Differential diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma by ultrasonography combined with multiphase enhanced computed tomography.

Purpose: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are primary liver cancers with different therapeutic methods and prognoses. This study aims to investigate the ultrasonography and enhanced computed tomography (CT) features of these cancers and improve the early diagnosis rate. Methods: We retrospectively analyzed the clinical and imaging data of 319 patients diagnosed with HCC and 124 patients diagnosed with ICC, confirmed by pathology. Results: A total of 443 patients were eligible in this study. From the perspective of clinical data, between HCC and ICC patients existed significant differences in age, gender, hepatic background, serum tumor markers of AFP and CA19.9, chronic hepatitis B/C and lymph node infiltration (p<0.05), but not in tumor size, microvascular invasion, serum tumor markers of CEA and CA125 (P>0.05). With respect to ultrasonography features, HCC patients had a higher proportion than ICC patients in splenomegaly (p=0.001), while ICC patients had a higher proportion than HCC patients in absence/not rich vascularity and intrahepatic bile duct dilatation (p<0.05). With respect to CT features, HCC patients were significantly different from ICC patients in the three-phase enhanced CT value mean, enhanced intensity and homogeneity of nodules (P<0.05). A multivariate logistic regression analysis was performed to further clarify the correlation of these indices. However, only age≤60 years (OR=1.861, P=0.045), male (OR=3.850, P<0.001), AFP>7ng/ml (OR=0.119, P<0.001), lymph node infiltration (OR=5.968, P<0.001), intrahepatic bile duct dilatation (OR=2.414, P=0.04), splenomegaly (OR=0.081, P<0.001), rim APHE (OR=3.109, P=0.002), and iso- or hyper enhancement (OR=0.188, P<0.001) were independent risk factors. Conclusions: While there are overlapping ultrasonography and CT features between HCC and ICC, the integration of tumor markers and specific imaging characteristics can be beneficial in distinguishing between the two.

A pan-cancer analysis of the prognosis and immune infiltration of eEF1A2 and its potential function in thyroid carcinoma.

Purpose: Eukaryotic translation elongation factor 1α2 (eEF1A2) promotes tumour progression in various cancers. We performed a pan-cancer analysis of eEF1A2 and explored its role in thyroid carcinoma (THCA). Methods: Databases from The Cancer Genome Atlas (TCGA), the University of Alabama at Birmingham Cancer data analysis Portal (UALCAN), and the Human Protein Atlas (HPA) were used to investigate the differential expression of eEF1A2 in pan-cancer. The pathological stage, prognostic characteristics, tumour microenvironment (TME), tumour mutational burden (TMB), and microsatellite instability (MSI) were analysed in diverse tumours with different expression levels of eEF1A2. The expression levels in papillary thyroid carcinoma (PTC) and its specific role in cell proliferation, migration, invasion, and cell glycolysis in PTC cells were verified by quantitative real time polymerase chain reaction (qRT-PCR), immunohistochemistry, cell counting kit-8, colony formation, wound healing, Transwell assay, and lactate acid and glucose assays.Results:eEF1A2 was differentially expressed in various malignant tumour tissues compared to control tissues and was associated with poor pathological stage and prognosis in most types of tumours. Moreover, eEF1A2 expression closely correlated with the infiltration of immunosuppressive cells, TMB, and MSI in some tumour types. Expression of eEF1A2 in PTC is higher than the para-carcinoma, and eEF1A2 downregulation suppressed TPC-1 and BCPAP cell proliferation, migration, invasion, and glycolysis. Conclusion: Our study suggests that the expression of eEF1A2 is related to the prognosis and immune infiltration of some tumours and may be a predictor of prognosis and immunotherapy. eEF1A2 could promote malignant behaviour of PTC cells.

Integrating US-guided FNAB, BRAFV600E mutation, and clinicopathologic characteristics to predict cervical central lymph-node metastasis in preoperative patients with cN0 papillary thyroid carcinoma.

