Advances in preoperative imaging evaluation of extramural vascular invasion of rectal cancer / 中国医师杂志

Rectal cancer is a common malignancy of the gastrointestinal tract. Extramural vascular invasion (EMVI) is a key indicator of risk stratification for rectal cancer and an important reference factor in determining individualised treatment options, so it is important to accurately assess whether extramural vessels are infiltrated by the tumour before surgery. The main imaging methods for rectal cancer include magnetic resonance imaging (MRI), computed tomography (CT) and transrectal ultrasound (TRUS). This article focuses on the performance and diagnostic efficacy of these imaging methods in the diagnosis of EMVI in rectal cancer, and provides clinical reference.

Effects of status of lymph vascular invasion on the survival of patients with squamous cell carcinoma of the penis / 现代泌尿外科杂志

【Objective】 To explore the effects of status of lymph vascular invasion (LVI) on the survival of patients with squamous cell carcinoma of the penis (SCCP). 【Methods】 Data of patients diagnosed as SCCP during Jan.1, 2010 and Dec.31, 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier method was used to draw the survival curve of patients with different LVI statuses, and log-rank test was conducted in parallel. Univariate and multivariate Cox regression analyses were used to assess the effects of LVI status on the overall survival. Patients were divided into different subgroups based on stage (localized, regional, and distant metastasis) and grade (well, moderately and poorly differentiated) of tumor, and the effects of LVI status on the overall survival of patients in different subgroups were assessed. 【Results】 A total of 1 435 patients were involved, including 1 102 (76.8%) without LVI and 333 (23.2%) with LVI. Median survival time of patients without LVI and with LVI were 27.5 months and 17.0 months, respectively (χ2=55.028, P<0.001). Cox regression analyses showed LVI was a significant prognostic factor in SCCP patients (HR=1.280, 95%CI:1.044-1.569, P=0.018). In the subgroup analysis, LVI was an independent risk factor affecting the overall survival of patients with localized tumor (HR=1.446, 95%CI:1.009-2.110, P=0.046) and regional tumor (HR=1.323, 95%CI:1.018-1.720, P=0.036);it was also an independent risk factor affecting the overall survival of SCCP patients with well differentiated tumor (HR=2.797, 95%CI:1.573-4.971, P=0.046) and moderately differentiated tumor (HR=1.431, 95%CI:1.071-1.914, P=0.015). 【Conclusion】 LVI status is a significant factor affecting the prognosis of SCCP patients. LVI is an independent risk factor for the overall survival of SCCP patients with localized and regional tumor, moderately differentiated and well differentiated tumor.

Expression of BZW2 and IVD in hepatocellular carcinoma tissues and effect on prognosis of liver transplant recipients with hepatocellular carcinoma / 器官移植

Objective To investigate the expression levels of basic leucine zipper and W2 domain 2 (BZW2) and isovaleryl-CoA dehydrogenase (IVD) in hepatocellular carcinoma (HCC) and evaluate their effect on clinical prognosis of liver transplant recipients with HCC. Methods Pathological specimens and clinical data of 87 liver transplant recipients with HCC were collected and retrospectively analyzed. The recurrence and metastasis of HCC after liver transplantation were assessed. Immunohistochemical staining was used to detect the expression levels of BZW2 and IVD. The relationship between BZW2, IVD and clinicopathological parameters of HCC and their effect on postoperative recurrence and clinical prognosis of the recipients was analyzed. Results Among 87 recipients, 31 cases recurred with a recurrence rate of 36%. HCC recurred at postoperative 2-49 months and the median recurrence time was postoperative 7 months. Immunohistochemical staining demonstrated that the positive expression rate of BZW2 in the HCC tissues was significantly higher than that in normal liver tissues (76% vs. 30%), and the positive expression rate of IVD was significantly lower compared with that in normal liver tissues (51% vs. 69%) (both P < 0.01). BZW2 expression was significantly correlated with tumor diameter and tumor capsule (both P < 0.05), whereas IVD expression was significantly associated with tumor diameter, alpha-fetoprotein (AFP) level, tumor, node and metastasis (TNM) staging and whether vascular invasion was found or not (all P < 0.05). In the high BZW2 expression group, the cumulative recurrence rate of HCC was significantly higher and the cumulative survival rate was significantly lower than those in the low BZW2 expression group. In the low IVD expression group, the cumulative recurrence rate of HCC was significantly higher and the cumulative survival rate was significantly lower compared with those in the high IVD expression group (all P < 0.05). Conclusions The expression level of BZW2 protein is up-regulated, whereas that of IVD protein is down-regulated in the HCC tissues. Moreover, the cumulative recurrence rate of HCC is relatively high and the cumulative survival rate is relatively low in liver transplant recipients with high BZW2 expression and low IVD expression.

