目的:探讨MRI及多层螺旋CT多平面重建显示胆囊癌对邻近结构侵犯的价值。方法:前瞻性分析18例(CT及MRI各9例)胆囊癌对邻近结构侵犯情况。CT及MRI均包括平扫及增强扫描,CT扫描病例除横断断位外,行冠状位、矢状位重建;MRI病例行横断位、冠状位及矢状位扫描。结果:胆囊癌对邻近结构侵犯的敏感度、特异度、准确度如下:①横断位和矢状位显示邻近肝实质侵犯分别为81.2％、100.0％、83.3％,冠状位分别为87.5％、100.0％、88.9％;②横断位显示胃窦侵犯分别为75.0％、90.0％、83.3％,冠状位及矢状位均分别为75.0％、80.0％、77.7％;③横断位显示十二指肠侵犯分别为70.0％、75.0％、72.2％,冠状位分别为80.0％、75.0％、77.7％,矢状位分别为70.0％、75.0％、72.5％;④横断位和冠状位显示结肠肝曲侵犯均分别为25.0％、85.7％、72.2％,矢状位分别为50.0％、71.4％、66.6％;⑤横断位和冠状位显示胆管侵犯均分别为75.0％、100.0％、83.3％,矢状位分别为66.6％、100.0％、77.7％;⑥横断位、冠状位及矢状位显示邻近腹膜侵犯及淋巴结转移准确度均为66.6％;显示网膜侵犯准确度均为50.0％。结论:横断位、冠状位及矢状位显示胆囊癌对邻近肝实质、胃、十二指肠、胆管侵犯的敏感度、特异度、准确度较高;而显示对结肠肝曲、腹膜、网膜侵犯的准确度较低。
目的：探讨胆囊癌肝侵犯的CT诊断及临床价值。方法：回顾性分析经手术、病理证实的17例胆囊癌肝侵犯CT资料。结果：肿块型11例，腔内型2例，厚壁型4例。侵犯肝左内叶5例，肝右叶前段3例，同时侵犯肝左内叶及右叶前段9例。5例侵犯深度＜2 cm，12例侵犯深度＞2 cm。CT表现为胆囊窝脂肪间隙消失，邻近胆囊窝的肝脏组织内出现不规则形低密度影，边界模糊，胆囊癌肿与肝脏组织分界不清，增强后肝内病灶不规则强化。结论：CT对胆囊癌肝侵犯的诊断及临床分期、治疗方案的选择具有重要价值。
ObjectiveTo find out the risk factors affecting the prognoses and microvascular invasion (MVI) of patients with China Liver Cancer Staging-stageⅠ a (CNLC Ⅰ a) hepatocellular carcinoma (HCC). MethodsBased on the established inclusion and exclusion criteria, the clinicopathologic information and follow-up data of patients with CNLC Ⅰ a HCC were retrospectively collected, who underwent radical resection in the West China Hospital of Sichuan University from Jan. 2012 to Dec. 2016. The Cox proportional hazards regression was utilized to analyze the risk factors affecting the prognosis of patients with CNLC Ⅰ a HCC, and the non-conditional logistic regression was utilized to analyze the preoperative clinical indicators associating with MVI. ResultsA total of 300 patients with CNLC Ⅰ a HCC were included in this study, among which 51 (17.0%) cases accompanied with MVI. The follow-up period ranged from 2 to 104 months (median 39 months), with a recurrence time ranging from 2 to 104 months (median 52 months), and an overall survival time ranging from 3 to 104 months (median 98 months). During the follow-up period, postoperative recurrence occurred in 145 (48.3%) cases. The Cox proportional hazards regression analysis revealed that: tumor diameter >3 cm, presences of MVI and satellite nodules increased the risk of shortened recurrence time for the patients with CNLC Ⅰ a HCC (P<0.05); Factors including gamma-glutamyltranspeptidase level >60 U/L, tumor low differentiation, presences of MVI and satellite nodules were associated with shortened overall survival time for the patients with CNLC Ⅰ a HCC (P<0.05). The preoperative alpha-fetoprotein level ≥400 μg/L and tumor diameter >3 cm increased the risk of presence of MVI for the patients with CNLC Ⅰ a HCC [χ2=3.059, OR(95%CI)=2.357(1.047, 5.306), P=0.038; χ2=3.002, OR(95%CI)=2.301(1.026, 5.162), P=0.043]. ConclusionThe results of this study suggest that adopting corresponding strategies to address the risk factors affecting prognosis of patients with CNLC Ⅰ a HCC and the risk factors associated with MVI can have a significant clinical impact on improving surgical treatment outcomes for these patients.
