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Introduction: Since the response of patients with rectal cancer (RC) to neoadjuvant therapy is highly variable, there is an urgent need to develop accurate methods to predict the post-treatment T (pT) stage. The purpose of this study was to evaluate the utility of multi-parametric MRI radiomics models and identify the most accurate machine learning (ML) algorithms for predicting pT stage of RC. Method: This retrospective study analyzed pretreatment clinical features of 171 RC patients who underwent 3 T MRI prior to neoadjuvant therapy and subsequent total mesorectal excision. Tumors were manually drawn as regions of interest (ROI) layer by layer on high-resolution T2-weighted image (T2WI) and contrast-enhanced T1-weighted image (CE-T1WI) using ITK-SNAP software. The most relevant features of pT stage from CE-T1WI, T2WI, and fusion features (combination of clinical features, CE-T1WI, and T2WI radiomics features) were extracted by the Least Absolute Shrinkage and Selection Operator method. Clinical, CE-T1WI radiomics, T2WI radiomics, and fusion models were established by ML multiple classifiers. Results: In the clinical model, the LightGBM algorithm demonstrated the highest efficiency, with AUC values of 0.857 and 0.702 for the training and test cohorts, respectively. For the T2WI and CE-T1WI models, the SVM algorithm was the most efficient; AUC = 0.969 and 0.868 in the training cohort, and 0.839 and 0.760 in the test cohort, respectively. The fusion model yielded the highest predictive performance using the LR algorithm; AUC = 0.967 and 0.932 in the training and test cohorts, respectively. Conclusion: Radiomics features extracted from CE-T1WI and T2WI images and clinical features were effective predictors of pT stage in patients with rectal cancer who underwent neoadjuvant therapy. ML-based multi-parameter MRI radiomics model incorporating relevant clinical features can improve the pT stage prediction accuracy of RC. [ABSTRACT FROM AUTHOR]

Tongue cancer is among the most prevalent head and neck cancers and is most commonly treated via surgery. We assessed the articulation differences in patients with early and advanced tongue cancer. The study included 26 postoperative tongue cancer patients. We evaluated articulation based on bilabial, labiodental, apical, posterior, laminal, apical front, and apical back speech sounds. The 26 postoperative tongue cancer patients (24 males, two females) had an average age of 54.3 (range 37–89 old) years. Twelve patients were classified as early T stage (T1/T2), while 14 were classified as advanced T stage (T3/T4). The total articulation score was not significantly related to the T stage but apical sounds were so associated. The total articulation score did not significantly differ between postoperative patients with early and advanced tongue cancer. In subgroup analysis, the apical sound was significantly impaired in postoperative patients with advanced tongue cancer. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasonography (EUS) is commonly utilized in preoperative staging of esophageal cancer, however with additional pain and cost as well as adverse events. Meanwhile, the accuracy of EUS is highly depend on the training and practice of operators and not universally available. Different operators would lead to high inter-observer variability. Therefore, it is desirable to explore an alternative way to determine preoperative T stage in esophageal cancer. Whether conventional endoscopy possess the ability to predict EUS T stage has never been investigated yet. In current study, with the assistance of Artificial intelligence, we have developed a deep learning model to predict EUS T stage based on 9,714 images collected from 3,333 patients. ResNet-152 pre-trained on the ImageNet dataset was trained with the appropriate transfer learning and fine-tuning strategies on the conventional endoscopic images and their corresponding labels (e.g., T1, T2, T3, T4 and Normal). Meanwhile, augmentation strategies including rotation and flipping were performed to increase the number of images to improve the prediction accuracy. Finally, 4,382 T1, 243 T2, 3,985 T3, 1,102 T4, 14,302 controls images were obtained and split into training dataset, validation dataset and independent testing dataset with the ratio of 4:1:1. Our model could achieve a satisfied performance with an area under the receiver-operating curve (AUC) were 0.9767, 0.9637, 0.9597 and 0.9442 for T1, T2, T3 and T4, respectively in independent testing dataset. In conclusion, conventional gastroscopy combined with artificial intelligence have the great potential to predict EUS T stage. [ABSTRACT FROM AUTHOR]

Abstract Tongue cancer is among the most prevalent head and neck cancers and is most commonly treated via surgery. We assessed the articulation differences in patients with early and advanced tongue cancer. The study included 26 postoperative tongue cancer patients. We evaluated articulation based on bilabial, labiodental, apical, posterior, laminal, apical front, and apical back speech sounds. The 26 postoperative tongue cancer patients (24 males, two females) had an average age of 54.3 (range 37–89 old) years. Twelve patients were classified as early T stage (T1/T2), while 14 were classified as advanced T stage (T3/T4). The total articulation score was not significantly related to the T stage but apical sounds were so associated. The total articulation score did not significantly differ between postoperative patients with early and advanced tongue cancer. In subgroup analysis, the apical sound was significantly impaired in postoperative patients with advanced tongue cancer.

Objective To summarize the clinicopathological characteristics and prognostic factors of salivary duct carcinoma (SDC) patients. Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. The clinical data of 30 SDC patients who were admitted to the Fourth Hospital of Hebei Medical University from 2014 to 2022, including case records, pathological diagnoses, immunohistochemical indicators, treatment methods, follow-up data, and other data, were retrospectively analyzed. SPSS 26.0 software was used to process the data and construct relevant curves. The chi-square test was used to analyze the correlation between different immunohistochemical indices and the recurrence and metastasis of SDC, and a single factor was used to analyze clinical prognostic factors. Results Among the 30 SDC patients, the male-to-female ratio was 5∶1, with a median age of 61.5 years. Approximately 60% of cases occurred in the parotid gland, whereas the remainder occurred in the submaxillary gland, sublingual gland, or minor salivary gland. Among them, 19 patients were androgen receptor-positive, 23 patients were human epidermal growth factor receptor-2 positive, and 26 patients were Ki-67 positive. Postoperative follow-up was 18-94 months, with a median follow-up of 37 months. There were 13 cases of recurrence and 14 cases of distant metastasis. The 5-year overall survival rate was only 31.2%. The long-term survival of patients who underwent postoperative radiotherapy and chemoradiotherapy was better than that of patients who underwent surgery alone (P= 0.027). T stage and lymph node invasion were associated with prognosis and survival (PP = 0.025). Conclusion Radical surgery combined with postoperative radiotherapy and chemoradiotherapy is helpful for improving long-term overall survival, and tumor T stage and lymph node metastasis may be the main factors affecting the prognosis of patients with SDC. Patients with Ki-67-positive cell counts ≥ 40% are prone to postoperative recurrence or metastasis.

