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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.  相似文献   
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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.  相似文献   
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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.  相似文献   
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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.  相似文献   
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目的初步探究体表光学引导跟踪系统(OGTS)在肿瘤放射治疗应用中的追踪精度。方法分为模体验证及临床验证, 模体验证采用专用设备, 利用OGTS记录光学标记点在反光球平台上从指定位置移动到目标位置的位移值, 将该位移值与模体中固定距离比较, 以计算系统的准确性与重复性。临床验证通过选取45例放疗患者进行OGTS跟踪准确性和重复性研究, 其中头部、乳腺、直肠肿瘤患者各15例。每例患者均获取随机3个治疗分次下图像引导校正摆位前后图像引导定位系统(IGPS)和OGTS的值, 分别记录每次误差校正的平移值。治疗前用IGPS修正患者摆位误差并获取相关数据, 以IGPS校正平移误差的结果为金标准验证OGTS监测患者位置平移的准确性, 计算综合平移偏差。结果模体测量结果显示, 跟踪准确性的综合平移偏差最大值为0.18 mm, 跟踪重复性综合平移偏差的标准差为0.03 mm。临床试验结果统计显示, IGPS与OGTS追踪精度仅在头部z方向上差异有统计学意义(t=2.21, P<0.05), 而在头部其他方向及乳腺、直肠的3个平移方向差异均无统计学意义(P>0.05)。综合平移偏差分析表明, ...  相似文献   
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目的评估一种肝脏金标植入新方法在兔肝脏内固定及取出的可行性, 以期用于射波刀金标追踪治疗。方法分为活体实验和离体实验。活体实验对10只家兔麻醉后, 经皮肝穿刺植入3颗金标, 10 d后植入设有外置套管和固定细线的第4颗金标, 以射波刀分别对参照组(第1颗和第2颗)和套管组(第1颗和第4颗)配准后追踪, 施照结束后, 评估金标植入成功率、配准精度及取出的安全性。离体实验在离体的肝脏进行金标拉力测试, 测量弹簧圈金标和无弹簧圈金标取出时所受阻力。结果实验过程中金标没有出现远处转移的情况, 植入与回收成功率均为100%。操作过程家兔未发生明显相关并发症和术后并发症。所有金标均成功追踪, 套管组的配准平移偏差在头脚方向和前后方向高于参照组(Z=-11.77、-4.57, P<0.05), 而左右方向低于参照组(Z=-2.52, P<0.05)。金标拉力测试结果显示弹簧圈金标拉力为(2.23±0.85)N,无弹簧圈金标拉力为(0.81±0.13)N, 差异有统计学意义(Z=-2.31, P<0.05)。结论螺旋线圈结构金标在穿刺针道内的固定效果好, 细线限制了金标肝外远处移位,...  相似文献   
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