原发灶18F-FDG PET/CT肿瘤代谢体积与晚期非小细胞肺癌患者预后的相关性研究

目的探讨晚期非小细胞肺癌(NSCLC)原发灶18F-FDG PET/CT肿瘤代谢活性体积(MTV)与预后的关系。资料与方法回顾性分析治疗前行PET/CT检查的110例均经病理或细胞学证实的Ⅲ、Ⅳ期NSCLC患者,所有患者均接受同步放、化综合治疗,治疗后随访2年以上,并用Kaplan-Meier法、Log-rank检验及Cox比例风险模型分析MTV及标准摄取值(SUV)与预后的关系,ROC曲线比较MTV与SUVmax预测患者预后的能力。结果全组患者2年总生存率为20.9%,ROC曲线分析显示,MTV与SUV预测预后的曲线下面积分别为0.649和0.523;MTV≤33.8cm3与MTV>33.8cm3患者2年生存率分别为27.6%和5.9%,差异具有统计学意义(P<0.05);单因素及多因素分析均显示,2年生存率与MTV、临床分期、病理类型有关(P<0.05)。结论晚期NSCLC原发灶MTV与患者的预后相关,MTV较大者,患者的生存期较短。     

Multimodality Diagnostics and Megatherapy in Poor Prognosis Ewing's Tumor Patients

BACKGROUND: The prognosis of Ewing's tumor patients has been improved gradually through cooperative therapy studies, so that meanwhile 55 to 65% of the patients survive relapse-free in the long term. Patients with multifocal primary, early or multiply-relapsed Ewing's tumors have a dismal prognosis. Megatherapy with subsequent stem cell transplantation seems to improve outcome in this patient cohort. Feasibility of this intense megatherapy regimen is crucially dependent on collaboration and multidisciplinary coordination of radiologists, radiotherapists, surgeons and oncologists. PATIENTS AND METHODS: Since 1988, 25 patients were treated with megatherapy consisting of melphalan, etoposide and total-body irradiation followed by stem cell transplantation. All patients received 6 courses of an induction therapy. Before the fourth therapy block, tumors that were bulky at initial diagnosis (> 200 ml) were excised, as well as lung metastases which could still be detected after the third chemotherapy block. During the fifth and sixth chemotherapy block, patients received local irradiation on all infiltrated sites. Persisting immunosuppression after high-dose treatment may facilitate the incidence of relapse. To improve proliferation and cytotoxic activity of early regenerating NK-cells, adoptive immunotherapy with systemic IL-2 therapy after megatherapy is part of the treatment protocol. RESULTS: Of 25 patients treated with megatherapy, 10 patients are still alive with a follow-up time of 6 months to 9 years after megatherapy. The time up to engraftment was decreased from 15 +/- 6 days down to 9 +/- 2 days through the use of G-CSF and CD34+ selected stem cells. At the same time, erythrocyte and platelet replacement was shortened. Frequently occurring complications were mucositis and infections. One patient died after developing septicemia and multi-organ failure, another patient developed a myelodysplastic syndrome 4.5 years after megatherapy. However, relapse is still the major cause of death. The influence of IL-2 on event-free survival cannot valued because 21 of 25 patients were treated with adoptive immunotherapy. CONCLUSION: The complex diagnostic and therapeutic strategy renders and EFS of 34% for a patient group with otherwise dismal prognosis. To clarify the efficiency of megatherapy in patients with advanced Ewing's tumors, a standardized treatment strategy is necessary to accumulate a sufficient number of patients for large cooperative studies in this subject.     

Multimodality Diagnostics and Megatherapy in Poor Prognosis Ewing's Tumor Patients

