AIM To investigate the relationship between histological mixed-type of early gastric cancer(EGC) in the mucosa and submucosa and lymph node metastasis(LNM).METHODS This study included 298 patients who underwent gastre...AIM To investigate the relationship between histological mixed-type of early gastric cancer(EGC) in the mucosa and submucosa and lymph node metastasis(LNM).METHODS This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated(pure D), pure undifferentiated(pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.RESULTS Of the 298 patients, 165(55.4%) had mucosa-confined EGC and 133(44.6%) had submucosa-invasive EGC. Only 13(7.9%) cases of mucosa-confined EGC and 30(22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion(OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type(OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixedtype(OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixedtype group(P = 0.012) and pure U group(P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group(P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixedtype(P = 0.012) and pure U group(P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group(P = 0.375). Multivariate logistic analysis showed that only female sex(OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion(OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC(P = 0.106).CONCLUSION for mucosal EGC, histological mixed-type is not an展开更多
BACKGROUND Lymphovascular invasion (LVI) is suggested to be an early and important step in tumor progression toward metastasis, but its prognostic value and genetic mechanisms in colorectal cancer (CRC) have not been ...BACKGROUND Lymphovascular invasion (LVI) is suggested to be an early and important step in tumor progression toward metastasis, but its prognostic value and genetic mechanisms in colorectal cancer (CRC) have not been well investigated. AIM To investigate the prognostic value of LVI in CRC and identify the associated genomic alterations. METHODS We performed a retrospective analysis of 1219 CRC patients and evaluated the prognostic value of LVI for overall survival by the Kaplan-Meier method and multivariate Cox regression analysis. We also performed an array-based comparative genomic hybridization analysis of 47 fresh CRC samples to examine the genomic alterations associated with LVI. A decision tree model was applied to identify special DNA copy number alterations (DCNAs) for differentiating between CRCs with and without LVI. Functional enrichment and protein-protein interaction network analyses were conducted to explore the potential molecular mechanisms of LVI. RESULTS LVI was detected in 150 (12.3%) of 1219 CRCs, and the presence was positively associated with higher histological grade and advanced tumor stage (both P < 0.001). Compared with the non-LVI group, the LVI group showed a 1.77-fold (95% confidence interval: 1.40-2.25, P < 0.001) increased risk of death and a significantly lower 5-year overall survival rate (P < 0.001). Based on the comparative genomic hybridization data, 184 DCNAs (105 gains and 79 losses) were identified to be significantly related to LVI (P < 0.05), and the majority were located at 22q, 17q, 10q, and 6q. We further constructed a decision tree classifier including seven special DCNAs, which could distinguish CRCs with LVI from those without it at an accuracy of 95.7%. Functional enrichment and proteinprotein interaction network analyses revealed that the genomic alterations related to LVI were correlated with inflammation, epithelial-mesenchymal transition, angiogenesis, and matrix remodeling. CONCLUSION LVI is an independent predictor for survival in CRC, and its development may 展开更多
