Development of a combined model incorporating clinical characteristics and magnetic resonance imaging features to enhance the predictive value of a prognostic model for locally advanced cervical cancer.

Objective: This study aimed to develop non-invasive predictive tools based on clinical characteristics and magnetic resonance imaging (MRI) features to predict survival in patients with locally advanced cervical cancer (LACC), thereby facilitating clinical decision-making. Methods: We conducted a retrospective analysis of clinical and MRI data from LACC patients who underwent radical radiotherapy at our center between September 2012 and May 2020. Prognostic predictors were identified using single-factor and multifactor Cox analyses. Clinical and MRI models were established based on relevant features, and combined models were created by incorporating MRI factors into the clinical model. The predictive performance of the models was evaluated using the area under the curve (AUC), consistency index (C-index), and decision curve analysis (DCA). Results: The study included 175 LACC patients. Multivariate Cox analysis revealed that patients with FIGO IIA-IIB stage, ECOG score 0-1, CYFRA 21-1<7.7 ng/ml, ADC ≥ 0.79 mm^2/s, and Kep ≥ 4.23 minutes had a more favorable survival prognosis. The clinical models, incorporating ECOG, FIGO staging, and CYFRA21-1, outperformed individual prognostic factors in predicting 5-year overall survival (AUC: 0.803) and 5-year progression-free survival (AUC: 0.807). The addition of MRI factors to the clinical model (AUC: 0.803 for 5-year overall survival) increased the AUC of the combined model to 0.858 (P=0.011). Similarly, the combined model demonstrated a superior predictive ability for 5-year progression-free survival, with an AUC of 0.849, compared to the clinical model (AUC: 0.807) and the MRI model (AUC: 0.673). Furthermore, the C-index of the clinical models for overall survival and progression-free survival were 0.763 and 0.800, respectively. Upon incorporating MRI factors, the C-index of the combined model increased to 0.826 for overall survival and 0.843 for progression-free survival. The DCA further supported the superior prognostic performance of the combined model. Conclusion: Our findings indicate that ECOG, FIGO staging, and CYFRA21-1 in clinical characteristics, as well as ADC and Kep values in MRI features, are independent prognostic factors for LACC patients undergoing radical radiotherapy. The combined models provide enhanced predictive ability in assessing the risk of patient mortality and disease progression.

Comparison of temporal-to-frontal horn shunt and ventriculo-peritoneal shunt for treatment of trapped temporal horn: a retrospective cohort study.

As a localized hydrocephalus, trapped temporal horn (TTH) can be effectively resolved via cerebrospinal fluid shunting. In addition to conventional ventriculo-peritoneal shunt (VPS), temporal-to-frontal horn shunt (TFHS) has been described as a less complex and invasive procedure with promising results; however, there is limited data comparing VPS to TFHS regarding patient outcomes. This study aims to compare TFHS versus VPS for treatment of TTH. We conducted a comparative cohort study with patients undergoing TFHS or VPS for TTH after surgery of trigonal or peritrigonal tumors between 2012 and 2021. The primary outcome was revision rates at 30-day, 6-month, and 1-year. Secondary outcomes included operative duration, postoperative pain, hospital stay, overdrainage, and cost for shunt placement and revision. A total of 24 patients included, with 13 (54.2%) patients receiving TFHS and 11 (45.8%) receiving VPS. Both cohorts shared similar baseline characteristics. There were no significant differences between TFHS and VPS in 30-day (7.7% vs 9.1%, p > 0.99), 6-month (7.7% vs 18.2%, p = 0.576), or 1-year (8.3% vs 18.2%, p = 0.590) revision rates. There were no significant differences in terms of operative duration (93.5 ± 24.1 vs 90.5 ± 29.6 min, p = 0.744), surgical site pain (0 vs 18.2%, p = 0.199), or postoperative length of stay (4.8 ± 2.6 vs 6.9 ± 4.0 days, p = 0.157) between the two groups. For the TFHS cohort, no patient experienced shunt related overdrainage, and there was a trend towards fewer overdrainage (0% vs 27.3%, p = 0.082) compared with VPS. TFHS offered significant reduction in cost for initial shunt (¥20,417 vs ¥33,314, p = 0.030) and total costs for shunt and revision (¥21,602 vs ¥43,196, p = 0.006) compared to VPS. As a technique of valveless shunt and without abdominal incision, TFHS is cosmetic, cost-effective, and completely free of overdrainage with similar revision rates as compared with VPS.

Characteristic features and proposed classification in 69 cases of intracranial microcystic meningiomas.

Microcystic meningioma (MM) is a rare subtype of intracranial meningiomas, with clinical and radiologic features not well characterized in the literature. Based on our experience, we propose a classification system of intracranial MMs. We reviewed the medical records, radiographic studies, and operative notes of a group of consecutive patients with intracranial MM. The mean age of the 69 patients was 46.8 ± 10.6 years (range, 21-75 years). Three types of intracranial MMs could be identified. Type 1 MMs presented as a solid lesion, hypointense or isointense on T1WI, hyperintense on T2WI, and homogeneous or heterogeneous enhancement, and were found in 43 patients (67.2%). Type 2 MMs represented signals similar to CSF both on T1WI and T2WI, and faint reticular enhancement with marginal enhancement, and these were found in 7 patients (10.9%). Type 3 MMs consisted of cystic-solid or cystic lesion and were found in 14 patients (21.9%). Significant differences were observed among the different types of MMs for the following variables: sex, presence of severe peritumoral brain edema (PTBE), and extent of tumor resection. Females were found in all of patients with type 2 MMs, but were only 35.7% of those with type 3 MMs (P = 0.018). Severe PTBEs were more common among patients with type 1 MMs (55.8%) than among those with type 2 (14.3%) and type 3 MMs (14.3%) (P = 0.007). Type 1 MMs (97.7%) were associated with a significantly higher rate of gross total resection compared with the other two types (71.4 and 78.6%) (P = 0.019). Total length of hospital stay after craniotomy ranged from 4 to 30 days (median, 8 days). There were no significant differences in progression-free survival among the three types of MMs (P = 0.788). The current classification identifies three distinct types of intracranial MM based on their radiological findings and growth patterns. The type 1 MMs are more commonly associated with severe PTBE. Type 2 and Type 3 MMs have a higher predilection towards parasaggital location with venous involvement and therefore have a lower rate of gross total resection.