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Objective: To date, there have been few studies examining the prognostic implications of histological subtypes in ureteral cancer. And chemotherapy plays a crucial role in the treatment of ureteral cancer, while many factors influence the efficacy of chemotherapy. This study aimed to utilize the Surveillance, Epidemiology and End Results database to assess the impact of histological type on ureteral cancer prognostic outcomes and discovered how histological type and T-stage influence the efficacy of chemotherapy. Methods: Based on Surveillance, Epidemiology, and End Results Program, we reviewed 8915 records of patients with primary ureteral cancer from 18 centers between 2000 and 2018. We focused on the overall survival and cancer-specific survival of the records and used Kaplan‒Meier method to calculate survival curves. Results: In the comparison of prognostic outcomes, atypical subtypes exhibited a less favorable prognosis compared to typical ureteral carcinoma. Notably, patients diagnosed with papillary urothelial carcinoma demonstrated the most favorable overall survival (p = 0.005). Statistically significant benefits were observed in the prognosis of patients with non-papillary urothelial carcinoma who received chemotherapy (HR = 0.860, 95% CI 0.764–0.966, p = 0.011), while chemotherapy did not yield a statistically significant effect on the prognosis of patients with papillary urothelial carcinoma (HR = 1.055, 95% CI 0.906–1.228, p = 0.493). Chemotherapy had an adverse impact on the prognosis of patients with T1 ureteral cancer (HR = 1.235, 95% CI 1.016–1.502, p = 0.034), whereas it exhibited a positive prognostic effect for T3/T4 cases (HR = 0.739, 95% CI 0.654–0.835, p < 0.001). Conclusions: Histological type affects the prognosis of ureteral cancer. And evaluation of cancer histological type and T stage in ureteral cancer patients prior to chemotherapy is mandatory. [ABSTRACT FROM AUTHOR]

Background: Conventional MRI staging can be challenging in the preoperative assessment of rectal cancer. Deep learning methods based on MRI have shown promise in cancer diagnosis and prognostication. However, the value of deep learning in rectal cancer T‐staging is unclear. Purpose: To develop a deep learning model based on preoperative multiparametric MRI for evaluation of rectal cancer and to investigate its potential to improve T‐staging accuracy. Study Type: Retrospective. Population: After cross‐validation, 260 patients (123 with T‐stage T1‐2 and 134 with T‐stage T3‐4) with histopathologically confirmed rectal cancer were randomly divided to the training (N = 208) and test sets (N = 52). Field Strength/Sequence: 3.0 T/Dynamic contrast enhanced (DCE), T2‐weighted imaging (T2W), and diffusion‐weighted imaging (DWI). Assessment: The deep learning (DL) model of multiparametric (DCE, T2W, and DWI) convolutional neural network were constructed for evaluating preoperative diagnosis. The pathological findings served as the reference standard for T‐stage. For comparison, the single parameter DL‐model, a logistic regression model composed of clinical features and subjective assessment of radiologists were used. Statistical Tests: The receiver operating characteristic curve (ROC) was used to evaluate the models, the Fleiss' kappa for the intercorrelation coefficients, and DeLong test for compare the diagnostic performance of ROCs. P‐values less than 0.05 were considered statistically significant. Results: The Area Under Curve (AUC) of the multiparametric DL‐model was 0.854, which was significantly higher than the radiologist's assessment (AUC = 0.678), clinical model (AUC = 0.747), and the single parameter DL‐models including T2W‐model (AUC = 0.735), DWI‐model (AUC = 0.759), and DCE‐model (AUC = 0.789). Data Conclusion: In the evaluation of rectal cancer patients, the proposed multiparametric DL‐model outperformed the radiologist's assessment, the clinical model as well as the single parameter models. The multiparametric DL‐model has the potential to assist clinicians by providing more reliable and precise preoperative T staging diagnosis. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Advancements in the classification of lung adenocarcinoma have resulted in significant changes in pathological reporting. The eighth edition of the tumour–node–metastasis (TNM) staging guidelines calls for the use of invasive size in staging in place of total tumour size. This shift improves prognostic stratification and requires a more nuanced approach to tumour measurements in challenging situations. Similarly, the adoption of new grading criteria based on the predominant and highest‐grade pattern proposed by the International Association for the Study of Lung Cancer (IASLC) shows improved prognostication, and therefore clinical utility, relative to previous grading systems. Spread through airspaces (STAS) is a form of tumour invasion involving tumour cells spreading through the airspaces, which has been highly researched in recent years. This review discusses updates in pathological T staging, adenocarcinoma grading and STAS and illustrates the utility and limitations of current concepts in lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Objective To assess the prognostic value of clinicopathological factors as well as BRAF and TERT promoter mutations in predicting distant metastasis in patients with papillary thyroid cancer. Design The status of BRAF and TERTp mutations were available in 1,208 thyroid cancer patients who received thyroidectomy at Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine from January 2008 to December 2021. Based on inclusion criteria, 99 distant metastasis thyroid cancers (DM-TCs) and 1055 patients without DM (Non-DM-TCs) were retrospectively reviewed. Results After univariate and multivariate analyses, a risk model was established for DM prediction based on factors: T3/T4 stage, lymph node metastasis (LNM) number over 5, and BRAF/TERT mutations (TLBT). It was defined based on the number of TLBT factors: low risk (no risk factor, n=896), intermediate risk (1 risk factor, n=199), and high risk (≥2 risk factors, n=59). Notably, compared with patients with low and intermediate risks, patients assigned to high TLBT risk have a shorter time of DM disease-free survival. Except for gene mutation, other factors were also included in the 2015 American Thyroid Association (ATA) risk guideline. Comparing with the ATA risk category, this risk model showed a better performance in predicting DM-TCs. Conclusions This study proposes a TLBT risk classifier consisting of T3/T4 stages, LNM (n>5), and BRAF+TERTp mutations for predicting DM-TCs. TLBT risk stratification may help clinicians make personalized treatment management and follow-up strategies. [ABSTRACT FROM AUTHOR]

This study aims to examine and compare clinical, radiological, and pathological data between colorectal cancer (CRC) patients with and without schistosomiasis and uncover distinctive CRC characteristics when accompanied by schistosomiasis. This retrospective study is based on data collected from 341 patients diagnosed with CRC post-surgery and pathology. Of these patients, 101 (Group A) were diagnosed with colorectal cancer co-occurring with schistosomiasis (CRC-S), while 240 patients (Group B) were diagnosed with colorectal cancer without concurrent schistosomiasis (CRC-NS). Both groups were compared and analyzed based on their clinical data, imaging-based TNM staging, lymph node metastasis, nerve invasion, vascular cancer thrombus, and histopathological differentiation. A Chi-squared test revealed a significant difference in gender distribution between the patients with CRC-S (Group A) and CRC-NS (Group B), with a p -value of 0.043 and χ2 = 4.115. Specifically, a higher incidence rate was observed among males in Group A. There was a difference in the overall distribution of TNM staging between the two groups (p = 0.034, χ2 = 6.764). After pairwise comparison, a statistically significant difference was observed in the T3 stage (p 0.05). Among the 101 patients with CRC-S, 87 (86%) showed linear calcification on CT imaging. Patients with CRC-S are mainly male, with tumor staging mostly in the middle stage, high tumor differentiation, and low malignancy. CT imaging can help identify the presence of lumps and linear calcification indicative of schistosome deposits. MRI can early clarify TNM staging and determine the presence of lymph node metastasis and nerve and vascular invasion.