Significance of paying attention to extramural vascular invasion before operation for rectal cancer / 国际外科学杂志

Rectal cancer is one of the most common malignant tumors of digestive system. Accurate preoperative diagnosis plays an important role in surgeons′ decision on treatment plan. Extramural venous invasion (EMVI), as an important prognostic factor for predicting lymph node metastasis, distant metastasis and overall survival time of rectal cancer, has been paid more attention in recent years. It may even be used as a new staging system for guiding clinical treatment and formulate accurate preoperative staging. Preoperative MRI(mrEMVI) and postoperative pathology (pEMVI) is equal in the accuracy of assessment of EMVI. mrEMVI can be used as an important item for preoperative multi disciplinary team or clinicians to evaluate the patient stage and formulate individual treatment plan, and can also be used as an important evaluation for whether to perform surgery after preoperative chemoradiotherapy (CRT) and whether to prolong postoperative chemoradiotherapy time. EMVI should be taken as one of the necessary preoperative examinations for all the rectal cancer patients.

Long-term effect and risk factors of allogeneic vein replacement in borderline resectable pancreatic cancer / 中华肝胆外科杂志

Objective:To evaluate the effect of allogenic vein replacement in treatment of borderline resectable pancreatic cancer, and to analyze risk factors of long-term stenosis.Methods:The clinical data of 77 patients with borderline resectable pancreatic cancer who underwent surgery from January 2013 to December 2021 at the Beijing Chaoyang Hospital, Capital Medical University were retrospectively analyzed. There were 34 males and 43 females, aged (61.4±10.8) years old. The peri-operative data, long-term prognosis and stenosis of allogenic vein were analysed. Risk factors of stenosis were analyzed by the Cox proportional hazards model. Patients were followed up by outpatient visits or by telephone.Results:Pancreatic cancer had invaded the junction of portal vein/superior mesenteric vein (SMV) in 41 patients, SMV in 22 patients and portal vein in 14 patients. The length of venous resection was (3.7±1.0) cm, the tumor longest diameter was (3.8±1.6) cm, lymph node metastasis was present in 57 patients, R 0 resection was carried out in 70 patients, and the postoperative complication rate was 29.9% (23/77). The survival rates in 6 months, 1-year and 2-year were 84.1%, 52.3% and 32.9% respectively. Mild venous stenosis occurred in 4 patients (5.2%), moderate stenosis in 9 patients (11.7%) and severe stenosis in 11 patients (14.3%). A vascular resection length of more than 3 cm ( RR=4.602, 95% CI: 1.657-12.781, P=0.003) and tumor recurrence ( RR=8.529, 95% CI: 1.129-64.448, P=0.038) were independent risk factors for long-term moderate and severe stenosis of allogeneic vein. Conclusion:It was safe and feasible for allogenic vein to be used to reconstruct the portal venous system in resection of borderline resectable pancreatic cancer. Long-term stenosis of the allogenic vein was related to a length of vascular resection of more than 3 cm and recurrence of tumor.

Surgical treatment strategy for pancreatic cancer with invasion of spleno-mesenterico-portal cofluence / 中华肝胆外科杂志

Pancreatic cancer is one of the most common malignant digestive tumors with high malignancy and poor five-year survival. Due to the biological behavior of tumor and local adjacency, pancreatic cancer is frequently invaded to adjacent portal vein, superior mesenteric vein, and splenic vein, making surgical resection difficult. For pancreatic cancer with invasion of spleno-mesenterico-portal confluence, the difficulty of surgical R 0 resection is further increased, so it is important to reasonably resect the invaded vessels and complete vascular reconstruction. In this research, we summarized the different revascularization approaches in our center, aiming to analyze the surgical treatment strategy for pancreatic cancer with invasion of spleno-mesenterico-portal confluence.