Background: The prognosis of Ewing's tumor patients has been improved gradually through cooperative therapy studies, so that meanwhile 55 to 65% of the patients survive relapse-free in the long term. Patients with multifocal primary, early or multiply-relapsed Ewing's tumors have a dismal prognosis. Megatherapy with subsequent stem cell transplantation seems to improve outcome in this patient cohort. Feasibility of this intense megatherapy regimen is crucially dependent on collaboration and multidisciplinary coordination of radiologists, radiotherapists, surgeons and oncologists. Patients and Methods: Since 1988, 25 patients were treated with megatherapy consisting of melphalan, etoposide and total-body irradiation followed by stem cell transplantation. All patients received 6 courses of an induction therapy. Before the fourth therapy block, tumors that were bulky at initial diagnosis (>200 ml) were excised, as well as lung metastases which could still be detected after the third chemotherapy block. During the fifth and sixth chemotherapy block, patients received local irradiation on all infiltrated sites. Persisting immunosuppression after high-dose treatment may facilitate the incidence of relapse. To improve proliferation and cytotoxic activity of early regenerating NK-cells, adoptive immunotherapy with systemic IL-2 therapy after megatherapy is part of the treatment protocol. Results: Of 25 patients treated with megatherapy, 10 patients are still alive with a follow-up time of 6 months to 9 years after megatherapy. The time up to engraftment was decreased from 15 - 6 days down to 9 - 2 days through the use of G-CSF and CD24+ selected stem cells. At the same time, erythrocyte and platelet replacement was shortened. Frequently occurring complications were mucositis and infections. One patient died after developing septicemia and multiorgan failure, another patient developed a myelodysplastic syndrome 4.5 years after megatherapy. However, relapse is still the major cause of death. The influence of IL-2 on event-free survival cannot valued because 21 of 25 patients were treated with adoptive immunotherapy. Conclusion: The complex diagnostic and therapeutic strategy renders an EFS of 34% for a patient group with otherwise dismal prognosis. To clarify the efficiency of megatherapy in patients with advanced Ewing's tumors, a standardized treatment strategy is necessary to accumulate a sufficient number of patients for large cooperative studies in this subject. Hintergrund: Im Rahmen der kooperativen Therapieoptimierungsstudien hat sich die Prognose der Ewing-Tumor-Patienten schrittweise verbessern lassen, so daß heute 55 bis 65% langfristig und erkrankungsfrei überleben. Patienten mit primär multifokalen oder früh- bzw. mehrfach rezidivierenden Ewing-Tumoren haben eine sehr schlechte Prognose. Sie scheinen von einer Megatherapie mit nachfolgender Transplantation von autologen hämatopoetischen Stammzellen zu profitieren. Voraussetzung für diese intensive Therapie ist eine koordinierte interdisziplinäre Zusammenarbeit zwischen Diagnostikern, Operateuren, Strahlentherapeuten und Onkologen. Patienten und Methode: Seit 1988 erhielten 25 Patienten eine Megatherapie, bestehend aus Melphalan, Etoposid und Ganzkörperbestrahlung. Die Patienten erhielten sechs Zyklen einer Induktionschemotherapie. Initial großvolumige Tumoren (>200 ml) oder nach dem dritten Chemotherapieblock noch nachweisbare Lungenmetastasen wurden vor dem vierten Therapieblock exstirpiert. Parallel zum fünften und sechsten Chemotherapieblock erfolgte die Lokalbestrahlung aller befallenen Lokalisationen. Einen möglichen Einfluß auf die Entwicklung von Rezidiven kann die fortbestehende Immundysregulation nach der Megatherapie haben. Um deshalb die Proliferation und zytotoxische Aktivität der früh regenerierenden NK-Zellen zu steigern, war eine immunmodulierende Nachbehandlung mit systemischen Interleukin-2-Gaben Teil des Therapiekonzeptes. Ergebnisse: Von 25 Patienten, die eine derartige Megatherapie erhielten, leben zehn Patienten mit einer Nachbeobachtungszeit von sechs Monaten bis zu neun Jahren. Durch den Einsatz von G-CSF und die Verwendung CD34+-selektionierter Stammzellen beträgt die Zeit bis zum Engraftment statt 15 - 6 Tagen nur noch 9 - 2 Tage. Parallel dazu verkürzte sich die Zeitspanne für regelmäßige Substitutionen der Erythrozyten und Thrombozyten. Regelmäßige Nebenwirkungen bzw. Komplikationen dieser intensiven Therapie waren Mukositis und Infektionen. Ein Patient entwickelte 4,5 Jahre nach der Megatherapie ein myelodysplastisches Syndrom, und ein Patient verstarb nach einer Sepsis im Multiorganversagen. Jedoch sind nach wie vor Rezidive die häufigste Todesursache. Schlußfolgerung: Durch dieses komplexe Diagnose- und Therapiekonzept kann bei einer Patientengruppe mit sehr schlechter Prognose eine EFS von 34% erreicht werden. Um die Aussagen zur Effizienz der Hochdosistherapie bei Ewing-Tumor-Patienten zu verbessern und vergleichbarer zu gestalten, sind größere kooperative Studien mit klar definierten Risikokriterien und Therapieregimen bei einer größeren Zahl von Patienten erforderlich.     

