the performance of these biomarkers in diagnosing LF stages.Furthermore,binary logistic regression analysis was conducted to determine the association of these three with LF progression in CHB.RESULTS Markedly increased HBcAb and notably decreased HBV-DNA and HBsAg were observed in moderate-to-severe cases vs their mild counterparts.A positive correlation was observed between HBV-DNA and HBsAg,whereas both markers were inversely associated with HBcAb.Moreover,LF staging exhibited a significant positive correlation with HBcAb and an inverse connection with HBVDNA and HBsAg.The receiver operating characteristic analysis revealed area under the curve values of 0.715,0.799,and 0.662 for HBcAb,HBV-DNA,and HBsAg in diagnosing LF staging,respectively.Combining these markers improved the area under the curve to 0.851.The final analysis identified HBcAb as promoting fibrosis advancement(odds ratio=2.765),whereas HBVDNA demonstrated protective properties(odds ratio=0.247).CONCLUSION HBcAb is negatively correlated with HBV-DNA and HBsAg but positively associated with LF staging.All three markers are valuable in assessing LF staging,and their combined use presents the highest diagnostic efficacy.Importantly,a high HBcAb/low HBV-DNA profile markedly increased fibrosis progression risks in CHB-affected individuals.展开更多
文摘The Barcelona Clinic Liver Cancer(BCLC)system was proposed in 1999 with the intent to improve a therapeutic algorithm for the management of patients with hepatocellular carcinoma(HCC)[1].Both the European and the American Guidelines on the Treatment of HCC have endorsed the BCLC as the standard staging algorithm with prognostic and therapeutic implications[2,3].The BCLC staging system stratifies HCC patients into five stages(0,A,B,C and D).According to the algorithm,liver transplantation(LT)is indicated only in patients in the stages BCLC 0 and A,special situations provided.
文摘Proton therapy represents the most advanced form of radiotherapy currently available. Hepato-cellular carcinoma (HCC) has been extensively treated with proton therapy since 1983 with en-couraging results in terms of effectiveness and safety, as reported in recent research articles, systematic reviews and meta-analyses. In this report, we summarized for the first time the results of proton therapy treatment for HCC according with respect to the Barcelona Clinic Liver Cancer Staging System, the most adopted classification system for HCC which provides information on both prognostic prediction and treatment allocation.
文摘BACKGROUND Gastric cancer(GC)is a prevalent malignancy with a substantial health burden and high mortality rate,despite advances in prevention,early detection,and treatment.Compared with the global average,Asia,notably China,reports disproportionately high GC incidences.The disease often progresses asymptoma-tically in the early stages,leading to delayed diagnosis and compromised out-comes.Thus,it is crucial to identify early diagnostic biomarkers and enhance treatment strategies to improve patient outcomes and reduce mortality.METHODS Retrospectively analyzed the clinical data of 148 patients with GC treated at the Civil Aviation Shanghai Hospital between December 2022 and December 2023.The associations of coagulation indices-partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen,fibrinogen degradation products(FDP),fasting blood glucose,and D-dimer(D-D)with TNM stage and distant metastasis were examined.RESULTS Prolongation of APTT,PT,and TT was significantly correlated with the GC TNM stage.Hence,abnormal coagulation system activation was closely related to disease progression.Elevated FDP and D-D were significantly associated with distant metastasis in GC(P<0.05),suggesting that increased fibrinolytic activity contributes to increased metastatic risk.CONCLUSION Our Results reveal coagulation indices,FDPs as GC biomarkers,reflecting abnormal coagulation/fibrinolysis,aiding disease progression,metastasis prediction,and helping clinicians assess thrombotic risk for early intervention and personalized treatment plans.
文摘BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.
基金supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiother-apy for Tumors(Fujian Medical University)the Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies).
