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Objective:To explore the value of nomogram based on arterial spin labeling (ASL) MRI perfusion parameters and clinicopathological features in predicting the response to chemoradiotherapy (CRT) in advanced nasopharyngeal carcinoma (ANPC, stage Ⅲ and Ⅳ).Methods:From June 2018 to January 2021, 70 patients with ANPC confirmed by pathology were prospectively enrolled in Affiliated Hospital of Jiangnan University. Nasopharyngeal MRI plain scan, ASL and contrast-enhanced scan were performed before CRT, and routine MRI re-examination was performed within 1 week after the end of CRT. The pre-CRT perfusion parameter tumor blood flow (TBF) from ASL and clinicopathological features were recorded, and the maximum diameter (MD) of the tumor on T 1WI images was measured. The patients were divided into CRT effective group (48 cases) and ineffective group (22 cases) according to the response evaluation criteria in solid tumors. The independent sample t test was used to compare the differences of TBF, age and MD between effective group and ineffective group. The χ 2 test was used to compare the differences of gender, clinical stage and pathological type between the 2 groups. Using binary logistic regression analysis, clinicopathological model and TBF combined clinicopathological model were constructed, and the nomogram of combined model was constructed. The diagnostic efficacy of the models was obtained by receiver operating characteristic (ROC) curve analysis, and the area under the ROC curves (AUC) of the 3 models were compared by DeLong method. The calibration curve for the nomogram was generated, and the concordance index (C index) was acquired. Results:The TBF of the effective group and the ineffective group were (113±9) and (97±14) ml·100 g -1·min -1, with a statistical difference ( t=5.17, P<0.001). The MD value of the effective group was smaller than that of the ineffective group, with a statistical difference ( t=-2.24, P=0.028). There were statistical differences in clinical stage and pathological type between the 2 groups (χ 2 values were 12.21 and 12.95, respectively, both P<0.001). Three independent predictors, including TBF (OR=7.749), clinical stage (OR=0.129) and pathological type (OR=5.228), were included in logistic regression analysis. The AUC, sensitivity and specificity of TBF model in predicting the response to CRT were 0.843, 87.5% and 72.7%, of clinicopathological model were 0.822, 80.2% and 59.1%, of the nomogram model were 0.893, 81.2% and 90.9%. There was no statistical difference of AUC between the nomogram model and TBF model ( Z=1.23, P=0.215). However, the AUC of the nomogram model was greater than that of the clinicopathological model ( Z=2.47, P=0.031). The calibration curve showed that there was a good concordance index (C index=0.892) between the predicted value of nomogram and the actual clinical observation value. Conclusion:TBF, clinical stage and pathological type are independent predictors of the response to CRT in ANPC patients, and the nomogram based on these three factors has a good ability in predicting the response to CRT.
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Objective To explore the correlation between CT perfusion imaging parameters and differentiation degree of gastric cancer.Methods Fifty patients with gastric cancer proved by surgery and pathology underwent 64-slice spiral CT perfusion imaging before surgery,and the CT perfusion parameters were obtained including blood flow(BF),blood volume(BV),mean transit time (MTT)and permeability surface(PS).The patients were divided into 3 groups (well,moderate and poor differentiation)according to the degree of cell differentiation.Statistical analysis was performed by using the SPSS 17.0 statistics software.Results The perfusion parameters of BF (mL·min-1 ·100 g-1 ),BV (mL/100 g),MTT (s)and PS (mL·min-1 ·100 g-1 )were as follows:75.28±6.81,9.01± 0.94,9.89±1.65 and 10.05±0.71 in well differentiation group with 10 patients (20%),110.01±31.90,18.18±5.62,9.81±3.69 and 40.08±1 5.82 in moderate differentiation group with 24 patients (48%),138.59±38.09,21.08±4.1 1,9.47 ±1.80 and 57.50± 13.28 in poor differentiation group with 1 6 patients (32%)respectively.Among three groups,there were statistic differences in BF, BV and PS between well differentiation group and moderate differentiation group or low differentiation group (P 0.05).Conclusion The BF,BV and PS values may be regarded as the evaluation index for malignant degree of gastric cancer.