Objective To investigate the diagnostic value of ultrasound texture analysis in T stage of rectal cancer. Methods The preoperative ultrasound images of 31 patients with rectal cancer confirmed by surgery or pathology were selected, and the region of interest （ROI） was delineated by mazda software. The software automatically calculated the texture characteristic parameters of mean, kurtosis, skewness, contrast, entropy, variance sum, autocorrelation, energy and deficit distance, compared the differences of texture parameters of rectal cancer in different stages, and drew the subject's working characteristic curve （ROC） for the statistically significant parameters, compared the area under the curve （AUC）, and evaluated its diagnostic efficiency. Results It was statistically shown that kurtosis, skewness, contrast, entropy, variance sum and autocorrelation were all influencing factors of T stage of rectal cancer, and the skewness, entropy, variance sum and autocorrelation of advanced rectal cancer （pT3-4 stage） were higher than those of early rectal cancer （pT1-2 stage） （P < 0.05）, while the kurtosis and contrast were lower than those of early rectal cancer （P < 0.05）. Among them, entropy has a higher diagnostic efficiency, and the AUC value is 0.88. Conclusion Ultrasound texture analysis can provide a more objective imaging basis for T staging of rectal cancer, and the texture characteristics of advanced rectal cancer are more complex than those of early rectal cancer. [ABSTRACT FROM AUTHOR]

Objective To detect the expression of platelet-leukocyte C kinase substrate 2(PLEK2) antibody in gallbladder carcinoma, and analyze the correlation between the expression of PLEK2 and the clinical characteristics of patients with gallbladder carcinoma and its impact on the prognosis after surgery. Methods A total of 46 patients who underwent cholecystectomy or radical resection of gallbladder carcinoma in Chaohu Hospital Affiliated to Anhui Medical University from March 2017 to February 2022, and whose postoperative pathology showed gallbladder carcinoma, were selected. Their medical records and follow-up da- ta were collected and tumor tissue immunohistochemical staining test was performed to analyze the correlation between the expression of PLEK2 and the clinical characteristics of patients and the impact on the survival of patients with gallbladder carcinoma. The follow-up end at August 30, 2022. Results The overall median survival time was 28 months (95% CI: 20-36 months). Among the 46 patients, 41 cases (89. 13%) were positive for PLEK2 in gallbladder carcinoma samples, and the degree of positive expression was significantly correlated with T stage, sex and cancer antigen 15-3 positive, with statistical significance (P<0.05). Univariate survival analysis showed that unexpected gallbladder carcinoma (preoperative diagnosis of benign gallbladder disease and intraoperative or postoperative pathological examination indicated malignancy), gender, CA125 positive, PLEK2 expression, and T stage were related to survival. T stage, PLEK2 expression were risk factors for the prognosis of patients with gallbladder carcinoma (P<0.05). Conclusion PLEK2 is positive expressed in gall- bladder carcinoma mostly, and its positive degree is related to T stage, sex and CA15-3 level, and it is an independent risk factor affecting the prognosis of patients with gallbladder carcinoma. [ABSTRACT FROM AUTHOR]

Abstract Objectives The latest version of the National Comprehensive Cancer Network recommends neoadjuvant therapy followed by surgical treatment or radical chemoradiotherapy for patients with cT3N0M0. Neoadjuvant therapy can improve the prognosis of patients with locally advanced esophageal cancer. Therefore, the evaluation or prediction of T stage is particularly important because the treatment could differently affect the prognosis. Here, we establish a model to predict the T stage of patients with T2‐3N0M0 to help choose the best treatment strategy. Methods From 1637 patents with esophageal cancer, we enrolled 48 patients and performed least absolute shrinkage and selection operator regression to screen for independent factors influencing pathological T stage. We, then, trained the decision tree to obtain the decision tree diagram and divided the T stages obtained by different methods into two categories, T2 and T3, for survival analysis. Results A total of 21 and 27 cases were predicted to be T2 and T3, respectively, under ultrasonic gastroscopy, 19 and 29 under magnetic resonance imaging, and 22 and 26 under pathological examination. Multivariate logistic regression analysis revealed that the muscularis propria thickness (MPT) (p = 0.0097) and the muscularis propria + mucosa thickness (MPMT) in the largest tumor cross‐section (p = 0.0239) were independent influencing factors. We plotted a decision tree diagram with these two factors. MPT in the largest tumor cross‐section >1.3 mm could be judged as pT3; if ≤1.3 mm, MPMT should be considered a thickness ≥1.7 mm could be judged as pT2 (otherwise pT3). Corresponding survival analysis was performed according to the T stage under different examination modalities. Conclusion MPT in the largest tumor cross‐section and MPMT in the largest tumor cross‐section are independent predicting factors of pathological T stage.

Clinical assessment of T and N stages in rectal cancer is important to guide decision-making. The present study aimed to assess the accuracy of the clinical T and N staging of rectal cancer compared to the pathological staging and their overall agreement in a large cohort of patients. This retrospective study used data from the National Cancer Database (NCDB) between 2004 and 2017. Patients with non-metastatic rectal adenocarcinoma who did not receive neoadjuvant therapy were reviewed and the clinical T and N stages were compared to their pathologic counterparts. The overall concordance between clinical and pathologic assessments was calculated using Kappa coefficient. The study included 8929 patients (57.3% male) with a mean age of 64 years. Clinical T stage and N stage were identical to pathologic stages in 70.3% and 77.6% of patients, respectively. Sensitivity and specificity of the clinical assessment of N stage was 35.2% and 95.5%, respectively. Concordance between the clinical and pathologic stages was moderate for the T stage (kappa = 0.575) and fair for the N stage (kappa = 0.346). Pathologic T4 stage (OR: 2.12, p < 0.0001), poorly differentiated adenocarcinoma (OR: 1.45, p = 0.026), lymphovascular invasion (OR: 4.5, p < 0.001), and longer time from diagnosis to first treatment (OR = 0.996, p = 0.046) were the independent predictors of N stage discrepancy. There was a moderate agreement between the clinical and pathologic T stages and a fair agreement between the clinical and pathologic N stages. The clinical assessment of the N stage was highly specific yet had low sensitivity. [ABSTRACT FROM AUTHOR]

Objectives: The latest version of the National Comprehensive Cancer Network recommends neoadjuvant therapy followed by surgical treatment or radical chemoradiotherapy for patients with cT3N0M0. Neoadjuvant therapy can improve the prognosis of patients with locally advanced esophageal cancer. Therefore, the evaluation or prediction of T stage is particularly important because the treatment could differently affect the prognosis. Here, we establish a model to predict the T stage of patients with T2‐3N0M0 to help choose the best treatment strategy. Methods: From 1637 patents with esophageal cancer, we enrolled 48 patients and performed least absolute shrinkage and selection operator regression to screen for independent factors influencing pathological T stage. We, then, trained the decision tree to obtain the decision tree diagram and divided the T stages obtained by different methods into two categories, T2 and T3, for survival analysis. Results: A total of 21 and 27 cases were predicted to be T2 and T3, respectively, under ultrasonic gastroscopy, 19 and 29 under magnetic resonance imaging, and 22 and 26 under pathological examination. Multivariate logistic regression analysis revealed that the muscularis propria thickness (MPT) (p = 0.0097) and the muscularis propria + mucosa thickness (MPMT) in the largest tumor cross‐section (p = 0.0239) were independent influencing factors. We plotted a decision tree diagram with these two factors. MPT in the largest tumor cross‐section >1.3 mm could be judged as pT3; if ≤1.3 mm, MPMT should be considered a thickness ≥1.7 mm could be judged as pT2 (otherwise pT3). Corresponding survival analysis was performed according to the T stage under different examination modalities. Conclusion: MPT in the largest tumor cross‐section and MPMT in the largest tumor cross‐section are independent predicting factors of pathological T stage. [ABSTRACT FROM AUTHOR]