文摘Background:Primary small cell carcinoma of the oesophagus(PSCCE)is a gastrointestinal tumour of rare onset.The current study was to investigate the role of a novel risk stratification system(RSS)for PSCCE.Methods:The study included patients with PSCCE attending any of five medical institutions in China in 2008-2021,four of which served as a training set(n=422)for construction of the RSS while the other served as a separate cohort(n=256)for validation of the model.The RSS was established based on covariates associated with overall survival(OS)with a two-sided P-value of<0.05 in multivariable regression.Survival discrimination of RSS was assessed.Results:In the training cohort,multivariate regression analysis revealed age,Eastern Cooperative Oncology Group score,and initial lymph node metastasis to be independent prognostic factors for OS in non-distant metastatic PESCC;concurrent hepatic metastasis was the only significant predictor of distant metastatic PESCC.Accordingly,the RSS was developed and could classify patients into four subgroups:low-risk localized disease(LLD,defined as non-distant metastasis PESCC without risk factors,n=58);high-risk localized disease(HLD,defined as non-distant metastasis PESCC with≥1 risk factor,n=199);low-risk metastatic disease(LMD,defined as metastatic PESCC without concomitant liver metastases,n=103);and high-risk metastatic disease(HMD,definded as metastatic disease with synchronous liver metastases,n=63).Three-year OS rates were 52.5%,29.5%,14.4%,and 5.7%for LLD,HLD,LMD,and HMD,respectively.When compared with the tumor-node-metastasis(TNM)system,RSS showed a consistently superior ability to predict OS in both the training and validation cohorts.Conclusion:The RSS is a reliable stratification model that could be used to optimize treatment for PESCC.
基金supported by the Sanming Project of Medicine in Shenzhen (SZSM202211017)。
文摘Accurate cancer staging is the foundation of precision oncology and guides prognosis prediction and therapeutic decision-making. The conjoint TNM System by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) has served as the global standard for tumor classification since inception.
文摘Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently the only definitive treatment;however,the subtle emergence of symptoms often leads to a diagnosis at an advanced stage,with merely 10%-15%of patients being eligible for surgical intervention.The primary obstacle to achieving a potential radical resection is the presence of distant metastatic disease or invasion of adjacent major vascular structures.This review aims to highlight the critical role of endoscopic ultrasound in the diagnosis and staging of pancreatic tumors.We systematically searched PubMed,MEDLINE and Web of Science by using‘pancreatic cancer’and‘endoscopic ultrasonography’as keywords.Relevant studies were reviewed and analyzed.Endoscopic ultrasonography(EUS)is efficient in the diagnosis and staging of pancreatic cancer,past studies reported the accuracy of EUS is 63%to 94%for T-staging and 44%to 82%for N-staging but there are still limitations that need to be comprehensively applied with other diagnostic methods to evaluation of distant metastasis for surgical resectability.Our review aims to reveal the value for the staging of pancreatic cancer.
文摘This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limitations in dataset diversity,and the need for explainable artificial intelligence to enhance adoption in pathology and personalized treatment.
基金Supported by Guangdong Medical Research Foundation,No.B2023272.
文摘BACKGROUND Esophageal cancer(EC)is one of the most prevalent malignant gastrointestinal tumors;accurate prediction of EC staging has high significance before treatment.AIM To explore a rational radiomic approach for predicting preoperative staging of EC based on magnetic resonance imaging(MRI).METHODS This retrospective study included 210 patients with pathologically confirmed EC,randomly divided into a primary cohort(n=147)and a validation cohort(n=63)in a ratio of 7:3.All patients underwent a preoperative MRI scan from the neck to the abdomen.High-throughput and quantitative radiomics features were extracted from T2-weighted imaging(T2WI)and gadolinium contrast-enhanced T1-weighted imaging(T1WI)-Gd images.Radiomics signatures were selected using minimal redundancy maximal relevance and the least absolute shrinkage and selection operator.Then a logistic regression model was built to predict the EC stages.The diagnostic performance of the radiomics model for discriminating between stages Ⅰ-Ⅱ and Ⅲ-Ⅳ was evaluated using the area under the curve(AUC),sensitivity(SEN),and specificity(SPE).RESULTS A total of 214 radiomics features were extracted.Following feature dimension reduction,the T1WI and T2WI sequences were retained,and 14 features from the T1WI sequence and 3 features from the T2WI sequence were selected to construct radiomics signatures.The radiomics signature combining T2WI with T1WI-Gd demonstrated superior discrimination of stages in the validation cohort(AUC:0.851;SEN:0.697;SPE:0.793),which outperformed single-sequence models(AUC:0.779,0.844;SEN:0.667,0.636;SPE:0.8,0.8).CONCLUSION MRI-based radiomics signatures could identify EC stages before treatment,which could serve as a noninvasive and quantitative approach aiding personalized treatment planning.
