Preoperative alkaline phosphatase-to-platelet count ratio as a prognostic factor for hepatocellular carcinoma with microvascular invasion.

OBJECTIVES: The association between platelet status and hepatocellular carcinoma (HCC) prognoses remains controversial. Herein, we aimed to clarify the prognostic value of multiple platelet-related biomarkers, including platelet count, platelet/lymphocyte ratio (PLR), aspartate aminotransferase to platelet ratio index (APRI), and alkaline phosphatase-to-platelet count ratio index (APPRI) in HCC with microvascular invasion (MVI) after curative resection or liver transplantation. MATERIALS AND METHODS: A retrospective review of 169 patients with solitary HCC and MVI who underwent resection or liver transplantation between January 2015 and December 2018 was conducted. Preoperative clinical, laboratory, pathologic, and imaging data were collected and analyzed. Overall survival (OS) and disease-free survival (DFS) were defined as the clinical endpoints. Univariate and multivariate Cox proportional hazards regression analyses were conducted to investigate potential predictors of DFS and OS. RESULTS: Multivariate Cox regression analyses revealed that maximum tumor diameter, poor cell differentiation, and APPRI were independent predictors of DFS; while poor cell differentiation, APRI, APPRI, prothrombin time, and alpha-fetoprotein were independent prognostic factors for OS. The 1-, 3-, and 5-year DFS rates were 66.90%, 48.40%, and 37.40% for patients with APPRI ≤0.74 and 40.40%, 24.20%,and 24.20% for patients with APPRI>0.74. The corresponding rates of OS over 1, 3, and 5 years were 92.40%, 88.10% and 77.70%, and 72.30%, 38.20%, and 19.10%, respectively. The DFS and OS rates of patients whose APPRI was more than 0.74 were substantially lower than those of patients whose APPRI was less than or equal to 0.74 (p = 0.002 and p < 0.001, respectively). CONCLUSION: Elevated preoperative APPRI is a noninvasive, simple, and easily assessable parameter linked to poor prognosis in individuals with single HCC and MVI after resection or liver transplantation.

Dynamic Observation of Lung Nodules on Chest CT Before Diagnosis of Early Lung Cancer.

Objective: Early recognition and diagnosis of lung cancer can help improve the prognosis of patients. However, early imaging patterns of malignant lung nodules are not fully clear. To understand the early imaging signs of malignant lung cancer nodules, the changes of the lung nodules before diagnosis were dynamically observed and analyzed. Materials and Methods: This retrospective study observed dynamic changes of lung nodules before pathological confirmation with consecutive regular chest CT examination from January 2003 to December 2018. At least 3 follow-up CT scans were performed in all cases, and the interval between each follow-up was about 1 year. The size, density, and morphological signs of the nodules were evaluated based on the CT axial image, and a reverse line chart or scatter plot with the diagnosis time as coordinate origin was constructed. Results: A total of 55 lung nodules in 53 patients (mean age, 58.40 years ±11.43 [standard deviation]; 20 women) were accessed. The follow-up time was 5.96 ± 2.68 years. The average diameters in maximum slice of the lesion at baseline and last scan were 6.83 ± 2.92 mm and 16.65 ± 7.34 mm, respectively. According to the reverse line chart, the nodule growth curve segments within 4 years from the last scan showed an ascending shape, and those beyond 4 years showed a flat shape. There are 90.9% (50/55) GGN and 9.1% (5/55) SN when the lesion first appears, and 21.8% (12/55) GGN, 38.2% (21/55) PSN, and 40% (22/55) SN in the last scan. There are 12.7% (7/55) and 98.2% (54/55) nodules with poor morphological signs at baseline and last scan, respectively. Conclusion: At the time node close to the diagnosis, the growth curve showed an upward pattern; the proportion of PSN and SN rose as the main density types; and the appearance of poor morphological signs of nodules increased. When a persistent lung nodule starts to show a malignant change, a further diagnostic workup is warranted.

MRI-Based Deep-Learning Model for Distant Metastasis-Free Survival in Locoregionally Advanced Nasopharyngeal Carcinoma.