ObjectiveTo assess the feasibility of intravoxel incoherent motion diffusion-weighted imaging (IVIM) in evaluating microvessel density (MVD) and microvascular invasion (MVI) of hepatocellular carcinoma (HCC).MethodsRat models were established to be scanned by IVIM. HCC lesions corresponding to IVIM image were examined pathologically to get data of MVD and MVI. Spearman correlation analysis was used to compare the apparent diffusion coefficient (ADC), D, D*, and f with MVD, independent samples t test was used to compare ADC, D, D*, and f between MVI (+) and MVI (–) groups.ResultsFifty HCC lesions were included finally. ADC and D values both showed a negative correlation with MVD (r=–0.406, P=0.003; r=–0.468, P=0.001), D* and f showed no statistical correlation with MVD (P=0.172, 0.074, respectively). The differences in ADC and all the IVIM parameters (D, D*, and f) between MVI (+) and MVI (–) HCCs were not statistically significant (P=0.393, 0.395, 0.221, 0.550).ConclusionADC and D can be used to evaluate MVD of HCC, but ADC and IVIM parameters were limited in evaluating MVI.
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
ObjectiveTo summarize research progress of molecular imaging in microvascular invasion of hepatocellular carcinoma.MethodThe literatures about the molecular imaging in recent years at home and abroad on the microvascular invasion of hepatocellular carcinoma were reviewed and analyzed.ResultsThe molecular imaging methods such as the Gd-EOB-DTPA enhanced scan, irrelevant movement within voxel diffusion weighted imaging, energy spectrum CT imaging, MR molecular probe imaging, etc. from the aspect of the microstructure multimodally studied the biological behaviors and characteristics of the disease had become the research hot topic and the development direction in the future, which played an important role in the early diagnosis and assessment of the microvascular invasion of hepatocellular carcinoma.ConclusionResearch method of molecular imaging has a prosperous prospect of clinical application in microvascular invasion of hepatocellular carcinoma.
ObjectiveTo assess value of preoperative clinical data and enhanced CT imaging features in predic-tion of microvascular invasion (MVI) and early recurrence (recurrence in one year) after curative resection for hepatoce-llular carcinoma (HCC). MethodsA retrospective analysis was conducted for 150 patients with HCC who underwent curative tumor resection in West China Hospital of Sichuan University from April 2014 to May 2015. The roles of preoperative CT characteristics and clinical data on MVI and early recurrence after curative tumor resection were evaluated by univariate and multivariate analyses. Resultscompared with HCC with no MVI and no early recurrence after curative resection, univariate analysis results showed that HCC with MVI and early recurrence had larger tumor size (P=0.002, P=0.005), a higher proportion of non-smooth tumor margin (P<0.001, P<0.001), and tumor multifocality (P=0.005, P=0.038), HCC with MVI had a higher proportion of incomplete tumor capsule (P=0.032), HCC with early recurrence had a higher proportion of incomplete and absence tumor capsules (P=0.038) and a faster washout on portal venous phase-the percentage attenuation ratio on the portal venous phase (P=0.049) and relative washout ratio on the portal venous phase (P=0.020) were higher. A multivariate logistic regression analysis results showed that non-smooth tumor margin (OR=7.075, P<0.001; OR=4.125, P<0.001) and tumor multifocality (OR=3.290, P=0.008; OR=2.354, P=0.047) were the independent predictors for MVI and early recurrence after curative tumor resection, HCC with early recurrence also had a faster washout on the portal venous phase (OR=1.023, P=0.017). ConclusionNon-smooth tumor margin and tumor multifocality are independent risk factors for MVI and early recurrence after curative tumor resection, and HCC with early recurrence has a faster washout on portal venous phase. Preoperative enhanced CT imaging could predict MVI and early recurrence after curative tumor resection and CT imaging findings are helpful to choose reasonable treatment and predict prognosis.