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Objective To analyze the clinical and pathological features of breast cancer in patients over 80 years old, to discuss the individualized treatment plan and further to provide foundation for clinical treatment . Methods Data of 58 breast cancer patients over 80 years old were retrospectively analyzed .They were treated from Jun.2008 to May.2014 and the diagnosis was confirmed by pathology after surgery .They were followed up by telephone.Results Among the 58 cases, invasive cancer accounted for 94.8%(55/58), in which triple-negative breast cancer accounted for 29.1%(16/55), and human epidermal growth factor receptor 2(HER2)pos-itive breast cancer accounted for 7.2%( 4/55 ) .Stage III breast cancer accounted for 24%( 14/58 ) .67.2%(39/58)patients underwent breast resection , 55.2%(32/58)patients underwent axillary treatment , 17.2%(10/58)patients received chemotherapy , and 51.7%(30/58) patients received endocrine therapy .Seven cases had recurrence and 3 cases died of the disease .Conclusions Breast cancer in elderly patients has its special clinical and pathological features .It has longer course , relatively late stage , and more complications .It has higher pro-portion of triple-negative breast cancer and lower proportion of positive HER 2.Elderly breast cancer patients are less tolerant to chemotherapy , thus surgery and endocrine therapy are the main treatment .
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Objective To explore the value of peripheral blood samples in KRAS mutation testing of colorectal cancer patients and the correlation between the number of circulating tumor cells and KRAS mutation testing.Methods We detected KRAS mutation using amplification refractory mutation system PCR method in paraffin embedded tissues and matched peripheral blood samples obtained from 112 colorectal cancer patients and 10 proctitic peripheral blood samples in Affiliated Hospital of Jiangnan University between 2013 and 2014.Meanwhile,immunofluorescence in situ hybridization method was used to count the circulating tumor cells in peripheral blood samples and proctitic control samples.Results Among the 112 colorectal cancer samples tested,25 cases of peripheral blood samples found KRAS mutation (41.1％) and which was 46 in formalin fixed paraffin embedded tissues testing (22.3 ％),with a significant difference (x2 =40.12,P ＜ 0.001).One case with KRAS wild type in formalin fixed paraffin embedded tissues was mutation type in peripheral samples.In another case,mutation site was different in different kinds of samples.The sensibility of KRAS mutation testing was 73.3％,41.9％ and 16.7％ when the number of circulating tumor cells was more than 15,5 to 15,and 1 to 5,respectively,with significant differences (x2 =23.70,P ＜ 0.001).No KRAS mutation and no circulating tumor cells were found in 10 proctitic control samples.Conclusion We find high specificity in KRAS mutation testing of peripheral blood samples.but the accurate rate is not satisfying.KRAS mutation testing in peripheral blood samples may be an optional choice to test KRAS mutations for colorectal cancer patients who were not subjected to surgery.The sensibility of KRAS mutation testing in peripheral blood samples has a corretion with the number of circulating tumor cells.
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Objective To analyze the CT features of primary pulmonary leiomyoma (PPL) and improve the diagnostic ability of PPL.Methods The CT findings and clinical characteristics were retrospectively analyzed in 6 patients with PPL proved by pathology,and the related literatures were reviewed.Results Six PPLs were single lesion from 3.0 to 8.5 cm in size,the shape was round or oval with extremely smooth margin.On CT plain scan,the CT values of all PPL lesions were 25-33 HU,4 lesions presented homogeneous moderate enhancement (40-60 HU) and 2 lesions presented inhomogeneous enhancement after contrast administration.A solid lesion showed obviously patchy enhancement with cystic degeneration,1 lesion presented ring enhancement.All lesions were benign histopathologically,the leiomyoma cells showed spindle shaped or in bundles with pseudocapsule,and with hyaline degeneration in 1 case.Smooth Muscle Actin (SMA) were all marked positive on immunohistochemistry.Conclusions CT findings of PPL have some characteristics,but lack of specificity,the final diagnosis still relies on pathological examination.
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Objective To investigate the cell apoptosis and the expression level of its related gene Survivin, PTEN. Methods Apoptotic cells and bodies were detected by TUNEL. Immunohistocbemical stains were performed to examine the expression of Survivin, PTEN and Ki-67. The software package SPSS 10.0 was used for statistical analysis. Results The Survivin positive rate in 73 tumors was 64.4 %, and there was significant negative correlation between Survivin weighted score and AI (r=-0.85,P<0.01). The mean AI of survivin-positive tumors was lower than that of Survivin-ncgative tumors(P=0.035). The PTEN positive rate in 73 tumors was 72.6 %, there was positive correlation between PTEN weighted score and AI (P=0.026). The mean AI of PTEN-positive tumors was higher than that of PTEN-negative tumors (P=0.034). There was significant negative correlation between AI and pathological grade and positive correlation between PI and pathological grade(r=-0.432, P=0.001, r=0.729, P<0.01). Conclusion Cell apoptosis was affected by some factors. AI was associated with the expression of Survivin and PTEN.