BACKGROUND: Distant metastasis is the primary cause of treatment failure in locoregionally advanced nasopharyngeal carcinoma (LANPC). PURPOSE: To develop a model to evaluate distant metastasis-free survival (DMFS) in LANPC and to explore the value of additional chemotherapy to concurrent chemoradiotherapy (CCRT) for different risk groups. STUDY TYPE: Retrospective. POPULATION: In all, 233 patients with biopsy-confirmed nasopharyngeal carcinoma (NPC) from two hospitals. FIELD STRENGTH: 1.5T and 3T. SEQUENCE: Axial T2 -weighted (T2 -w) and contrast-enhanced T1 -weighted (CET1 -w) images. ASSESSMENT: Deep learning was used to build a model based on MRI images (including axial T2 -w and CET1 -w images) and clinical variables. Hospital 1 patients were randomly divided into training (n = 169) and validation (n = 19) cohorts; Hospital 2 patients were assigned to a testing cohort (n = 45). LANPC patients were divided into low- and high-risk groups according to their DMFS (P < 0.05). Kaplan-Meier survival analysis was performed to compare the DMFS of different risk groups and subgroup analysis was performed to compare patients treated with CCRT alone and treated with additional chemotherapy to CCRT in different risk groups, respectively. STATISTICAL TESTS: Univariate analysis was performed to identify significant clinical variables. The area under the receiver operating characteristic (ROC) curve (AUC) was used to assess the model performance. RESULTS: Our deep-learning model integrating the deep-learning signature, node (N) stage (from TNM staging), plasma Epstein-Barr virus (EBV)-DNA, and treatment regimens yielded an AUC of 0.796 (95% confidence interval [CI]: 0.729-0.863), 0.795 (95% CI: 0.540-1.000), and 0.808 (95% CI: 0.654-0.962) in the training, internal validation, and external testing cohorts, respectively. Low-risk patients treated with CCRT alone had longer DMFS than patients treated with additional chemotherapy to CCRT (P < 0.05). DATA CONCLUSION: The proposed deep-learning model, based on MRI features and clinical variates, facilitated the prediction of DMFS in LANPC patients. LEVEL OF EVIDENCE: 3. TECHNICAL EFFICACY STAGE: 4.

Hipbone biomechanical finite element analysis and clinical study after the resection of ischiopubic tumors / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the changes of hipbone biomechanics after the resection of ischiopubic tumors and their relationships with the complications in the convalescent stage, and directing the postoperative pelvic reconstruction.</p><p><b>METHODS</b>DICOM data were used to create an intact hipbone finite element model and postoperative model. The biomechanical indices on the same region in the two models under the same boundary condition were compared. The differences of displacement, stress, and strain of the two models were analyzed with statistical methods.</p><p><b>RESULTS</b>The distribution areas of the hipbone nodes' displacement, stress, and strain were similar before and after the simulated operation. The sacroiliac joint nodes' displacement (P=0.040) and strain (P=0.000), and the acetabular roof nodes' stress (P=0.000) and strain (P=0.005) of two models had significant differences, respectively.But the sacroiliac joint nodes' stress (P=0.076) and the greater sciatic notch nodes' stress (P=0.825) and strain (P=0.506) did not have significant differences.</p><p><b>CONCLUSIONS</b>The resection of ischiopubic tumors mainly affect the biomechanical states of the homolateral sacroiliac joint and acetabular roof. The complications in the convalescent stage are due to the biomechanical changes of the sacroiliac joint and the acetabular roof and disappearances of the stabilization and connection functions of the pubic symphysis and superior ramus of pubis.</p>

[Measurement of anatomical relationships of facial nerve canal related to middle ear and mastoid surgery on multi-slice computed tomography-multiplanar reformation images].

OBJECTIVE: To investigate the anatomical relationships of facial nerve canal related to middle ear and mastoid surgery by multi-slice computed tomography (MSCT) and its multiplanar reconstruction ( MPR) technology. METHODS: High-resolution CT scanning with multislice spiral CT of temporal bones without bone abnormality of 373 ears in 187 adult patients were examined. All original images were processed by MPR. The distances between facial nerve canal (FNC) and jugular foramen (JF), lateral surface of mastoid bone (M), external acoustic canal (EAC), posterior fossa dural plate (PFD), sigmoid sinus (SS), promontory (P), cochlear window (CW), pyramidal eminence (PE), posterior semicircular canal (PSC), oval window (OW), head of malleus (MH), incus lenticular process (ILP) and lateral semicircular canal (LSC) were measured on different MPR images. These measurements were also analyzed with respects to side, gender, pneumatization and jugular foramen position differences. RESULTS: On average, FNC-JF was 5.43 mm, FNC-M 15.99 mm, FNC-EAC 4.42 mm, FNC-PFD 9.01 mm, FNC-SS 9.44 mm, FNC-P 6.02 mm, FNC-CW 6.51 mm, FNC-PE 2.64 mm, FNC-PSC 3.12 mm, FNC-OW 1.19 mm, FNC-MH 2.27 mm, FNC-ILP 3.09 mm and FNC-LSC 0.90 mm. FNC-M was longer in males than that of females (P < 0.05). FNC-JF and FNC-SS were longer on left side than those of the right (P < 0.05). FNC-PFD was shorter on left side (P < 0.05). FNC-PFD, FNC-EAC, FNC-SS and FNC-M were longer in well pneumatized mastoids than those of poorly pneumatized mastoids (P < 0.05). FNC-PE was longer in poorly pneumatized mastoids than that of well pneumatized mastoids (P < 0.05). FNC-PFD, FNC-P, FNC-CW and FNC-PSC were longer in bones with jugular foramen variation than those of bones without jugular foramen variation (P < 0.05). FNC-JF, FNC-SS and FNC-M were longer in bones without jugular foramen variation than those of bones with jugular foramen variation (P < 0.05). CONCLUSIONS: Anatomical relationships of facial nerve canal related to middle ear and mastoid surgery can be accurately measured on MSCT-MPR images. It is helpful to avoid injuring facial nerve in middle ear and mastoid surgery.