BACKGROUND: The prevalence of cervical central lymph-node metastasis (CLNM) is high in patients with papillary thyroid carcinoma (PTC). There is considerable controversy surrounding the benefits of prophylactic central lymph-node dissection (pCLND) in patients with clinically negative central compartment lymph nodes (cN0). Therefore, it is crucial to accurately predict the likelihood of cervical CLNM before surgery to make informed surgical decisions. METHODS: Date from 214 PTC patients (cN0) who underwent partial or total thyroidectomy and pCLND at the Guizhou Provincial People's Hospital were collected and retrospectively analyzed. They were divided into two groups in accordance with cervical CLNM or not. Their information, including clinical characteristics, ultrasound (US) features, pathological results of fine-needle aspirations biopsy (FNAB), and other characteristics of the groups, was analyzed and compared using univariate and multivariate logistic regression analyses. RESULTS: A total of 214 patients were eligible in this study. Among them, 43.5% (93/214) of PTC patients had cervical CLNM, and 56.5% (121/214) did not. The two groups were compared using a univariate analyses, and there were no significant differences between the two groups in aspect ratio, boundary, morphology, component, and BRAFV600E (P > 0.05), and there were significant differences between gender, age, maximum tumor size, tumor location, capsule contact, microcalcifications, color Doppler flow imaging (CDFI), and Hashimoto's thyroiditis (HT) (P < 0.05). A multivariate logistic regression analysis was performed to further clarify the correlation of these indices. However, only age (OR = 2.455, P = 0.009), maximum tumor size (OR = 2.586, P = 0.010), capsule contact (OR = 3.208, P = 0.001), and CDFI (OR = 2.225, P = 0.022) were independent predictors of cervical CLNM. Combining these four factors, the area under the receiver-operating characteristic (ROC) curve for the joint diagnosis is 0.8160 (95% 0.7596-0.8725). Univariate analysis indicated that capsule contact (P = 0.001) was a possible predictive factor of BRAFV600E mutation. CONCLUSIONS: In conclusion, four independent predictors of cervical CLNM, including age < 45 years, tumor size > 1.0 cm, capsule contact, and rich blood flow, were screened out. Therefore, a comprehensive assessment of these risk factors should be conducted when designing individualized treatment regimens for PTC patients.

The combination of hand grip strength and modified Glasgow prognostic score predicts clinical outcomes in patients with liver cancer.

Purpose: Previous studies have shown that both hand grip strength (HGS) and the modified Glasgow Prognostic Score (mGPS) are associated with poor clinical outcomes in patients with liver cancer. In spite of this, no relevant studies have been conducted to determine whether the combination of HGS and mGPS can predict the prognosis of patients with liver cancer. Accordingly, this study sought to explore this possibility. Methods: This was a multicenter study of patients with liver cancer. Based on the optimal HGS cutoff value for each sex, we determined the HGS cutoff values. The patients were divided into high and low HGS groups based on their HGS scores. An mGPS of 0 was defined as low mGPS, whereas scores higher than 0 were defined as high mGPS. The patients were combined into HGS-mGPS groups for the prediction of survival. Survival analysis was performed using Kaplan-Meier curves. A Cox regression model was designed and adjusted for confounders. To evaluate the nomogram model, receiver operating characteristic curves and calibration curves were used. Results: A total of 504 patients were enrolled in this study. Of these, 386 (76.6%) were men (mean [SD] age, 56.63 [12.06] years). Multivariate analysis revealed that patients with low HGS and high mGPS had a higher risk of death than those with neither low HGS nor high mGPS (hazard ratio [HR],1.50; 95% confidence interval [CI],1.14-1.98; p = 0.001 and HR, 1.55; 95% CI, 1.14-2.12, p = 0.001 respectively). Patients with both low HGS and high mGPS had 2.35-fold increased risk of death (HR, 2.35; 95% CI, 1.52-3.63; p < 0.001). The area under the curve of HGS-mGPS was 0.623. The calibration curve demonstrated the validity of the HGS-mGPS nomogram model for predicting the survival of patients with liver cancer. Conclusion: A combination of low HGS and high mGPS is associated with poor prognosis in patients with liver cancer. The combination of HGS and mGPS can predict the prognosis of liver cancer more accurately than HGS or mGPS alone. The nomogram model developed in this study can effectively predict the survival outcomes of liver cancer.

Moisture Property and Thermal Behavior of Two Novel Synthesized Polyol Pyrrole Esters in Tobacco.