Metabolic Tumor Volume Measured by F-18 FDG PET/CT can Further Stratify the Prognosis of Patients with Stage IV Non-Small Cell Lung Cancer

Purpose

This study aimed to further stratify prognostic factors in patients with stage IV non-small cell lung cancer (NSCLC) by measuring their metabolic tumor volume (MTV) using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).

Materials and Methods

The subjects of this retrospective study were 57 patients with stage IV NSCLC. MTV, total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured on F-18 FDG PET/CT in both the primary lung lesion as well as metastatic lesions in torso. Optimal cutoff values of PET parameters were measured by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier survival curves were used for evaluation of progression-free survival (PFS). The univariate and multivariate Cox proportional hazards models were used to select the significant prognostic factors.

Results

Univariate analysis showed that both MTV and TLG of primary lung lesion (MTV-lung and TLG-lung) were significant factors for prediction of PFS (P < 0.001, P = 0.038, respectively). Patients showing lower values of MTV-lung and TLG-lung than the cutoff values had significantly longer mean PFS than those with higher values. Hazard ratios (95 % confidence interval) of MTV-lung and TLG-lung measured by univariate analysis were 6.4 (2.5–16.3) and 2.4 (1.0–5.5), respectively. Multivariate analysis revealed that MTV-lung was the only significant factor for prediction of prognosis. Hazard ratio was 13.5 (1.6–111.1, P = 0.016).

Conclusion

Patients with stage IV NSCLC could be further stratified into subgroups of significantly better and worse prognosis by MTV of primary lung lesion.     

Multivariate Analysis of Prognostic Factors in Patients with Glioblastoma

BACKGROUND: To identify prognostic factors for overall survival in patients with newly diagnosed glioblastoma undergoing radiation therapy. PATIENTS AND METHODS: From January 1980 to June 2000, we treated 432 consecutive patients with glioblastoma at out institution. 17 patients were excluded from the analysis for various reasons. Mean age of the 415 patients who were included in the study was 59 years (19-81 years), Karnofsky performance status (KPS) was > or = 70 in 280 patients. 343 patients underwent resection, 72 had a biopsy. Various fractionation schemes were used (conventional fractionation, n = 112; hypofractionation, n = 94; accelerated hyperfractionation, n = 209). Survival probabilities were estimated using the method of Kaplan and Meier. Multivariate analysis was done with a Cox regression model. RESULTS: By July 2001, 406 patients had died. Medial overall survival was 8.2 months. Of ten factors considered in a proportional hazards model stratified for treatment (fractionation scheme and type of surgery), significant variables in a multivariate model were age (50-64 years vs < 50 years [RR 1.35; 95% CI 1.02-1.78], > or = 65 years vs < 50 years [RR 2.08; 95% CI 1.54-2.81]), performance status (KPS < 70 vs > or = 70 [RR 1.53; 95% CI 1.23-1.90]), and central tumor location (yes vs no [RR 1.39; 95% CI 1.04-1.87]). Blood hemoglobin (Hb) values were available in 318 patients and serum lactate dehydrogenase (LDH) levels in 234 patients. 89 patients were anemic (Hb men < 13 g/dl, women < 12 g/dl), in 80 patients the LDH level was raised beyond the upper limit of the normal range (> 240 U/l). By including the three significant variables, both parameters had an additional significant effect with an estimated relative risk of about 1.4 in their corresponding subgroups. CONCLUSION: Besides established prognostic factors, anemia and raised serum LDH levels may negatively influence outcome in glioblastoma patients. Our results from data-dependent modeling have to be confirmed by independent studies.     

利用综合失血指数评估脾破裂的伤情及预后

目的 对外伤性脾破裂失血量（ＨＶ）、失血速度（ＨＳ）与围手术期失代偿性休克（ＰＯＤＳ）以及脾破裂类型的关系,进行综合评价和对比,找出一种评价患者病情的客观指标。方法 根据脾破裂患者术前时间和术中测定的ＨＶ,计算患者的ＨＳ,取其二者常用对数之乘积作为评价患者伤情的综合失血指数（ＳＨＩ）,并确定不同ＨＶ、不同ＨＳ和不同ＳＨＩ与ＰＯＤＳ的对应关系,以及ＨＳ与脾破裂类型的关系。结果 ＰＯＤＳ在不同ＨＶ组别     

Histogram Analysis of Intravoxel Incoherent Motion for Differentiating Recurrent Tumor from Treatment Effect in Patients with Glioblastoma: Initial Clinical Experience