文摘BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer follows a sequence from esophagitis to non-dysplastic Barrett’s esophagus,dysplastic Barrett’s esophagus,and eventually esophageal adenocarcinoma(EAC).This study explored the application of deep learning technology in the precise diagnosis of pathological classification and staging of EAC to enhance diagnostic accuracy and efficiency.AIM To explore the application of deep learning models,particularly Wave-Vision Transformer(Wave-ViT),in the pathological classification and staging of esophageal cancer to enhance diagnostic accuracy and efficiency.METHODS We applied several deep learning models,including multi-layer perceptron,residual network,transformer,and Wave-ViT,to a dataset of clinically validated esophageal pathology images.The models were trained to identify pathological features and assist in the classification and staging of different stages of esophageal cancer.The models were compared based on accuracy,computational complexity,and efficiency.RESULTS The Wave-ViT model demonstrated the highest accuracy at 88.97%,surpassing the transformer(87.65%),residual network(85.44%),and multi-layer perceptron(81.17%).Additionally,Wave-ViT exhibited low computational complexity with significantly reduced parameter size,making it highly efficient for real-time clinical applications.CONCLUSION Deep learning technology,particularly the Frequency-Domain Transformer model,shows promise in improving the precision of pathological classification and staging of EAC.The application of the Frequency-Domain Transformer model enhances the automation of the diagnostic process and may support early detection and treatment of EAC.Future research may further explore the potential of this model in broader medical image analysis applications,particularly in the field of precision medicine.
基金Supported by Medical Scientific Research Foundation of Guangdong Province of China,No.A2023502Basic and Applied Basic Research Foundation of Guangdong Province,No.2023A1515220135 and No.2023A1515110607.
文摘BACKGROUND Transabdominal ultrasound after the oral administration of an echoic cellulosebased gastric ultrasound contrast agent has recently been suggested to be effective in T staging of gastric cancer(GC).AIM To explore the clinical characteristics and transabdominal features associated with T3-T4 staging of GC.METHODS In total,113 patients who underwent transabdominal ultrasonography and had confirmed GC based on surgical pathology were included.Variables including clinical characteristics[age,body mass index,gender,clinical features,pathological type,histologic type,Lauren type,carcinoembryonic antigen(CEA),and CA19-9]and transabdominal ultrasound features(thickness and length of lesion,presence of angle sign,presence of ulcer,and lesion location)were recorded.Univariate and multivariable logistic regression analyses were performed to identify the factors associated with T3-T4 staging.RESULTS Ninety-two patients were T3-T4 staging and 21 were T1-T2 staging.Univariate analysis revealed that the thickness of gastric lesions(1.6±0.6 cm vs 1.0±0.4 cm,P<0.001),length of gastric lesions(5.7±2.2 cm vs 2.9±1.0 cm,P<0.001),presence of angle sign(92.4%vs 19.0%,P<0.001),elevated CEA(36.9%vs 0%,P<0.001)and elevated CA19-9(27.2%vs 14.3%,P=0.034)were statistically significant between the two groups.Multivariable logistic regression analysis revealed that the length of gastric lesions[odds ratio(OR)=2.373,95%confidence interval(95%CI):1.281-4.396,P=0.006]and presence of angle sign(OR=31.083,95%CI:4.449-217.164,P<0.001)were independent factors associated with T3-T4 staging.A receiver operating characteristic curve was plotted,and the area under the curve was 0.950(95%CI:0.906-0.994,P<0.001).CONCLUSION Transabdominal ultrasound features,including an angle sign and lesion length,help identify T3-T4 staging.
文摘The authors regret that the scientific names of some species mentioned in the paper were incorrectly presented.The incorrect sci-entific names,their locations in the paper,correct spellings and refer-ences,are listed below.
基金Supported by Nn10 Program of Harbin Medical University Cancer Hospital,No.Nn10 PY 2017-03.