目的:建立并验证浸润性乳腺癌(invasive breast cancer,IBC)患者术前预测淋巴管血管侵犯(lymphovascular invasion,LVI)的影像组学模型。方法:纳入258例经病理组织学检查证实的IBC患者,包括LVI阴性和阳性,按7∶3随机分配为训练集和验证...目的:建立并验证浸润性乳腺癌(invasive breast cancer,IBC)患者术前预测淋巴管血管侵犯(lymphovascular invasion,LVI)的影像组学模型。方法:纳入258例经病理组织学检查证实的IBC患者,包括LVI阴性和阳性,按7∶3随机分配为训练集和验证集。运用最大相关性最小冗余度(the maximum relevance minimum redundancy,mRMR)和最小绝对收缩和选择算子(the least absolute shrinkage and selection operator,LASSO)算法筛选自患者二维超声图像中获取的影像组学特征,建立影像组学评分,同时联合临床特征建立术前预测IBC患者LVI状态的模型,并评估模型的效能。结果:由最终筛选得到的10个影像组学特征建立的影像组学评分,在训练集及验证集中均表现良好,训练组及验证组曲线下面积(area under curve,AUC)分别为0.801和0.786。在临床模型中,腋窝淋巴结(axillary lymph node,ALN)状态和超声乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类对IBC患者的LVI状态预测是有意义的。最终,整合了超声影像组学评分和临床模型有效临床特征的影像组学模型在训练集和验证集中预测能力均表现最佳(训练组AUC:0.865;验证组AUC:0.857)。决策曲线分析(decision curve analysis,DCA)表明,影像组学模型具有临床应用价值且优于其他两种单纯模型。结论:上述影像组学模型可用于术前预测IBC患者的LVI状态,并可作为指导后续个体化治疗的有效临床工具。展开更多
AIM To assess the prognostic value of lymphovascular invasion(LVI)in Bismuth-Corlette typeⅣhilar cholangiocarcinoma(HC)patients. METHODS A retrospective analysis was performed on 142consecutively recruited typeⅣHC p...AIM To assess the prognostic value of lymphovascular invasion(LVI)in Bismuth-Corlette typeⅣhilar cholangiocarcinoma(HC)patients. METHODS A retrospective analysis was performed on 142consecutively recruited typeⅣHC patients undergoing radical resection with at least 5 years of followup.Survival analysis was performed by the KaplanMeier method,and the association between the clinicopathologic variables and survival was evaluated by log-rank test.Multivariate analysis was adopted to identify the independent prognostic factors for overall survival(OS)and disease-free survival(DFS).Multiple logistic regression analysis was performed to determine the association between LVI and potential variables. RESULTS LVI was confirmed histopathologically in 29(20.4%)patients.Multivariate analysis showed that positive resection margin(HR=6.255,95%CI:3.485-11.229,P<0.001),N1 stage(HR=2.902,95%CI:1.132-7.439,P=0.027),tumor size>30 mm(HR=1.942,95%CI:1.176-3.209,P=0.010)and LVI positivity(HR=2.799,95%CI:1.588-4.935,P<0.001)were adverse prognostic factors for DFS.The independent risk factors for OS were positive resection margin(HR=6.776,95%CI:3.988-11.479,P<0.001),N1 stage(HR=2.827,95%CI:1.243-6.429,P=0.013),tumor size>30 mm(HR=1.739,95%CI:1.101-2.745,P=0.018)and LVI positivity(HR=2.908,95%CI:1.712-4.938,P<0.001).LVI was associated with N1 stage and tumor size>30 mm.Multiple logistic regression analysis indicated that N1 stage(HR=3.312,95%CI:1.338-8.198,P=0.026)and tumor size>30 mm(HR=3.258,95%CI:1.288-8.236,P=0.013)were associated with LVI. CONCLUSION LVI is associated with N1 stage and tumor size>30mm and adversely influences DFS and OS in typeⅣHC patients.展开更多
It is often difficult to evaluate the grade of malignancy and choose an appropriate treatment for colorectal carcinoids in clinical settings. Although tumor size and depth of invasion are evidently not enough to strat...It is often difficult to evaluate the grade of malignancy and choose an appropriate treatment for colorectal carcinoids in clinical settings. Although tumor size and depth of invasion are evidently not enough to stratify the risk of this rare tumor, the present guidelines or staging systems do not mention other clinicopathological variables. Recent studies, however, have shed light on the impact of lymphovascular invasion on the outcome of colorectal carcinoids. It has been revealed that the presence of lymphovascular invasion was among the strongest risk factors for metastasis along with tumor size and depth of invasion. Furthermore, tumors smaller than 1 cm, within submucosal invasion and without lymphovascular invasion, carry minimal risk for metastasis with 100% 5-year survival in the studies from Japan as well as from the USA. This would suggest that these tumors could be curatively treated by endoscopic resection or transanal local excision. On the other hand, colorectal