CT radiomics based machine-learning model predicts portal vein-superior mesenteric vein involvement in pancreatic ductal adenocarcinoma / 中华肝胆外科杂志

Objective:To investigate the value of machine learning-based computed tomography (CT) images radiomics analysis in preoperative evaluation of surgical portal vein-superior mesenteric vein (PV-SMV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC).Methods:The retrospective study was conducted with 156 consecutive PDAC patients who were underwent surgery at the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University between January 2010 and July 2021. There were 95 males and 61 females, with the age of (65.7±8.2) years. Patients were randomly split into training set and validation set by a ratio of 3∶2. Minimum redundancy maximum relevance was used to select radiomic features, which were extracted from contrast-enhanced CT images. Five machine learning classifiers were developed, and those models' area under the curve (AUC) values were compared with the conventional radiologic-feature-based evaluation.Results:Ninety-four and 52 patients were included into the training set and validation set, respectively. Their PV-SMV invasion rates were confirmed by intraoperative exploration with 31.9%(30/94) and 40.3%(25/61), respectively. Five models: LASSO regression, random forest, support vector machine, k-nearest neighbor and Naive Bayesian, were established based on ten features from CT images radiomics, and LASSO regression model achieved the highest AUC value compared with the other four models (all P<0.05). Compared with the conventional radiologic evaluation, the LASSO regression model had higher AUC (0.920 vs. 0.752) and sensitivity (92.0% vs. 86.5%)(both P<0.05). Conclusion:Machine learning-based CT images radiomics analysis can be used to evaluate PV-SMV invasion status preoperatively in PDAC. The LASSO regression model showed better performance than the conventional radiologic evaluation.

Risk Factors of Vascular Invasion in Patients with Resectable Gastric Cancer / 肿瘤防治研究

Objective To explore the risk factors for vascular invasion and its influence on prognosis of resectable gastric cancer patients by analyzing the clinicopathological features. Methods We retrospectively analyzed the data of 1077 patients with stage Ⅰ-Ⅲ gastric cancer who underwent surgical resection. According to whether vascular invasion occurred, they were divided into LVI positive group (n=672) and LVI negative group (n=405). Logistic univariate and multivariate analyses were used for the relation between clinical pathological features and LVI. Survival analysis was used to study the relation between vascular invasion and survival rate in patients with stage Ⅰ gastric cancer. Results Univariate analysis showed that tumor size, type of differentiation, depth of invasion, lymph node metastasis, TNM stage, Lauren classification, nerve invasion and the increase of CEA, CA125 and CA199 were risk factors for vascular invasion (P < 0.05). Multivariate analysis showed that poor differentiation, deep invasion, lymph node metastasis, nerve invasion and elevated CA724 were independent risk factors for vascular invasion. The 5-year survival rate of stage Ⅰ gastric cancer patients with vascular invasion was significantly lower than that without vascular invasion (P < 0.01). Conclusion Gastric cancer patients with poor differentiation, deep invasion, lymph node metastasis, nerve invasion and elevated CA724 are more prone to vascular invasion. Patients with stage I gastric cancer at risk of vascular invasion should be treated more aggressively.

Research advances in peripheral vascular invasion of hepatic alveolar echinococcosis / 临床肝胆病杂志

Alveolar echinococcosis proliferates in the form of chronic infiltration and has no obvious symptoms and signs in the early stage, and when attending the hospital, some patients already have one or more complications and invasion of important intrahepatic vessels and bile ducts. The research on peripheral vascular invasion of alveolar echinococcosis may help to determine the best individualized treatment and thus improve the cure rate and prognosis of patients. This article reviews the pathological mechanism, clinical manifestations, imaging, clinical classification, and treatment of alveolar echinococcosis.

Analysis of influencing factors for lung metastasis of hepatocellular carcinoma after liver transplantation and application value of its nomogram prediction model / 中华消化外科杂志

