The effect of primary tumor volume on the prognosis of nasopharyngeal carcinoma in era of volumetric modulated arc therapy: a propensity score matched cohort study

Abstract Objective The role of Primary Tumor Volume (PTV) in Nasopharyngeal Carcinoma (NPC) treated with Volumetric Modulated Arc Therapy (VMAT) is still unclear. The aim of this study was to access the effect of PTV in prognosis prediction of nasopharyngeal carcinoma in era of VMAT. Methods Between January 20 and November 2011, 498 consecutive NPC patients with stage I-IVA disease who received VMAT at a single center were retrospectively analyzed. Receiver Operating Characteristic (ROC) was performed to access the cut-off point of PTV. Univariate Kaplan-Meier and multivariate Cox regression analyses were used to evaluate prognostic value for PTV. The Propensity Score Matching (PSM) was used to adjust baseline potential confounders. Results The 5-year Locol-Regional Failure-Free (L-FFR), Distant Failure-Free Survival (D-FFR), Disease-Free Survival (DFS) and Overall Survival (OS) were 90.6%, 83.7%, 71.5% and 79.3%, respectively. Before PSM, the 5-year L-FFR, D-FFR, DFS, OS rates for NPC patients with PTV ≤ 38 mL vs. PTV > 38 mL were 94.1% vs. 90.4% (p= 0.063), 87.9% vs. 76.3% (p< 0.001), 78.5% vs. 58.5% (p< 0.001) and 86.3% vs. 66.7% (p< 0.001) respectively. Multivariate analysis showed PTV was an independent prognostic factor for D-FFS (p= 0.034), DFS (p= 0.002) and OS (p= 0.001). PTV classified was still an independent prognostic factor for OS after PSM (HR = 2.034, p= 0.025. Conclusions PTV had a substantial impact on the prognosis of NPC patients treated with VMAT before and after PSM simultaneously. PTV > 38 mL may be considered as an indicator of the clinical stage of nasopharyngeal carcinoma. Level of evidence III.

Prognostic value of metabolic parameters of 18F-FDG PET/CT in advanced non-small cell lung cancer treated with first-line immunotherapy combined with chemotherapy / 中华放射医学与防护杂志

Objective:To investigate the prognostic value of metabolic parameters of 18F-fluorodeoxyglucose ( 18F-FDG) positron emission computed tomography/computed tomography(PET/CT) in advanced non-small cell lung cancer(NSCLC) treated with first-line immune checkpoint inhibitor (ICI) combined with chemotherapy. Methods:A retrospective study was conducted to evaluate patients with advanced NSCLC who underwent baseline PET/CT before treatment at the Affiliated Cancer Hospital of Zhengzhou University from 2019 to 2021. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-offs for metabolic parameters of PET/CT, including total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), and maximum standard uptake value (SUV max). Kaplan-Meier method, Log-rank test, and Cox regression model were used to calculate the overall survival (OS) and the progression-free survival(PFS). Results:A total of 44 patients were enrolled. Univariate analysis showed that the factors influencing PFS were TMTV and the number of metastatic sites ( χ2=4.19, 11.28, P<0.05) and the factors influencing OS were TMTV and TLG ( χ2=14.96, 6.05, P<0.05). Multivariate analysis suggested that number of metastatic sites was an independent prognostic marker for PFS ( P=0.011) and TMTV was an independent prognostic marker for OS ( P=0.038). Conclusions:TMTV is a prognostic indicator of OS while the number of metastatic sites is a prognostic indicator of PFS in advanced NSCLC patients who received first-line ICI combined with chemotherapy, but further prospective studies are needed.

Imaging nodal volume and survival in oral tongue cancer with cervical lymph node metastasis

Abstract Objectives Oral tongue cancer is the most prevalent type of oral cavity cancer and presents the worst prognosis. With the use of TNM staging system, only the size of primary tumor and lymph node are considered. However, several studies have considered the primary tumor volume as a possible significant prognostic factor. Our study, therefore, aimed to explore the role of nodal volume from imaging as a prognostic implication. Methods Medical records and imaging (either from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan) of 70 patients diagnosed with oral tongue cancer with cervical lymph node metastasis between January 2011 and December 2016 were retrospectively reviewed. The pathological lymph node was identified, and nodal volume was measured using the Eclipse radiotherapy planning system and was further analysed for its prognostic implications, particularly on overall survival, disease-free survival, and distant metastasis-free survival. Results From A Receiver Operating Characteristic (ROC) curve analysis, the optimal cut-off value of the nodal volume was 3.95 cm3, to predict the disease prognosis, in terms of overall survival and metastatic-free survival (p≤ 0.001 and p= 0.005, respectively), but not the disease-free survival (p= 0.241). For the multivariable analysis, the nodal volume, but not TNM staging, was a significant prognostic factor for distant metastasis. Conclusions In patients with oral tongue cancer and cervical lymph node metastasis, the presence of an imaging nodal volume of ≥3.95 cm3 was a poor prognostic factor for distant metastasis. Therefore, the lymph node volume may have a potential role to adjunct with the current staging system to predict the disease prognosis. Level of Evidence: 2b.