carcinoids with either lymphovascular invasion or tumor size larger than 1 cm carry the risk for metastasis equivalent to adenocarcinomas. Therefore, it should be emphasized that histological examination of lymphovascular invasion is mandatory in the specimens obtained by endoscopic resection or transanal local excision, as this would provide useful information for determining the need for additional radical surgery with regional lymph node dissection. Although the present guidelines or TNM staging system do not mention the impact of lymphovascular invasion, this would be among the next promising targets in order to establish better guidelines and staging systems, particularly in early-stage colorectal carcinoids.展开更多
目的探讨基于轴位脂肪抑制T2加权成像(fat suppression-T2 weighted imaging,FS-T2WI)及T1加权对比增强(T1-weighted contrast-enhanced,T1CE)序列联合临床预测因子创建的临床-影像组学模型在预测无淋巴结转移的直肠癌患者术前淋巴血管...目的探讨基于轴位脂肪抑制T2加权成像(fat suppression-T2 weighted imaging,FS-T2WI)及T1加权对比增强(T1-weighted contrast-enhanced,T1CE)序列联合临床预测因子创建的临床-影像组学模型在预测无淋巴结转移的直肠癌患者术前淋巴血管浸润(lymphovascular invasion,LVI)中的应用价值。材料与方法回顾性纳入2016年12月至2021年12月河南省人民医院收治的行MRI扫描且术后病理证实为直肠癌的221例患者的病例及影像资料。采用单因素和多因素logistic回归分析LVI阳性组和LVI阴性组的临床数据,以确定LVI的独立预测因子;通过ITK-SNAP软件手动勾画肿瘤全层感兴趣区(region of interest,ROI),利用开源软件PyRadiomics提取影像组学特征,采用SPSS随机数字表法按8∶2比例将患者分为训练集(177例)和测试集(44例),并经过特征降维构建影像组学标签;基于临床预测因子是否加入影像组学模型构建了四个预测模型。根据受试者工作特征曲线下面积(area under the curve,AUC)、敏感度和特异度评估不同预测模型的诊断效能。结果肿瘤最大直径是直肠癌患者LVI的独立临床预测因子(P<0.05)。单独的FS-T2WI、T1CE序列以及两者联合(FS-T2WI+T1CE)的测试集AUC分别为0.757、0.802及0.869,FS-T2WI+T1CE联合临床预测因子的临床-影像组学模型诊断效能最好,测试集AUC为0.898(95%CI:0.769、0.968)。结论本研究构建的临床-影像组学模型具有较高的诊断效能,可以辅助临床对无淋巴结转移的直肠癌患者术前个体化LVI预测,改善治疗方案。展开更多
基金Supported by Medical Science and Technology Development Foundation of Nanjing Department of Health,No.201402032
文摘AIM To investigate the relationship between histological mixed-type of early gastric cancer(EGC) in the mucosa and submucosa and lymph node metastasis(LNM).METHODS This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated(pure D), pure undifferentiated(pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.RESULTS Of the 298 patients, 165(55.4%) had mucosa-confined EGC and 133(44.6%) had submucosa-invasive EGC. Only 13(7.9%) cases of mucosa-confined EGC and 30(22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion(OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type(OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixedtype(OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixedtype group(P = 0.012) and pure U group(P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group(P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixedtype(P = 0.012) and pure U group(P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group(P = 0.375). Multivariate logistic analysis showed that only female sex(OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion(OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC(P = 0.106).CONCLUSION for mucosal EGC, histological mixed-type is not an
基金the National Natural Science Foundation of China,No.81874201Shanghai Municipal Commission of Health and Family Planning,No.ZK2015A32 and No.201840359
文摘BACKGROUND Lymphovascular invasion (LVI) is suggested to be an early and important step in tumor progression toward metastasis, but its prognostic value and genetic mechanisms in colorectal cancer (CRC) have not been well investigated. AIM To investigate the prognostic value of LVI in CRC and identify the associated genomic alterations. METHODS We performed a retrospective analysis of 1219 CRC patients and evaluated the prognostic value of LVI for overall survival by the Kaplan-Meier method and multivariate Cox regression analysis. We also performed an array-based comparative genomic hybridization analysis of 47 fresh CRC samples to examine the genomic alterations associated with LVI. A decision tree model