Background: T1a renal cell carcinoma (RCC) is typically considered a curable disease, irrespective of the choice of local treatment modality. Objective: To identify factors associated with the risk of local and distant recurrence, and overall survival (OS) in patients with primary nonmetastatic clinical T1a RCC. Design, setting, and participants: A population-based nationwide register study of all 1935 patients with cT1a RCC, diagnosed during 2005–2012, identified through The National Swedish Kidney Cancer Register, was conducted. Outcome measurements and statistical analysis: Outcome variables were recurrence (local or distant) and OS. Possible explanatory variables included tumor size, RCC type, T stage, surgical technique, age, and gender. Associations with disease recurrence and OS were evaluated by multivariable regression and Cox multivariate analyses, respectively. Results and limitations: Among 1935 patients, 938 were treated with radical nephrectomy, 738 with partial nephrectomy, and 169 with ablative treatments, while 90 patients had no surgery. Seventy-eight (4%) patients were upstaged to pT3. Local or metastatic recurrences occurred in 145 (7.5%) patients, significantly more often after ablation (17.8%). The risk of recurrence was associated with tumor size, upstaging, and ablation. Larger tumor size, disease recurrence, and older age adversely affected OS, whereas partial nephrectomy and chromophobe RCC (chRCC) were associated with improved survival. Limitations include register design and a lack of comorbidity or performance status data. Conclusions: Upstaging and recurrence occurred, respectively, in 4.0% and 7.5% of patients with nonmetastatic RCCs ≤4 cm. Tumor size upstaging and ablation were associated with the risk for recurrence, while tumor size and recurrence were associated with decreased OS. Patients with chRCC and partial nephrectomy had prolonged OS in a real-world setting. Patient summary: We studied factors that may influence the risk of disease recurrence and overall survival, in a large nationwide patient cohort having nonmetastatic renal cell carcinoma ≤4 cm. Tumor size, tumor type, and treatment were associated with the risk of recurrence and overall death. Partial nephrectomy prolonged overall survival.

Background: The eighth edition of the American Joint Committee on Cancer tumour, node, and metastasis staging system did not take T stage into consideration when evaluating Stage IV C medullary thyroid carcinoma (MTC) patients. The aim of this study is to investigate the clinical outcomes and implications of T stage in this population. Methods: Eligible patients from the Surveillance, Epidemiology, and End Results database and the Department of Thyroid Surgery in West China Hospital of Sichuan University and who were diagnosed with Stage IV C MTC were included in this study. The overall survival (OS), the cancer‐specific survival (CSS), and the precise cause of MTC‐induced death were analysed. The potential risk factors, including the T stage, in the OS and CSS were evaluated by univariate and multivariate Cox regression models. Results: This retrospective study enroled 204 Stage IV C MTC patients. The 5‐ and 10‐year OS rates were 31.8% and 17.1%, respectively, and the 5‐ and 10‐year CSS rates were 40.4% and 22.5%, respectively. More importantly, the rates of MTC‐induced death between primary or distant metastatic lesions in Stage IV C MTC patients were comparable in our institution. Additionally, the univariate and multivariate analyses demonstrated that the presence of an advanced T stage was an independent prognostic factor for both the OS (T4 vs. T1–T3, hazard ratio [HR]: 1.714, 95% confidence interval [CI]: 1.175–2.500, p =.005) and the CSS (T4 vs. T1–T3, HR: 1.848, 95% CI: 1.229–2.780, p =.003). Conclusion: To achieve a better risk stratification, further classification of Stage IV C MTC patients by the T stage may be preferable. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the prognostic value of thyroid invasion of parathyroid carcinoma without lymph node or distant metastasis. Methods: Two hundred and nine cases of parathyroid carcinoma from the SEER (1989–2014) were eligible for this study. A Chi-squared test, t test, X-tile, Kaplan–Meier curves, and multivariate Cox proportional hazard regression were used for analysis. Results: Thyroid invasion, sex, race, age, radiation, and surgery were not significantly associated with cancer-specific survival by multivariate analysis. However, tumor size ≥ 4 cm was significantly associated with worse cancer-specific survival (P < 0.001). Conclusion: Thyroid invasion, which was the criterion for T1 and T2 staging criteria of parathyroid carcinoma according to the AJCC, did not affect the prognosis of patients with parathyroid carcinoma without local lymph node or distant metastasis. Our study indicates that a tumor size ≥ 4 cm may be an appropriate indicator of T1 and T2 cancer staging. [ABSTRACT FROM AUTHOR]

Serosal invasion is an independent negative prognostic factor in certain cancers, including CRC. However, the mechanisms behind serosal invasion are poorly understood. We therefore assumed that epithelial-mesenchymal transition (EMT) might be involved. Our study included 34 patients with CRC, 3 stage pT2, 14 stage pT3 and 17 showing serosal invasion (stage pT4a according to TNM staging system). RNA isolated from formalin-fixed paraffin-embedded tissue samples was analysed for expression of the miR-200 family and their target genes CDKN1B, ONECUT2, PTPN13, RND3, SOX2, TGFB2 and ZEB2 using real-time PCR. We found upregulation of miR-200b and ONECUT2 in CRC pT3 and pT4a compared to normal mucosa, and downregulation of CDKN1B in CRC pT3. Moreover, we observed, downregulation of miR-200b, PTPN13 and ZEB2 in CRC with serosal invasion (pT4a) compared to pT3. Our results suggest the involvement of partial EMT in serosal invasion of CRC. In addition, PTPN13 seems to be one of the important regulators involved in serosal invasion, and ONECUT2 in tumour growth. [ABSTRACT FROM AUTHOR]

Objective: to reveal technical nuances for obtaining high-quality images using a computed tomography protocol with pneumogastrography and virtual gastroscopy, which contribute to the detection and assessment of the morphological type of gastric cancer and to the determination of its localization and invasion depth.Material and methods. The investigation enrolled 250 patients with both early (24.8%) and locally advanced (75.2%) gastric cancer treated in Petrov National Medical Research Center for Oncology from 2015 to 2018. Preoperative chemotherapy was performed in 142 (56.8%) patients and was not done in 108 (43.2%). All the patients underwent preoperative computed tomography with pneumogastrography and virtual gastroscopy. All the patients were radically operated on through subtotal or total gastric resection.Results. Computed tomography with pneumogastrography and virtual gastroscopy was used to detect gastric cancer in 98.4% of patients; the cases with early T1a and T1b invasion depth cancers were 23.2%. The tumor could not be significantly differentiated in 4 (1.6%) patients. This group consisted of: 3 (1.2%) and 1 (0.4%) patients with pT1a and pT1b invasion depth tumors, respectively. All non-visualized tumors had a superficial morphological type of growth (Type 0–II (3 cases with 0–IIa and 1 case with 0–IIb); their sizes were less than 2 cm. Three tumors were localized in the antral portion of the stomach; one was in its cardiac portion.Conclusion. Computed tomography with pneumogastrography and virtual gastroscopy is an effective technique to detect gastric cancer, including its early types of category T1, which makes it possible to assess its localization, morphological type, and invasion depth.