Application value of low-dose 4DCT scanning in simulation and target delineation for solitary pulmonary tumors / 中华放射肿瘤学杂志

Objective:To explore the feasibility of low-dose 4DCT scanning in simulation and target delineation for solitary pulmonary tumors (SPTs).Methods:23 patients with SPTs received 4DCT scanning simulation with the conventional scanning (CON), low voltage (LV), low current (LA) and low voltage combined with low current (LVA) in sequence. Based on the 4DCT images derived from the four sets of scanning parameters, the internal gross tumor volume (IGTV CON, IGTV V, IGTV A, IGTV VA) of SPTs were delineated and matched. Taking IGTV CON as reference, the tumor displacement and the centroid position of IGTV V, IGTV A and IGTV VA were compared with IGTV CON. The radiation doses under different scanning parameters were compared. Results:The volumes of IGTV CON, IGTV V and IGTV A were (12.26±12.30) cm 3, (12.21±12.16) cm 3 and (11.87±11.70) cm 3, respectively ( P=0.337). IGTV VA was (11.34±11.07) cm 3, significantly smaller than IGTV CON ( P=0.005). There was no significant difference in the centroid positions of IGTV CON, IGTV V, IGTV A and IGTV VA in three directions ( P=0.491, 0.360, 0.136). The Dice′s similarity coefficient (DSC VA) was significantly lower than DSC V and DSC A ( P=0.004, 0.030). The tumor displacement measured by the four sets of 4DCT images was similar in the LR direction ( P=0.470), and also in the AP direction ( P=0.108). For the displacement in the SI direction, LVA scanning was smaller than CON ( P=0.015). The radiation doses under four different scanning conditions were (397.0±140.3) mGy·cm, (175.0±61.8) mGy·cm, (264.8±95.3) mGy·cm and (116.8±41.2) mGy·cm, respectively ( P<0.001). Conclusions:LV or LA scanning exert no significant effect on the volume, centroid position of IGTV and the tumor displacement in 4DCT simulation for SPTs. The radiation dose that patients receive under LV and LV scanning is lower than that of CON. Consequently, LV or LA scanning is feasible in 4DCT simulation and target delineation for SPTs.

The relationship between tumor volume changes, squamous cell carcinoma antigen, carcinoembryonic antigen, carbohydrate antigen 125 and the prognosis of cervical cancer patients with concurrent radiotherapy / 中国医师进修杂志

Objective:To investigate the relationship between tumor volume changes, squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and the prognosis of cervical cancer patients with concurrent radiotherapy and chemotherapy and their combined prediction of prognosis.Methods:One hundred and twenty-eight patients in Shanxi Cancer Hospital from February 2018 to February 2020, with cervical cancer undergoing radical concurrent radiotherapy and chemotherapy were selected for a prospective study. According to different prognostic effects, the patients were divided into poor prognosis group (44 cases) and good prognosis group (84 cases). The general data, tumor reduction rate (TVRR), SCC-Ag, CEA, and CA125 levels were compared between the two groups, and the Logistic regression equation was used to analyze the prognostic factors of patients with concurrent radiotherapy and chemotherapy for cervical cancer. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to analyze the performance of each index and the joint prediction of prognosis. Kaplan-Meier survival curve analysis and log-rank (Mantel-Cox) were used to test the survival curves of TVRR, SCC-Ag, CEA, CA125 high-risk individuals and low-risk individuals.Results:The TVRR in the poor prognosis group was significantly lower than that in the good prognosis group: (76.63 ± 7.52)% vs. (85.54 ± 6.71)%, the SCC-Ag, CEA, CA125 were significantly higher than those in the good prognosis group: (6.98 ± 2.15) μg/L vs. (4.61 ± 1.37) μg/L, (9.34 ± 2.23) μg/L vs. (5.76 ± 1.87) μg/L, (68.79 ± 12.01) kU/L vs. (49.97 ± 15.22) kU/L, and there were statistical differences ( P<0.05). Logistic regression showed that TVRR, SCC-Ag, CEA and CA125 were significant factors influencing the prognosis of patients with concurrent chemoradiotherapy for cervical cancer ( P<0.05). Among the single indicators, TVRR predicted the highest prognosis AUC, and the combined prognostic AUC of all indicators (0.837, 95% CI 0.761 to 0.920) was higher than any single indicator, with a sensitivity of 81.82% and specificity of 84.52%. The survival curves of TVRR, SCC-Ag, CEA, CA125 between high-risk and low-risk patients showed statistically significant differences ( P<0.05). Conclusions:The changes in tumor volume, SCC-Ag, CEA, CA125 and the prognosis of patients with concurrent radiotherapy and chemotherapy for cervical cancer have a certain correlation. The combined examination of the four in the early stage is expected to become a new approach to clinically predict the prognosis of cervical cancer and make appropriate treatment plans.

