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.
Objective To explore the impact of microvascular invasion (MVI) on the survival prognosis of patients after radical hepatectomy for hepatocellular carcinoma, to analyze its related risk factors and preoperative prediction methods, and to provide reference and support for the treatment of early postoperative recurrence. MethodsBy searching domestic and international medical literature databases, we screened studies related to MVI in hepatocellular carcinoma, focusing on the definition, grading, risk factors, preoperative prediction methods, and postoperative treatment strategies of MVI, and summarized the results of the existing studies. ResultsMVI was a well-established risk factor for the intrahepatic metastasis and early postoperative recurrence of hepatocellular carcinoma. Currently, various methods were employed to predict MVI, including laboratory indicators, imaging genomics, and genomics. The laboratory indicators used for prediction included alpha-fetoprotein, protein induced by vitamin K absence or antagonist-Ⅱ, hepatitis B virus, tumor diameter, vascular endothelial growth factor A, and circulating tumor cells. Imaging genomics involved preoperative MRI with irregular tumor shape and intra-voxel incoherent motion diffusion-weighted imaging D value < 1.16 × 10-3 mm2/S, CT enhancement imaging features with irregular tumor margins, multiple foci, and contrast-enhanced ultrasound portal venous and delayed phase scores. Genomics included the maximum variant allele frequency of circulating tumor DNA. In cases where MVI was detected after surgery, adjuvant therapy options had gained attention, such as transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, targeted therapy, immunotherapy, radiation therapy, antiviral therapy, and local treatment combined with systemic treatment. ConclusionsThe study of MVI and its targeted treatment strategies are important for reducing the postoperative recurrence rate of hepatocellular carcinoma and improving patient survival. The preoperative prediction model and postoperative treatment plan should be optimized in the future to provide more effective treatment reference for patients.
【Abstract】Objective To evaluate the prognostic value of plasma D-dimer level in cancer thrombosis and vascular invasion assessment and to analyze the correlation between plasma D-dimer level and the Pittsburgh modified TNM staging in patients with hepatocellular carcinoma for orthotopic liver transplantation. MethodsThe plasma D-dimer level was quantitated using Golden method in 120 patients with hepatocellular carcinoma for orthotopic liver transplantation. Cancer thrombosis in trunk vein and microvascular invasion was diagnosed by pathology. The relationship between plasma D-dimer level in different Child-pugh’s classification patients and vascular invasion as well as the Pittsburgh modified TNM staging was analyzed with χ2 test, factorial analysis of variance and q test by microsoft SPSS 9.0.ResultsIn ChildPugh’s A, B and C patients, the difference of plasma D-dimer level between patients with trunk vein cancer thrombosis and patients without vascular invasion was significant (P＜0.05). The differences of plasma D-dimer level between patients with microvascular invasion and patients without vascular invasion were significant (P＜0.01) in Child-Pugh’s B and C patients but was insignificant in Child-Pugh’s A patients (Pgt;0.05). The differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅲ tumor, and between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅳ tumor were significant (P＜0.05), but the differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅲ tumor and patients with TNM Ⅳ tumor were insignificant (Pgt;0.05).ConclusionPlasma D-dimer level, which increasing as upgrade of the Pittsburgh TNM staging, is useful in the vascular invasion and cancer thrombosis assessment in patients with hepatocellular carcinoma for liver transplantation, and the correlation was more significant as progression of vascular invasion and upgrade of Child-pugh’s classification.
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.
Objective To summarize the research progress of MRI in the assessment of rectal cancer before surgery. Methods Literatures about the recent studies on the research progress of MRI in the assessment of rectal cancer before surgery were reviewed according to the results searched from Pubmed, CNKI, and WanFang database. Results Preoperative staging, circumferential resection margin, and extramural vascular invasion were closely related to the prognosis of rectal cancer patients, MRI could provide a good assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion for rectal cancer patients, but it still had some deficiencies which needed further studies. Conclusion Application of MRI in the assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion before surgery, is conducive to the development of the most appropriate treatment options for patients with rectal cancer.