Objective*To investigate the expression and diagnostic value of prostate specific antigen (PSA), tumor abnormal protein (TAP) and colon cancer metastasis related gene 1 (MACC1) in the blood of patients with prostate cancer. Methods·One hundred and seven patients with prostate cancer (case group) admitted to Dahua Hospital, Xuhui District, Shanghai, from January 2019 to December 2020 were retrospectively analyzed, and 60 healthy people (control group) who underwent physical examination in the hospital in the same period were selected. The levels of blood PSA, TAP and MACC1 in the two groups, as well as their correlation with Gleason score and T stage, were analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the value of various indexes in the diagnosis of prostate cancer. Results*The levels of blood PSA, TAP and MACC1 in the case group were significantly higher than those in the control group (P<0.05). With the increase of Gleason grade, the levels of blood PSA, TAP and MACC1 increased gradually. With the progress of T stage, the levels of blood PSA, TAP and MACC1 increased gradually. The levels of PSA and MACC1 in the patients with lymph node metastasis were significantly higher than those without lymph node metastasis, but the levels of TAP in the patients with lymph node metastasis were significantly lower than those without lymph node metastasis (P<0.05). The analysis results of ROC curve showed that the AUC of PSA in the diagnosis of prostate cancer was 0.764, the sensitivity was 86.12%, the specificity was 88.63%, and the cut-off value was 6.01 μg/L. The AUC of TAP in the diagnosis of prostate cancer was 0.796, the sensitivity was 88.18%, the specificity was 89.58%, and the cut-off value was 135.62 μm2. The AUC of MACC1 in the diagnosis of prostate cancer was 0.873, the sensitivity was 78.46%, the specificity was 80.10%, and the cut-off value was 37.80 pg/mL. The AUC (0.941), sensitivity (93.15%) and specificity (94.08%) of combined detection were higher than those of any single detection (P<0.05). Spearman correlation analysis showed that the blood PSA, TAP and MACC1 levels were positively correlated with Gleason score (r=0.648, 0.513, 0.501; P=0.000), and with T stage (r=0.616, 0.537, 0.542; P=0.000). Conclusion*Blood PSA, TAP and MACC1 are closely related to Gleason score and T stage of prostate cancer, which has some value in the diagnosis of prostate cancer, and the combined detection of three items has higher diagnostic value. [ABSTRACT FROM AUTHOR]

Although much is known about how adipose tissue affects the development of clear cell renal carcinoma (ccRCC), little information is available for the utility of sex-specific abdominal visceral fat composition as a predictor of clear cell renal carcinoma (ccRCC) T stage. We conducted CT-based sex-specific abdominal fat measurements in ccRCC patients to assess whether VFA distribution could predict the ccRCC T stage. In total, 253 patients (182 males and 71 females) from our hospital with pathologically confirmed ccRCC (178 low T-stage and 75 high T-stage) were retrospectively reviewed for the present study. Computed tomography (CT) scans were assessed using ImageJ to differentiate between the visceral and subcutaneous fat areas (VFA and SFA), after which the relative VFA (rVFA) and total fat area (TFA) were computed. The relationships between these fat area-related variables, patient age, sex, and BMI, and ccRCC T stage were then evaluated through univariate and multivariate logistic regression analysis to clarify the association between general or sex-specific abdominal visceral fat and T stage. Following adjustment for age, males with high T stage ccRCC exhibited an increased rVFA as compared to males with low T stage ccRCC, with the same relationship being observed among females. This association between rVFA and high T stage was confirmed through both univariate and multivariate models. As thus, sex-specific visceral fat composition is a reliable independent predictor that can identify both male and female patients with high T stage ccRCC.

BackgroundTransient receptor potential channel 1 (TRPC1) regulates the progression of several cancers, but its clinical implication in renal cell carcinoma (RCC) has not been explored yet. This study aimed to investigate the correlation of TRPC1 with clinical characteristics and prognosis in patients with RCC.MethodsTotally, 177 patients with primary RCC who received surgical resection were retrospectively screened. Their tumor and paired adjacent tissue specimens were retrieved to assess TRPC1 mRNA expression using RT-qPCR and TRPC1 protein expression using immunohistochemistry (IHC).ResultsBoth TRPC1 IHC score and TRPC1 mRNA expression were elevated in RCC tissue than in adjacent tissue (both P < 0.001). Meanwhile, both TRPC1 IHC score and TRPC1 mRNA expression in tumor were associated with higher T stage (both P = 0.02) and TNM stage (P = 0.009, P = 0.003, respectively). However, no correlation was found in tumor TRPC1 IHC score or TRPC1 mRNA expression with other tumor properties (all P > 0.05). Besides, the 3-, 5-, and 7-year overall survival (OS) were 81.4, 68.6, and 60.2%, respectively in patients with high tumor TRPC1 protein, while they were 89.3, 82.7, and 76.7%, respectively in patients with low tumor TRPC1 protein. High (vs. low) TRPC1 protein in the tumor was associated with shorter OS (P = 0.017), while high (vs. low) TRPC1 mRNA in the tumor was not correlated with OS (P = 0.144). By the forward stepwise method, TRPC1 protein expression independently predicted poor OS (P = 0.01, hazard ratio = 2.052).ConclusionTRPC1 serves as a potential biomarker reflecting tumor features and long-term survival profile in patients with RCC.

