Analysis of preoperative nutrition, immunity and inflammation correlation index on the prognosis of upper tract urothelial carcinoma surgical patients: a retrospective single center study.

BACKGROUND: SII, PNI, SIRI, AAPR, and LIPI are prognostic scores based on inflammation, nutrition, and immunity. The purpose of this study was to examine the prognostic value of the SII, PNI, SIRI, AAPR, and LIPI in patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision. MATERIALS AND METHODS: Data of UTUC patients in Sichuan Provincial People's Hospital from January 2017 to December 2021 were collected. The optimal critical values of SII, PNI, SIRI, and AAPR were determined by ROC curve, and LIPI was stratified according to the dNLR and LDH. The Kaplan-Meier method was used to draw the survival curve, and Cox proportional hazard model was used to analyze the factors affecting the prognosis of UTUC patients. RESULTS: A total of 81 patients with UTUC were included in this study. The optimal truncation value of PNI, SII, SIRI and AAPR were determined to be 48.15, 596.4, 1.45 and 0.50, respectively. Univariate Cox proportional hazard regression showed that low PNI, high SII, high SIRI, low AAPR and poor LIPI group were effective predictors of postoperative prognosis of UTUC patients. Multivariate Cox proportional hazard regression showed that high SII was an independent risk factor for postoperative prognosis of UTUC patients. According to ROC curve, the prediction efficiency of fitting indexes of PNI, SII, SIRI, AAPR and LIPI is better than that of using them alone. CONCLUSIONS: The SII, PNI, SIRI, AAPR, and LIPI was a potential prognostic predictor in UTUC patients who underwent radical nephroureterectomy with bladder cuff excision.

MRI-based multiregional radiomics for preoperative prediction of tumor deposit and prognosis in resectable rectal cancer: a bicenter study.

OBJECTIVE: To build T2WI-based multiregional radiomics for predicting tumor deposit (TD) and prognosis in patients with resectable rectal cancer. MATERIALS AND METHODS: A total of 208 patients with pathologically confirmed rectal cancer from two hospitals were prospectively enrolled. Intra- and peritumoral features were extracted separately from T2WI images and the least absolute shrinkage and selection operator was used to screen the most valuable radiomics features. Clinical-radiomics nomogram was developed by radiomics signatures and the most predictive clinical parameters. Prognostic model for 3-year recurrence-free survival (RFS) was constructed using univariate and multivariate Cox analysis. RESULTS: For TD, the area under the receiver operating characteristic curve (AUC) for intratumoral radiomics model was 0.956, 0.823, and 0.860 in the training cohort, test cohort, and external validation cohort, respectively. AUC for the peritumoral radiomics model was 0.929, 0.906, and 0.773 in the training cohort, test cohort, and external validation cohort, respectively. The AUC for combined intra- and peritumoral radiomics model was 0.976, 0.918, and 0.874 in the training cohort, test cohort, and external validation cohort, respectively. The AUC for clinical-radiomics nomogram was 0.989, 0.777, and 0.870 in the training cohort, test cohort, and external validation cohort, respectively. The prognostic model constructed by combining intra- and peritumoral radiomics signature score (radscore)-based TD and MRI-reported lymph nodes metastasis (LNM) indicated good performance for predicting 3-year RFS, with AUC of 0.824, 0.865, and 0.738 in the training cohort, test cohort and external validation cohort, respectively. CONCLUSION: Combined intra- and peritumoral radiomics model showed good performance for predicting TD. Combining intra- and peritumoral radscore-based TD and MRI-reported LNM indicated the recurrence risk. CLINICAL RELEVANCE STATEMENT: Combined intra- and peritumoral radiomics model could help accurately predict tumor deposits. Combining this predictive model-based tumor deposits with MRI-reported lymph node metastasis was associated with relapse risk of rectal cancer after surgery. KEY POINTS: • Combined intra- and peritumoral radiomics model provided better diagnostic performance than that of intratumoral and peritumoral radiomics model alone for predicting TD in rectal cancer. • The predictive performance of the clinical-radiomics nomogram was not improved compared with the combined intra- and peritumoral radiomics model for predicting TD. • The prognostic model constructed by combining intra- and peritumoral radscore-based TD and MRI-reported LNM showed good performance for assessing 3-year RFS.