To overcome the shortcomings of high relative humidity and harmful oxidation products from traditional humectants, excellent humectants and flavor precursors were reported herein. Glucosamine hydrochloride was used as the starting material for the cyclization, oxidation, and alkylation processes that produced pyrrole acid. Then, esterification occurred with polyol catalyzed by EDC and DMAP to give the target compounds 2-(2,3-dihydroxypropyl) 4-methyl 5-methyl-1-propyl-1H-pyrrole-2,4-dicarboxylate (Gpe) and (2-hydroxypropyl) 4-methyl 5-methyl-1-propyl-1H-pyrrole-2,4-dicarboxylate (Ppe). Nuclear magnetic resonance (1H NMR, 13C NMR), infrared spectroscopy (IR), and high-resolution mass recorded spectrometry (HRMS) were used to confirm the two novel polyol pyrrole ester compounds. When Gpe and Ppe were added to the tobacco shred, low-field nuclear magnetic resonance (LF-NMR) imaging was applied to assess the hygroscopicity and moisturizing capacity. Furthermore, thermogravimetry (TG) and pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) techniques were applied to study their thermal behaviors. These results showed that the target compounds (Gpe and Ppe) are good humectants with thermal properties of high-temperature stability and flavor release.

Preparation of tobacco pyrolysis liquids in subcritical/supercritical ethanol and their application in the aroma enhancement of heated cigarettes.

For the aroma enhancement research of heated cigarettes, it is worth exploring whether tobacco can be pyrolyzed into pyrolysis liquids containing a large number of volatile aroma components. In this study, tobacco pyrolysis liquids were prepared in subcritical/supercritical ethanol, and their applications in the aroma enhancement of heated cigarettes were investigated. The optimal conditions of supercritical liquefaction reactions were determined by optimizing the reaction time, liquid/solid mass ratio and temperature conditions. Moreover, the effect of supercritical liquefaction conditions on volatile aroma components in tobacco pyrolysis liquids was investigated by GC-MS. The results indicated that the reaction temperature had the most significant impact on the tobacco pyrolysis reaction, and higher reaction temperature promoted the pyrolysis conversion of tobacco, resulting in enhanced tobacco conversion and a high content of volatile components in the tobacco pyrolysis liquid. The optimal reaction conditions for the preparation of tobacco pyrolysis liquid were found to be a temperature of 220°C, a liquid/solid mass ratio = 15, and a 2-h reaction time. Meanwhile, the content of ester compounds and nicotine in the tobacco pyrolysis liquid increased significantly with the increase of reaction temperature. Sub/supercritical ethanol treatment significantly destroyed the surface structure of tobacco, and the degree of tobacco depolymerization increased when temperature rised. The analysis of aroma compounds in the smoke of heated cigarettes indicated that the tobacco pyrolysis liquid could significantly increase the release of aromatic substances and has a significant aroma-enhancing effect. This article proposed and prepared tobacco pyrolysis liquid in subcritical/supercritical ethanol and explored its potential application in the aroma enhancement of heated cigarettes, offering a new route for flavor enhancement technology for this type of product.

Identifying Actionable Variants Using Capture-Based Targeted Sequencing in 563 Patients With Non-Small Cell Lung Carcinoma.

Although the NSCLC diagnostic standards recommend the detection of driver gene mutation, comprehensive genomic profiling has not been used widely in clinical practice. As to the different mutation spectrum characteristics between populations, the research based on Chinese NSCLC cohort is very important for clinical practice. Therefore, we collected 563 surgical specimens from patients with non-small cell lung carcinoma and applied capture-based sequencing using eight-gene panel. We identified 556 variants, with 416 potentially actionable variants in 54.88% (309/563) patients. These single nucleotide variants, insertions and deletions were most commonly found in EGFR (55%), followed by ERBB2 (12%), KRAS (11%), PIK3CA (9%), MET (8%), BRAF (7%), DDR2 (2%), NRAS (0.3%). By using ten protein function prediction algorithms, we also identified 30 novel potentially pathogenic variants. Ninety-eight patients harbored EFGR exon 21 p.L858R mutation and the catalytic domain of the protein tyrosine kinase (PTKc) in EGFR is largely mutated. In addition, there were nine frequent pathogenic variants found in five or more patients. This data provides the potential molecular basis for directing the treatment of lung cancer.

TRIM23 overexpression is a poor prognostic factor and contributes to carcinogenesis in colorectal cancer.