Objective To explore the risk factors of lymph node metastasis in patients with gallbladder cancer,and to provide references for comprehensive treatment and prognosis evaluation of gallbladder cancer. Methods　We retrospectively analyzed the clinical and pathological data of patients with gallbladder cancer confirmed by postoperative pathological examination who underwent radical resection of gallbladder cancer in the Second Affiliated Hospital of Kunming Medical University from January 1,2013 to September 30,2020.The patients were divided into Lymph node metastasis group and non-lymph node metastasis group， univariate and multivariate analysis was used to determine the relevant risk factors of gallbladder cancer lymph node metastasis. Results　A total of 101 patients were finally included, of which 41 patients had lymph node metastasis and 60 patients had no lymph node metastasis. The univariate analysis showed that T stage， histological grade， liver invasion，preoperative CA19-9≥100 U/mL and preoperative CA19-9+CEA+CA125 combination were risk factors for lymph node metastasis of gallbladder adenocarcinoma (P < 0.05). The results of multivariate analysis showed that T stage，histological grade，and preoperative CA19-9+CEA+CA125 combination were independent risk factors for lymph node metastasis of gallbladder adenocarcinoma (P < 0.05). Conclusions　 Patients with gallbladder adenocarcinoma with CA19-9≥100 U/mL or CEA≥20 ng/mL or CA125≥50 U/mL should consider expanding the scope of lymph node dissection. For patients with gallbladder adenocarcinoma with T3-T4 staging, histologicalgrade G3-G4 and preoperative CA19-9≥100 U/mL or CEA≥20 ng/mL or CA125≥50 U/mL,comprehensive postoperative treatment and close follow up should be considered. [ABSTRACT FROM AUTHOR]

This study explored the value of contrast-enhanced ultrasound (CEUS) in the differentiation of benign and malignant bladder occupying lesions. Eighty-two patients with space-occupying bladder lesions were selected as the research object, there were a total of 105 lesions. The differences of contrast-enhanced ultrasound parameters between benign and malignant lesions were compared, including time to arrival (AT), time to peak (TTP), peak intensity (PI) and washout time (WT). The results showed that 61 malignant lesions were confirmed pathologically after operation, and the sensitivity, specificity and accuracy of CEUS in diagnosing malignant bladder lesions were 90.16%, 90.91% and 90.48% respectively. PI and WT values of the high-grade malignant lesions were significantly higher than those of the low-grade malignant lesions (P<0.05). The PI and WT of T staged T3 lesions were significantly higher than those of Ta-1 and T2 lesions (P<0.05). The areas under the ROC curve of PI and WT for predicting high-grade lesions were 0.712 and 0.888, respectively. The areas under the ROC curve of PI and WT in predicting T stage ≥ T3 lesions were 0.812 and 0.852, respectively. CEUS is of high value in the diagnosis of bladder space occupying lesions, preoperative T staging and pathological grading, and is worthy of clinical use. [ABSTRACT FROM AUTHOR]

Abstract Background Preoperative staging of urinary bladder carcinomas using TNM system is crucial in the management of bladder cancer which is determined mainly by stage and grade of tumor at diagnosis. We aim to evaluate the diagnostic accuracy of multiparametric MRI (mp-MRI) for assessment of the bladder cancer T stage and histologic grade. Results The overall T2-WI diagnostic accuracy for the T stage was 72.3%, increased to be 87.1% for contrast-enhanced images, and 92.6% for DWI, reaching the maximum accuracy 94.5% using the combined multi-parametric MRI technique. Diagnostic accuracies of mp-MRI in differentiating superficial from muscle-invasive (91%) and organ-confined from non-organ confined tumors (92%) were superior to DW-MRI (89% and 87%), DCE-MRI (84% and 83%), and T2W-MRI (74% and 71%), respectively. The agreement between MRI findings and histopathological staging was greater in mp-MRI (k = 0.91; excellent agreement) than in DW-MRI (k = 0.77; moderate agreement), DCE-MRI (k = 0.76; substantial agreement), and T2W-MRI (k = 0.53; fair agreement). Conclusion Mp-MRI provides useful information for evaluating the local T stages of bladder cancer and can predict the histological grades of urinary bladder cancers with high diagnostic accuracy.

Although much is known about how adipose tissue affects the development of clear cell renal carcinoma (ccRCC), little information is available for the utility of sex-specific abdominal visceral fat composition as a predictor of clear cell renal carcinoma (ccRCC) T stage. We conducted CT-based sex-specific abdominal fat measurements in ccRCC patients to assess whether VFA distribution could predict the ccRCC T stage. In total, 253 patients (182 males and 71 females) from our hospital with pathologically confirmed ccRCC (178 low T-stage and 75 high T-stage) were retrospectively reviewed for the present study. Computed tomography (CT) scans were assessed using ImageJ to differentiate between the visceral and subcutaneous fat areas (VFA and SFA), after which the relative VFA (rVFA) and total fat area (TFA) were computed. The relationships between these fat area-related variables, patient age, sex, and BMI, and ccRCC T stage were then evaluated through univariate and multivariate logistic regression analysis to clarify the association between general or sex-specific abdominal visceral fat and T stage. Following adjustment for age, males with high T stage ccRCC exhibited an increased rVFA as compared to males with low T stage ccRCC, with the same relationship being observed among females. This association between rVFA and high T stage was confirmed through both univariate and multivariate models. As thus, sex-specific visceral fat composition is a reliable independent predictor that can identify both male and female patients with high T stage ccRCC. [ABSTRACT FROM AUTHOR]

Objective: Stage I and II cervical cancer with pelvic and/or para-aortic lymph node (LN) metastases are upstaged to stage IIIC under the new FIGO 2018 staging system, and radical chemoradiotherapy was recommended. But heterogeneity in outcome existed in this group of patients. We conducted this retrospective analysis to evaluate the heterogeneity of these patients and tried to provide a more detailed classification to reflect the prognosis and guide the treatment. We also evaluated the efficacy and toxicity of surgery followed by sequential chemoradiotherapy in this cohort. Methods: Early-stage cervical cancer with LN involvement that had radical hysterectomy followed by sequential chemoradiotherapy were retrospectively analyzed. Survival analyses were conducted to identify the prognostic factors. Results: A total of 242 patients were included in the study; 64 (26.4%) patients had treatment failure, and 51 (21.1%) died. Pathology, T stage, the number of pathologic LN (pLN), and neoadjuvant chemotherapy or not were independent prognostic factors for disease-free survival and overall survival (OS). Patients with T1N < 3 pLN had significantly better survival than T2N < 3 pLN/T1-2 N≥ 3 pLN, with failure rates of 11.6% and 35.8% in each group; and 5 year OS was 92% and 62%, respectively (P = 0.000). About 1.5% of the patients discontinued radiotherapy, and 14.1% had G3-4 hematological toxic effects during radiotherapy; 1.7% developed G2-3 lower limb edema, and 2.9% developed severe urinary toxicity. Conclusion: Nodal involvement alone is inadequate as the sole pathologic factor to predict survival in early-stage cervical cancer. The combination of tumor and node subcategory provides better prognostic discrimination. [ABSTRACT FROM AUTHOR]

Inflammation in the tumor microenvironmentisanessentialaspectof tumor biologicalactivity. Interferon γ and IL-10 are pro-inflammatoryand anti-inflammatorycytokinesthatplay a crucialrole in regulatingthehost'simmuneresponseto cancer cells. IFN-γ and IL-10 expression are associatedwithpoor prognosis andlowsurvivalrate in breastcarcinomapatients. This cross-sectional study was performed on the 60 paraffin-embedded samples of radical mastectomy during January 2016-December 2019 at Anatomical Pathology Laboratory of Dr. Soetomo General Academic Hospital Surabaya. The samples were divided based on tumor size into four groups (T1, T2, T3, T4). TheanalyzedwasusingKruskal Wallistest. Immunohistochemical staining was performed to detect the expression of IFN-γ and IL-10. There was a significant difference in IFN-γ expression in the four groups (p=0.005) and no significant difference in IL-10 expression in the four groups (p=0,191). Interferon gamma and IL-10 were important in determining prognosis and targeted therapy in breast cancer patients. These results may contribute to the development of breast cancer research. [ABSTRACT FROM AUTHOR]