was applied to identify special DNA copy number alterations (DCNAs) for differentiating between CRCs with and without LVI. Functional enrichment and protein-protein interaction network analyses were conducted to explore the potential molecular mechanisms of LVI. RESULTS LVI was detected in 150 (12.3%) of 1219 CRCs, and the presence was positively associated with higher histological grade and advanced tumor stage (both P < 0.001). Compared with the non-LVI group, the LVI group showed a 1.77-fold (95% confidence interval: 1.40-2.25, P < 0.001) increased risk of death and a significantly lower 5-year overall survival rate (P < 0.001). Based on the comparative genomic hybridization data, 184 DCNAs (105 gains and 79 losses) were identified to be significantly related to LVI (P < 0.05), and the majority were located at 22q, 17q, 10q, and 6q. We further constructed a decision tree classifier including seven special DCNAs, which could distinguish CRCs with LVI from those without it at an accuracy of 95.7%. Functional enrichment and proteinprotein interaction network analyses revealed that the genomic alterations related to LVI were correlated with inflammation, epithelial-mesenchymal transition, angiogenesis, and matrix remodeling. CONCLUSION LVI is an independent predictor for survival in CRC, and its development may
文摘目的:建立并验证浸润性乳腺癌(invasive breast cancer,IBC)患者术前预测淋巴管血管侵犯(lymphovascular invasion,LVI)的影像组学模型。方法:纳入258例经病理组织学检查证实的IBC患者,包括LVI阴性和阳性,按7∶3随机分配为训练集和验证集。运用最大相关性最小冗余度(the maximum relevance minimum redundancy,mRMR)和最小绝对收缩和选择算子(the least absolute shrinkage and selection operator,LASSO)算法筛选自患者二维超声图像中获取的影像组学特征,建立影像组学评分,同时联合临床特征建立术前预测IBC患者LVI状态的模型,并评估模型的效能。结果:由最终筛选得到的10个影像组学特征建立的影像组学评分,在训练集及验证集中均表现良好,训练组及验证组曲线下面积(area under curve,AUC)分别为0.801和0.786。在临床模型中,腋窝淋巴结(axillary lymph node,ALN)状态和超声乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类对IBC患者的LVI状态预测是有意义的。最终,整合了超声影像组学评分和临床模型有效临床特征的影像组学模型在训练集和验证集中预测能力均表现最佳(训练组AUC:0.865;验证组AUC:0.857)。决策曲线分析(decision curve analysis,DCA)表明,影像组学模型具有临床应用价值且优于其他两种单纯模型。结论:上述影像组学模型可用于术前预测IBC患者的LVI状态,并可作为指导后续个体化治疗的有效临床工具。
基金Supported by Science and Technology Support Project of Sichuan Province,No.2015SZ0070 and No.2014FZ0049
文摘AIM To assess the prognostic value of lymphovascular invasion(LVI)in Bismuth-Corlette typeⅣhilar cholangiocarcinoma(HC)patients. METHODS A retrospective analysis was performed on 142consecutively recruited typeⅣHC patients undergoing radical resection with at least 5 years of followup.Survival analysis was performed by the KaplanMeier method,and the association between the clinicopathologic variables and survival was evaluated by log-rank test.Multivariate analysis was adopted to identify the independent prognostic factors for overall survival(OS)and disease-free survival(DFS).Multiple logistic regression analysis was performed to determine the association between LVI and potential variables. RESULTS LVI was confirmed histopathologically in 29(20.4%)patients.Multivariate analysis showed that positive resection margin(HR=6.255,95%CI:3.485-11.229,P<0.001),N1 stage(HR=2.902,95%CI:1.132-7.439,P=0.027),tumor size>30 mm(HR=1.942,95%CI:1.176-3.209,P=0.010)and LVI positivity(HR=2.799,95%CI:1.588-4.935,P<0.001)were adverse prognostic factors for DFS.The independent risk factors for OS were positive resection margin(HR=6.776,95%CI:3.988-11.479,P<0.001),N1 stage(HR=2.827,95%CI:1.243-6.429,P=0.013),tumor size>30 mm(HR=1.739,95%CI:1.101-2.745,P=0.018)and LVI positivity(HR=2.908,95%CI:1.712-4.938,P<0.001).LVI was associated with N1 stage and tumor size>30 mm.Multiple logistic regression analysis indicated that N1 stage(HR=3.312,95%CI:1.338-8.198,P=0.026)and tumor size>30 mm(HR=3.258,95%CI:1.288-8.236,P=0.013)were associated with LVI. CONCLUSION LVI is associated with N1 stage and tumor size>30mm and adversely influences DFS and OS in typeⅣHC patients.