A study of waterside microenvironmental factors and their effects on summer outdoor thermal comfort in a Cfa-climate campus.

Outdoor thermal comfort (OTC) studies explore outdoor subjects' responses to their thermal environment, usually evaluated using the neutral temperature (NT). This study investigated the influences of microenvironmental factors around a waterbody on thermal perceptions, using questionnaires and meteorological measurements at the Central Lake of Southwest University of Science and Technology (SWUST) in Mianyang. Microenvironmental factors included sky view factor (SVF) and distance from the lake (DFL). It was found that people felt most comfortable in the shade of trees although some volunteers voted artificial canopy as their preferred thermal adaptation element. In addition, a linear regression yielded an NT of 28.44 °C in Mianyang during the summer of 2022. There were NT variations among different measurement sites (e.g., on the east shore, it was 28.18 °C on the waterside, 27.11 °C away from the lake, and 25.53 °C far from the lake; while it was 27.57 °C under the tree crown, 25.11 °C on the lawn, and 29.13 °C in the square). This variation may be due to human adaptation towards microenvironmental factors and their effects on microclimate. The variation in thermal responses owing to microenvironmental differences (different NTs at various types of sites) might be a novel finding in the field of OTC. This study provides important directions for microenvironment design in the future for OTC improvement.

Indoor thermal responses and their influential factors-- impacts of local climate and contextual environment: A literature review.

Indoor thermal comfort/perception (ITC) would be affected by contextual factors. The present article reviewed findings (thermal responses represented by neutral temperature, NT) of ITC studies published in recent decades. There were two types of contextual factors: climate (latitude, altitude, and distance from the sea) and building characteristics (building type, and ventilation mode). Through associating NTs with their contextual factors, it was found that people's thermal responses were significantly affected by climatic factors, especially latitude in summers. Increasing latitude by 10° resulted in NT decrease of around 1 °C. Others- e.g., building characteristics- were influential to some degrees. Effects of ventilation mode (natural ventilated, NV; air-conditioned, AC) varied for the seasons. Generally, people in NV buildings had higher summer NTs, such as 26.1 °C in NV and 25.3 °C in AC in Changsha. The results demonstrated significant human adaptations to climatic and microenvironmental influences. The design and construction of future residences could be more fine-tuned with the building insolation and heating/cooling technology to fit the thermal preferences of local residents for the best internal temperature settings. This study's findings may potentially serve as a foundation for future ITC research.

A study of the thermal comfort in urban mountain parks and its physical influencing factors.

Urban thermal comforts are increasingly holding people's attention due to global warming and urban heat islands. Urban parks can absorb sunlight radiation, which reduces air temperature, improving urban microclimates. Various factors in the park are confirmed to be effective in heat mitigation. However, there are few studies on thermal comfort in urban mountain parks, and mountain areas might cause peculiar climatic conditions owing to their particular landforms. To fill this gap in the research, this study explored thermal comfort in mountain parks and the environmental factors that would affect thermal comfort. A field measurement in the summertime (July & August) of 2018, it was found that trees, the river, and the area of parks could adjust the thermal comforts of mountain parks. Their effects varied throughout the day, and the impacts of trees were most pronounced at noon and late afternoon, while the influence of rivers and park areas was most pronounced at noon. Increasing the leaf area index by 1 point could result in decreases in physiological equivalent temperature, land surface temperature, and solar radiation level by 3.90 °C, 2.69 °C, and 270.10 W/m2, respectively. The findings have practical implications for future urban mountain park design works.

The application of apparent diffusion coefficients derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer.