ObjectiveStage I and II cervical cancer with pelvic and/or para-aortic lymph node (LN) metastases are upstaged to stage IIIC under the new FIGO 2018 staging system, and radical chemoradiotherapy was recommended. But heterogeneity in outcome existed in this group of patients. We conducted this retrospective analysis to evaluate the heterogeneity of these patients and tried to provide a more detailed classification to reflect the prognosis and guide the treatment. We also evaluated the efficacy and toxicity of surgery followed by sequential chemoradiotherapy in this cohort.MethodsEarly-stage cervical cancer with LN involvement that had radical hysterectomy followed by sequential chemoradiotherapy were retrospectively analyzed. Survival analyses were conducted to identify the prognostic factors.ResultsA total of 242 patients were included in the study; 64 (26.4%) patients had treatment failure, and 51 (21.1%) died. Pathology, T stage, the number of pathologic LN (pLN), and neoadjuvant chemotherapy or not were independent prognostic factors for disease-free survival and overall survival (OS). Patients with T1N < 3 pLN had significantly better survival than T2N < 3 pLN/T1-2 N≥ 3 pLN, with failure rates of 11.6% and 35.8% in each group; and 5 year OS was 92% and 62%, respectively (P = 0.000). About 1.5% of the patients discontinued radiotherapy, and 14.1% had G3-4 hematological toxic effects during radiotherapy; 1.7% developed G2-3 lower limb edema, and 2.9% developed severe urinary toxicity.ConclusionNodal involvement alone is inadequate as the sole pathologic factor to predict survival in early-stage cervical cancer. The combination of tumor and node subcategory provides better prognostic discrimination.

ObjectiveTo determine whether there is a correlation between texture features extracted from high-resolution T2-weighted imaging (HR-T2WI) or apparent diffusion coefficient (ADC) maps and the preoperative T stage (stages T1–2 versus T3–4) in rectal carcinomas.Materials and MethodsOne hundred and fifty four patients with rectal carcinomas who underwent preoperative HR-T2WI and diffusion-weighted imaging were enrolled. Patients were divided into training (n = 89) and validation (n = 65) cohorts. 3D Slicer was used to segment the entire volume of interest for whole tumors based on HR-T2WI and ADC maps. The least absolute shrinkage and selection operator (LASSO) was performed to select feature. The significantly difference was tested by the independent sample t-test and Mann-Whitney U test. The support vector machine (SVM) model was used to develop classification models. The correlation between features and T stage was assessed by Spearman’s correlation analysis. Multivariate logistic regression analysis was performed to identify independent predictors of tumor invasion. The performance of classifiers was evaluated by the receiver operating characteristic (ROC) curves.ResultsThe wavelet HHH NGTDM strength (RS = -0.364, P < 0.001) from HR-T2WI was an independent predictor of stage T3–4 tumors. The shape maximum 2D diameter column (RS = 0.431, P < 0.001), log σ = 5.0 mm 3D first-order maximum (RS = 0.276, P = 0.009), and log σ = 5.0 mm 3D first-order interquartile range (RS = -0.229, P = 0.032) from ADC maps were independent predictors. In training cohorts, the classification models from HR-T2WI, ADC maps and the combination of two achieved the area under the ROC curves (AUCs) of 0.877, 0.902 and 0.941, with the accuracy of 79.78%, 89.86% and 89.89%, respectively. In validation cohorts, the three models achieved AUCs of 0.845, 0.881 and 0.910, with the accuracy of 78.46%, 83.08% and 87.69%, respectively.ConclusionsTexture analysis based on ADC maps shows more potential than HR-T2WI in identifying preoperative T stage in rectal carcinomas. The combined application of HR-T2WI and ADC maps may help to improve the accuracy of preoperative diagnosis of rectal cancer invasion.

The aim of this study is to develop and test radiomics models based on magnetic resonance imaging (MRI) to preoperatively and respectively predict the T stage, perineural invasion, and microvascular invasion of extrahepatic cholangiocarcinoma (eCCA) through a non-invasive approach. This research included 101 eCCA patients (29–83 years; 45 females and 56 males) between August 2011 and December 2019. Radiomics features were retrospectively extracted from T1-weighted imaging, T2-weighted imaging, diffusion-weighted imaging, and apparent diffusion coefficient map using MaZda software. The region of interest was manually delineated in the largest section on four MRI images as ground truth while keeping 1–2 mm margin to tumor border, respectively. Pretreatment, dimension reduction method, and classifiers were used to establish radiomics signatures for assessing three pathological characteristics of eCCA. Finally, independent training and testing datasets were used to assess radiomics signature performance based on receiver operating characteristic curve analysis, accuracy, precision, sensitivity, and specificity. This study extracted 1208 radiomics features from four MRI images of each patient. The best performing radiomics signatures for assessing the T stage, perineural invasion, and microvascular invasion were respectively produced by L1_normalization + linear discriminant analysis (LDA) + logistic regression, Box_Cox transformer + LDA + K-nearest neighbor, and L2_normalization + LDA + AdaBoost. The area under the curve values of the radiomics signatures for predicting the training and testing cohorts in each subgroup were respectively 1 and 0.962 (T stage), 1 and 1 (both perineural invasion and microvascular invasion). These proposed radiomic models based on MR images had powerful performance and high potential in predicting T stage, perineural, and microvascular invasion of eCCA. Prognostic study. [Display omitted] • MRI radiomics models were built to predict T stage, perineural, and microvascular invasion. • MRI-based radiomics model achieved AUC 1 and 0.962 (train and test) for predicting T stage. • The AUCs were 1 and 1 (train, test) in perineural and microvascular invasion models, respectively. [ABSTRACT FROM AUTHOR]

This study aimed to quantitatively analyze published data regarding the ability of double contrast-enhanced ultrasonography (DCEUS) to clarify tumor depth (T stage) in primary gastric carcinoma patients. We obtained six studies, including 926 gastric cancer (GC) patients who were diagnosed by DCEUS from the Cochrane Library "Cochrane Central Register of Controlled Trials (CENTRAL)," OVID MEDLINE, EMBASE, PUBMED and EBSCOhost, to 2019. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), forest plot analysis and summary receiver operating characteristic (SROC) curve analysis were used to evaluate the diagnostic accuracy of DCEUS. In our study, all the patients were examined by DCEUS. The quality of all included studies was good. The meta-analysis of six studies (n = 926) revealed that the summary sensitivity and specificity of DCEUS in discriminating T1-T2 versus T3-T4 gastric carcinomas were 0.94 and 0.91, respectively. The pooled sensitivity and specificity of DCEUS were 0.67 and 0.98 for T1 stage, 0.81 and 0.95 for T2 stage, 0.89 and 0.86 for T3 stage and 0.87 and 0.96 for T4 stage, respectively. The SROC curve revealed that the areas under the curve (AUC) of T1-T2 were 0.97 for each stage and 0.82 (T1), 0.84 (T2), 0.91 (T3) and 0.97 (T4). These results indicate that the accuracy of DCEUS in discriminating T1-T2 is higher than that in discriminating T3-T4, and the diagnostic value of DCEUS in discriminating the T3 stage requires further consideration. Finally, our analysis suggested that the diagnostic accuracy of DCEUS is available to guide surgeons in the pre-operative diagnosis of GC patients for more precise treatment. [ABSTRACT FROM AUTHOR]