Relationship between metabolic parameters of 18F-FDG PET-CT and clinical characteristics in newly diagnosed multiple myeloma / 白血病·淋巴瘤

Objective:To investigate the relationship between metabolic parameters of 18F-FDG PET-CT and clinical characteristics in newly diagnosed patients with multiple myeloma (MM). Methods:The clinical data of 47 MM patients who underwent 18F-FDG PET-CT at initial diagnosis from June 2018 to December 2020 in the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The association of metabolic parameters of 18F-FDG PET-CT with the following clinical parameters including age, gender, disease classification, DS stage, international staging system (ISS) stage, hemoglobin, albumin, serum calcium, serum crearinine, lactate dehydrogenase, β 2-microglobulin, high-sensitivity C-reactive protein (hs-CRP), bone marrow plasma cell ratio, the number of lesions and extramedullary lesions. Results:Among 47 MM patients, in terms of tumor metabolic volume (MTV), patients at DS stage Ⅲ was higher than those at stage Ⅰ-Ⅱ [172.88 (42.69, 391.55) vs. 19.63 (4.24, 42.61), P < 0.001], patients with serum calcium ≥ 2.65 mmol/L was higher than those with serum calcium <2.65 mmol/L [310.71 (99.68, 549.62) vs. 58.00 (19.63, 248.34), P = 0.038], patients with hs-CRP ≥ 3.3 mg/L was higher than those hs-CRP < 3.3 mg/L [211.39 (57.79, 397.70) vs. 35.34 (7.91, 153.02), P = 0.002], and patients with the number of lesions >3 was higher than those with the number of lesions ≤ 3 [211.39 (57.79, 393.02) vs. 16.43 (5.12, 38.23), P < 0.001]. In terms of total lesion glycolysis (TLG) value, patients at DS stage Ⅲ was higher than those at stage Ⅰ-Ⅱ [460.44 (92.62, 1 113.85) vs. 46.68 (9.32, 89.89), P = 0.001], patients with bone marrow plasma cell ratio <10% was higher than those with bone marrow plasma cell ratio ≥10% [1 039.36 (615.28, 1 167.80) vs. 150.80 (45.36, 821.01), P = 0.031], patients with serum calcium ≥ 2.65 mmol/L was higher than those with serum calcium < 2.65 mmol/L [1 031.55 (251.87, 2 115.98) vs. 177.59 (45.82, 761.66), P = 0.033], patients with hs-CRP ≥ 3.3 mg/L was higher than those hs-CRP < 3.3 mg/L [487.40 (141.38, 1 107.02) vs. 63.44 (19.40, 634.31), P = 0.003], patients with lesion number >3 was higher than those with lesion number ≤3 [625.32 (150.80, 1 134.35) vs. 40.04 (10.96, 70.88), P < 0.001]. There were no statistically significant differences in the maximum standardized uptake value (SUV max) and mean standardized uptake value (SUV mean) among different clinical parameter groups (all P > 0.05). Conclusion:MTV and TLG in 18F-FDG PET-CT metabolic parameters can better reflect the characteristics of MM patients compared with SUV max and SUV mean.

Fully-automated 3D volume segmentation in CT images for preoperatively predicting the overall survival of resectable pancreatic ductal adenocarcinoma: a cohort study / 中华胰腺病杂志

Objective:To verify the predictive value of fully-automated 3D volume segmentation of CT images for the overall survival prognosis of resectable pancreatic ductal adenocarcinoma (PDAC).Methods:From July 2018 to March 2019, the clinical data of 198 cases of resectable PDAC were continuously collected in the First Affiliated Hospital of Naval Medical University. According to the level of carbohydrate antigen(CA)19-9 and carcinoembryonic antigen(CEA), the patient were divided into low CA19-9 group(≤210 U/ml ), high CA19-9 group (>210 U/ml ), normal CEA group (<5 ng/ml ) and high CEA group (≥5 ng/ml). Using our fully-automated segmentation tool developed in the early stage, images at the plain phase and portal phase were matched to those at the late artery phase by taking the artery phase as the matching target to establish UNet model; and the PDAC tumor and pancreatic glands were three-dimensionally segmented to estimate the tumor 3D volume. Univariate and multivariate logistic regression analysis were performed to compare the tumor 3D volume with the common preoperative risk factors (tumor 2D long diameter, CA19-9 level, CEA level, etc.) in predicting the patients′ survival. C-index was used to estimate the accuracy for predicting the survival. Receiver operating characteristics curve (ROC) was drawn and AUC was calculated to evaluate the accuracy for predicting the 1-year and 2-year overall survival and the influence of CA19-9 and CEA level on the patients′ overall survival.Results:Univariate logistic analysis showed that age, tumor 3D volume, tumor location, CA19-9 and CEA level were correlated with the patients′ overall survival. Multivariate logistic analysis showed that tumor 3D volume, CA199 and CEA were correlated with the overall survival. Among them, tumor 3D volume was most strongly correlated with the overall survival ( HR=2.25, 95% CI1.49-3.39, P<0.0001). The prognostic C-index of automatic 3D tumor volume, tumor long diameter, serum CEA and CA19-9 was 0.667(95% CI0.617-0.717), 0.637(0.583-0.691), 0.593(0.527-0.659) and 0.585(0.526-0.644), respectively. The AUCs of 3D tumor volume, tumor location, tumor long diameter, serum CEA and CA19-9 for predicting 1-year and 2-year survival were 0.726 and 0.698, 0.562 and 0.562, 0.703 and 0.660, 0.583 and 0.624, 0.602 and 0.609 respectively. C-index and AUC of tumor 3D volume was significantly better than those of the other common preoperative risk factors, and the difference was statistically significant (all P value <0.05). The survival of patients with large tumor 3D volume was greatly poorer than that of patients with small tumor 3D volume in low CA19-9 group, high CA19-9 group, normal CEA group and high CEA group, and the differences were all statistically significant ( HR=2.27, 95% CI 1.39-3.72; HR=2.42, 95% CI1.23-4.74; HR=2.08, 95% CI1.07-4.06; HR=2.67, 95% CI1.63-4.38, all P value <0.01). And the automatic 3D volume was the strongest predictor for the survival in high CA19-9 group. Conclusions:The tumor 3D volume obtained by automatic CT segmentation was an objective and reliable prognostic biomarker, which can supplement the established preoperativel risk factors and was expected to guide the personalized choice of neoadjuvant therapy.