ObjectiveTo evaluate the prognostic significance of visceral pleural invasion in diameter 3-5 cm nonsmall cell lung cancer(NSCLC). MethodsA total of 112 patients who underwent lobectomy and pathologically diagnosed with NSCLC(3-5 cm) were included in our hospital between January 2006 and December 2010.There were 72 males and 40 females at average age of 61(28-72) years. There were 62 patients diagnosed as adenocarcinoma and 44 as squamous cell lung cancer. Viceral pleural invasion(VPI) was identified in 63 patients as a VPI group. The other 49 patients without VPI were as a NVPI group. All patients were performed with lobectomy and mediastinal lymph node dissection. ResultsThere was no perioperative mortality. More smokers were included in the VPI group when compared with the NVPI group(53.9% vs. 28.6%, P=0.007). More squamous cell cancers were included in the VPI group, while more adenocarcinoma were included in the NVPI group with a statistical difference(P=0.003). The average follow-up duration was 52 months. A total of 32 death occurred at the endpoint. The overall survival(OS) of all included patients was 71.4%. The average follow-up duration was 51 months in the VPI group and 54 months in the NVPI group(P=0.441). There was no statistical difference in OS between the VPI group and the NVPI group(61.7% vs. 83.7%, P=0.017). Cox regression showed age less than 65 years(P=0.007), TNM stage(P=0.013), and VPI(P=0.035) were significant prognostic factors for NSCLC. ConclusionWe identified the presence of VPI as an independent poor prognostic factor in NSCLC patients with diameter at 3-5 cm.
ObjectiveTo comprehend the impact of perineural invasion (PNI) on the occurrence, development, and prognosis of colorectal cancer (CRC), providing a reference for the diagnosis and treatment of CRC. MethodThe latest literature relevant researches on the mechanism, diagnosis, treatment, and prognosis of PNI in CRC both domestically and internationally was reviewed. ResultsThe mechanisms underlying PNI involved nerve growth factors, chemokines, and other signaling molecules, which regulated the interactions between the nerves and cancer cells to promote the tumor invasion and metastasis. The diagnostic approaches primarily relied on the histopathological examination with immunohistochemistry and radiomics. Therapeutically, the PNI-positive patients benefited from surgical intervention in combination with neoadjuvant or adjuvant treatment. Targeting the neural pathways and immune checkpoint inhibitors (such as programmed cell death 1 and cytotoxic T lymphocyte associated protein 4 inhibitors) showed potentials in reducing neural invasion and tumor progression. Emerging strategies that disrupted tumor-nerve interactions also represented promising therapeutic avenues. The PNI was recognized as a critical prognostic indicator for CRC, providing guidance in risk assessment and individualized treatment planning. ConclusionsPNI serves as an important indicator for evaluating the prognosis of CRC, it has a guiding value for therapy decision-making. Further research of molecular mechanisms and diagnostic methods relevant PNI can potentially yield more effective therapeutic options and is expected to improve prognosis of patients with CRC.
ObjectiveTo evaluate therapeutical effects of Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection of primary hepatocellular carcinoma with microvascular invasion. MethodsThe clinical data of 45 cases of primary hepatocellular carcinoma with microvascular invasion underwent Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection from June 2010 to June 2013 in Liaoning Cancer Hospital were retrospectively analyzed. These patients were divided into Huaier granule plus TACE treatment group (20 cases) and simple TACE treatment group (25 cases) according to the postoperative treatment of the patients. The immune function (CD4+/CD8+ ratio and IL-2 level), 1and 3-year tumor recurrence rates and 3-year cumulative survival rate were compared between two groups after operation. Result① The CD4+/CD8+ ratio and IL-2 level had no significant differences between the 2 groups before operation (P > 0.05), which in the Huaier granule plus TACE treatment group were significantly higher than those in the simple TACE treatment group (P < 0.05) on month 3, 6, and 12 after operation.② 1and 3-year tumor recurrence rates in the Huaier granule plus TACE treatment group were significantly lower than those in the simple TACE treatment group[15% (3/20) versus 48% (12/25), P < 0.05; 45% (9/20) versus 80% (20/25), P < 0.05]. ③ The 3-year cumulative survival rate was 75% and 68% in the Huaier granule plus TACE treatment group and the simple TACE treatment group, respectively. The survival curve analysis showed that the 3-year survival rate had a decreased trend, which in the Huaier granule plus TACE treatment group was slightly higher than that in the simple TACE treatment group, but the difference had no statistical significance between the 2 groups (P > 0.05). ConclusionsAlthough the results of this study fails to confirm that Huaier granule plus TACE treatment for primary hepatocellular carcinoma with microvascular invasion following radical resection could significantly improve the 3-year cumulative survival rate, it could effectively decrease the recurrence rate. It is needed larger sample size to further explore in future research.