Objective:To investigate the influencing factors for lung metastasis of hepato-cellular carcinoma after liver transplantation and application value of its nomogram prediction model.Methods:The retrospective cohort study was conducted. The clinicopathological data of 339 hepatocellular carcinoma patients with lung metastasis after liver transplantation who were admitted to Zhongshan Hospital of Fudan University from January 2015 to June 2019 were collected. There were 299 males and 40 females, aged from 23 to 73 years, with a median age of 54 years. According to the random numbers showed in the computer, all 339 patients were divided into training dataset consisting of 226 and validation dataset consisting of 113, with a ratio of 2:1. All patients underwent classic orthotopic liver transplantation. Observation indicators: (1) analysis of clinicopathological data of patients in the training dataset and validation dataset; (2) follow-up; (3) analysis of influencing factors for lung metastasis of hepatocellular carcinoma after liver transplanta-tion; (4) construction and evaluation of nomogram prediction model for lung metastasis of hepatocellular carcinoma after liver transplantation. Follow-up was conducted using outpatient examination and telephone interview to detect lung metastasis of patients up to November 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the paired t test. Measurement data with skewed distribution were represented as M( P25, P75) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute number or percentages, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to calculate lung metastasis rate and draw lung metastasis curve. The Log-rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analysis. Based on the results of multivariate analysis, the nomogram prediction model was constructed. The prediction accuracy of the nomogram model was evaluated using C-index and receiver operating characteristic (ROC) curve. The calibration curve was used to evaluate the prediction error of the model. Results:(1) Analysis of clinicopathological data of patients in the training dataset and validation dataset: there was no significant difference in general data between patients in the training dataset and validation dataset ( P>0.05). (2) Follow-up: 226 patients in training dataset and 113 patients in validation dataset were followed up. The follow-up time of training dataset was 5.2 to 69.0 months, with a median follow-up time of 29.3 months, and the follow-up time of validation dataset was 4.3 to 69.0 months, with a median follow-up time of 30.4 months. Up to the last follow-up, 48 cases of the training dataset and 22 cases of the validation dataset had lung metastasis, with the incidence and median time of lung metastasis were 21.24%(48/226), 19.47%(22/113) and 8.5 months, 7.8 months, respectively. There was no significant difference in lung metastasis between patients in the training dataset and validation dataset ( χ2=0.144, P>0.05). (3) Analysis of influencing factors for lung metastasis of hepatocellular carcinoma after liver transplantation: results of univariate analysis showed that age, alpha fetoprotein, tumor diameter, tumor differentiation degree, vascular invasion, systemic immune inflammation index and postoperative treatment were related factors for lung metastasis of hepatocellular carcinoma after liver transplantation ( hazard ratio=0.465, 3.413, 1.140, 3.791, 2.524, 2.053, 1.833, 95% confidence interval as 0.263?0.822, 1.740?6.695, 1.091?1.191, 1.763?8.154, 1.903?3.349, 1.047?4.027, 1.038?3.238, P<0.05) . Results of multivariate analysis showed that age, tumor diameter and vascular invasion were independent influencing factors for lung metastasis of hepatocellular carcinoma after liver transplantation ( hazard ratio=0.462, 1.076, 2.170, 95% confidence interval as 0.253?0.843, 1.013?1.143, 1.545?3.048, P<0.05). (4) Construction and evaluation of nomogram prediction model for lung metastasis of hepatocellular carcinoma after liver transplantation: the C-index was 0.810 (95% confidence interval as 0.758?0.863) and 0.802 (95% confidence interval as 0.723?0.881) of the nomogram prediction model for lung metastasis of hepatocellular carcinoma after liver transplanta-tion in the training dataset and validation dataset, respectively, showing good discrimination ability. The area under ROC of 0.5-, 1- and 2-year nomogram prediction model in the training dataset and the validation dataset were 0.815(95% confidence interval as 0.725?0.905), 0.863(95% confidence interval as 0.809?0.917), 0.835(95% confidence interval as 0.771?0.900)and 0.873(95% confidence interval as 0.801?0.945), 0.858(95% confidence interval as 0.760?0.956), 0.841(95% confidence interval as 0.737?0.945), respectively, which illustrated that the model had good predictive ability. The formula of nomogram prediction model=33.300 06+(?33.300 06)×age(≤50 years=0, >50 years=1)+2.857 14×tumor diameter (cm)+31.585 71×vascular invasion (M0 stage of microvascular invasion staging=0, M1 stage of microvascular invasion staging=1, M2 stage of microvascular invasion staging=2, visible tumor thrombus=3). The optimal threshold of nomogram risk score was 77.5. Patients with risk score ≥77.5 were assigned into high risk group, and patients with risk score <77.5 were assigned into low risk group. The 0.5-,1- and 2-year lung metastasis rate of patients in the high risk group and low risk group of the training dataset were 16.7%, 39.2%, 46.4% and 1.4%, 4.1%, 6.9%, respectively, showing a significant difference between the two groups ( χ2=54.86, P<0.05). The 0.5-,1- and 2-year lung metastasis rate of patients in the high risk group and low risk group of the validation dataset were 17.6%, 29.0%, 39.5% and 0, 3.1%, 4.8%, respectively, showing a significant difference between the two groups ( χ2=25.29, P<0.05). Conclusions:Age, tumor diameter and vascular invasion are independent influencing factors for lung metastasis of hepatocellular carcinoma after liver transplantation. The nomogram prediction model based on age, tumor diameter and vascular invasion can predict risk of lung metastasis for hepatocellular carcinoma patients after liver transplantation accurately.