OBJECTIVE: To investigate the diagnostic performance of the apparent diffusion coefficient (ADC) derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer. MATERIALS AND METHODS: One hundred forty-six patients with rectal cancer who underwent preoperative MRI were prospectively enrolled. Two radiologists independently placed free-hand regions of interest (ROIs) in the largest tumor cross section and three small ROIs on the peritumoral zone adjacent to the tumor contour. Maximum values of tumor ADC (ADCtmax), minimum values of tumor ADC (ADCtmin), mean values of tumor ADC (ADCtmean), mean values of peritumor ADC (ADCpmean), and ADCpmean/ADCtmean (ADC ratio) were obtained on ADC maps and correlated with prognostic factors using uni- and multivariate logistic regression, and receiver operating characteristic curve (ROC) analysis. RESULTS: Interobserver agreement was excellent for ADCtmax and ADCtmean (intraclass correlation coefficient [ICC], 0.915-0.958), and were good for ADCtmin, ADCpmean, and ADC ratio (ICC, 0.774-0.878). The ADC ratio was significantly higher in the poor differentiation, T3-4 stage, lymph node metastasis (LNM)-positive, extranodal extension (ENE)-positive, tumor deposit (TD)-positive, and lymphovascular invasion (LVI)-positive groups than that in the well-moderate differentiation, T1-2 stage, LNM-negative, ENE-negative, TD-negative, and LVI-negative groups (p = 0.008, < 0.001, < 0.001, 0.001, < 0.001, and < 0.001, respectively). The area under the ROC curve (AUC) of the ADC ratio was the highest for assessing poor differentiation (0.700), T3-4 stage (0.707), LNM-positive (0.776), TD-positive (0.848), and LVI-positive (0.778). Both the ADC ratio (AUC = 0.677) and ADCpmean (AUC = 0.686) showed higher diagnostic performance for assessing ENE. CONCLUSION: The ADC ratio could provide better predictive performance for assessing preoperative prognostic factors in resectable rectal cancer. KEY POINTS: • Both the peritumor/tumor ADC ratio and ADCpmean are correlated with important prognostic factors of resectable rectal cancer. • Both peritumor ADC and peritumor/tumor ADC ratio had higher diagnostic performance than tumor ADC for assessment of prognostic factors in resectable rectal cancer. • Peritumor/tumor ADC ratio showed the most capability for the assessment of prognostic factors in resectable rectal cancer.

Diffusion-weighted MR volume and apparent diffusion coefficient for discriminating lymph node metastases and good response after chemoradiation therapy in locally advanced rectal cancer.

OBJECTIVE: To determine diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) volume and apparent diffusion coefficient values (ADCs) for assessing lymph node metastases (LNM) and good response after chemoradiation therapy (CRT) in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS: This retrospective study consisted of 61 patients with LARC who underwent pre- and post-CRT DW images. Two radiologists independently placed free-hand regions of interest in each tumor-containing section on DW images to calculate pre- and post-CRT tumor volume and tumor volume reduction rates (Δvolume). Regions of interest were drawn to include tumor on maximum cross-sectional slice to obtain ADCs. Areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate diagnostic performance in identifying LNM and good response after CRT using these parameters. RESULTS: Inter-observer agreement and intra-observer agreement were excellent for pre- and post-CRT DW MR volume (intraclass correlation coefficient [ICC], 0.889-0.948) and moderate for pre- and post-CRT ADCs (ICC, 0.535-0.811). AUCs for identifying LNM were 0.508 for pre-CRT DW MR volume versus 0.705 for pre-CRT ADC, 0.855 for post-CRT DW MR volume versus 0.679 for post-CRT ADC, and 0.887 for Δvolume versus 0.533 for ΔADC. AUCs for identifying good response were 0.518 for pre-CRT volume versus 0.506 for pre-CRT ADC, 0.975 for post-CRT volume versus 0.723 for post-CRT ADC, and 0.987 for Δvolume versus 0.655 for ΔADC. CONCLUSION: DW MR Δvolume provided high diagnostic performance in discriminating LNM after CRT. DW MR Δvolume was equally as accurate as post-CRT DW MR volume for evaluating good response. KEY POINTS: • Inter-observer agreement and intra-observer agreement were excellent for pre- and post-CRT DW MR volume (intraclass correlation coefficient [ICC], 0.889-0.948) and moderate for pre- and post-CRT ADCs (ICC, 0.535-0.811). • DW MR Δvolume provided high diagnostic performance in identifying LNM after CRT (AUC, 0.887) and good response (AUC, 0.987) and was significantly more accurate than pre-CRT DW MR volume (AUC, 0.508 and 0.518, respectively) and ADCs (AUC, 0.705 and 0.506, respectively). • DW MR Δvolume (AUC, 0.987) was equally as accurate as post-CRT DW MR volume (AUC, 0.975) for evaluating good response, while pre-CRT DW MR volume and ADCs were not reliable for evaluating LNM and good response after CRT (AUC, 0.506-0.723).