BACKGROUND AND PURPOSE:Intravoxel incoherent motion can simultaneously measure diffusion and perfusion characteristics. Our aim was to determine whether the perfusion and diffusion parameters derived from intravoxel incoherent motion could act as imaging biomarkers for distinguishing recurrent tumor from treatment effect in patients with glioblastoma.MATERIALS AND METHODS:Fifty-one patients with pathologically confirmed recurrent tumor (n = 31) or treatment effect (n = 20) were assessed by means of intravoxel incoherent motion MR imaging. The histogram cutoffs of the 90th percentiles for perfusion and normalized CBV and the 10th percentiles for diffusion and ADC were calculated and correlated with the final pathology results. A leave-one-out cross-validation was used to evaluate the diagnostic performance of our classifiers.RESULTS:The mean 90th percentile for perfusion was significantly higher in the recurrent tumor group (0.084 ± 0.020) than in the treatment effect group (0.040 ± 0.010) (P < .001). The 90th percentile for perfusion provided a smaller number of patients within an overlap zone in which misclassifications can occur, compared with the 90th percentile for normalized CBV. The mean 10th percentile for diffusion was significantly lower in the recurrent tumor group than in the treatment effect group (P = .006). Receiver operating characteristic curve analyses showed the 90th percentile for perfusion to be a significant predictor for differentiation, with a sensitivity of 87.1% and a specificity of 95.0%. There was a significant positive correlation between the 90th percentiles for perfusion and normalized CBV (r = 0.674; P < .001).CONCLUSIONS:A histogram analysis of intravoxel incoherent motion parameters can be used as a noninvasive imaging biomarker for differentiating recurrent tumor from treatment effect in patients with glioblastoma.

In clinical practice, it is often difficult to determine whether a progressively enhancing lesion occurring after concurrent chemoradiotherapy is caused by a recurrent tumor or by treatment effect.¹ Several studies have used physiologic imaging techniques, such as T2*-weighted dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging, to differentiate recurrent tumor from treatment effect.^1,2 Intravoxel incoherent motion (IVIM) was introduced by Le Bihan et al^3,4 as a method for simultaneously measuring perfusion and diffusion. Le Bihan et al⁴ defined IVIM as the microscopic translational motions that occur in each image voxel in MR imaging. In biologic tissues, these incoherent motions include molecular diffusion of water and microcirculation of blood in the capillary network, called “perfusion.” These 2 phenomena account for the bi-exponential decay of the signal intensity on DWI when different diffusion b-values are applied. With the use of IVIM theory, both true molecular diffusion and water molecule motion in the capillary network can be estimated by means of a single diffusion imaging acquisition technique. The major advantages of IVIM MR imaging are as follows: it allows the simultaneous acquisition of diffusion and perfusion parameters, which can provide perfusion measures within corresponding solid lesions on ADC or the D-map without the requirement for a co-registration processing step; intravenous contrast injection is not required; and it allows processing and image analysis to be performed within a reasonable timeframe.In the present study, we attempted to validate IVIM-derived perfusion and diffusion parameters through the use of both the pathologic correlation and normalized CBV (nCBV) derived from DSC MR perfusion imaging, which has been commonly used as a perfusion parameter for assessing the glioblastoma treatment response. For pathologic correlation, we used IVIM MR imaging in patients with pathologically confirmed recurrent tumor or treatment effect.Our first hypothesis was that the difference in vascularity between recurrent tumor and treatment effect can be assessed by means of an IVIM-derived perfusion fraction (f), and it would correlate with the value of nCBV derived from DSC MR perfusion imaging. Our second hypothesis was that the true diffusion parameter (D), derived from a biexponential model that separates perfusion effects, may be more significantly different between the recurrent tumor and the treatment effect groups than ADC. The purpose of this study was to determine whether the perfusion (f) and diffusion (D) parameters derived from IVIM can act as imaging biomarkers for distinguishing recurrent tumor from treatment effect in patients with glioblastoma.     