The tripartite motif (TRIM) family proteins play a great role in carcinogenesis. However, the expression pattern, prognostic value and biological functions of tripartite motif containing 23 (TRIM23) in colorectal cancer (CRC) are poorly understood. Here, we found that TRIM23 is up-regulated and associated with tumour size, lymph node metastasis, American Joint Committee on Cancer (AJCC) stage and poor prognosis in CRC. Multivariate Cox regression analyses revealed that TRIM23 overexpression could be identified as an independent prognostic factor for CRC. TRIM23 could promote the proliferation of CRC cell in vitro and in vivo; additionally, TRIM23 depletion induced G1-phase arrest. Gene set enrichment analysis (GSEA) revealed that P53 and cell cycle signalling pathway-related genes were enriched in patients with high TRIM23 expression levels. We show in this study that TRIM23 physically binds to P53 and enhances the ubiquitination of P53, thereby promoting tumour proliferation. Thus, our data indicated that TRIM23 acts as an oncogene in colorectal carcinogenesis and may provide a novel therapeutic target for CRC management.

[Expression of TRIM59 in Non-small Cell Lung Cancer and Its Correlation with Prognosis].

BACKGROUND: TRIM proteins are important members of E3 ubiquitin ligases, and many studies have confirmed that TRIM family members play an important role in the development of various tumors. We found that TRIM59 expression level in non-small cell lung cancer (NSCLC) was significantly increased through second-generation sequencing. The purpose of this study was to investigate the expression of TRIM59 in NSCLC and its relationship with the clinicopathological parameters as well as the prognosis of patients. METHODS: The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets were excavated to analyze the expression of TRIM59 mRNA in NSCLC and its relationship with the prognosis of patients; The expression of TRIM59 protein in 90 tumor tissues and adjacent tissues was detected by immunohistochemical staining, and the relationship between the expression of TRIM59 protein and clinicopathological parameters and prognosis was analyzed. RESULTS: Overexpression of TRIM59 mRNA in tumor tissues predicted poor prognosis. The expression level of TRIM59 protein was significantly higher in tumor tissues than in adjacent tissues, and TRIM59 protein expression was correlated with tumor size (P=0.007), tumor differentiation (P=0.009), tumor-node-metastasis (TNM) stage (P=0.003) and lymph node metastasis (P=0.003). Multivariate Cox regression analyses showed that along with TNM stage, overexpression of TRIM59 could be considered an independent prognostic factor for NSCLC patients. CONCLUSIONS: The expression of TRIM59 is closely related to the prognosis of NSCLC patients, and it is an independent risk factor for NSCLC patients.

Preparation of PolyHIPE Scaffolds for 3D Cell Culture and the Application in Cytotoxicity Evaluation of Cigarette Smoke.

Polystyrene-based polyHIPE (polymerized high internal phase emulsion) materials were prepared by the copolymerization of styrene and divinylbenzene in the continuous phase of a HIPE. The resultant polyHIPE materials were found to have an open-cellular morphology and high porosity, and the polyHIPE structure could be well adjusted by varying the water/oil (W/O) ratio and the amount of emulsifier in the HIPE. Cell culture results showed that the resultant polyHIPE materials, which exhibited larger voids and connected windows as well as high porosity, could promote cell proliferation on the 3D scaffold. A 3D cell cytotoxicity evaluation system was constructed with the polystyrene-based polyHIPE materials as scaffolds and the cigarette smoke cytotoxicity was evaluated. Results showed that the smoke cytotoxicity against A549 cells is much lower in the 3D cell platform compared to the traditional 2D system, showing the great potential of the polyHIPE scaffolds for 3D cell culture and the cytotoxic evaluation of cigarette smoke.

Discovery of Natural Dimeric Naphthopyrones as Potential Cytotoxic Agents Through ROS-Mediated Apoptotic Pathway.

A study on the secondary metabolites of Aspergillus sp. XNM-4, which was derived from marine algae Leathesia nana (Chordariaceae), led to the identification of one previously undescribed (1) and seventeen known compounds (2-18). Their planar structures were established by extensive spectroscopic analyses, while the stereochemical assignments were defined by electronic circular dichroism (ECD) calculations. The biological activities of the compounds were assessed on five human cancer cell lines (PANC-1, A549, MDA-MB-231, Caco-2, and SK-OV-3), and one human normal cell line (HL-7702) using an MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide] assay. Among them, the dimeric naphthopyrones 7, 10 and 12 exhibited potent cytotoxicity. Further mechanism studies showed that 12 induced apoptosis, arrested the cell cycle at the G0/G1 phase in the PANC-1 cells, caused morphological changes and generated ROS; and it induces PANC-1 cells apoptosis via ROS-mediated PI3K/Akt signaling pathway.