Thymocytes induce renal tubular epithelial cells to undergo the epithelial-to-mesenchymal transition.

BACKGROUND: Renal tubulointerstitial fibrosis is known to occur as a result of epithelial cell transformation into myofibroblasts via the epithelial-to-mesenchymal transition (EMT) process. It has been reported that macrophages, regulatory T (Treg) cells, and gamma delta T (γδ T) cells can promote fibrosis via EMT in vivo. OBJECTIVE: Our study intended to detect whether thymocytes can induce renal tubular cells to undergo the EMT. METHODS: Rat thymocytes were activated by phytohemagglutinin and concanavalin A. The rat renal tubular epithelial cells (NRK-52E) were incubated in a conditioned medium harvested from activated thymocytes or co-cultured with freshly isolated thymocytes for 48 hours. Real-time reverse transcription-polymerase chain reaction, immunofluorescence, and western blotting analysis were used to test the expression of the epithelial and mesenchymal markers in NRK-52E cells. Scratch assay was designed to test the cell migration abilities of NRK-52E cells. Student's t test and oneway analysis of variance test were used for statistical analysis. RESULTS: The combined stimulation with phytohemagglutinin and concanavalin A activated the primary isolated rat thymocytes. After treatment with conditioned medium or freshly isolated thymocytes, the expression levels of cytokeratin 19 and E-cadherin were downregulated in NRK-52E cells, while the mRNA and protein expression levels of alpha-smooth muscle actin, desmin, and vimentin were upregulated (P < 0.05). We found that the cell migration abilities of the induced NRK-52E cells were significantly improved. CONCLUSIONS: Both activated rat thymocytes (more percentage of CD8+ T cells) and freshly isolated thymocytes have promoting effects on the EMT of NRK-52E cells.

Thymic carcinoma metastasize to the small intestine: a case report.

BACKGROUND: Thymic carcinoma is a rare mediastinal neoplasm with a high malignant potential. It often shows pleural invasion and distant metastasis. The metastasis of thymic carcinoma to the small intestine is rarely reported and difficult to distinguish from other gastrointestinal tract tumors. CASE PRESENTATION: An elderly man presented with lower abdominal pain for 2 months. Abdominal CT showed a mass communicated with the small intestinal lumen. After radical resection of the small intestinal tumor, resected specimens showed moderately differentiated squamous-cell carcinoma with lymph nodes metastases. The patient received chest CT and was found to have a mass in anterior mediastinum. Biopsies of the mass revealed thymic squamous-cell carcinoma. CONCLUSIONS: We highlighted the metastasis of thymic carcinoma to the small intestine is rare and easily misdiagnosed. In patients with a mass communicated with the small intestinal lumen, a suspicion of thymic carcinoma metastasis should not be overlooked and we should make accurate differential diagnosis from the other small intestinal tumors.

Outdoor Scene Understanding Based on Multi-Scale PBA Image Features and Point Cloud Features.