Effect of tumor and normal lung volumes on the lung volume-dose parameters of IMRT in non-small-cell lung cancer

OBJECTIVES: To explore the effect of tumor and normal lung volumes on lung volume-dose parameters in patients with non-small-cell lung cancer (NSCLC) who had undergone intensity-modulated radiation therapy (IMRT). METHODS: The clinical data of 208 patients with NSCLC who underwent radical IMRT between June 2014 and June 2018 were retrospectively analyzed. A regression model curve was used to evaluate the effect of tumor and normal lung volumes on normal lung relative volumes receiving greater than 5 and 20 Gy (V5, V20), on mean lung dose (MLD), and on absolute volumes spared from greater than 5 and 20 Gy (AVS5, AVS20). RESULTS: The V5, V20, and MLD of the bilateral lung were fitted to a quadratic equation curve with the change in tumor volume, which increased initially and then decreased when the tumor volume increased. The V5, V20, and MLD of the lung reached their apex when the tumor volumes were 288.07, 341.69, and 326.83 cm3, respectively. AVS5 and AVS20 decreased in a logarithmic curve with an increase in tumor volume. The V5, V20, and MLD of the small normal lung volume group were all significantly higher than those of the large normal lung volume group (p<0.001, p=0.004, p=0.002). However, the AVS5 and AVS20 of the small normal lung volume group were all significantly lower than those of the large normal lung volume group (p<0.001). CONCLUSION: The effects of tumor volume and normal lung volume on dose-volume parameters should be considered. AVS5 is an important supplementary dose limitation parameter for patients whose tumor volume exceeds a certain boundary value (approximately 300 cm3).

Comparison of spatial location and dynamic changes of functional parameters of primary tumors of thoracic esophageal cancer based on DWI and 18F-FDG PET-CT before and during radiotherapy / 中华放射肿瘤学杂志

Objective:To evaluate the spatial position and functional parameters of 18F-FDG PET-CT and diffusion-weighted imaging (DWI) before and during radiotherapy (RT) based on the medium of 3DCT in patients with esophageal cancer and to explore whether the high-signal area derived from DWI can be used for individualized definition of the volume in need of dose-escalation for esophageal cancer. Methods:Thirty-two patients with esophageal cancer treated with concurrent chemoradiotherapy or neoadjuvant chemoradiation sequentially underwent repeated 3DCT, 18F-FDG PET-CT and enhanced MRI scans before RT and at the 15 th time of RT. All images were fused with the 3DCT images by deformable registration. The gross tumor volume (GTV) was delineated based on PET Edge on the first and second 3DCT, PET-CT and DWI and corresponding T 2-weighted MRI (T 2W-MRI) fused images, and defined as GTV CTpre and GTV CTdur, GTV PETpre, GTV PETdur, GTV DWIpre and GTV DWIdur, respectively. SUV (SUV max, SUV mean, SUV peak), MTV, TLG, ADC (ADC min and ADC mean) values and △SUV (△SUV max, △SUV mean, △SUV peak), △MTV, △TLG, △ADC (△ADC mean and △ADC min) of lesions were measured before and during RT. Results:The differences in SUV (SUV max, SUV mean, SUV peak), MTV, TLG, ADC mean and ADC min of the GTV before and during RT were statistically significant (all P<0.001). The tumor ADC and SUV values before and during RT showed no significant correlation, and there was no correlation between △ADC and △SUV (both P>0.05). The conformity index (CI) of GTV PETpre to GTV DWIpre was significantly higher than that of GTV PETdur to GTV DWIdur ( P<0.001). The shrinkage rate of maximum diameter (△LD DWI)(24%) and the shrinkage rate of tumor volume (VRR DWI)(60%) based on DWI during RT were significantly greater than the corresponding PET-based △LD PET (14%) and VRR PET (41%)( P=0.017 and P<0.001). Conclusions:The location of high residual FDG uptake based on PET-CT yields poor spatial matching compared with the area with residual high signal based on DWI during RT. Tumor ADC and SUV values may play complementary roles as imaging markers for prediction of patterns of failure and for definition of the volume in need of dose-escalation. In addition, the shrinkage rates of tumor maximum diameter/volume based on DWI during RT are significantly faster than those based on PET-CT. Therefore, the feasibility of selecting boosting of the high signal area derived from DWI for individualized definition of the volume for esophageal cancer is not clear.

