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Objective:To investigate the risk factor of hepatocellular carcinoma (HCC) with vessels encapsulating tumor clusters (VETC) and the application value of its risk scoring model.Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 149 patients with HCC who were admitted to two medical centers, including 97 cases in the Jiangnan University Medical Center and 52 cases in the Affiliated Xingtai People′s Hospital of Hebei Medical University, from January 2017 to April 2020 were collected. There were 116 males and 33 females, aged (58±12)years. There were 74 cases with VETC and 75 cases without VETC. Observation indica-tors: (1) clinical characteristics of patients with and without VETC; (2) imaging features of patients with and without VETC; (3) multivariable analysis of HCC patients with VETC; (4) construction of VETC related risk scoring model and its performance evaluation; (5) postoperative early tumor recurrence of patients with and without VETC who were confirmed by risk scoring model and histopathological examination. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolutes, and comparison between groups was conducted using the chi-square test and continuous correction chi-square test. Variables of clinical and imaging characteristics with statistically signifi-cant were included in the multivariate analysis. Multivariate analysis was conducted using the Logistic regression model of backward stepwise selection. VETC related risk scoring model was constructed based on the results of Logistic regression model. The receiver operating characteristic (ROC) curve was drawn, and the area under curve (AUC), the sensitivity, specificity, accuracy and their 95% confidence interval ( CI) were calculated. The maximizing Youden index was the optimal cutoff value for VETC prediction. The Hosmer Lemeshow goodness of fit test was used to assess the consistency between VETC risk scoring model predicted VTEC status and the true VETC status. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-rank test was used for survival analysis. Results:(1) Clinical characteristics of patients with and without VETC. Cases with postoperative albumin <36 g/L were 57 in patients with VETC, versus 68 in patients without VETC, respectively, showing a significant difference between them ( χ2=5.13, P<0.05). (2) Imaging features of patients with and without VETC. Cases with lesion imaging presence as nonperipheral washout, cases with lesion imaging presence as mosaic architecture, cases with lesion imaging presence as intratumoral hemorrhage, cases with lesion imaging presence as corona enhancement, cases with lesion imaging presence as non-smooth tumor margin, cases with lesion imaging presence as peritumoral enhancement in arterial phase, cases with lesion imaging presence as intratumoral arteries, cases with lesion imaging presence as peritumoral hypointensity in hepatobiliary phase, cases with lesion imaging enhancement type as uniform low enhancement, uniform high enhance-ment, heterogeneous enhancement with septations and heterogeneous enhancement with irregular ring-like structures, cases with intratumoral necrosis or ischemic, cases with tumor diameter >5 cm were 73, 35, 33, 15, 39, 28, 42, 27, 4, 5, 27, 38, 45, 46 in patients with VETC, versus 64, 16, 13, 3, 19, 15, 9, 13, 9, 35, 5, 26, 10, 10 in patients without VETC, respectively, showing significant differences in the above indicators between them ( χ2=8.92, 11.15, 12.97, 9.28, 11.74, 5.77, 33.14, 6.96, 41.79, 36.05, 37.86, P<0.05). (3) Multivariable analysis of patients with VETC. Results of multivariable analysis showed that lesion imaging enhancement as heterogeneous enhancement with septations, lesion imaging enhancement as heterogeneous enhancement with irregular ring-like structures, intratumoral necrosis or ischemia and tumor diameter >5 cm were independent risk factors influen-cing patients with VETC ( odds ratio=4.18, 7.62, 4.23, 4.08, 95% CI as 1.60?11.60, 2.00?31.70, 1.71?10.90, 1.60?10.80), P<0.05). (4) Construction of VETC related risk scoring model and its performance evaluation. The VETC related risk scoring model was constructed as (heterogeneous enhancement with septations, presence: 1.0, absence: 0)+(heterogeneous enhancement with irregular ring-like structures, presence: 1.5, absence: 0)+(intratumoral necrosis or ischemia, presence: 1.0, absence: 0)+(main tumor diameter >5 cm, presence: 1.0, absence: 0). The AUC, sensitivity, specificity, and accuracy of VETC related risk scoring model were 0.86 (95% CI as 0.80?0.92), 79.7% (95% CI as 69.2%?87.3%), 80.0% (95% CI as 69.6%?87.5%) and 79.9% (95% CI as 72.7%?85.5%), respectively. Results of Hosmer-Lemeshow goodness of fit test showed a good consistency between VETC risk scoring model predicted VETC status and true VETC status ( P>0.05). (5) Postoperative early tumor recurrence of patients with and without VETC who were confirmed by risk scoring model and histopathological examination. All 149 patients were followed up for 29(range, 26?35)months. The time to tumor recurrence and 2-year cumulative tumor recurrence rate of 149 patients were 29(range, 24?33)months and 43.0%, respectively. The 2-year tumor cumulative recurrence rate of patients with and without VETC predicted by risk scoring model was 47.8% and 37.9%, respectively, showing a significant difference between ( χ2=3.90, P<0.05). The 2-year cumulative tumor recurrence rate of patients with and without VETC confirmed by postoperative histopathological examination was 47.4% and 38.1%, respectively, showing a significant difference between ( χ2=4.20, P<0.05). Conclusions:Lesion imaging enhancement as heterogeneous enhancement with septations or irregular ring-like structures, intratumoral necrosis or ischemia and tumor diameter >5 cm are independent risk factors influen-cing HCC patients with VETC. The proposed risk scoring model based on those three risk factors achieves an optimal preoperative diagnostic performance.