The value of preoperative systemic immune-inflammation index in predicting vascular invasion of hepatocellular carcinoma: a meta-analysis

Vascular invasion and systemic immune-inflammation index (SII) are risk factors for the prognosis of patients with hepatocellular carcinoma. At present, the correlation between the two is not clear. This meta-analysis explored the relationship between preoperative SII and vascular invasion in patients with hepatocellular carcinoma. According to the search formula, the Pubmed, Embase, Cochrane, Web of Science, and CNKI databases were searched for the relevant research until March 2020. After the quality evaluation of the included literature, the odds ratio (OR) and its corresponding 95% confidence interval (CI) were used as the effect measure. Stata 15. 0 software was used for statistical analysis. The meta-analysis eventually included seven retrospective cohort studies of 3583 patients with hepatocellular carcinoma. The results showed that the choice of SII cut-off value affects SII's efficiency in predicting the risk of vascular invasion. In the cohort of studies with appropriate SII cut-off value, the high SII preoperative group had a higher risk of vascular invasion (OR=2.62; 95%CI: 2.07-3.32; P=0.000) and microvascular invasion (OR=1.82; 95%CI: 1.01-3.25; P=0.045) than the low SII group. The tumor diameter (OR=2.88; 95%CI: 1.73-4. 80; P=0.000) of the high SII group was larger than that of the low SII group. There was no publication bias in this study (Begg's test, P=0.368). As a routine, cheap, and easily available index, SII can provide a certain reference value for clinicians to evaluate vascular invasion before operation.

Clinical value of extramural vascular invasion in rectal cancer / 中华放射肿瘤学杂志

Extramural vascular invasion (EMVI) is a prognostic factor in rectal cancer. The previous evaluation of EMVI relies on the analysis of postoperative pathological results. With the development of MRI, MRI can accurately assess the status of EMVI (mrEMVI). MrEMVI has become the important prognostic indicator for rectal cancer. The risk of local recurrence and distant metastasis in mrEMVI-positive patients will be significantly increased. The aim of this article is to review the diagnostic features, clinical significance, and impact on treatment patterns of EMVI, and project its future development trend of EMVI.

Association of Lympho-vascular Invasion with Various Known Prognostic Markers in Breast Carcinomna

Breast cancer is the one of the most frequent neoplasm in women. In the last decades, detection of disease in earlier clinical stages has improved prognosis, however five-year disease-free survival still remains at about 72%. For this reason, continuing efforts to establish reliable prognostic markers are made. The presence of lymph node metastasis is one of the most important prognostic factors in breast cancer. Studies show that D2-40 immuno-stain demonstrated a significant higher detection of LVI as compared with routine H&E staining in early breast cancer. LVI is associated with axillary lymph node metastases and a long-term prognostic factor. A precise identification of LVI would have a strong clinical impact for breast cancer patients. In this study, we aim to demonstrated.LVI as a significant predictor of poor prognosis in patients with lymph node-negative patients with primary invasive breast cancer and its association with other known parameters such as tumour size, tumour grade, nodal metastasis and age

Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer

BACKGROUND/AIMS: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascular invasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance. METHODS: In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUS image findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion, types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors and evaluated vessels. RESULTS: The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in the veins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings were significantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µm vs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of ≥1,000 µm between the tumors and main vessels were correctly diagnosed. CONCLUSIONS: Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.