Outdoor scene understanding based on the results of point cloud classification plays an important role in mobile robots and autonomous vehicles equipped with a light detection and ranging (LiDAR) system. In this paper, a novel model named Panoramic Bearing Angle (PBA) images is proposed which is generated from 3D point clouds. In a PBA model, laser point clouds are projected onto the spherical surface to establish the correspondence relationship between the laser ranging point and the image pixels, and then we use the relative location relationship of the laser point in the 3D space to calculate the gray value of the corresponding pixel. To extract robust features from 3D laser point clouds, both image pyramid model and point cloud pyramid model are utilized to extract multiple-scale features from PBA images and original point clouds, respectively. A Random Forest classifier is used to accomplish feature screening on extracted high-dimensional features to obtain the initial classification results. Moreover, reclassification is carried out to correct the misclassification points by remapping the classification results into the PBA images and using superpixel segmentation, which makes full use of the contextual information between laser points. Within each superpixel block, the reclassification is carried out again based on the results of the initial classification results, so as to correct some misclassification points and improve the classification accuracy. Two datasets published by ETH Zurich and MINES ParisTech are used to test the classification performance, and the results show the precision and recall rate of the proposed algorithms.

High expression of ACTL6A leads to poor prognosis of oral squamous cell carcinoma patients through promoting malignant progression.

OBJECTIVE: The aim was to research ACTL6A's role in oral squamous cell carcinoma (OSCC). METHODS: OSCC and normal samples were obtained from patients and public databases. GSEA was performed. CIBERSORT was utilized to analyze immune landscape. Kaplan-Meier survival analysis and multivariate Cox regression analysis were conducted. After knocking down ACTL6A, we performed MTT assay, transwell assays, and flow cytometry to detect the impact of knockdown. RESULTS: ACTL6A expressed higher in OSCC samples than normal samples. The CNV and mutation rate of TP53 was higher in ACTL6A high-expression group. TFs E2F7 and TP63 and miRNA hsa-mir-381 were significantly related to ACTL6A. ACTL6A could influence immune microenvironment of OSCC. Knockdown of ACTL6A inhibited OSCC cells' proliferation, migration, and invasion. ACTL6A was able to predict OSCC prognosis independently. CONCLUSION: ACTL6A expressed higher in OSCC than normal samples and it could be used as an independent prognostic marker in OSCC patients.

T2WI-based MRI radiomics for the prediction of preoperative extranodal extension and prognosis in resectable rectal cancer.

OBJECTIVE: To investigate whether T2-weighted imaging (T2WI)-based intratumoral and peritumoral radiomics can predict extranodal extension (ENE) and prognosis in patients with resectable rectal cancer. METHODS: One hundred sixty-seven patients with resectable rectal cancer including T3T4N + cases were prospectively included. Radiomics features were extracted from intratumoral, peritumoral 3 mm, and peritumoral-mesorectal fat on T2WI images. Least absolute shrinkage and selection operator regression were used for feature selection. A radiomics signature score (Radscore) was built with logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each Radscore. A clinical-radiomics nomogram was constructed by the most predictive radiomics signature and clinical risk factors. A prognostic model was constructed by Cox regression analysis to identify 3-year recurrence-free survival (RFS). RESULTS: Age, cT stage, and lymph node-irregular border and/or adjacent fat invasion were identified as independent clinical risk factors to construct a clinical model. The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and independent clinical risk factors achieved a better AUC than the clinical model in the training (0.799 vs. 0.736) and validation cohorts (0.723 vs. 0.667). Nomogram-based ENE (hazard ratio [HR] = 2.625, 95% CI = 1.233-5.586, p = 0.012) and extramural vascular invasion (EMVI) (HR = 2.523, 95% CI = 1.247-5.106, p = 0.010) were independent risk factors for predicting 3-year RFS. The prognostic model constructed by these two indicators showed good performance for predicting 3-year RFS in the training (AUC = 0.761) and validation cohorts (AUC = 0.710). CONCLUSION: The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and clinical risk factors could predict preoperative ENE. Combining nomogram-based ENE and MRI-reported EMVI may be useful in predicting 3-year RFS. CRITICAL RELEVANCE STATEMENT: A clinical-radiomics nomogram could help preoperative predict ENE, and a prognostic model constructed by the nomogram-based ENE and MRI-reported EMVI could predict 3-year RFS in patients with resectable rectal cancer. KEY POINTS: • Intratumoral and peritumoral 3 mm Radscore showed the most capability for predicting ENE. • Clinical-radiomics nomogram achieved the best predictive performance for predicting ENE. • Combining clinical-radiomics based-ENE and EMVI showed good performance for 3-year RFS.

