Clinical value of inflammatory biomarkers in predicting prognosis of patients with ureteral urothelial carcinoma / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical value of inflammation-related markers in predicting the prognosis of patients with ureteral urothelial carcinoma.@*METHODS@#200 patients with ureteral urothelial carcinoma were randomly divided into two groups by split sample validation: modeling group and validation group. Paraffin embedded pathological specimens of the patients were reviewed. Immunohistochemical method was used to detect tumor-infiltrating neutrophil (TIN) (CD66b+), tumor-associated macrophage (TAM) (CD163+), lymphocyte (CD+, CD4+, CD8+) counts, peripheral blood neutrophil / lymphocyte ratio (NLR) and tumor tissue neutrophil/monocyte ratio (NMR). According to the results of pathological staging, the patients were divided into non-muscle-invasive and muscle-invasive ureteral urothelial carcinoma group. The resolution of the models was evaluated, and the prognostic nomogram models including only peripheral blood parameters and all parameters were established to compare the accuracy of the two models in predicting the prognosis of patients with urothelial carcinoma of the ureter.@*RESULTS@#The median follow-up time was 36 months, the progression-free survival was 40 months, and 42 cases (21.0%) showed tumor progression within 3 years. Tumor size, pathological stage and pathological grade were all single-factor variables predicting the first recurrence of ureteral urothelial carcinoma three years after operation. Tumor size, pathological stage, pathological grade, TIN, TAM, NLR and NMR were multi-factor variables predicting the first recurrence three years after operation. Among 104 cases of non-muscle-invasive ureteral urothelial carcinoma, 10 cases (9.6%) recurred for the first time 3 years after operation, 96 cases (33.3%) of muscle invasive ureteral urothelial carcinoma, and the diffe-rence between the two groups was statistically significant (χ2=15.53, P < 0.05). The predictive nomogram model of progression free survival was established. The concordance index of progression free survi-val was 0.722 (95%CI: 0.70-0.78) in non-muscle-invasion group, and 0.725 (95%CI: 0.71-0.79) in muscle-invasion group, which was in good agreement with the observed 3-year survival rate. The results of discrimination test showed that the concordance index of the whole parameter prediction model of ureteral urothelial carcinoma was 0.726, which was higher than that of peripheral blood parameters (consistency index 0.672). The immune microenvironment of ureteral urothelial carcinoma improved the prediction accuracy of the model.@*CONCLUSION@#The prognosis prediction model based on immune inflammation-related markers was established as a perfection and supplement for the existing pathological grading and staging system, providing a basis for accurate individualized treatment of patients with urete-ral urothelial carcinoma. The prognosis prediction model based on the relevant indicators of peripheral blood samples is established, which is easy to obtain specimens, and the detection method is simple and economical, which is more conducive to clinical application.

Diagnostic Value of Combining Permeability with T1 Perfusion Parameters in Quantitative Dynamic Contrast-enhanced Magnetic Resonance Imaging for Glioma Grading / 中国医学科学院学报

<p><b>UNLABELLED</b>OBJECTIVE To investigate the diagnostic value of combining permeability with T1 perfusion parameters in quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in glioma grading.</p><p><b>METHODS</b>Magnetic resonance imaging was performed in 16 patients with high grade gliomas (HGG) and 12 patients with low grade gliomas(LGG) confirmed by pathology. The permeability was quantitatively analyzed and the T1 perfusion parameters of the tumor were calculated by the pharmacokinetic model,including volume transfer constant (K(trans)),volume fraction of extravascular extracellular space (ve),reflux constant (kep),fractional plasma volume (vp),cerebral blood flow (CBF),cerebral blood volume (CBV),and mean transit time (MTT). A t-test was used to calculate the statistical significance of quantitative analysis parameters between HGG and LGG. The receiver operating characteristic curve analysis was also performed for evaluating the sensitivity,specificity,and area under curve (AUC) of the permeability parameters and perfusion parameters and the combination of these parameters.</p><p><b>RESULTS</b>The differences of the K(trans),ve,CBF,and CBV values [(0.276<0.164)/min vs. (0.084<0.044)/min;0.486<0.191 vs. 0.274<0.132;(1.755<1.164)ml/(g·min) vs. (0.761<0.625) ml/(g·min);(0.204<0.101) ml/g vs. (0.115<0.097)ml/g] were statistically significant (t=3.934,3.293,2.672,2.338,P<0.05) between HGG and LGG. The differences of the kep,vp, and MTT value [(1.632<1.204)/min vs. (1.537<1.194)/min;0.114<0.107 vs. 0.055<0.039;(0.128<0.070)min vs. (0.145<0.066)min] were not statistically significant (t=0.208,1.823,0.688,P>0.05). When the K(trans) value was 0.105/min,the AUC was the largest (0.919) by the single parameter in glioma grading,and meanwhile the sensitivity and specificity were 87.5% and 83.3%,respectively. When the ve-CBF value was 0.631,the AUC was the largest (0.974) by the multiple parameter,and meanwhile the sensitivity and specificity were 93.7% and 100.0%,respectively.</p><p><b>CONCLUSION</b>Combining permeability with perfusion parameters in quantitative DCE-MRI can improve the accuracy of the glioma grading.</p>

