Hepatic resection prolongs overall survival in the selected patients with nasopharyngeal carcinoma liver metastases

BackgroundThe role of surgery in nasopharyngeal carcinoma liver metastases (NCLM) remains elusive, and the current application is limited. We aim to investigate whether hepatic resection (HR) of NCLM improves survival compared with non-hepatic resection (NHR) treatment.MethodsOne hundred and thirty-three patients with NCLM from 2007 to 2017 were divided into two groups. Propensity score matching (PSM) analysis was used to compare the clinical outcomes.ResultsAfter PSM the median overall survival (OS) and the 1, 3 and 5-year OS rates in HR group were 32.60 months, 86.2%, 37.3% and 37.3%, respectively; while for NHR group these values were 19.57 months, 61.5%, 12.9% and 2.9%, respectively (P = 0.008). Multivariate analysis indicated hepatitis B virus infection (P = 0.029) and hepatic resection (P = 0.018) were independent prognostic factors.ConclusionOur study revealed that hepatectomy yields a survival benefit safely compared with systemic treatments, especially for patients with the size of largest metastasis < 5 cm, unilobar distribution of liver tumor and received unanatomical hepatectomy.     

支气管镜智能导航植入可回收金标在射波刀同步呼吸追踪可行性的体模研究

目的 探究支气管镜智能导航下植入可回收金标在射波刀同步呼吸追踪的可行性。方法 在充气状态下获取经反腐处理的生物猪肺CT影像,利用智能导航软件在左、右肺叶分别设计8例模拟肿瘤病灶位点。设置多痰支气管环境组4例和湿润支气管环境组4例,根据射波刀金标植入原则,将智能规划后的32个可回收金标经支气管植入到每个模拟肿瘤病灶周围。模拟呼气末状态,再次扫描生物猪肺获取植入的金标CT影像,并记录成功植入金标数。利用射波刀计划系统(Multiplan v4.6)设计8个可执行的Synchrony治疗计划,对模拟呼吸运动的生物猪肺进行施照,记录可追踪金标数。施照后通过支气管镜取回已植入的可回收金标,记录成功回收金标个数。提取射波刀log文件中的治疗数据进行追踪数据整理分析,统计整个治疗过程的平移修正偏差、旋转修正偏差以及刚性误差。结果 实验过程中没有出现可回收金标滑脱、掉落等情况。支气管镜智能导航引导下成功植入与取出可回收金标32个,植入成功率与回收成功率均为100%。射波刀施照过程中金标追踪率为100%,刚性误差均＜5 mm,治疗后统计射波刀log文件数据,多痰支气管环境组与湿润支气管环境组在左右方向平移偏差、左右方向旋转偏差、俯仰方向旋转偏差的差异均无统计学意义(P>0.05)。多痰支气管环境组在前后方向平移偏差(Z=-3.57, P<0.01)及头脚方向平移偏差(Z=-2.53,P<0.05)稍高于湿润支气管环境组,而平旋方向旋转偏差(Z=-3.88,P<0.01)及刚性误差(Z=-3.32,P<0.01)均低于湿润支气管环境组。结论 经支气管镜智能导航植入可回收金标技术可行,可回收金标在体模支气管内稳定性好,且射波刀追踪精度可满足临床要求,有较好的临床应用与教学应用前景。     

Comparative outcomes of pancreatic neuroendocrine neoplasms: A population-based analysis of the SEER database

BackgroundA paucity of data exists regarding the natural history and survival outcomes of pancreatic neuroendocrine neoplasms (PanNENs), a rare histological subtype which can be classified as functional (F-PanNENs) and non-functional (NF-PanNENs). The purpose of this study is to characterize their clinicopathological features and survival outcomes in a large cohort of patients from United States.MethodsAll patients diagnosed with F-PanNENs or NF-PanNENs between 1998 and 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patient demographic, clinicopathological features and survival outcomes were analyzed. Logistic regression analysis was used to identify factors associated with NF-PanNENs diagnosis over F-PanNENs. Cox regression analysis was utilized to determine the prognostic variables for overall survival (OS) in all PanNENs patients.ResultsA total of 2347 patients were identified: 1181 in the F-PanNENs group and 1206 in the NF-PanNENs group. NF-PanNENs were larger in size, poorly differentiated, more commonly found in a head pancreas location, and had increased lymph node positivity and liver involvement compared to F-PanNENs. Patients with F-PanNENs were associated better survival outcomes than those with NF-PanNENs. Diagnosis at early year, poorer differentiation, and larger tumor size were independently correlated with NF-PanNENs diagnosis. In addition, multivariable analysis determined that age, gender, year of diagnosis, marital status, tumor grade, size, stage, number, and surgical treatment were independent prognostic factors for OS of all PanNENs patients.ConclusionThe clinicopathological characteristics and survival outcomes were significantly different between NF-PanNENs and F-PanNENs. Furthermore, we identified the clinical features correlated with NF-PanNENs diagnosis over F-PanNENs.     