Whole-genome DNA methylation profiling reveals epigenetic signatures in developing muscle in Tan and Hu sheep and their offspring.

Introduction: The Tan sheep is a popular local breed in China because of its tenderness and flavor. The Hu sheep breed is also famous for its high litter size, and its muscle growth rate is faster than that of Tan sheep. However, the epigenetic mechanism behind these muscle-related phenotypes is unknown. Methods: In this study, the longissimus dorsi tissue from 18 6 month-old Tan sheep, Hu sheep, and Tan-Hu F2 generation (6 sheep per population) were collected. After genomic DNA extraction, whole-genome bisulfite sequencing (WGBS) and bioinformatics analysis were performed to construct genome-wide DNA methylome maps for the Tan sheep, Hu sheep and their Tan-Hu F2 generation. Results: Distinct genome-wide DNA methylation patterns were observed between Tan sheep and Hu sheep. Moreover, DNA methylated regions were significantly increased in the skeletal muscle from Tan sheep vs. the F2 generation compared to the Hu sheep vs. F2 generation and the Tan sheep vs. Hu sheep. Compared with Hu sheep, the methylation levels of actin alpha 1 (ACTA1), myosin heavy chain 11 (MYH11), Wiskott-Aldrich syndrome protein (WAS), vav guanine nucleotide exchange factor 1 (VAV1), fibronectin 1 (FN1) and Rho-associated protein kinase 2 (ROCK2) genes were markedly distinct in the Tan sheep. Furthermore, Gene Ontology analysis indicated that these genes were involved in myotube differentiation, myotube cell development, smooth muscle cell differentiation and striated muscle cell differentiation. Conclusion: The findings from this study, in addition to data from previous research, demonstrated that the ACTA1, MYH11, WAS, VAV1, FN1, and ROCK2 genes may exert regulatory effects on muscle development.

Ewing sarcoma of the ileum with wide multiorgan metastases: A case report and review of literature.

BACKGROUND: Ewing sarcoma (ES) is an aggressive small round cell tumor that usually occurs in younger children and young adults but rarely in older patients. Its occurrence in elderly individuals is rare. ES of the ileum with wide multiorgan metastases is rarely reported and difficult to distinguish radiologically from other gastrointestinal tract tumors. CASE SUMMARY: A 53-year-old man presented with right lower quadrant pain for 2 wk. Computed tomography results showed a heterogeneous mass within the ileum and widespread multiorgan metastases. This mass was biopsied, and pathological examination of the resected specimen revealed features consistent with an extraskeletal ES. CONCLUSION: This case emphasizes the importance of recognizing this rare presentation in the small intestine to broaden the differential diagnosis of adult intraabdominal tumors.

Analysis of m6A modulator-mediated methylation modification patterns and the tumor microenvironment in lung adenocarcinoma.

Lung adenocarcinoma (LUAD) is the most common histological subtype of lung cancer. In the development and progression of LUAD, epigenetic aberration plays a crucial role. However, the function of RNA N6-methyladenosine (m6A) modifications in the LUAD progression is unknown. The m6A regulator modification patterns in 955 LUAD samples were analyzed comprehensively. Patterns were systematically correlated with the tumor microenvironment (TME) cell-infiltration characteristics. Using principal component analysis algorithms, the m6Ascore was generated to quantify m6A modification patterns in individual tumors. Then, their values for predicting prognoses and therapeutic response in LUAD patients were assessed. Three distinct m6A modification patterns in LUAD were identified. Among them, the prognosis of m6Acluster C was the best, while the prognosis of m6Acluster A was the worst. Interestingly, the characterization of TME cell infiltration and biological behavior differed among the three patterns. To evaluate m6A modification patterns within individual tumors, an m6Ascore signature was constructed. The results showed that the high m6Ascore group was associated with a better prognosis; tumor somatic mutations and tumor microenvironment differed significantly between the high- and low- m6Ascore groups. Furthermore, in the cohort with anti-CTLA-4 treatment alone, patients with a high m6Ascore had higher ICI scores, which indicated significant therapeutic advantage and clinical benefits.