Clinicopathologic factors associated with pathologic upstaging in patients clinically diagnosed stage T2N0M0 squamous cell esophageal carcinoma

Background: Even with the use of contrast-enhanced thin-layer chest computed tomography (CT) and endoscopic ultrasonography (EUS), the likelihood of cT2N0M0 squamous cell esophageal cancer correlating with the final pathologic outcome is exceedingly low. We therefore sought to investigate the associations between different risk factors and pathologic upstaging in stage T2N0M0 esophageal cancer patients who underwent esophagectomy. Materials and Methods: We retrospectively reviewed the clinicopathological characteristics of 224 stage T2N0M0 squamous cell esophageal cancer patients who underwent complete resection over a 2-year period (October 2016–September 2018). The tumor volume (TV) was automatically measured from thin-layer chest CT scans using imaging software. Univariate and multivariate analyses were performed to identify the risk factors associated with upstaging. A receiver operating characteristic (ROC) curve was plotted, and its ability to identify pathological upstaging was assessed. Results: A total of 224 patients with clinical stage T2N0M0 squamous cell esophageal carcinoma (SCEC) underwent esophagectomy; of these patients, 96 (42.86%) had a more advanced stage during the final pathologic review than during the initial diagnosis. The risk factors for pathologic upstaging included a large TV, high total cholesterol (TC), high triglycerides (TGs), high platelet-to-lymphocyte ratio (PLR), and high number of lymph nodes examined. The ROC analysis demonstrated an area under the curve of 0.845 (95% confidence interval 0.794–0.895). Conclusions: In SECC diagnosed as stage T2N0M0 by CT and EUS, the incidence of postoperative pathologic upstaging increases with a large TV, high TC, high TGs, high PLR, and high number of lymph nodes examined

The effect of tumor volume on the prognosis of locally advanced rectal cancer / 中国肿瘤临床

Objective: To evaluated the prognostic effect of tumor volume in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME). Methods: This was a retrospective analysis of 128 patients with newly diagnosed rectal cancer who received preoperative concurrent chemoradiation plus TME from January 2011 to September 2016 in Hunan Cancer Hospital. The receiver-operating characteristic (ROC) curve was used to analyze the gross tumor volume (GTV) cut-off point. Prognostic analysis was performed using Kaplan-Meier, Log-rank, and Cox regression models. Results: After NCRT, T-stage declined 58.6%, N-stage declined 69.5%, and the overall TNM stage declined 77.3%. After NCRT, the pathological complete response (pCR) rate was 16.4% and the anus-protection rate was 57.03%. The GTV cut-off point was 79.31 mL. There were significant differences in OS, DFS, LRFS and DMFS between patients with GTV ≥79.31 mL and patients with GTV <79.31 mL over three years. GTV was significantly related to MRI-T staging (ρ=0.236; P=0.007), T downstaging (ρ=0.229; P=0.009),TNM downstaging (ρ=0.219; P=0.013), and tumor regression grade (TRG) (ρ=0.517; P<0.001); however, GTV was not significantly related to MRI-N staging and N downstaging. Conclusions: GTV is closely related to local recurrence and distant metastasis of LARC, and is an important prognostic factor. Tumor volume was significantly related to pretreatment MRI-T staging, T downstaging, TNM downstaging after NCRT, and TRG, but not to pretreatment MRI-N staging and N downstaging.

Early evaluate the feasibility and reproducibility of sorafenib-targeted therapy for hepatocellular carcinoma by volume measurement approach / 中华放射学杂志