文摘BACKGROUND The prognosis of gastric cancer(GC)patients is poor,and an accurate prognostic staging system would help assess patients'prognostic status before treatment and determine appropriate treatment strategies.AIM To develop positive lymph node ratio(LNR)and machine learning(ML)-based staging systems for GC patients with varying differentiation.METHODS This multicenter retrospective cohort study included 11772 GC patients,with 5612 in the training set(Harbin Medical University Cancer Hospital)and 6160 in the validation set(Surveillance,Epidemiology,and End Results Program database).X-tile software identified optimal cutoff values for the positive LNR,and five ML models were developed using pT and LNR staging.Risk scores were divided into seven stages,constructing new staging systems tailored to different tumor differentiation levels.RESULTS In both the training and validation sets,regardless of the tumor differentiation level,LNR staging demonstrated superior prognostic stratification compared to pN.Extreme Gradient Boosting exhibited better predictive performance than the other four models.Compared to tumor node metastasis staging,the new staging systems,developed for patients with different degrees of differentiation,showed significantly better predictive performance.CONCLUSION The new positive lymph nodes ratio staging and integrated staging systems constructed for GC patients with different differentiation grades exhibited better prognostic stratification capabilities.
基金Supported by the Czech Ministry of Health,General University Hospital in Prague,No.VFN00064165。
文摘BACKGROUND Whole-body magnetic resonance imaging(wbMRI)allows general assessment of systemic cancers including lymphomas without radiation burden.AIM To evaluate the diagnostic performance of wbMRI in the staging of diffuse large B-cell lymphoma(DLBCL),determine the value of individual MRI sequences,and assess patients’concerns with wbMRI.METHODS In this single-center prospective study,adult patients newly diagnosed with systemic DLBCL underwent wbMRI on a 3T scanner[diffusion weighted images with background suppression(DWIBS),T2,short tau inversion recovery(STIR),contrast-enhanced T1]and fluorodeoxyglucose(18F-FDG)positron emission tomo-graphy/computed tomography(PET/CT)(reference standard).The involvement of 12 nodal regions and extranodal sites was evaluated on wbMRI and PET/CT.The utility of wbMRI sequences was rated on a five-point scale(0=not useful,4=very useful).Patients received a questionnaire regarding wbMRI.RESULTS Of 60 eligible patients,14(23%)were enrolled and completed the study.The sensitivity of wbMRI in the nodal involvement(182 nodal sites)was 0.84,with 0.99 specificity,positive predictive value of 0.96,negative predictive value of 0.97,and 0.97 accuracy.PET/CT and wbMRI were concordant both in extranodal involvement(13 instances)and staging(κ=1.0).The mean scores of the utility of MRI sequences were 3.71±0.73 for DWIBS,2.64±0.84 for T1,2.14±0.77 for STIR,and 1.29±0.73 for T2(P<0.0001).Patients were mostly concerned about the enclosed environment and duration of the MRI examination(27%of patients).CONCLUSION The wbMRI exhibited excellent sensitivity and specificity in staging DLBCL.DWIBS and contrast-enhanced T1 were rated as the most useful sequences.Patients were less willing to undergo wbMRI as a second examination parallel to PET/CT,especially owing to the long duration and the enclosed environment.
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In this editorial,we comment on the article by Lambert et al,published in the recent issue of the World Journal of Radiology.The focus of the editorial is to explore the advancements in whole-body magnetic resonance imaging(WB-MRI)techno-logy,its current clinical applications,and the challenges that must be addressed to fully realize its potential in oncological imaging.WB-MRI has emerged as a pivotal tool in oncological imaging,offering comprehensive disease assessment without ionizing radiation.Its applications span the detection of bone metastases,evaluation of hematologic malignancies,and staging of a wide range of cancers,including lymphoma,prostate,and breast cancers.Advanced techniques such as diffusion-weighted imaging have enhanced its diagnostic performance by pro-viding superior lesion-to-background contrast and quantitative metrics.Despite its diagnostic strengths,WB-MRI faces challenges in standardization,patient acceptance,and integration into clinical workflows.Variability in acquisition pro-tocols,hardware differences,and patient-related factors,such as anxiety and motion artifacts,have limited widespread adoption.Emerging guidelines like MET-RADS-P and ONCO-RADS aim to address these issues by promoting stan-dardized protocols tailored to specific clinical needs.This editorial explores the advancements in WB-MRI technology,its current clinical applications,and the barriers that must be overcome to maximize its utility.By addressing these cha-llenges and embracing standardization,WB-MRI holds the potential to redefine the landscape of oncological imaging,aligning diagnostic precision with modern treatment goals of reducing long-term patient risk.