Value and related factors of preoperative diagnosis of extramural vascular invasion of rectal cancer by 3.0T magnetic resonance imaging / 中华肿瘤杂志

Objective@#To evaluate the value of preoperative diagnosis of extramural vascular invasion (EMVI) of rectal cancer with 3.0T high-resolution magnetic resonance imaging (MRI) and the MRI-related factors of EMVI in rectal cancer.@*Methods@#The clinical and imaging data of 40 patients with rectal cancer were retrospectively analyzed. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficacy of preoperative diagnosis of EMVI of rectal cancer by high-resolution MRI, and to analyze the relationship between the EMVI and clinical and MRI features.@*Results@#Of the 40 patients, 19 cases were diagnosed as positive EMVI and 21 were negative by MRI. Pathological diagnosis of EMVI was positive in 10 cases and negative in 30 cases. The sensitivity, specificity and accuracy of MRI in the diagnosis of EMVI were 100%, 70.0% and 77.5%, respectively. Preoperative MRI and postoperative pathology were moderately consistent in the diagnosis of EMVI in rectal cancer (Kappa=0.538, P<0.001). Pathological EMVI positivity were related to tumor size under MRI examination (P=0.028), degree of differentiation (P<0.001), depth of invasion (P=0.002), lymph node metastasis (P=0.001), liver metastasis (P=0.011), tumor apparent diffusion coefficient (ADC) value (P=0.010) and exponential apparent diffusion coefficient (eADC) value (P=0.003). It also related to extramural nerve invasion by pathological examination (P=0.005).@*Conclusion@#According to the EMVI imaging score of rectal cancer, preoperative MRI has a high value in the diagnosis of EMVI of rectal cancer.

Faster R-CNN-based artificial intelligence image-aided diagnosis platform in identifying EMVI of rectal cancer: A multicenter clinical study / 中国实用外科杂志

OBJECTIVE: To explore the clinical application value of artificial intelligence image aided diagnosis platformbased on Faster R-CNN in identifying EMVI of rectal cancer.METHODS: In the multicenter retrospective study,500 patients with rectal cancer who underwent high-resolution MRI examination between July 2016 and February 2019 wereselected from seven hospitals in China. They were divided into 174 positive and 326 negative patients. Patients wererandomized to a training group(400 patients,including 133 positive and 267 negative) and a validation group(100 patients,including 41 positive and 59 negative) using a random number method. Using the Faster R-CNN to learn and train 20 430 high-resolution MRI images of thetraining group,an artificial intelligence image-aided diagnosis platform was established. The5107 high-resolution MRI images of thevalidation group were clinically validated.Receiver operating characteristic(ROC) curveand area under the curve(AUC) were used tocompare the diagnostic results of the artificialintelligence image-aided diagnosis platform andthe senior image expert.RESULTS: The accuracy,sensitivity,specificity,positive predictive valueand negative predictive value of EMVI forartificial intelligence image-aided diagnosis platform were 93.4%, 97.3%, 89.5%, 0.90 and 0.97,respectively. The area under the receiver operating characteristiccurve(AUC) was 0.98. The time required to automatically recognize a single image was 0.2 seconds,which had clearadvantages compared to radiologists(estimated to be about 10 seconds).CONCLUSION: The artificial intelligence image-assisted diagnosis platform based on Faster R-CNN has high efficiency and feasibility for identifying rectal cancerEMVI,and can assist imaging diagnosis.

Problems and strategy in surgical treatment of biliary tract tumors / 中华消化外科杂志

Biliary tract tumor is a high degree malignancy,which presents with early metastasis and poor prognosis.However,the incidence keeps increasing in recent years compared with other digestive system tumors,the clinical and basic research started late.The biliary tract system is very complicated,it starts up to the liver,descending through the pancreas into the duodenum,involving these three organs,beside this,the portal vein and the hepatic artery are in close proximity.Thus,there are many problems to be solved in current surgical treatment,including how to assess accurately before surgery,whether to undergo preoperative biliary drainage,the extent of liver resection,the extent of lymph node dissection,whether venous involvement should be resected and constructed,whether liver transplantation is useful to these tumors,operation scope of early gallbladder carcinoma.