Repeatability of Automated Image Segmentation with BraTumIA in Patients with Recurrent Glioblastoma

BACKGROUND AND PURPOSE:Despite high interest in machine-learning algorithms for automated segmentation of MRIs of patients with brain tumors, there are few reports on the variability of segmentation results. The purpose of this study was to obtain benchmark measures of repeatability for a widely accessible software program, BraTumIA (Versions 1.2 and 2.0), which uses a machine-learning algorithm to segment tumor features on contrast-enhanced brain MR imaging.MATERIALS AND METHODS:Automatic segmentation of enhancing tumor, tumor edema, nonenhancing tumor, and necrosis was performed on repeat MR imaging scans obtained approximately 2 days apart in 20 patients with recurrent glioblastoma. Measures of repeatability and spatial overlap, including repeatability and Dice coefficients, are reported.RESULTS:Larger volumes of enhancing tumor were obtained on later compared with earlier scans (mean, 26.3 versus 24.2 mL for BraTumIA 1.2; P < .05; and 24.9 versus 22.9 mL for BraTumIA 2.0, P < .01). In terms of percentage change, repeatability coefficients ranged from 31% to 46% for enhancing tumor and edema components and from 87% to 116% for nonenhancing tumor and necrosis. Dice coefficients were highest (>0.7) for enhancing tumor and edema components, intermediate for necrosis, and lowest for nonenhancing tumor and did not differ between software versions. Enhancing tumor and tumor edema were smaller, and necrotic tumor larger using BraTumIA 2.0 rather than 1.2.CONCLUSIONS:Repeatability and overlap metrics varied by segmentation type, with better performance for segmentations of enhancing tumor and tumor edema compared with other components. Incomplete washout of gadolinium contrast agents could account for increasing enhancing tumor volumes on later scans.

Automated tumor-segmentation software is usually evaluated by comparing automated segmentations with those obtained by or approved by human expert observers. For example, in the Multimodal Brain Tumor Image Segmentation Benchmark (BRATS) challenges, consensus segmentations were obtained by fusing the input of human expert observers, and segmentation software performance was measured using the Dice score, sensitivity, specificity, and 95th percentile of the Hausdorff distance.¹ Although this analysis is helpful for evaluating segmentation accuracy, it does not measure the variability of automated segmentation. Measurements of segmentation variability are important for quantifying the uncertainty for any given segmentation volume measurement and estimating the smallest change in these parameters that can be measured reliably. These estimates are useful to evaluate the suitability of automated segmentation software for clinical applications in which interval change in tumor size is the primary parameter of interest.The primary goal of this study was to study the variability of segmentation volumes and spatial overlap obtained using the widely available software package, Brain Tumor Image Analysis (BraTumIA)² (Version 1.2 and Version 2.0; https://www.nitrc.org/projects/bratumia).² This software uses machine-learning techniques to produce fully automated segmentations of high-grade gliomas, which are highly correlated with the results of manual human rater segmenations.^2,3     

The Initial Area Under the Curve Derived from Dynamic Contrast-Enhanced MRI Improves Prognosis Prediction in Glioblastoma with Unmethylated MGMT Promoter

BACKGROUND AND PURPOSE:Although perfusion and permeability MR parameters have known to have prognostic value, they have reproducibility issues. Our aim was to evaluate whether the initial area under the time-to-signal intensity curve (IAUC) derived from dynamic contrast-enhanced MR imaging can improve prognosis prediction in patients with glioblastoma with known MGMT status.MATERIALS AND METHODS:We retrospectively examined 88 patients with glioblastoma who underwent preoperative dynamic contrast-enhanced MR imaging. The means of IAUC values at 30 and 60 seconds (IAUC30_mean and IAUC60_mean) were extracted from enhancing tumors. The prognostic values of IAUC parameters for overall survival and progression-free survival were assessed with log-rank tests, according to the MGMT status. Multivariate overall survival and progression-free survival models before and after adding the IAUC parameters as covariates were explored by net reclassification improvement after receiver operating characteristic analysis for 1.5-year overall survival and 1-year progression-free survival and by random survival forest.RESULTS:High IAUC parameters were associated with worse overall survival and progression-free survival in the unmethylated MGMT group, but not in the methylated group. In the unmethylated MGMT group, 1.5-year overall survival and 1-year progression-free survival prediction improved significantly after adding IAUC parameters (overall survival area under the receiver operating characteristic curve, 0.86; progression-free survival area under the receiver operating characteristic curve, 0.74–0.76) to the model with other prognostic factors (overall survival area under the receiver operating characteristic curve, 0.81; progression-free survival area under the receiver operating characteristic curve, 0.69; P < .05 for all) except in the case of IAUC60_mean for 1-year progression-free survival prediction (P = .059). Random survival forest models indicated that the IAUC parameters were the second or most important predictors in the unmethylated MGMT group, except in the case of the IAUC60_mean for progression-free survival.CONCLUSIONS:IAUC can be a useful prognostic imaging biomarker in patients with glioblastoma with known MGMT status, improving prediction of glioblastoma prognosis with the unmethylated MGMT promoter status.