Objective Early evaluate the feasibility and reproducibility of sorafenib-targeted therapy for hepatocellular carcinoma by RECIST1.1, mRECIST and three-dimensional volume measurement. Methods Seventy patients with pathology or typical imaging findings confirmed as hepatocellular carcinoma along with the sorafenib-targeted treatment for more than 2 months between October 2004 to April 2017 in the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Patients underwent chest, abdominal and pelvic CT scans and enhanced scans before and after 2 weeks of sorafenib treatment. Two physicians used RECIST 1.1, mRECIST, and volume measurement criteria to evaluate the efficacy of treatment. According to their averaged results, the patients were divided into two groups (control group and non-control group). Kaplan-Meier survival analysis was used to compare the prognostic values between different response evaluation criterias for early predicting the efficacy of sorafenib-targeted therapy in advanced hepatocellular carcinoma. Kappa test was used to assess the efficacy response consistency in intra-group and inter-group. Results Based on mRECIST and RECIST 1.1 measurements, the control group included 34 cases, and the non-control group included 36 cases. Based on semi-automatic volume measurement, the control group included 38 cases, and the non-control group included 32 cases. Before the treatment with sorafenib, the RECIST 1.1 and mRECIST methods were used. There was a high degree of consistency between the two doctors (Kappa values were 0.79 and 0.71, respectively), and the semi-automatic volume measurement method was extremely consistent (Kappa value was 0.90); the consistency in intra-observer by three different methods was extremely high (Kappa values were 0.91, 0.85, 0.97, respectively). After the treatment with sorafenib, the consistency between the two radiologists using RECIST 1.1 measurement was high (Kappa value was 0.65), the consistency of mRECIST measurement was moderate (Kappa value was 0.52), and the consistency of tumor volume measurement was extremely high (Kappa The value was 0.83), the consistency in intra-observer using the above three methods was high or very high (Kappa values were 0.86, 0.74, 0.90, respectively). The RECIST 1.1 and mRECIST measurements were less sensitive in early evaluation of sorafenib-targeted treatment, and there was no significant difference between the control group and the non-control group (P=0.578 and 0.613) while the semi-automatic volumetric measurement was sensitive (P=0.004). Conclusion Semi-automated three-dimensional volume measurement which has better intra-and inter-group consistency and reproducibility can reflect the efficacy of sorafenib-targeted therapy for hepatocellular carcinoma in early stage.

Prognostic value of metabolic tumor volume and total lesion glycolysis from ¹⁸F-FDG PET/CT in lymph node metastases and risk stratification of endometrial carcinoma / 부인종양

OBJECTIVE: To investigate the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), measured by preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT), in risk stratification of patients with endometrial carcinoma (EC). METHODS: The patients with pathological diagnosis of EC who underwent preoperative ¹⁸F-FDG PET/CT imaging were retrospectively selected for analysis of the prognostic values of PET parameters in risk classification and lymph node metastases (LNMs). Receiver-operating-characteristic analysis was used to analyze the correlation of PET parameters cutoff values with deep myometrial invasion (MI), lymphovascular space involvement and LNM for prognostic values in risk stratification. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detection of LNM are 83.3%, 99.7%, 90.9%, 99.5% and 99.2%, respectively. The MTV and TLG of primary lesion of EC in the patients with LNM are notably higher than those in patients without LNM, p<0.010. The MTV and TLG of the EC primary lesions in high-risk patients are significantly higher than those in low-risk patients (p<0.010), but the maximum standardized uptake value (SUVmax) is not. The MTV and TLG of primary lesions were superior to SUVmax for predicting of deep MI, LNM and high-risk of EC (p<0.005). CONCLUSION: MTV and TLG of primary lesions are more valuable in predicting risk stratification of EC patients. Preoperative ¹⁸F-FDG PET/CT imaging is useful in predicting the LNM of EC and may help guide pelvic lymphadenectomy to avoid unnecessary pelvic lymphadenectomy in EC patients with low-risk stratification.

Prognostic Value of Baseline and Interim Total Metabolic Tumor Volume and Total Lesion Glycolysis Measured on ¹⁸F-FDG PET-CT in Patients with Follicular Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to investigate the prognostic significance of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) in patients with follicular lymphoma (FL) at baseline and mid-treatment with ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans. MATERIALS AND METHODS: The study analyzed data from 48 patients with FL who were treated in Jiangsu Province Hospital and reviewed their baseline PET-CT scans. TMTV and TLG were computed by using the absolute value of 2.0, 2.5, and 3.0 thresholding method, respectively. RESULTS: Median age was 53 years, 75.0% of patients had stage III to IV disease, 43.8% had a Follicular Lymphoma International Prognostic Index 1 (FLIPI1) score of 3 to 5 and 20.8% had a FLIPI2 score of 3 to 5. Receiver operating characteristic (ROC) curve analysis showed the optimal cut-off values for TMTV3.0 and TLG3.0 were 476.4 (sensitivity, 85.7%; specificity, 78.0%; area under the curve [AUC], 0.760; p=0.003) and 2,676.9 (sensitivity, 71.4%; specificity, 78.0%; AUC, 0.760; p=0.003). On multivariable analysis, TMTV3.0 and TLG3.0 were independent predictors of both progression-free survival (PFS) (hazard ratio [HR], 5.406; 95% confidence interval [CI], 1.326 to 22.040; p=0.019 and HR, 6.502; 95% CI, 1.079 to 39.182; p=0.042) and overall survival (OS) (HR, 4.111; 95% CI, 1.125 to 15.027; p=0.033 and HR, 5.885; 95% CI, 1.014 to 34.148; p=0.049). ROC curve analysis showed the optimal cut-off values for ΔTMTV3.0 and ΔTLG3.0 were 66.3% (sensitivity, 85.7%; specificity, 63.4%; AUC, 0.774; p 66.3%) and TLG (ΔTLG > 64.5%) reduction are valuable tools for early treatment response assessment in FL patients.