ObjectiveTo explore the risk factors that affect the long-term prognosis of liver cancer after liver transplantation, and to evaluate the clinical value of the Chinese Medical Association’s new microvascular invasion pathological classification.MethodsThe clinical pathology and follow-up data of 112 patients with liver cancer who underwent liver transplantation from January 2015 to December 2018 were retrospectively analyzed. Prognostic risk factors were analyzed by Cox proportional hazard regression model.ResultsAll of the 112 patients were followed up. The postoperative follow-up period was 12 to 60 months [(28.3±13.5) months], and the median overall survival time was 38-month. The results of the Cox proportional hazard regression model suggested that the preoperative Child classification and microvascular invasion pathological classification were independent factors affecting the prognosis of patients (P<0.05), the higher microvascular invasion pathological classification and Child grade, the worse the prognosis.ConclusionThe Chinese Medical Association’s new microvascular invasion pathological classification can predict the prognosis of patients with liver cancer after liver transplantation and has a good predictive value.
ObjectiveTo explore the location and characteristics of postoperative recurrence of papillary thyroid carcinoma. MethodsThe clinical data of 96 patients who underwent reoperation for papillary thyroid cancer at the Affiliated Cancer Hospital of Zhengzhou University from January 2017 to March 2024 were retrospectively analyzed. ResultsOut of 96 patients, 3 had thyroid recurrence, 89 had lymph node recurrence, and 4 had thyroid and lymph node recurrence. There were 69 cases of single recurrence and 27 cases of multiple recurrence. Ten cases underwent lobectomy and lateral area cleaning, 8 cases underwent central area cleaning, 33 cases underwent lateral area cleaning, and 45 cases underwent central area+lateral area cleaning. Postoperative pathological examination revealed that there was lymph node metastasis in 93 cases (16 cases in the central region, 44 cases in the lateral region, and 33 cases in both the central and lateral regions), with 3 cases remaining non metastatic; 58 cases had extracapsular invasion of lymph nodes. Compared with patients with multiple relapses, patients with single recurrence had younger age (t=–3.385, P=0.001), lower incidence of gross extracapsular invasion of lymph nodes during surgery (χ2=6.970, P=0.008), higher number of metastatic lymph nodes (t=4.034, P=0.001), and higher rate of lymph node metastasis in zones Ⅱ, Ⅲ, and Ⅳ (χ2=8.142, P=0.004; χ2=6.357, P=0.012; χ2=12.547, P<0.001). ConclusionsPostoperative recurrence of papillary thyroid cancer is mainly due to lymph node recurrence. The advanced age and the visible lymph node extracapsular invasion may increased risk of postoperative recurrence of papillary thyroid cancer. Lymph node metastasis in the central region is a possible cause of multiple relapses and surgeries.
Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
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 determine the most appropriate T-stage and surgical resection range of non-small cell lung cancer(NSCLC) with adjacent lobe invasion (ALI). Methods Fifty one NSCLC patients who were confirmed as direct ALI were divided into an ALI-T2 and an ALI-T3 group according to the eighth edition of TNM classification. Cases were matched by propensity score matching method at a ratio of 2∶1. The overall survival (OS), progression free survival (PFS), postoperative hospitalization, and postoperative complications among the groups were compared. Results Patients' characteristics were comparable among the groups. Three-year or 5-year survival rate in the ALI-T2 group, the single-lobe invasion T2 (SLI-T2) group, and the T3 (SLI-T3) group was 73.90% and 61.60%, 89.60% and 89.60%, 68.90% and 61.20%, respectively. The OS of SLI-T2 group was significantly higher than that of the ALI-T2 ( P=0.042) group and with similar survival in the SLI-T3 group( P=0.955). In the survival analysis of the ALI-T3 group, the 3-year or 5-year OS of the SLI-T3 group was 70.80% and 65.70%, respectively, while in the poorest prognosis ALI-T3 group was only 31.60% and 21.00% ( P=0.009), respectively. However, no statistical difference was detected between the ALI-T3 and SLI-T4 groups ( P=0.343). The PFS of the patients in the ALI-T3 group was closer to the SLI-T4 group level while lower than that of the SLI-T3 group, but the trend had not been confirmed by statistical analysis ( P 1=0.071, P 2=0.648). The OS and PFS did not differ between the patients undergoing a lobectomy plus wedge resection (LWR) and those undergoing a bilobectomy or pneumonectomy. Compared with a bilobectomy or pneumonectomy, LWR had distinct advantages in the postoperative hospital stay (6.90±3.11days vs. 9.23± 4.43 days, P=0.030), the postoperative duration of drainage (4.41±2.98 days vs. 6.50±4.11 days, P=0.041) and complication rates (4.00% vs. 31.58%, P=0.032). Conclusions We believe that T1-2 stage tumor invading adjacent lobe should be classified as T3 and ALI-T3 tumor should be revised as T4. Beside that, LWR could be considered as a reasonable surgical option for patients with lesser invasive depth (less than 2 cm) in the adjacent lobes.