Glioblastoma (GBM) is the most common primary malignant tumor in the adult brain. Although its prognosis remains poor (median survival, ∼14.7 months),¹ some patients with GBM show a distinct prognosis and response to chemoradiation. Previous studies have investigated the prognostic factors of GBM, including MR imaging^2–4 and molecular biomarkers (O⁶-methylguanine-DNA methyltransferase [MGMT] promoter methylation).⁵Previous studies have shown that high relative cerebral blood volume (rCBV; derived via dynamic susceptibility contrast-enhanced MR imaging) and high volume transfer constant (K^trans; derived via dynamic contrast-enhanced [DCE] MR imaging) are associated with poor survival outcomes.^6–8 However, rCBV and K^trans measurements have reproducibility issues related to postprocessing techniques, including normalization, model-based calculation, arterial input function, and software.^9–13 In contrast, the initial area under the time-to–signal intensity curve (IAUC), derived via DCE MR imaging, is a model-free parameter that does not require an arterial input function or a complicated model-based calculation and is highly reproducible.^10,14 Because IAUC reflects both tumor perfusion and permeability,^9,10,15 we hypothesized that IAUC might be useful for predicting the survival outcome in GBM. In this study, we used automatically calculated IAUC parameters to maximize reproducibility.MGMT removes alkyl groups from the alkylation site of temozolomide. Methylation of the MGMT promoter inhibits MGMT activity and yields a better response to temozolomide and improved prognosis.⁵ Because the MGMT status is available after surgery in most patients with GBM, the predictive ability of IAUC for prognosis in patients with GBM with known MGMT status is clinically relevant. Here, we aimed to assess whether IAUC can improve prognosis prediction in patients with GBM with known MGMT status.     

乳腺肿瘤整形保乳手术治疗早期乳腺癌患者的临床效果及对患者预后的影响

目的探究乳腺肿瘤整形保乳手术治疗早期乳腺癌患者的临床效果及患者预后的影响。方法从2016年7月-2019年7月收治的早期乳腺癌患者中选择108例作为研究样本,分作两组。其中常态组54例患者行非整形保乳手术治疗,科研组54例患者行乳腺肿瘤整形保乳手术治疗,对于其临床效果及患者预后的影响进行深入分析。结果科研组术中引流量、出血量及手术操作时间等手术指标较常态组明显更优,同时科研组无复发与远处转移情况,较参照组明显更优(P<0.05),组间具有显著差异。结论乳腺肿瘤整形保乳手术对早期乳腺癌患者的临床效果确切,同时对其预后产生积极影响,其乳房美容效果优良。     

Predicting the Prognosis of Oral Tongue Carcinoma Using a Simple Quantitative Measurement Based on Preoperative MR Imaging: Tumor Thickness versus Tumor Volume

BACKGROUND AND PURPOSE:Several studies indicated that tumor thickness or tumor volume might be helpful predictors for the prognosis of oral tongue squamous cell carcinoma. Our aim was to compare the value of tumor thickness versus tumor volume measurement based on preoperative MR imaging in predicting the prognosis of oral tongue squamous cell carcinoma, especially focusing on lymph node metastases and local recurrence.MATERIALS AND METHODS:Clinical, pathologic, and imaging data of patients with 46 oral tongue squamous cell carcinomas were retrospectively studied. Logistic regression analysis was used to evaluate the prognostic value of tumor thickness and tumor volume based on MR imaging. Receiver operating characteristic analysis was applied for the optimal cutoff value for the identified risk variable for prognosis.RESULTS:A higher intraclass correlation coefficient was achieved for the measurement of tumor thickness compared with tumor volume (0.990 versus 0.972). Multivariate analysis showed that tumor thickness was a significant predictor of lymph node metastases (P = .024), while tumor volume was not a significant predictor of either lymph node metastases or local recurrence (P > .05). Receiver operating characteristic results indicated that setting a tumor thickness of 8.5 mm as a cutoff value could achieve the optimal diagnostic efficiency for predicting lymph node metastases (area under the curve, 0.753; sensitivity, 0.889; specificity, 0.536).CONCLUSIONS:Tumor thickness based on preoperative MR imaging was useful in predicting the prognosis of oral tongue squamous cell carcinoma, especially lymph node metastases, in our patient population, while tumor volume was not.

