肿瘤标志物和肺门淋巴结与肺腺癌全身骨显像骨转移的关系

 目的 探讨肺腺癌肿瘤标志物与骨转移之间的关系。方法 回顾性分析278例肺腺癌患者的全身骨显像，采用单因素Pearson卡方分析和Logistic二分类回归法对肺腺癌骨转移的相关因素进行分析。结果 （1）单因素卡方分析结果: CA125（P=0.000）、CYFRA21-1（P=0.000）、NSE（P=0.000）、SCC（P=0.036）、CEA（P=0.000）、ALP（P=0.000）、肺门淋巴节（P=0.000）均是骨转移的危险因素（均P<0.05）；（2）二分类分析结果：CA125（P=0.009, OR=1.007）、NSE（P=0.012, OR=1.097）、ALP（P=0.001, OR=1.022）、CEA（P=0.013, OR=1.004）、肺门淋巴节（P=0.029, OR=2.136）是骨转移的危险因素（均P<0.05, 均OR>1），具有统计学意义; SCC（P=0.169, OR=1.194)、ProGRP（P=0.703, OR=1.004）是骨转移的危险因素（均OR>1），但不具统计学意义（均P>0.05）。结论 CA125、NSE、ALP、CEA、肺门淋巴节与骨转移有关；SCC、ProGRP是骨转移的危险因素，但不具统计学意义；CYFRA21-1与骨转移无关。     

Diagnosis of intrahepatic cholangiocarcinoma by Raman spectroscopy provides high efficiency: A protocol for systematic review and meta-analysis

Background:We aim to evaluate the efficiency of Raman spectroscopy (RS) in diagnosing suspected patients with intrahepatic cholangiocarcinoma (ICC), manifested by diagnostic sensitivity, specificity, and accuracy.Methods:We will research widely the articles concerning the use of RS in ICC through authenticated database including PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, Cochrane Library, and CNKI between January 2012 and November 2020, retrieving at least 1500 spectra with strict criteria. This study will be carried out in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We are going to summarize the test performance using random effects models.Results:Based on the pooled sensitivity, specificity, and diagnostic accuracy, we intend to provide the relative diagnostic efficiency in ICC through RS.Conclusion:Through this systematic review and meta-analysis, we intend to provide the pooled sensitivity, specificity and diagnostic accuracy of RS in the diagnosis of suspected ICC. Other parameters like positive likelihood ratios (LR), negative LR, diagnostic odds ratio (DOR), and area under curve (AUC) of the summary receiver operating characteristics (SROC) curve will also be calculated and related figures will be drawn to help illustrate the efficacy of RS in the diagnosis of ICC.     

Bcl-2和Bag-1在肝外胆管癌中的表达及意义

目的:研究B细胞淋巴瘤-2(B-cell leukemia-2,Bcl-2)和Bcl-2结合抗凋亡基因-1(Bcl-2associated athanogene-l,Bag-1)在肝外胆管癌组织中的表达情况,探讨其表达强度与胆管癌临床病理特征的关系.方法:采用免疫组化法检测50例肝外胆管癌组织及30例胆囊管组织中Bcl-2和Bag-1蛋白的表达情况,结合临床病理特征进行统计学分析.结果:Bcl-2和Bag-1蛋白在胆管癌组织中的表达阳性率(88.0％、70.0％)均高于胆囊管组织(43.3％、50.0％)(P＜0.05),差异有统计学意义.Bcl-2和Bag-1的表达程度与胆管癌的分化程度、临床分期及有无淋巴结转移有关,Bcl-2和Bag-1的表达呈一致性.结论:Bcl-2和Bag-1与胆管癌的发生发展有密切关系,Bag-1可能协同Bcl-2参与胆管癌的发生、发展,两者的表达程度密切相关,可作为胆管癌患者预后的预测因素.     

Risk Factors for Cholangiocarcinoma in Thailand: A Systematic Review and Meta-Analysis

