Gastrointestinal stromal tumours: Preoperative imaging features to predict recurrence after curative resection.

PURPOSE: To identify whether preoperative factors could predict the recurrence after curative resection of gastrointestinal stromal tumours (GISTs) and evaluate the performance of a prediction model using preoperative factors for GIST recurrence compared to a model using preoperative/postoperative factors. METHOD: This retrospective study included patients who underwent curative resection and preoperative CT for GIST. CT imaging features as preoperative factors were analysed by two abdominal radiologists. Modified National Institutes of Health scores were accessed as a postoperative factor. Multiple logistic regression analysis was performed to assess the preoperative and postoperative factors in predicting GIST recurrence. Through the logistic regression, two prediction models using preoperative factors only and both preoperative/postoperative factors were constructed, respectively. The internal validation of the prediction models was performed using bootstrapping sampling. RESULTS: Data in 113 patients were evaluated. Among them, 14 patients had recurrence. The multiple logistic regression analysis demonstrated that non-gastric location (odds ratio [OR] = 5.12, p = 0.029), ill-defined margin (OR = 4.93, p = 0.023), and prominent vessels around tumour (OR = 6.78, p = 0.007) were significant factors. The prediction models using these preoperative factors and adding a postoperative factor showed an area under the receiver operating characteristic curve of 0.863 and 0.897, respectively, which were not statistically different. The bootstrapping sampling showed the two models were valid. CONCLUSION: The prediction model derived from non-gastric location, ill-defined margin, and prominent vessels around tumour can be used preoperatively to estimate the risk of recurrence after resection of GIST.

Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses.

BACKGROUND: Lupus nephritis (LN) is present in over 50% of patients with systemic lupus erythematosus (SLE) which is managed with immunosuppressive and immunomodulatory therapies. However, several novel therapeutic approaches for LN are under investigation due to the adverse effects spectrum of conventional therapy; Methods: We performed a comprehensive review of meta-analyses aggregating the comparative efficacies of various pharmacotherapies for LN. We conducted a literature search and retrieved a total of 23 meta-analyses and network meta-analyses for summarization. Pharmacotherapies were evaluated across six major outcomes: remission, relapse, mortality, end stage kidney disease (ESKD) progression, infection, and malignancy. RESULT: Calcineurin inhibitors (CNI), particularly tacrolimus (TAC), in combination with glucocorticoids (GC) outperformed cyclophosphamide (CPA) with GC in the rate of remission, either complete or partial remission, and in terms of infectious complications. In maintenance therapy, MMF was superior to azathioprine (AZA) as the MMF-treated patients had lower relapse rate. INTERPRETATION: This review aggregates evidence of therapy for clinicians and sheds light on comparative efficacies of alternative LN treatments. As more promising agents are entering the market, such as voclosporin, belimumab, and obinutuzumab, LN management might undergo significant changes during the next years.

A pictorial review on clinicopathologic and radiologic features of duodenal gastrointestinal stromal tumors.

Duodenal gastrointestinal stromal tumors (GISTs) are rare, and studies on their management are not sufficient. Owing to the complex anatomy of the duodenum and pancreatic head, GISTs can be misdiagnosed as pancreatic head tumors. Surgical resection is the first treatment for localized duodenal GISTs; thus, noninvasive imaging is important for the diagnosis and treatment of GISTs. Computed tomography, magnetic resonance imaging and endoscopic ultrasonography findings can be helpful for the diagnosis of duodenal GISTs and can help differentiate GISTs from other adjacent tumors.