Significance of Metabolic Tumor Volume and Total Lesion Glycolysis Measured Using ¹⁸F-FDG PET/CT in Locally Advanced and Metastatic Gallbladder Carcinoma

PURPOSE: This study aimed to determine the prognostic value of new quantitative parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), including metabolic tumor volume (MTV), in patients with locally advanced and metastatic gallbladder cancer (GBC). MATERIALS AND METHODS: In total, 83 patients initially diagnosed with locally advanced and metastatic GBC and who underwent 18F-FDG PET/CT at the time of initial diagnosis were retrospectively reviewed. The metabolic volume-based PET parameters of primary tumors and metastatic lesions were measured, including maximum and average standardized uptake values (SUV), MTV, and total lesion glycolysis. An overall survival (OS) analysis was performed using the Kaplan-Meier method with PET and clinical parameters. A Cox proportional hazards regression analysis was performed to determine independent prognostic factors. RESULTS: In univariate analysis, pathologic differentiation (p<0.001), performance status (PS; p=0.003), C-reactive protein (CRP) level (p=0.009), and PET-related SUVmt max (the highest SUV among the metastatic lesions) (p=0.040) and MTVtotal (the sum of the MTVs of both the primary and metastatic lesions) (p=0.031), were significant for OS. In multivariate analysis, MTVtotal (hazard ratio: 2.07; 95% confidence interval: 1.23–3.48; p=0.006) remained significant for the prediction of OS, as did differentiation (p=0.001), PS (p=0.001), and CRP (p=0.039). CONCLUSION: In locally advanced and metastatic GBC, volume-based PET/CT parameters of the total tumor burden of malignancy, such as MTVtotal, were found to be useful for the identification of patients with poor prognosis.

Predictive value of serum CEA level combined with PET/CT metabolic parameters MTV and TLG in primary liver metastases from colorectal cancer / 中国基层医药

Objective@#To analyze the predictive value of serum carcinoembryonic antigen(CEA) level combined with primary PET/CT metabolic parameters, metabolic tumor volume(MTV) and total glycolysis(TLG) in liver metastasis of colorectal cancer.@*Methods@#The clinical data of 86 patients with colorectal cancer who underwent PET/CT examination in the People's Hospital of Zhejiang Province from January 2013 to December 2017 were retrospectively analyzed.Univariate and multivariate logistic regression was used to analyze the relationship between clinicopathological parameters, MTV, TLG and liver metastasis.@*Results@#Of the 86 patients, there were 17 cases(19.77%) of liver metastases.Univariate analysis showed that there were significant differences in T stage(χ2=8.83), tumor location(χ2=5.43) and serum CEA content(t=11.65) between the liver metastasis group and the non-liver metastasis group(all P<0.05). The levels of TLG[(101.94±20.14)g] and MTV[(14.09±3.25)cm3] in the liver metastasis group were significantly lower than those in the non-liver metastasis group[(135.95±22.63)g, (25.09±4.33)cm3](t=5.66, 9.80, all P<0.01). Multivariate logistic regression analysis showed that T stage(OR=3.56, 95%CI: 1.06-12.00), tumor location(OR=1.38, 95% CI: 1.05-1.81), TLG(OR=1.68, 95% CI: 1.11-2.54), MTV(OR=3.86, 95% CI: 1.63-9.14) and serum CEA(OR=2.95, 95% CI: 1.60-5.41) were the influencing factors of liver metastases in patients with colorectal cancer(all P<0.05).@*Conclusion@#T stage, tumor location, primary PET/CT metabolic parameters(TLG, MTV) and serum CEA levels are the influencing factors of liver metastasis in patients with colorectal cancer, suggesting that the detection of serum CEA level combined with primary PET/CT metabolic parameters has certain predictive value for liver metastasis of colorectal cancer.

Anesthetic management of 55 children with anterior mediastinal tumors / 上海交通大学学报（医学版）

Objective • To summarize the anesthetic management of surgical treatment for children with anterior mediastinal tumors. Methods • The anesthetic management data of 55 children with anterior mediastinal tumors were retrospectively analyzed. Children with mediastinal tumors were divided into safe group (n=22), uncertain group (n=19) and unsafe group (n=14) according to the general anesthesia risk classification table, and different anesthesia strategies were given according to different grades. General data, standardized tumor volume (STV), adverse events related to tumors and extubation time were recorded. Results • The general data of safe group, uncertain group and unsafe group had no statistical difference (P>0.05). There were significant differences in STV and extubation time after operation among the three groups (P<0.05). Adverse events related to tumors occurred in the maintenance stage of anesthesia in three groups, and the operation was completed safely after timely treatment. Conclusion • It is conducive to the management of anesthesia combined with the risk classification of general anesthesia in children with mediastinal tumors. The vital signs should be closely monitored during anesthesia, and adverse events should be detected and handled in time to avoid catastrophic events.