Comparison of enhanced magnetic resonance imaging and magnetic resonance cholangiopancreatography in the differential diagnosis of benign and malignant intraductal papillary mucinous neoplasms of the pancreas / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the value of liver acquisition with volume acceleration (LAVA) and magnetic resonance cholangiopancreatography (MRCP) in diagnosing benign and malignant intraductal papillary mucinous neoplasms (IPMN) of the pancreas.</p><p><b>METHODS</b>The MR findings of 35 IPMN patients confirmed by pathology were analyzed retrospectively, and the sequences included T1WI, T2WI, LAVA, and MRCP. All patients were divided into two groups: the group of MRI enhancement (including T1WI, T2WI, and MRI enhancement) and the group of MRCP (including T1WI, T2WI, and MRCP). Two groups were evaluated by the receiver operating characteristic (ROC) curve.</p><p><b>RESULTS</b>Totally 23 cases of intraductal papillary mucinous tumors and 12 cases of intraductal papillary mucinous carcinomas were diagnosed. Finally, 29 cases (29/35) of IPMN were diagnosed correctly in the group of MR enhancement, and 25 cases (25/35) diagnosed correctly in the group of MRCP. The differential diagnostic accuracy of the group of MRI enhancement (82.9%) was higher than that of the group of MRCP (71.4%), although the difference was not statistically significant (P=0.068). The sensitivity, specificity, positive predictive value, and the area under the ROC curve (AUC) of the group of MRI enhancement were 83.3%, 82.6%, 71.4%, and 0.850, and those of the group of MRCP were 75.0%, 69.6%, 52.3%, and 0.723. The AUC of the group of MRI enhancement was significantly larger than that of the group of MRCP (P=0.0465).</p><p><b>CONCLUSION</b>MRI enhancement is more valuable than MRCP in the differential diagnosis of benign and malignant IPMN.</p>

Comparison of enhanced magnetic resonance and diffusion-weighted imaging for detection of hepatic metastases / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the roles of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) using the liver acquisition with volume acceleration(LAVA) sequence and diffusion-weighted imaging(DWI) in the detection of hepatic metastases sized ≤3 cm.</p><p><b>METHODS</b>We retrospectively analyzed the MRI data of 16 patients with hepatic metastases. All the sequences used included T1WI, T2WI,3D-LAVA, and DWI (b value=500 s/mm(2)). All patients were divided into two groups based on the sequences: group A (T1WI, T2WI, and 3D-LAVA enhanced MR) and group B(T1WI,T2WI and DWI). The hepatic metastases were evaluated by analyzing the receiver operating characteristic (ROC) curves.</p><p><b>RESULTS</b>A total of 39 hepatic metastatic lesions were identified. The sensitivity, specificity, Youden index and the area under the ROC curve (AUC) were 97.4%, 88.2%, 0.856, and 0.944 in group A and 82.1%, 91.2%, 0.733, and 0.834 in group B. The ROC curves (p=0.040) and Youden index(p=0.043) in group A were significantly larger than in group B.</p><p><b>CONCLUSION</b>Gadolinium-EOB-DTPA-enhanced MRI has higher accuracy than DWI in the detection of small metastases.</p>

Evaluation of renal function and pathologica changes in patients with lupus nephritis by ~(99)Tc~m-DTPA renal dynamic imaging / 中华核医学杂志

Objective To analyze the relation between ~(99)Tc~m-DTPA renal dynamic imaging and pathological changes in patients with lupus nephritis (LN).Methods Ten normal control and 29 patients with LN underwent ~(99)Tc~m-DTPA renal dynamic imaging.The LN patients were divided into two groups:silent LN (SLN) group,18 patients;and obvious LN (OLN) group,11 patients.For each case,glomerular filtration rate (GFR),peak time (t_p),half excretion time (t_(1/2)) and the excretion rate at 20 min (R_(20)) were calculated.Assessment of renal function on the scintigraphic images was evaluated by nuclear medicine physicians.The t-test,Fisher'exact probability and R×C association were used for data analysis.Results There were significant differences between normal people and two goups of LN in tp(t=5.3,9.3,both P＜0.05),t_(1/2)(t=6.9,12.0,both P＜0.05)and R_(20)(t=10.1,12.1,both P＜0.05).As to GFR,there was significant decrease in OLN patients(t=4.1,P＜0.05),but not in SLN patients(t=1.7,P＞0.05).Diagnoses of renal function by renal dynamic imaging were compared with the renal pathological changes (r=0.2273,P＜0.05).Conclusions ~(99)Tc~m-DTPA renal dynamic imaging is useful for evaluation of the early stage renal function for LN patients and to diagnose LN patients with no symptom of renal impairment.It may help to assess the degree of renal parenchymal damage while obviating the need for renal biopsy in these patients.