The expression of KLK7 in pancreatic cancer and the effects on the biological behavior of pancreatic cancer cells / 中华外科杂志

Objective@#To investigate the expression of KLK7 in pancreatic cancer and its clinical significance.@*Methods@#Immunohistochemistry was used to detect the expression of KLK7 protein in pancreatic cancer tissue microarray with 92 samples. Statistical analysis of the relationship between KLK7 and clinicopathological characteristics was finished. Pancreatic cancer cell lines were infected with lentiviuses in order to get cells with KLK7 stable overexpression.KLK7-siRNA was transfected into pancreatic cancer cells to knock down KLK7.Cell proliferation and chemosensitivity were detected by CCK-8 assay; Cell invasion and migration abilities were detected by Transwell assay. At the same time, subcutaneous xenograft tumor models were established in nude mice to observe the effect of KLK7 on tumor growth in nude mice. Data were statistically analyzed by rank sum test, χ2 test and Logistic regression analysis.@*Results@#The expression level of KLK7 in pancreatic cancer tissues was higher than that in paired adjacent tissues (P<0.05). KLK7 expression was correlated with vascular invasion(χ2=7.535, P<0.05). Further univariate and multivariate analysis showed that KLK7 expression was an independent risk factor for vascular invasion of pancreatic cancer(χ2=7.535, P<0.05). The overexpression of KLK7 in pancreatic cancer cell lines BxPC-3 and CFPAC can increase their proliferation abilities, reduce the chemosensitivity and promote their migration and invasion behaviour; The results of in vivo experiments showed that the volume of subcutaneously transplanted tumors in the overexpressing KLK7 group was significantly larger than that in the control group (t=4.479, P<0.05). The group of overexpressing KLK7 showed greater tumor weight than the control group(t=2.831, P<0.05).@*Conclusions@#The expression level of KLK7 in pancreatic ductal adenocarcinoma was higher than that in paired adjacent tissues and it is an independent risk factor for vascular invasion of pancreatic cancer.KLK7 can promote the proliferation of pancreatic cancer cells, reduce the chemosensitivity and increase the invasion and migration of pancreatic cancer cells.

Application value of multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a tumor-to-vessel contact computed tomography grading system in preoperative evaluation of pancreatic cancer / 中华消化外科杂志

Objective To investigate the application value of multiple imaging techniques in the multidetector computed tomography (MDCT) combined with assessment of vascular invasion using a tumor-to-vessel contact (TVC) computed tomography grading system in preoperative evaluation of pancreatic cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 66 patients with pancreatic cancer who were admitted to the Wuxi No.2 People's Hospital of Nanjing Medical University between February 2012 and July 2017 were collected.Surgical results of 66 patients showed that tumors of 48 and 18 patients were respectively located in head or uncinate process of the pancreas and body and tail of pancreas.The 317 vessels of 66 patients were detected.Fifty patients underwent radical resection and 250 vessels were detected,resected tumor diameter was (2.7± 1.4) cm (range,1.3-7.7 cm);16 underwent palliative operation and 67 vessels were detected.Patients received enhanced scans of MDCT,and multiplanar reformatted (MPR),curved planar reconstructions (CPR),CT angiography (CTA),arterial and venous images of three-dimensional (3D) CT and negative-contrast CT cholangiopancreatography (nCTCP) were build.The morphology evaluation of pancreatic tumor was done by a senior radiology physician.The peripancreatic vascular invasion was evaluated using a TVC computed tomography grading system by two senior radiology physicians.Two physicians read collectively films and then achieved consistent results if there was a disputed result.Observation indicators:(1) tumor detection and morphology evaluation by MDCT;(2) detection of processing images on vascular invasion signs and vascular anatomical variations after MDCT;(3) TVC grading results of peripancreatic vascular invasion by MDCT;(4) correlation between TVC grading results of peripancreatic vascular invasion by MDCT and surgical grading results;(5) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was per-formed to detect postoperative survival up February 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The measured values of tumor diameter by MDCT and surgical resection were done by Pearson correlation analysis.The Spearman analysis was used to analyze the correlation in the consistency of the vascular invasion results evaluated by two viewers and between TVC grading evaluation results and surgical grading results.Results (1) Tumor detection and morphology evaluation by MDCT:66 patients underwent MDCT,nCTCP combined with MPR images showed that there were 63 low-density tumors and 3 isopycnic tumors.The nCTCP images of 66 patients showed that 42 had biliary system dilatation and pancreatic duct dilatation,11 had pancreatic duct dilatation,5 had pancreatic duct break and 8 didn't have obvious signs of biliary and pancreatic duct dilatation and break.Results of MDCT of 66 patients showed that 48 tumors were located in head or uncinate process of pancreas,18 in the body and tail of pancreas,showing a consistency with surgical results.Pearson correlation analysis showed that measured values of tumor diameter was (2.7± 1.4) cm (range,1.3-7.2 cm) in 50 patients with radical resection,with a correlation with measured values of tumor diameter of surgical resection (r =0.904,P＜0.05).(2) Detection of processing images on vascular invasion signs and vascular anatomical variations after MDCT:results of MDCT in 2 patients with radical resection showed that vascular variations were confirmed intraoperatively;left gastric artery directly started with celiac axis in 1 patient,common hepatic artery started with superior mesenteric artery,and celiac axis was invaded by tumor tissues,with grading 2 of TVC grading evaluation;accessory left hepatic artery in 1 patient started with gastroduodenal artery and was invaded by tumor tissues,with grading 2 of TVC grading evaluation.Results of MDCT in 2 patients with palliative operation showed peripancreatic vascular invasion,tumor of 1 patient invaded inferior vena cava,and tumor of other patient invaded superior mesenteric artery and involved the first branch of superior mesenteric artery.(3) TVC grading results of peripancreatic vascular invasion by MDCT:there was an overall positive correlation of TVC grading evaluation results in 317 peripancreatic vessels invasion of 66 patients between two physicians (r =0.827,P＜0.05).There was a positive correlation of TVC grading evaluation results in celiac axis,common hepatic artery,superior mesenteric artery,superior mesenteric vein and portal vein between two physicians (r=0.661,0.911,0.809,0.911,0.614,P＜0.05).(4) Correlation between TVC grading results of peripancreatic vascular invasion by MDCT and surgical grading results:there was an overall positive correlation in 317 peripancreatic vessels invasion of 66 patients between TVC grading evaluation results and surgical grading results (r=0.806,P＜0.05).There were positive correlations between TVC grading evaluation results and surgical grading results in the artery group (celiac axis,common hepatic artery and superior mesenteric artery) and vein group (superior mesenteric vein and portal vein) (r=0.703,0.823,P＜ 0.05).There were positive correlations between TVC grading evaluation results and surgical grading results in the celiac axis,common hepatic artery,superior mesenteric artery,superior mesenteric vein and portal vein (r =0.792,0.464,0.823,0.809,0.812,P＜0.05).(5) Follow-up and survival situations:56 of 66 patients were followed up for 3-18 months,with a median time of 7 months.During the follow-up,53 patients had tumor metastases,including 50 deaths and 3 survivors with tumor;3 patients had tumor-free survival.Conclusion Multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a TVC computed tomography grading system can accurately evaluate morphology of pancreatic tumor and peripancreatic vascular invasion,and increase accuracy of preoperative assessment of pancreatic cancer.

