ABSTRACT
Objective To evaluate the performance of FibroTouch in combination with four hepatic fibrosis biomarkers for assessment of the degree of hepatic fibrosis among patients with chronic schistosomiasis-induced liver disorders. Methods A total of 63 patients with chronic schistosomiasis-induced liver diseases admitted to The Third People’s Hospital of Kunshan City from January to March 2021 were enrolled as the observation group, while 50 healthy volunteers receiving health examinations in the hospital during the study period were randomly selected as the control group. The liver stiffness measurement (LSM) was determined using the FibroTouch technique, and the serum levels of four hepatic fibrosis biomarkers were detected using chemilumi-nescence immunoassay, including type IV collagen (IV-C), type III procollagen (PC-III), hyaluronidase (HA) and laminin (LN). The receiver operating characteristic (ROC) curves of LSM and four hepatic fibrosis biomarkers alone and in combination for assessing the degree of hepatic fibrosis among patients with chronic schistosomiasis-induced liver disorders were plotted and the area under the ROC curve (AUC) was estimated to examine the value of LSM and four hepatic fibrosis biomarkers alone and in combination for assessing the degree of hepatic fibrosis. Results There were 63 subjects in the observation group, including 28 men and 35 women, and the participants had a mean age of (65.34 ± 12.56) years and a mean body mass index (BMI) of (24.47 ± 11.05) kg/m2. There were 50 subjects in the control group, including 22 men and 28 women, and the participants had a mean age of (64.28 ± 13.10) years and a mean BMI of (25.12 ± 11.64) kg/m2. There were no significant differences between the observation and control groups in terms of gender ratio (χ2 = 0.002, P > 0.05), age (t = 0.437, P > 0.05) or BMI (t = 0.303, P > 0.05). The LSM [(8.65 ± 5.22) vs. (3.24 ± 1.10) kPa; t = 8.013, P < 0.05], IV-C [(51.80 ± 9.45) vs. (30.10 ± 10.34) ng/L; t = 11.506, P < 0.05], PC-III [(77.28 ± 17.22) vs. (48.62 ± 9.54) ng/L; t = 11.224, P < 0.05], HA [(39.55 ± 5.32) vs. (84.89 ± 10.34) ng/L; t = 30.158, P < 0.05] and LN [(99.47 ± 7.37) vs. (61.93 ± 9.80) ng/L; t = 22.496, P < 0.05] were significantly greater in the observation group than in the control group, and Spearman correlation analysis showed that the degree of liver fibrosis positively correlated with LSM (rs = 0.675, P < 0.01), IV-C (rs = 0.421, P < 0.01), PC-III (rs = 0.517, P < 0.01), HA (rs = 0.550, P < 0.01) and LN (rs = 0.539, P < 0.01) among patients with chronic schistosomiasis-induced liver diseases. ROC curve analysis revealed that the AUC of LSM for assessment of the hepatic fibrosis degree was 0.884 (P < 0.001), and the LSM cutoff, sensitivity and specificity were 11.75 kPa, 71.43% and 84.00% at the highest Youden index, respectively. In addition, the AUC of four hepatic fibrosis biomarkers for assessment of the hepatic fibrosis degree was 0.577 to 0.670, with 70.174 to 115.237 ng/L cutoff values, 17.46% to 68.25% sensitivity and 71.01% to 96.00% specificity. In addition, the sensitivity and specificity of LSM combined with four hepatic fibrosis biomarkers were 92.06% and 95.07% for assessment of the hepatic fibrosis degree among patients with chronic schistosomiasis-induced liver diseases. Conclusion FibroTouch in combination with detection of four hepatic fibrosis biomarkers has a high sensitivity and specificity for assessing the degree of hepatic fibrosis among patients with chronic schistosomiasis-induced liver diseases, which deserves widespread clinical uses.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the lymph node metastasis and the rational lymphadenectomy in thoracic esophageal carcinoma.</p><p><b>METHODS</b>Eighty-seven patients with thoracic esophageal squamous carcinoma received esophagectomy plus two-field or three-field lymphadenectomy based on cervical ultrasonography.</p><p><b>RESULTS</b>Thirty-five patients (40.2% ) with enlarged cervical nodes revealed by cervical ultrasonography received cervical lymphadenectomy. The proportion of cervical lymphadenectomy was 66.7% (16/24) in upper thoracic esophageal carcinomas, significantly higher than 30.2% (19/63) in middle and lower esophageal carcinomas (P=0.002). Regional and cervical lymph node metastasis were found in 48(55.2% ) and 17(19.5% ) patients respectively. The regional lymph node metastatic rates were 37.5% (9/24), 62.3% (33/53) and 60.0% (6/10) respectively in the patients with upper, middle, and lower thoracic esophageal carcinoma. The cervical lymph node metastatic rates in the patients with or without regional lymph node metastasis were 31.3% (15/48) and 5.1% (2/39) respectively(P=0.002). The rates of upper, mid, lower mediastinal and upper abdominal lymph node metastasis were 25.3%, 23.0%, 5.7%, and 24.1% respectively. Cervical lymph node metastasis was significantly correlated with upper and mid mediastinal metastasis (both P< 0.01), but not with lower mediastinal and upper abdominal lymph node metastasis. The overall postoperative morbidity rate was significantly higher in three field lymphadenectomy group than that in two field group(60.0% vs. 34.6%, P=0.020).</p><p><b>CONCLUSION</b>Selective 3-field lymphadenectomy based on cervical ultrasonography should be performed in thoracic esophageal carcinoma, especially with upper and mid mediastinal lymph node metastasis.</p>