Prevalence and incidence of pseudomyxoma peritonei in urban China: A nationwide retrospective cohort study

BackgroundPseudomyxoma peritonei (PMP) is an extremely rare condition. Information regarding the disease burden of PMP in developing countries is limited. This study aimed to determine the epidemiology of PMP in China.MethodsPMP data were extracted from the national databases of Urban Basic Medical Insurance. All cases were identified using the International Classification of Diseases (ICD) codes and Chinese diagnostic terms. The national prevalence from 2012 to 2016 and incidence in 2016 were estimated.ResultsIn total, 153 patients with PMP were identified. The crude prevalence of PMP in 2016 was 2.47 (95% confidence interval [CI] 1.71 to 3.23) per million person-year, with a higher prevalence in females than males. Prevalence increased with age, with the first peak in those aged 15–29 years and the highest in those aged >80 years. The crude incidence of PMP in 2016 was 1.19 (95% CI 0.59 to 1.78) per million person-years. Similar to the prevalence, the rates were higher in women than in men. The incidence also increased with age, with the highest prevalence in those aged >80 years. Besides, the most frequent comorbidities before and after the first diagnosis of PMP were unspecified secondary malignancies and malignancies of unspecified sites, followed by abdominal malignant tumours.ConclusionsThe rate of PMP was lower in mainland China than in European countries and increased with advancing age. Women were more likely to have PMP than men. Furthermore, an insufficient understanding of this rare disease presents a major challenge in accurately evaluating the disease burden.     

The impact of molecular and mismatch repair status on the survival outcomes of surgically treated patients with colorectal peritoneal metastases

BackgroundStratification of patients with colorectal peritoneal metastases (CRPM) using RAS/BRAF mutational status may refine patient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This study aimed to analyse the association of RAS/BRAF status and their variants, with clinicopathological variables and survival outcomes in patients who have undergone CRS ± HIPEC.MethodsA single centre, peritonectomy database was interrogated for patients with CRPM who underwent peritonectomy procedures between 2010 and 2020.ResultsDuring the study period, 174 patients were included. Molecular status was obtained on 169 patients, with 68 (40.5%) KRAS, 25 (14.8%) BRAF and 6 (3.6%) NRAS mutations detected. Patients with BRAF mutations were more likely to be mismatch repair deficient (dMMR) (BRAF 20%, KRAS 4.4%, wild type 8.6%, p = 0.015). Most common BRAF and KRAS variants were, V600E (80%) and G12D (39.7%), respectively. BRAF V600E was independently associated with worse overall (median: 28 months, multivariate: HR 2.29, p = 0.026) and disease-free survival (median: 8 months, multivariate: HR 1.8, p = 0.047). KRAS G12V was a strong prognostic factor associated with disease-free survival (median: 9 months, HR 2.63, p = 0.016). dMMR patients (14/161, 8.7%) exhibited worse median overall survival compared to those with proficient MMR (dMMR 27 months, pMMR 29 months p = 0.025).ConclusionThis study highlights the importance of molecular analysis in CRPM stratification. BRAF V600E mutations predict poor outcomes post CRS and HIPEC and may help refine patient selection for this procedure. Molecular analysis should be performed preoperatively to characterise prognosis and guide perioperative therapeutic options.     

放射性脑损伤的研究进展

原发性或转移性脑部恶性肿瘤患者接受放射治疗时,会引起脑组织功能和形态学变化,导致放射性脑损伤,并且其发病机制尚无统一定论,现有的研究进展和治疗方案有待阐明和完善。本综述从血管损伤、炎症反应、神经元功能障碍、胶质细胞损伤以及肠道微生物方面讨论放射性脑损伤的发病机制,以及治疗与预防的相关研究进展,旨在为放射性脑损伤的研究和临床诊治提供参考和理论依据。     

Novel CT based clinical nomogram comparable to radiomics model for identification of occult peritoneal metastasis in advanced gastric cancer

BackgroundOccult peritoneal metastasis (OPM) in advanced gastric cancer (AGC) patients remains a major diagnostic challenge. The aim of this study was to develop novel predictive models for identification of OPM in AGCs.MethodA total of 810 patients with primary AGCs from two hospitals were retrospectively selected and divided into training (n = 393), internal validation (n = 215) and external validation cohorts (n = 202). CT based machine learning models were built and tested to predict the OPM status in AGCs., which are 1) Radiomic signatures: using venous CT imaging features, 2) Clinical models: integrating tumor location, differentiation and extent of serosal exposure, and 3) Radiomics models: combining of radiomic signature, tumor location and tumor differentiation.ResultTotal incidence of OPM was 8.27% (67/810). Clinical models yielded comparable classification accuracy with the corresponding radiomics models with similar AUCs (0.902–0.969 vs. 0.896–0.975) while the radiomic signatures showed relatively low AUCs of 0.863–0.976. In the case where the specificity is higher than 90%, the overall sensitivity of clinical model and radiomics model for OPM positive cases was 76.1% (51/67) and 82.1% (55/67). A nomogram based on the logistic clinical model was drawn to facilitate the usage and verification of the clinical model.ConclusionBoth the novel CT based clinical nomogram and radiomics model provide promising method to yield high accuracy in identification of OPM in AGC patients.     

支气管镜智能导航金标植入技术虚拟仿真教学实验软件的研发应用

目的探讨支气管镜智能导航金标植入技术的虚拟仿真教学软件在放射治疗领域临床应用的必要性和可行性。方法使用Unity3D引擎开发3D虚拟操作及交互系统,运用3Dmax、Maya等工具,以SQL作为数据库支持,场景采用现在主流的次时代制作流程,针对金标植入中的重难点系统分为12个步骤,10个知识点进行仿真展示演练,采用内部测试与远程评价测试,通过获取每位测试者的测试情况,根据测试结果进行系统应用价值的分析。结果截至2022年5月1日,系统访问量高达2 409,参与实验测试人数425人次,实验完成率为100%,实验通过率为96.5%,获得167位实验者评价,涵盖福建医科大学多级医学影像技术系、医学影像学等相关专业学生及放疗相关工作人员,获得一致好评。结论支气管镜智能导航金标植入技术的虚拟仿真教学实验软件在学生的教学和相关专业人员的培训中具有应用价值。