Clinical significance of C-reactive protein-to-prealbumin ratio in predicting early recurrence in resectable pancreatic cancer

Purpose@#Resectable pancreatic ductal adenocarcinoma (PDAC) has a high risk of recurrence after curative resection; despite this, the preoperative risk factors for predicting early recurrence remain unclear. This study therefore aimed to identify preoperative inflammation and nutrition factors associated with early recurrence of resectable PDAC. @*Methods@#From March 2021 to November 2021, a total of 20 patients who underwent curative resection for PDAC were enrolled in this study. We evaluated the risk factors for early recurrence within 1 year by univariate and multivariate analyses using Cox hazard proportional regression. The cutoff values for predicting recurrence were examined using receiver operating characteristic (ROC) curves. @*Results@#In our univariate and multivariate analyses, C-reactive protein (CRP), CRP-albumin ratio, and CRP-prealbumin ratio, as well as sex and age, were significant independent prognostic factors for early recurrence in PDAC. However, known inflammatory factors (neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios), nutritional factors (albumin, prealbumin, ferritin, vitamin D), and inflammatory-nutritional factors (Glasgow Prognostic Score, modified Glasgow Prognostic Score, albumin-bilirubin) showed no association with early recurrence. In addition, using cutoff values by ROC curve analysis, a high preoperative CRP level of >5 mg/L, as well as high CRP-to-albumin (>5.3) and CRP-to-prealbumin (>1.3) ratios showed no prognostic value. @*Conclusion@#Our results showed that inflammatory and perioperative nutritional factors, especially CRP-to-prealbumin ratio, have significant associations with early recurrence after curative resection in resectable PDAC. Therefore, for such patients, a cautious approach is needed when inflammation and poor nutritional status are present.

Deep Learning-Based Assessment of Functional Liver Capacity Using Gadoxetic Acid-Enhanced Hepatobiliary Phase MRI

Objective@#We aimed to develop and test a deep learning algorithm (DLA) for fully automated measurement of the volume and signal intensity (SI) of the liver and spleen using gadoxetic acid-enhanced hepatobiliary phase (HBP)-magnetic resonance imaging (MRI) and to evaluate the clinical utility of DLA-assisted assessment of functional liver capacity. @*Materials and Methods@#The DLA was developed using HBP-MRI data from 1014 patients. Using an independent test dataset (110 internal and 90 external MRI data), the segmentation performance of the DLA was measured using the Dice similarity score (DSS), and the agreement between the DLA and the ground truth for the volume and SI measurements was assessed with a Bland-Altman 95% limit of agreement (LOA). In 276 separate patients (male:female, 191:85; mean age ± standard deviation, 40 ± 15 years) who underwent hepatic resection, we evaluated the correlations between various DLA-based MRI indices, including liver volume normalized by body surface area (LV BSA), liver-to-spleen SI ratio (LSSR), MRI parameter-adjusted LSSR (aLSSR), LSSR x LV BSA, and aLSSR x LV BSA, and the indocyanine green retention rate at 15 minutes (ICG-R15), and determined the diagnostic performance of the DLA-based MRI indices to detect ICG-R15 ≥ 20%. @*Results@#In the test dataset, the mean DSS was 0.977 for liver segmentation and 0.946 for spleen segmentation. The BlandAltman 95% LOAs were 0.08% ± 3.70% for the liver volume, 0.20% ± 7.89% for the spleen volume, -0.02% ± 1.28% for the liver SI, and -0.01% ± 1.70% for the spleen SI. Among DLA-based MRI indices, aLSSR x LV BSA showed the strongest correlation with ICG-R15 (r = -0.54, p < 0.001), with area under receiver operating characteristic curve of 0.932 (95% confidence interval, 0.895–0.959) to diagnose ICG-R15 ≥ 20%. @*Conclusion@#Our DLA can accurately measure the volume and SI of the liver and spleen and may be useful for assessing functional liver capacity using gadoxetic acid-enhanced HBP-MRI.

Use of a Cutting Balloon Dilation as a Rescue Therapy in Patients with Benign Bilioenteric Anastomotic Strictures Refractory to Conventional Balloon Dilation / 대한췌담도학회지

Percutaneous balloon dilation with or without placement of an external biliary drain is a nonoperative alternative method for treating benign bilioenteric anastomotic strictures. Although this procedure has a high technical success rate, outcomes are less optimal when attempting to dilate refractory tight strictures. For the stricture, cutting balloon can be an option. We present four patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation. To the patients, a peripheral cutting balloon over-the-wire system was inflated, following subsequent conventional non-compliant balloon dilation. After the balloon dilation treatment, an external drainage catheter was placed through the stricture site and maintained for up to 30 days. Technical and end-treatment success was achieved in all four patients. In conclusion, the use of cutting balloon dilation may appear to be a safe and effective alternative method of treatment in patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation.