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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.
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Objective To investigate the role of COOH-terminus tensin like molecule (CTEN) in epithelial-mesenchymal transformation of gastric cancer and its prognostic factors.Methods The expressions of CTEN,E-cadherin and Vimentin in 220 patients with gastric cancer were detected by immunohistochemical staining.Results The positive expression rate of CTEN was 61.8％ (136/220) in gastric cancer specimens,higher than 15％ (3/20) in adjacent tissues (x2 =16.488,P ＜0.01);the positive expression rate of E-cadherin in gastric cancer specimens was 25.5％ (56/220),lower than 85％ (17/20) in adjacent tissues (x2 =30.713,P ＜0.01);and the positive expression rate of Vimentin in gastric cancer specimens was 35.0％ (77/220),higher than 10％ (2/20) in adjacent tissues.There was no significant difference in the expression of CTEN between different genders,ages,size of tumors and histopathological types (P ＞ 0.05).In different infiltration depth,the CTEN expression difference were statistically significant (x2 =54.058,P ＜0.01),CTEN expression rate in lymph node metastasis group was obviously higher than without lymph node metastasis group (x2 =15.989,P ＜0.01),and CTEN expression rate in distant metastasis group was obviously higher than without distant metastasis group (x2 =4.143,P ＜0.01).CTEN and E-cadherin expression in gastric cancer tissue showed a negative correlation (r =0.357,P ＜ 0.01),while CTEN and Vimentin expression were positively correlated (r =0.498,P ＜0.01).220 cases of patients with gastric cancer received follow-up.Median survival time of CTEN negative express group was 48.2 months (95％ confidence interal,44.0-52.5 months),69.0％ for the 5-year cumulative survival rate.The survival analysis showed median survival time of CTEN positive expression group was 41.8 months (95％ confidence interal,38.3-45.3 months),48.5 ％ for the 5-year cumulative survival rate,which were lower than that in negative group (x2 =4.884,P ＜ 0.05).Multifactor analysis showed CTEN expression,lymph node metastasis and distant metastasis were independent risk factors for the prognosis of gastric cancer patients (P ＜ 0.05).Conclusions CTEN was positively correlated with gastric cancer invasion and metastasis,and played an important role in gastric cancer epithelial mesenchymal transformation.CTEN is independent risk factor for prognosis of gastric cancer,detection of CTEN gene mutation has important significance to evaluate the treatment and prognosis of gastric cancer.
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Objective To investigate the clinical and pathological features of microscopic thymoma(MT).Methods The histopathological features of 12 cases of MT were observed by histopathologic and immunohistochemical methods.The pathological morphology,diagnosis,and differential diagnosis were discussed combined with literature.Results 6 cases of MT were accompanied by myasthenia gravis(MG) symptoms.Focal hyperplastic thymic epithelial islands were accompanied by large tracts of mature adipose tissue in 12 cases of MTs,and immunohistochemistry showed CK positive.Cyst formation was found in 5 cases,lymphoid hyperplasia in 7 cases,and vascular proliferation in 5 cases.Conclusions MG may be the clinical manifestation of MT.MT can occur in thymic cortex,medulla and cortex and medulla junction.Since the tumor is small and the lesions are multiple,it can not be found by X-ray or CT examination.Diagnosis depends on histopathological examination.Correct understanding of the clinical and pathological features of MT has guiding significance on the treatment and prognosis judgment of MT.Thymic resection was recommended for MG patients either with or without thymoma.