文摘It is often difficult to evaluate the grade of malignancy and choose an appropriate treatment for colorectal carcinoids in clinical settings. Although tumor size and depth of invasion are evidently not enough to stratify the risk of this rare tumor, the present guidelines or staging systems do not mention other clinicopathological variables. Recent studies, however, have shed light on the impact of lymphovascular invasion on the outcome of colorectal carcinoids. It has been revealed that the presence of lymphovascular invasion was among the strongest risk factors for metastasis along with tumor size and depth of invasion. Furthermore, tumors smaller than 1 cm, within submucosal invasion and without lymphovascular invasion, carry minimal risk for metastasis with 100% 5-year survival in the studies from Japan as well as from the USA. This would suggest that these tumors could be curatively treated by endoscopic resection or transanal local excision. On the other hand, colorectal carcinoids with either lymphovascular invasion or tumor size larger than 1 cm carry the risk for metastasis equivalent to adenocarcinomas. Therefore, it should be emphasized that histological examination of lymphovascular invasion is mandatory in the specimens obtained by endoscopic resection or transanal local excision, as this would provide useful information for determining the need for additional radical surgery with regional lymph node dissection. Although the present guidelines or TNM staging system do not mention the impact of lymphovascular invasion, this would be among the next promising targets in order to establish better guidelines and staging systems, particularly in early-stage colorectal carcinoids.
文摘目的探讨基于轴位脂肪抑制T2加权成像(fat suppression-T2 weighted imaging,FS-T2WI)及T1加权对比增强(T1-weighted contrast-enhanced,T1CE)序列联合临床预测因子创建的临床-影像组学模型在预测无淋巴结转移的直肠癌患者术前淋巴血管浸润(lymphovascular invasion,LVI)中的应用价值。材料与方法回顾性纳入2016年12月至2021年12月河南省人民医院收治的行MRI扫描且术后病理证实为直肠癌的221例患者的病例及影像资料。采用单因素和多因素logistic回归分析LVI阳性组和LVI阴性组的临床数据,以确定LVI的独立预测因子;通过ITK-SNAP软件手动勾画肿瘤全层感兴趣区(region of interest,ROI),利用开源软件PyRadiomics提取影像组学特征,采用SPSS随机数字表法按8∶2比例将患者分为训练集(177例)和测试集(44例),并经过特征降维构建影像组学标签;基于临床预测因子是否加入影像组学模型构建了四个预测模型。根据受试者工作特征曲线下面积(area under the curve,AUC)、敏感度和特异度评估不同预测模型的诊断效能。结果肿瘤最大直径是直肠癌患者LVI的独立临床预测因子(P<0.05)。单独的FS-T2WI、T1CE序列以及两者联合(FS-T2WI+T1CE)的测试集AUC分别为0.757、0.802及0.869,FS-T2WI+T1CE联合临床预测因子的临床-影像组学模型诊断效能最好,测试集AUC为0.898(95%CI:0.769、0.968)。结论本研究构建的临床-影像组学模型具有较高的诊断效能,可以辅助临床对无淋巴结转移的直肠癌患者术前个体化LVI预测,改善治疗方案。