Patients with oral tongue squamous cell carcinoma (SCC) are at risk of cervical lymph node metastases and local recurrence, with the risk increasing with the size and extent of tumor, defined by T stage, and influencing treatment strategy.^1–3 Previous studies indicated that tumor thickness or tumor volume might also be helpful predictors for the clinical outcomes of patients with oral tongue SCC, such as cervical lymph node metastases, local recurrence, or survival rate.^2–10 Which one of these 2 parameters has a better prognostic value is still unclear, however, with only a few studies focusing on this issue. Yuen et al⁴ compared the prognostic value of these 2 parameters, tumor thickness and tumor volume, together with other parameters such as tumor diameter, length, width, and area. Their measurements were based on surgical histologic specimens that were unavailable before the procedure, however, and tumor shrinkage during specimen preparation might also influence its precision in measurement.MR imaging has been increasingly used in the preoperative evaluation of oral tongue SCCs, due to its excellent soft-tissue resolution. Preoperative MR imaging could help us to define tumor extent and volume accurately.¹¹ Therefore, our study aimed to clarify the better predictor for the short-term prognosis of oral tongue SCCs between tumor thickness and tumor volume based on preoperative MR imaging, specifically focusing on lymph node metastases and local recurrence.     

Prediction of Prognosis in Glioblastoma Using Radiomics Features of Dynamic Contrast-Enhanced MRI

ObjectiveTo develop a radiomics risk score based on dynamic contrast-enhanced (DCE) MRI for prognosis prediction in patients with glioblastoma.Materials and MethodsOne hundred and fifty patients (92 male [61.3%]; mean age ± standard deviation, 60.5 ± 13.5 years) with glioblastoma who underwent preoperative MRI were enrolled in the study. Six hundred and forty-two radiomic features were extracted from volume transfer constant (K^trans), fractional volume of vascular plasma space (V_p), and fractional volume of extravascular extracellular space (V_e) maps of DCE MRI, wherein the regions of interest were based on both T1-weighted contrast-enhancing areas and non-enhancing T2 hyperintense areas. Using feature selection algorithms, salient radiomic features were selected from the 642 features. Next, a radiomics risk score was developed using a weighted combination of the selected features in the discovery set (n = 105); the risk score was validated in the validation set (n = 45) by investigating the difference in prognosis between the “radiomics risk score” groups. Finally, multivariable Cox regression analysis for progression-free survival was performed using the radiomics risk score and clinical variables as covariates.Results16 radiomic features obtained from non-enhancing T2 hyperintense areas were selected among the 642 features identified. The radiomics risk score was used to stratify high- and low-risk groups in both the discovery and validation sets (both p < 0.001 by the log-rank test). The radiomics risk score and presence of isocitrate dehydrogenase (IDH) mutation showed independent associations with progression-free survival in opposite directions (hazard ratio, 3.56; p = 0.004 and hazard ratio, 0.34; p = 0.022, respectively).ConclusionWe developed and validated the “radiomics risk score” from the features of DCE MRI based on non-enhancing T2 hyperintense areas for risk stratification of patients with glioblastoma. It was associated with progression-free survival independently of IDH mutation status.     

Beyond Mean Tumor Dose: The Importance of Particle Density in Radioembolization

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影响无淋巴结转移胃癌病人预后的因素

目的探讨无淋巴结转移胃癌病人影响术后长期生存的因素。方法对98例接受根治性切除的无淋巴结转移胃癌病人进行单因素和多因素分析,与同期111例有淋巴结转移胃癌病人对比。结果无淋巴结转移组肿瘤体积较小、早期病人较多、分化较好、肿瘤局限于黏膜和肌层者较多。5年存活率64%高于淋巴结转移组的54%(P<0.05)。多因素分析表明,性别、反酸史、肿瘤大小、分期、分化程度低和穿透深度是影响预后的独立因素。结论无淋巴结转移胃癌病人的预后较好,影响长期生存的因素是女性、反酸史、肿瘤体积>3cm、进展期、分化程度低和侵犯浆膜。扩大淋巴结清扫范围并不改善预后。     

血糖水平在糖尿病合并脑卒中预后的临床分析

目的：探讨血糖水平与糖尿病合并脑卒中病情及预后的相关性。方法：回顾性分析60例患者血糖水平,分析血糖水平与病情及预后的关系。结果：糖尿病合并脑率中以脑梗塞多见,而血糖≥16.7 mmol/L者重症多见,病死率较高。结论：糖尿病合并脑卒中的病情预后与患者血糖水平相关。     