Bioinformatics on vascular invasion markers in hepatocellular carcinoma via Big-Data analysis / 中华流行病学杂志

Objective To investigate the biomarkers in hepatocellular carcinoma and their prognostic value via GEO (Gene Expression Omnibus) and TCGA (The Cancer Genome Atlas) database.Methods Datasets of hepatocellular carcinoma were downloaded from GEO (GSE67140) and TCGA.MicroRNA in SNU423,SNU449,HepG2,Hep3B,SNU398 cell lines which had low or high invasion capabilities were investigated and verified,in 81 patients with and 91 without vascular invasion hepatocellular carcinoma.The prognostic value of these microRNAs were studied via TCGA database,obtained from 362 patients with hepatocellular carcinoma,through Kaplan-Meier and Multivariate Cox proportional hazard analysis.Target genes were analyzed by GO and KEGG.Results Expressions of hsa-mir-1180,hsa-mir-149,hsa-mir-744 and hsa-mir-940 were all up regulated in high invasion capable cell lines (SNU423,SNU449) and vascular invasion patients with hepatocellular carcinoma (logFC＞l,P＜0.05).Results from the Survival analysis showed that hsa-mir-1180 (HR=1.623,95％ CI:1.114-2.365,P=0.012),hsa-mir-149 (HR=2.400,95％ CI:1.639-3.514) and hsa-mir-940 (HR =1.704,95 ％ CI:1.188-2.443,P =0.004) were independent risk factors on the prognosis of patients with hepatocellular carcinoma (P＜0.05).The mechanism might be related to factors as immune response,focal adhesion and adherence junction signaling pathways.Conclusion With TCGA and GEO data mining,we found that hsa-mir-1180,hsa-mir-149,hsa-mir-744 and hsa-mir-940 were all highly related to the prognosis of hepatocellular carcinoma,that enabled it to be used to further study the biomarkers related to the prognosis of hepatocellular carcinoma.