The prognostic significance of primary tumor volume by MRI in cT3 low rectal cancer / 中国实用外科杂志

OBJECTIVE: To evaluate the clinical significance of primary tumor volume(PTV) by preoperative highresolution MRI measurement in subgroup of cT3 low rectal cancer. METHODS: A total of 99 patients with low rectal cancer who confirmed by pathology and assessed at stage-cT3 by MRI,did not undergo neoadjuvant chemoradiotherapy(nCRT) treated in Department of Colorectal Surgery,Fujian Medical University Union Hospital from June 2010 to December 2012 were adopted in the study. The relations between PTV and the depths of tumor infiltration out of mesorectum were analyzed through Spearman correlation analysis. The receiver-operating characteristic(ROC) curve was used to analyze the PTV and 3-year disease-free survival. Cox proportional hazard model was performed for influence factors analysis. RESULTS: The depth of tumor infiltration mesorectum and the PTV were revealed significantly correlated(P 15 cm~3 or PTV≤14.8 cm~3/>14.8 cm~3. The difference between groups revealed significant in the 3-year disease-free survival rate,the local recurrence rate and the distant metastases rate.COX regression analysis was utilized for 3-year disease-free survival,and the multivariate analysis indicated that PTV was an independent impact factor(HR=0.180,95%CI 0.078-0.415,P<0.05). CONCLUSION: The primary tumor volume (PTV) by preoperative high-resolution MRI measurement might be used as a new prognostic parameter for cT3 low rectal cancer.

Predictive value of serum CEA level combined with PET/CT metabolic parameters MTV and TLG in primary liver metastases from colorectal cancer / 中国基层医药

Objective To analyze the predictive value of serum carcinoembryonic antigen ( CEA) level combined with primary PET/CT metabolic parameters,metabolic tumor volume( MTV) and total glycolysis( TLG) in liver metastasis of colorectal cancer.Methods The clinical data of 86 patients with colorectal cancer who underwent PET/CT examination in the People＇s Hospital of Zhejiang Province from January 2013 to December 2017 were retrospectively analyzed.Univariate and multivariate logistic regression was used to analyze the relationship between clinicopathological parameters,MTV, TLG and liver metastasis. Results Of the 86 patients, there were 17 cases (19.77%) of liver metastases.Univariate analysis showed that there were significant differences in T stage( χ2 =8.83),tumor location(χ2 =5.43) and serum CEA content(t=11.65) between the liver metastasis group and the non-liver metastasis group(all P＜0.05).The levels of TLG[(101.94 ±20.14)g] and MTV[(14.09 ±3.25)cm3] in the liver metastasis group were significantly lower than those in the non-liver metastasis group[(135.95 ± 22.63) g, (25.09 ± 4.33)cm3] ( t=5.66,9.80,all P＜0.01).Multivariate logistic regression analysis showed that T stage ( OR=3.56,95%CI:1.06-12.00),tumor location(OR=1.38,95% CI:1.05-1.81),TLG(OR=1.68,95% CI: 1.11-2.54),MTV(OR=3.86,95% CI:1.63-9.14) and serum CEA( OR=2.95,95% CI:1.60-5.41) were the influencing factors of liver metastases in patients with colorectal cancer( all P＜0.05).Conclusion T stage, tumor location,primary PET/CT metabolic parameters(TLG,MTV) and serum CEA levels are the influencing factors of liver metastasis in patients with colorectal cancer,suggesting that the detection of serum CEA level combined with primary PET/CT metabolic parameters has certain predictive value for liver metastasis of colorectal cancer.

Relationship between factors of gross tumor volume and locoregional failure of radical intensity-modulated radiation therapy for esophageal carcinoma / 中华放射肿瘤学杂志

Objective Investigate the relationship between gross tumor volume (GTV)-related factors including GTV-T volume,the maximum thickness of the esophageal lesion plane and GTV-T volume/length(GTV-T volume divided by the length of the lesion calculated by the number of GTV-T layers) and the locoregional failure of radical intensity-modulated radiation therapy (IMRT) for esophageal carcinoma.Methods A total of 133 patients with esophageal cancer undergoing radical IMRT were enrolled.The factors related to GTV-T including GTV-T volume,the maximum thickness of the esophageal lesions,GTV-T volume/length were calculated.The relationship between GTV-T related factors and local recurrence of tumors was retrospectively analyzed.Results There was positively linear association between the locoregional failure rate of GTV-T and the volume of GTV-T.The volume of GTV-T tumor was 36 cm3,the maximum wall thickness was 2.5 cm,and the GTV-T volume/length was calculated as 5.3 cm2.These critical values could be utilized to predict the risk of locoregional failure of IMRT for esophageal carcinoma.Conclusions The GTV-T factors can be adopted to predict the local control and the risk of locoregional failure of radical IMRT for esophageal carcinoma to certain extent.