Background and objective: Cholangiocarcinoma remains a serious public health concern in Thailand. While manyof the risk factors for cholangiocarcinoma in western countries are well-recognized, it remains unclear whether theyare the same in Thailand. We set out to investigate the risk factors for cholangiocarcinoma in Thailand. Methods:Starting March 4, 2016, we reviewed studies found using pre-specified keywords on SCOPUS, Pro Quest ScienceDirect, PubMed, and online public access catalog of Khon Kaen University. Two review authors independently screenedstudies for inclusion criteria, extracted data, and assessed the studied Risk of Bias. The Newcastle-Ottawa Scale and theJoanna Briggs Institute Critical Appraisal Tools were used to assess the quality of included studies. The risk effects offactors were estimated as a pooled adjusted odds ratio with a 95% confidence interval. The heterogeneity of results wasconsidered using the I-square, Tau-square and Chi-square statistics. Results: A strong association was found betweencholangiocarcinoma and age, Opisthorchis viverrini infection, eating raw cyprinoid fish, family history of cancer, liquorconsumption, and taking praziquantel. There was only a mild association found between eating nitrite-containing foods,fresh vegetables, education, smoking behavior, and sex. No association was found between cholangiocarcinoma andeating fermented fish (Pla-ra), northeastern Thai or Chinese sausage, sticky rice, meat, chewing betel nut, or eatingfruit. There were two protective factors including fresh vegetables consumption and education attainment. Conclusion:There are unique risk factors of cholangiocarcinoma in Thailand, including age, Opisthorchis     

Differentiation of small intrahepatic mass-forming cholangiocarcinoma from small liver abscess by dual source dual-energy CT quantitative parameters

PurposeTo investigate the use of dual source dual-energy CT (DECT) quantitative parameters compared with the use of conventional CT for differentiating small (≤3 cm) intrahepatic mass-forming cholangiocarcinoma (IMCC) from small liver abscess (LA) during the portal venous phase (PVP).Material and methodsIn this institutional review board-approved, retrospective study, 64 patients with IMCCs and 52 patients with LAs who were imaged in PVP using dual-energy mode were included retrospectively. A radiologist drew circular regions of interest in the lesion on the virtual monochromatic images (VMI), color-coded iodine overlay images, and linear blending images with a linear blending ratio of 0.3 to obtain CT value, its standard deviation, slope (k) of spectral curve and normalized iodine concentration (NIC). Two radiologists assessed lesion type on the basis of qualitative CT imaging features.ResultsCT values on VMI at 50–130 keV (20 keV-interval), k, and NIC values were significantly higher in IMCCs than in LAs (p < 0.0001). The best single parameter for differentiating IMCC from LA was CT value at 90 keV, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 89.1%, 86.5%, 87.9%, 89.1%, and 86.5%, respectively. The best combination of parameters was CT value at 90 keV, k, and NIC, with values of 87.5%, 84.6%, 83.6%, 87.5%, and 84.6%, respectively. Compared with CT value at linear blending images, CT value at 90 keV showed greater sensitivity (89.1% vs 60.9%, p < 0.0001) and similar specificity (86.5% vs 84.6%, p = 1.0000), and combined CT value at 90 keV, k, and NIC showed greater sensitivity (87.5% vs 60.9%, p < 0.0001) and similar specificity (84.6% vs 84.6%, p = 1.0000). Compared with qualitative analysis, CT value at 90 keV showed greater sensitivity (89.1% vs 65.6%, p = 0.0059) and specificity (86.5% vs 69.2%, p = 0.0352), and combined CT value at 90 keV, k, and NIC showed greater sensitivity (87.5% vs 65.6%, p = 0.0094) and similar specificity (84.6% vs 69.2%, p > 0.05).ConclusionQuantitative analysis of dual source dual-energy CT quantitative parameters showed greater accuracy than quantitative and qualitative analyses of conventional CT for differentiating small IMCCs from small LAs on single PVP scan.     

Soft surface irregularity of malignant perihilar biliary strictures in cholangiography as a risk factor for early dysfunction of multiple metal stents

BackgroundMultiple metal stents (multi-MS) in the perihilar bile duct often develop dysfunction in an unexpectedly short period.AimsThis study is aimed to identify the risk factors for shorter patency of multi-MS.MethodsOf 97 patients who underwent multi-MS placement, 68 patients were followed-up for >28 days were retrospectively analyzed. Univariate analyses with the log-rank test was performed on 20 factors, including two newly defined classifications of cholangiography: the R classification, which classifies the rough image (localized type [R1] or spreading type [R2]); and the S classification, which classifies the surface texture (soft irregularity [S1], solid irregularity [S2], or smooth [S3]).ResultsStent dysfunction occurred in 36 patients (53%) (median time, 209 days). Type S1 was a significant risk factor for short stent patency (median, 100 days in S1 [n = 18]; 231 in S2 [n = 38]; 356 in S3 [n = 12], p < 0.0001). On multivariate analysis, type S1 was again the only independent factor among the six factors (HR 4.8, p < 0.001).ConclusionSoft surface irregularity of the perihilar malignancy in cholangiography was found to be a significant risk factor for a shorter time to dysfunction of multi-MS.     

Intrahepatic cholangiocarcinoma: current management and emerging therapies

Introduction: Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify ‘target-able’ molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients.

Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies.

Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.