Relationship between high bile juice amylase levels and chronic bacterial infections in patients with gallbladder cancer

Purpose@#Pancreatic enzyme reflux into the biliary tract is associated with chronic inflammation and increased cellular proliferation in the biliary epithelium, leading to biliary carcinoma. We evaluated the relationship between high bile juice amylase levels and biliary microflora in patients with malignant gallbladder lesions. @*Methods@#In this retrospective study, 25 gallbladder specimens were obtained from patients with gallbladder cancer to evaluate amylase levels and perform bacterial culture. The samples were divided into high and low amylase groups and culture-positive and negative groups for analysis. Bile juice amylase 3 times higher than the normal serum amylase level (36–128 IU/L) was considered high. @*Results@#The number of positive cultures was higher in the high amylase group than in the low amylase group, but the difference was insignificant. There were no differences in other clinicopathological factors. Sixteen patients showed positive culture results; Escherichia coli and Klebsiella spp. were the most common gram-negative bacteria, whereas Enterococcus and Streptococcus spp. were the most common gram-positive bacteria. Age and bile juice amylase levels were significantly higher in the culture-positive group than in the culture-negative group. The incidence of bacterial resistance to cephalosporins was 6.25%–35.29%, and this incidence was particularly high for lower-generation cephalosporins. @*Conclusion@#Bacteria in gallbladder were identified more frequently when the amylase level was high. High amylase levels in the gallbladder can be associated with caused chronic bacterial infections with occult pancreaticobiliary reflux, potentially triggering gallbladder cancer

Clinical impact of serum prealbumin in pancreaticobiliary disease

Purpose@#Although there are many studies on prealbumin in individual diseases such as malignant or inflammatory diseases, there are few comparative studies. This study aimed to compare the clinical differences between prealbumin levels in cholecystitis and pancreaticobiliary malignancies and investigate the clinical impact of low prealbumin levels in pancreaticobiliary malignancies. @*Methods@#From June 2021 to September 2021, 61 patients who had undergone surgery for various pancreaticobiliary diseases were enrolled in this study, and their clinicopathological data were retrospectively analyzed. @*Results@#Many elderly patients with malignant diseases had poor American Society of Anesthesiologists (ASA) scores, significantly lower albumin and prealbumin levels, and higher systemic immune inflammation indices. The low prealbumin group was older; had poorer ASA scores; and had significantly lower body mass index and hemoglobin and albumin levels and higher systemic immune inflammation indices than the normal prealbumin group. In malignant diseases, the low prealbumin group had significantly lower body mass index and hemoglobin levels and a tendency toward more advanced disease (lymph node and distant metastasis). @*Conclusion@#Preoperative low prealbumin levels had an area under the receiver operator characteristic curve of 0.69, suggesting that it may be useful for predicting pancreaticobiliary malignancies. Prealbumin levels were lower in malignant diseases, possibly related to poor nutritional status and systemic immune inflammation. Low prealbumin levels may predict the risk of more advanced disease.

Clinical Significance of Redundant Nerve Roots of the Cauda Equina in Spine MRI

Purpose@#This study aimed to evaluate the association of redundant nerve roots of the cauda equina (RNRCEs) with the degree and duration of symptoms in patients with lumbar spinal canal stenosis. @*Materials and Methods@#Between January 2017 and December 2018, 224 patients demonstrating central canal stenosis on lumbar spine MRI were included. Various imaging findings associated with spinal canal stenosis were investigated, as were the presence, level, type, and length of RNRCEs, and the presence of nerve root swelling. Clinically, the degree of symptoms and symptom changes after treatment were investigated. Multinomial logistic regression was used for statistical analysis. @*Results@#RNRCEs were present in 142 patients (63.4%). Most RNRCEs were observed above the level of stenosis (47.3%). RNRCE was associated with the number of stenoses and symptom duration (p < 0.05). The presence, level, type, and length of RNRCE and nerve root swelling significantly affected the severity of symptoms (p < 0.05). The type of treatment influenced symptom changes (p < 0.05). @*Conclusion@#The recognition and assessment of RNRCEs on spinal MRI are clinically important because the presence, level, type, and length of a RNRCE may be associated with the degree of symptoms and help predict the clinical outcome according to treatment methods.

Risk Factors for pT3a Prostate Cancerin the Patients With cT1-2 on PreoperativeMultiparametric Magnetic Resonance Imaging

Purpose@#Our study aimed to evaluate the predictive value of multiparametric magnetic resonance imaging (mpMRI)to assess the capsular extension of prostate cancer. Risk factors for extraprostatic invasion or microscopic invasionof bladder neck (pT3a stage) in the cases showing localized disease findings on MRI scan were also identified. @*Materials and Methods@#We identified 198 patients who underwent robot-assisted or conventional laparoscopicradical prostatectomy in our institute between June, 2016 and May, 2018. Altogether, 170 patients withpreoperational mpMRI scans and complete pathologic data were included. Positive and negative predictive valuesof mpMRI to detect capsular extension were estimated. Chi-square test was performed for ratio variables. Logisticregression analysis was performed to identify capsular invasion risk factors. @*Results@#Median age and prostate-specific antigen level were 68 years and 7.5 ng/mL, respectively. Based onfindings, 16 patients (9.4%) were identified as cT3a stage (unilateral or bilateral extraprostatic extension), whereas37 patients (21.8%) as pT3a stage. Positive and negative predictive values of mpMRI to detect capsular extensionwere 75.0% and 73.9%, respectively. In the logistic regression analysis, positive biopsy core rate was the significantpredictor for pT3a disease in the patients with negative capsular invasion findings on mpMRI (p<0.001). Accordingto receiver-operating characteristic curve (area under the curve=0.691, p=0.001), the positive biopsy core rateof 0.275 was the best threshold. @*Conclusions@#Multiparametric MRI is an appropriate test to predict pT3a disease preoperatively. The patients withpositive core rate over 0.275 may have pT3a diseases despite negative image findings.