文摘BACKGROUND Cutaneous melanoma is an aggressive skin cancer with high metastatic potential.Accurate staging is critical to guide therapeutic strategies and improve prognosis.Whole-body magnetic resonance imaging(WB-MRI),particularly when combined with diffusion-weighted imaging(DWI),has emerged as promising tool for comprehensive,radiation-free assessment of metastatic spread.AIM To systematically review the diagnostic performance and clinical utility of WBMRI in the staging and restaging of cutaneous melanoma,with comparison to conventional imaging modalities such as computed tomography(CT)and positron emission tomography/CT(PET/CT).METHODS A systematic literature review was conducted using PubMed,Embase,Scopus and Web of Science databases for studies published in the last 10 years.Inclusion criteria focused on comparative diagnostic accuracy studies of WB-MRI vs CT and PET/CT for melanoma staging.The methodological quality of the studies was appraised using the QUADAS-2 tool.RESULTS Sixteen studies involving over 700 patients met the inclusion criteria.WB-MRI showed high sensitivity(73%-90%)and specificity(up to 98%)in detecting metastases,particularly in bone,liver and soft tissue.DWI enhanced lesion detection,and WB-MRI often influenced clinical management decisions.However,CT outperformed WB-MRI in identifying small pulmonary nodules.AI-assisted analysis and contrastenhanced sequences further improved diagnostic confidence.CONCLUSION WB-MRI represents a robust imaging modality for staging cutaneous melanoma,offering superior soft-tissue contrast and functional imaging without ionizing radiation.Its strengths lie in detecting bone,liver and brain metastases.Challenges include limited lung lesion detection,cost,and availability.Advances in artificial intelligence,Hybrid PET/MRY systems,and radiomics are poised to expand WB-MRI’s role in personalized melanoma management.
文摘BACKGROUND Existing assessment systems for chronic hepatitis B(CHB)-associated liver fibrosis(LF)exhibit insufficient accuracy,thereby requiring further improvements.AIM To investigate the association of LF staging with hepatitis B core antibody(HBcAb),hepatitis B virus DNA(HBV-DNA),and hepatitis B surface antigen(HBsAg)in patients with CHB.METHODS We selected 120 patients with CHB receiving treatment in Hangzhou Linping District First People’s Hospital from January 2020 to June 2024.Participants were allocated into the mild(F0-F1,n=52)and moderate-to-severe groups(F2-F4,n=68)following the rigorous LF staging criteria.HBcAb,HBV-DNA,and HBsAg concentrations were measured.Pearson correlations were employed to examine the correlations of HBcAb with HBV-DNA and HBsAg,whereas Spearman correlation analysis was conducted to identify the associations of the three with LF staging.Receiver operating characteristic(ROC)curves were further used to analyze the performance of these biomarkers in diagnosing LF stages.Furthermore,binary logistic regression analysis was conducted to determine the association of these three with LF progression in CHB.RESULTS Markedly increased HBcAb and notably decreased HBV-DNA and HBsAg were observed in moderate-to-severe cases vs their mild counterparts.A positive correlation was observed between HBV-DNA and HBsAg,whereas both markers were inversely associated with HBcAb.Moreover,LF staging exhibited a significant positive correlation with HBcAb and an inverse connection with HBVDNA and HBsAg.The receiver operating characteristic analysis revealed area under the curve values of 0.715,0.799,and 0.662 for HBcAb,HBV-DNA,and HBsAg in diagnosing LF staging,respectively.Combining these markers improved the area under the curve to 0.851.The final analysis identified HBcAb as promoting fibrosis advancement(odds ratio=2.765),whereas HBVDNA demonstrated protective properties(odds ratio=0.247).CONCLUSION HBcAb is negatively correlated with HBV-DNA and HBsAg but positively associated with LF staging.All three markers are valuable in assessing LF staging,and their combined use presents the highest diagnostic efficacy.Importantly,a high HBcAb/low HBV-DNA profile markedly increased fibrosis progression risks in CHB-affected individuals.