Upregulation of ASAP3 contributes to colorectal carcinogenesis and indicates poor survival outcome.

The function and clinical implication of ArfGAP with SH3 domain, ankyrin repeat, and PH domain 3 (ASAP3) in colorectal cancer (CRC) remains undefined. In the present study, we showed that the expression level of ASAP3 was dramatically increased in CRC and its upregulation was associated with American Joint Committee on Cancer stage (P < 0.001) and poor prognosis (P = 0.0022). The combination of stage and ASAP3 expression improved the prediction of survival in CRC patients. Suppression of ASAP3 inhibited cell proliferation by inducing G1 phase arrest without influencing apoptosis. ASAP3 promoted growth of colon tumors in mice with colitis, and accelerated cell invasion and migration in vitro. Increased ASAP3 was associated with activation of the nuclear factor-κB (NF-κB) canonical pathway in CRC. Upregulation of ASAP3 increased the phosphorylation and nuclear translocation of the p65 NF-κB subunit. Mechanistically, ASAP3 interacts with NF-κB essential modulator (NEMO) and could reduce the polyubiquitinylation of NEMO. Overall, ASAP3 might regulate NF-κB via binding to NEMO. ASAP3 acts as an oncogene in colonic cancer and could be a potential biomarker of colon carcinogenesis.

TRIM47 overexpression is a poor prognostic factor and contributes to carcinogenesis in non-small cell lung carcinoma.

Non-small cell lung carcinoma (NSCLC) is the most common malignancy with the highest morbidity and mortality. In this study, we found that tripartite motif containing 47 (TRIM47) expression level was higher in tumor tissues than in normal adjacent tissues. Overexpression of TRIM47 closely correlated with poor prognosis in patients with NSCLC. Multivariate Cox regression analyses showed that TRIM47 overexpression could be considered an independent prognostic factor for NSCLC. TRIM47 depletion significantly inhibited cell proliferation and induced G1phase arrest in A549 and H358 cell lines. Moreover, TRIM47 silencing remarkably inhibited cell migration, cell invasion, and tumorigenicity in nude mice. Gene set enrichment analysis (GSEA) revealed that cancer-related process and pathways, including p53-cell cycle and NFκB-epithelial mesenchymal transition (EMT) pathway, were significantly correlated with TRIM47 expression. Real-time PCR and Western blot analysis revealed that TRIM47 exerts an inhibitory effect on p53 and an facilitatory effect on NF-κB, thereby promoting tumor proliferation and metastasis. Taken together, TRIM47 acts as a tumor oncogene in NSCLC. Our data provide insight into the possible biological mechanism of TRIM47 in the progression of NSCLC and highlight its usefulness as a potential therapeutic target.

Systematic evaluation of supervised classifiers for fecal microbiota-based prediction of colorectal cancer.

Predicting colorectal cancer (CRC) based on fecal microbiota presents a promising method for non-invasive screening of CRC, but the optimization of classification models remains an unaddressed question. The purpose of this study was to systematically evaluate the effectiveness of different supervised machine-learning models in predicting CRC in two independent eastern and western populations. The structures of intestinal microflora in feces in Chinese population (N = 141) were determined by 454 FLX pyrosequencing, and different supervised classifiers were employed to predict CRC based on fecal microbiota operational taxonomic unit (OTUs). As a result, Bayes Net and Random Forest displayed higher accuracies than other algorithms in both populations, although Bayes Net was found with a lower false negative rate than that of Random Forest. Gut microbiota-based prediction was more accurate than the standard fecal occult blood test (FOBT), and the combination of both approaches further improved the prediction accuracy. Moreover, when unclassified OTUs were used as input, the BayesDMNB text algorithm achieved higher accuracy in the Chinese population (AUC=0.994). Taken together, our results suggest that Bayes Net classification model combined with unclassified OTUs may present an accurate method for predicting CRC based on the compositions of gut microbiota.

Roles of competing endogenous RNAs in gastric cancer.