Tumor Volume and Tumor Hypoxia in Head and Neck Cancers

BACKGROUND: The prognostic impact of tumor volume and hypoxia is well established. We have investigated a possible prognostic impact of the hypoxic tumor volume which can be calculated as the product of tumor volume and hypoxia. PATIENTS AND METHODS: 125 patients with squamous cell cancer of the head and neck were investigated. All had locoregionally confined disease. The total tumor volume was calculated from pretreatment CT scans as the sum of all visible macroscopic tumor lesions (e.g., primary tumor plus neck nodes), and all patients underwent measurement of tumor oxygenation by pO2 histography. The hypoxic tumor volume was calculated as the product of the total tumor volume and the relative frequency of pO2 readings < 5 mmHg. The nonhypoxic volume was the difference between total tumor volume hypoxic volume. RESULTS: The total tumor volume ranged from 2 to 283 cm3 (mean 47 +/- 53 cm3), the hypoxic volume from 0 to 199 cm3 (mean 18 +/- 30 cm3), and the nonhypoxic volume from 1 to 237 cm3 (mean 29 +/- 34 cm3), and there was a strong correlation between the three parameters. 84 patients died and 41 survived in the observation period with a median survival of 12.5 months. Tumor volume and tumor oxygenation had a significant impact on survival. The tumor volume was significantly different in patients who had died as compared to surviving patients (mean 54 vs. 34 cm3; p = 0.017). The hypoxic volume was also different (11 vs. 22 cm3; p = 0.009), whereas the nonhypoxic volume was not significantly different (24 vs. 32 cm3; p = 0.2). If the impact of large versus small tumor volumes (total volume, hypoxic volume, and nonhypoxic volume, subdivision according to each median) on survival was analyzed, a significant impact of total tumor volume (median survival 298 vs. 485 days; p = 0.03) and a marginal impact of the hypoxic volume (342 vs. 404 days; p = 0.08), but no impact of the nonhypoxic volume were found (383 vs. 374 days; p = 0.6). In a multivariate Cox regression model, the hypoxic tumor volume was a strong and independent prognostic factor for survival (p = 0.001) and more important than the total tumor volume (p = 0.02) whereas the nonhypoxic volume had no impact on prognosis (p = 0.33). CONCLUSIONS: The total tumor volume is a major prognostic factor, but its impact mainly results from the hypoxic volume and can be explained by the strong correlation between total tumor volume and hypoxic volume. The nonhypoxic volume had no impact on survival. As a consequence, methods to measure and localize the hypoxic volume should be further developed.     

Treatment Planning and Volumetric Response Assessment for Yttrium-90 Radioembolization: Semiautomated Determination of Liver Volume and Volume of Tumor Necrosis in Patients with Hepatic Malignancy

Purpose

The primary purpose of this study was to demonstrate intraobserver/interobserver reproducibility for novel semiautomated measurements of hepatic volume used for Yttrium-90 dose calculations as well as whole-liver and necrotic-liver (hypodense/nonenhancing) tumor volume after radioembolization. The secondary aim was to provide initial comparisons of tumor volumetric measurements with linear measurements, as defined by Response Evaluation Criteria in Solid Tumors criteria, and survival outcomes.

Methods

Between 2006 and 2009, 23 consecutive radioembolization procedures were performed for 14 cases of hepatocellular carcinoma and 9 cases of hepatic metastases. Baseline and follow-up computed tomography obtained 1?month after treatment were retrospectively analyzed. Three observers measured liver, whole-tumor, and tumor-necrosis volumes twice using semiautomated software.

Results

Good intraobserver/interobserver reproducibility was demonstrated (intraclass correlation [ICC]?>?0.9) for tumor and liver volumes. Semiautomated measurements of liver volumes were statistically similar to those obtained with manual tracing (ICC?=?0.868), but they required significantly less time to perform (p?<?0.0001, ICC?=?0.088). There was a positive association between change in linear tumor measurements and whole-tumor volume (p?<?0.0001). However, linear measurements did not correlate with volume of necrosis (p?>?0.05). Dose, change in tumor diameters, tumor volume, and necrotic volume did not correlate with survival (p?>?0.05 in all instances). However, Kaplan?CMeier curves suggest that a >10% increase in necrotic volume correlated with survival (p?=?0.0472).

Conclusion

Semiautomated volumetric analysis of liver, whole-tumor, and tumor-necrosis volume can be performed with good intraobserver/interobserver reproducibility. In this small retrospective study, measurements of tumor necrosis were suggested to correlate with survival.