Value of intravoxel incoherent motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rectal cancer.

OBJECTIVE: To assess the role of region of interest (ROI) selection of intravoxel incoherent motion (IVIM) for predicting lymph node metastases (LNM) and tumor response after chemoradiation therapy (CRT) in locally advanced rectal cancer. MATERIALS AND METHODS: Seventy-nine patients with biopsy-proven rectal adenocarcinoma who underwent pre- and post-CRT MRI and surgery were prospectively enrolled. The exclusion criteria included nonresectable and/or metastatic disease and loss of follow-up. Pathological stage was determined using ypTNM stage and tumor regression grade. Slow diffusion coefficient (D), fast diffusion coefficient (D*), perfusion-related diffusion fraction (f), apparent diffusion coefficient (ADC) and their percentage changes (Δ%) were evaluated by two readers using whole-volume, single-slice and small samples ROI methods. Risk factors including carcinoembryonic antigen, post-CRT T-staging, extramural venous invasion and IVIM parameters were evaluated through multivariate analyses. Areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate diagnostic performance. Duration of follow-up was two-year. Recurrence-free survival of patients with LNM and tumor response was estimated using Kaplan-Meier analysis. RESULTS: Interobserver agreement were good for pre- and post-CRT three ROI methods (intraclass correlation coefficient [ICC], 0.581-0.953). Whole-volume ROI-derived Δ%D was an independent risk factor for LNM, non-pathological complete response (non-pCR) and poor response (odds ratio, 0.940, 0.952, 0.805, respectively; all p < 0.001). Whole-volume ROI-derived Δ%D showed best AUC of 0.810, 0.851 and 0.903 for LNM, non-pCR and poor response (cutoff value, 31.8%, 54.5%, 52.8%, respectively). Patients with post-CRT LNM showed reduction in 2-year recurrence-free survival (hazard ratio, 3.253). CONCLUSIONS: Whole-volume ROI-derived Δ%D provided high diagnostic performance for evaluating post-CRT LNM and tumor response. Patients with post-CRT LNM showed earlier recurrence.

Assessment of histologic prognostic factors of resectable rectal cancer: comparison of diagnostic performance using various apparent diffusion coefficient parameters.

This study is to investigate optimum apparent diffusion coefficient (ADC) parameter for predicting lymphovascular invasion (LVI), lymph node metastasis (LNM) and histology type in resectable rectal cancer. 58 consecutive patients with resectable rectal cancer were retrospectively identified. The minimum, maximum, average ADC and ADC difference value were obtained on ADC maps. Maximum ADC and ADC difference value increased with the appearance of LVI (r = 0.501 and 0.495, P < 0.001, respectively) and development of N category (r = 0.615 and 0.695, P < 0.001, respectively). ADC difference value tended to rise with lower tumor differentiation (r = - 0.269, P = 0.041). ADC difference value was an independent risk factor for predicting LVI (odds ratio = 1.323; P = 0.005) and LNM (odds ratio = 1.526; P = 0.005). Maximum ADC and ADC difference value could distinguish N0 from N1 category, N0 from N1-N2, N0-N1 from N2 (all P < 0.001). Only ADC difference value could distinguish histology type (P = 0.041). ADC difference value had higher area under the receiver operating characteristic curve than maximum ADC in identifying LVI (0.828 vs 0.797), N0 from N1 category (0.947 vs 0.847), N0 from N1-N2 (0.935 vs 0.874), and N0-N1 from N2 (0.814 vs 0.770). ADC difference value may be superior to the other ADC value parameters to predict LVI, N category and histology type of resectable rectal cancer.