Long noncoding RNA (lncRNA) is >200 nucleotides long and lacks coding ability. LncRNA was regarded as transcript noise, until emerging results showed its roles in development, homeostasis and carcinogenesis. LncRNAs containing microRNA (miRNA) response elements could compete with the miRNA target gene and regulate its expression through decreasing free functional miRNA. Such lncRNA is called competing endogenous RNA (ceRNA), and the 'lncRNA-miRNA' interaction appreciably enriches the world of RNA-RNA regulation. Gastric cancer involves dysregulation of both protein-coding genes and noncoding genes, and the ceRNA regulatory mechanism may participate in this pathogenic process. In this review, we discuss recent findings on the roles of ceRNAs in gastric carcinogenesis.

Contribution of ultrasound-guided fine-needle aspiration cell blocks of metastatic supraclavicular lymph nodes to the diagnosis of lung cancer.

PURPOSES: Routine smears of fine-needle aspiration (FNA) specimens of supraclavicular lymph nodes with ultrasound (US) real-time guidance have proven useful in lung cancer staging, but the clinical value of additional information from cell-block of FNA samples has been little researched. This study mainly focused on the contribution of cell block analysis to the diagnosis and staging in lung cancer. MATERIALS AND METHODS: Clinical data about 211 lung cancer patients with supraclavicular lymph node enlargement admitted to ultrasonography in the Zhejiang Cancer Hospital and recommended a needle biopsy under US-guided, the adequacy of the specimens for preparing cell blocks was acquireded, and the additional immunohistochemistry or genetic information provided from cell block analysis was examined. RESULTS: In 211 lung cancer patients referred for US-guided FNA (median age 61.8 ± 10.0 years, range 30-88) 279 aspirations were performed. Conventional smears could be obtained from 185 aspirates (66.3%) and contained 176 (95.1%) diagnostic smears. Cell blocks could be obtained from 94 aspirates (33.7%) and contained diagnostic material in 88 (93.6%) aspirates. Above all, cell blocks also made epithelial growth factor receptor gene mutation analysis in 17 patients with FNA samples, and the positive rate was 70.6%. Overall, cell blocks provided clinically significant information for 51 of the 211 patients participating in the study (24.2%). CONCLUSION: Cell-block samples from US-guided FNA is a promising, relatively noninvasive technique to provide additional information in lung cancer diagnosis. Analysis of cell blocks allows for genetic analysis of the patients with supraclavicular lymph nodes metastasis.

A novel approach to segment and classify regional lymph nodes on computed tomography images.

Morphology of lymph nodal metastasis is critical for diagnosis and prognosis of cancer patients. However, accurate prediction of lymph node type based on morphological information is rarely available due to lack of pathological validation. To obtain correct morphological information, lymph nodes must be segmented from computed tomography (CT) image accurately. In this paper we described a novel approach to segment and predict the status of lymph nodes from CT images and confirmed the diagnostic performance by clinical pathological results. We firstly removed noise and preserved edge details using a revised nonlinear diffusion equation, and secondly we used a repulsive-force-based snake method to segment the lymph nodes. Morphological measurements for the characterization of the node status were obtained from the segmented node image. These measurements were further selected to derive a highly representative set of node status, called feature vector. Finally, classical classification scheme based on support vector machine model was employed to simulate the prediction of nodal status. Experiments on real clinical rectal cancer data showed that the prediction performance with the proposed framework is highly consistent with pathological results. Therefore, this novel algorithm is promising for status prediction of lymph nodes.

Quantitative analysis and prediction of regional lymph node status in rectal cancer based on computed tomography imaging.

OBJECTIVES: To quantitatively evaluate regional lymph nodes in rectal cancer patients by using an automated, computer-aided approach, and to assess the accuracy of this approach in differentiating benign and malignant lymph nodes. METHODS: Patients (228) with newly diagnosed rectal cancer, confirmed by biopsy, underwent enhanced computed tomography (CT). Patients were assigned to the benign node or malignant node group according to histopathological analysis of node samples. All CT-detected lymph nodes were segmented using the edge detection method, and seven quantitative parameters of each node were measured. To increase the prediction accuracy, a hierarchical model combining the merits of the support and relevance vector machines was proposed to achieve higher performance. RESULTS: Of the 220 lymph nodes evaluated, 125 were positive and 95 were negative for metastases. Fractal dimension obtained by the Minkowski box-counting approach was higher in malignant nodes than in benign nodes, and there was a significant difference in heterogeneity between metastatic and non-metastatic lymph nodes. The overall performance of the proposed model is shown to have accuracy as high as 88% using morphological characterisation of lymph nodes. CONCLUSIONS: Computer-aided quantitative analysis can improve the prediction of node status in rectal cancer.