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Objective: To determine whether there is a correlation between texture features extracted from high-resolution T2-weighted imaging (HR-T2WI) or apparent diffusion coefficient (ADC) maps and the preoperative T stage (stages T1–2 versus T3–4) in rectal carcinomas. Materials and Methods: One hundred and fifty four patients with rectal carcinomas who underwent preoperative HR-T2WI and diffusion-weighted imaging were enrolled. Patients were divided into training (n = 89) and validation (n = 65) cohorts. 3D Slicer was used to segment the entire volume of interest for whole tumors based on HR-T2WI and ADC maps. The least absolute shrinkage and selection operator (LASSO) was performed to select feature. The significantly difference was tested by the independent sample t-test and Mann-Whitney U test. The support vector machine (SVM) model was used to develop classification models. The correlation between features and T stage was assessed by Spearman's correlation analysis. Multivariate logistic regression analysis was performed to identify independent predictors of tumor invasion. The performance of classifiers was evaluated by the receiver operating characteristic (ROC) curves. Results: The wavelet HHH NGTDM strength (RS = -0.364, P < 0.001) from HR-T2WI was an independent predictor of stage T3–4 tumors. The shape maximum 2D diameter column (RS = 0.431, P < 0.001), log σ = 5.0 mm 3D first-order maximum (RS = 0.276, P = 0.009), and log σ = 5.0 mm 3D first-order interquartile range (RS = -0.229, P = 0.032) from ADC maps were independent predictors. In training cohorts, the classification models from HR-T2WI, ADC maps and the combination of two achieved the area under the ROC curves (AUCs) of 0.877, 0.902 and 0.941, with the accuracy of 79.78%, 89.86% and 89.89%, respectively. In validation cohorts, the three models achieved AUCs of 0.845, 0.881 and 0.910, with the accuracy of 78.46%, 83.08% and 87.69%, respectively. Conclusions: Texture analysis based on ADC maps shows more potential than HR-T2WI in identifying preoperative T stage in rectal carcinomas. The combined application of HR-T2WI and ADC maps may help to improve the accuracy of preoperative diagnosis of rectal cancer invasion. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to evaluate the significance of MRI-based radiomics model derived from high-resolution T2-weighted images (T2WIs) in predicting tumor pathological features of rectal cancer. Methods A total of 152 patients with rectal cancer who underwent surgery without any neoadjuvant therapy between March 2017 and September 2018 were included retrospectively. The patients were scanned using a 3-T magnetic resonance imaging, and high-resolution T2WIs were obtained. Lesions were delineated, and 1029 radiomics features were extracted. Least absolute shrinkage and selection operator was used to select features, and multilayer perceptron (MLP), logistic regression (LR), support vector machine (SVM), decision tree (DT), random forest (RF), and K-nearest neighbor (KNN) were trained using fivefold cross-validation to build a prediction model. The diagnostic performance of the prediction models was assessed using the receiver operating characteristic curves. Results A total of 1029 features were extracted, and 15, 11, and 11 features were selected to predict the degree of differentiation, T stage, and N stage, respectively. The best performance of the radiomics model for the degree of differentiation, T stage, and N stage was obtained by SVM [area under the curve (AUC), 0.862; 95% confidence interval (CI), 0.750–0.967; sensitivity, 83.3%; specificity, 85.0%], MLP (AUC, 0.809; 95% CI, 0.690–0.905; sensitivity, 76.2%; specificity, 74.1%), and RF (AUC, 0.746; 95% CI, 0.622-0.872; sensitivity, 79.3%; specificity, 72.2%). Conclusion This study demonstrated that the high-resolution T2WI–based radiomics model could serve as pretreatment biomarkers in predicting pathological features of rectal cancer.

Shu-Hui Lin,1,2,* Hsin-Kai Wang,3,4,* Kun-Tu Yeh,1,5 Hui-Chun Tai,1,6 Hui-Yi Wang,1 Lan-Ru Huang,2 Chun-Wen Chiu,7 Chia-Min Chung,8,9 Bharath Kumar Velmurugan101Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan; 3Public Health Bureau, Tainan City Government, Tainan, Taiwan; 4Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; 5School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 6Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 7Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan; 8Graduate Institute of BioMedical Sciences, China Medical University, Taichung, Taiwan; 9Environment-Omics-Diseases Research Center, China Medical University Hospital, Taichung, Taiwan; 10Toxicology and Biomedicine Research Group, Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam*These authors contributed equally to this work Purpose: c-MYC has been noted in many tumor types, but its functional significance and clinical utility in oral squamous cell carcinoma (OSCC) are not well known. Here we studied the expression of c-MYC in correlation to clinical outcome in patients with oral squamous cell carcinoma.Methods: The current study, using immunohistochemical staining, first examined c-MYC expression in OSCC patients and further correlated its expression with clinicopathological parameters.Results: c-MYC was expressed in the majority of OSCC patients (n=133). The c-MYC expression is associated with histological grade (P=0.0205) of patients with oral squamous cell carcinoma. Multivariate Cox regression analysis revealed that TN stage (P0.05). Multiplicative-scale interaction between T stage (III/IV) and low c-MYC expression on mortality risk was identified (P=0.0233). Kaplan–Meier survival analysis demonstrated that oral cancer patients (T III/IV stage) with high c-MYC expression had better survival than those with low and medium c-MYC expression (P=0.0270).Conclusion: Our data indicate that c-MYC is a potential biomarker that can be used as a therapeutic target for treating OSCC patients with T stage (III/IV).Keywords: T stage, c-MYC, OSCC, biomarker, survival

Aim: The aim of the study is to identify the cutoff value for depth of infiltration that predicts the risk of lymph node metastasis in the neck in surgically treated patients affected by pT1/pT2 cN0 oral squamous cell carcinoma (OSCC). Materials and Methods: Meta-analysis of six articles, including 938 patients, was performed from a PubMed search of the last 15 years. Results: The mean depth of infiltration in N0 neck was 4.42 mm, standard deviation (SD) 0.66 (95% confidence interval [CI], 3.89–4.95), while the mean depth of infiltration in N+ neck was 6.95 mm, SD 1.36 (95% CI, 5.86–8.04). One sample t-test done to analyze the level of significance between the cutoff depth of infiltration for N0 and N+ was found to be significant,P= 0.002. Receiver operating characteristic analysis was done to find the cutoff depth of infiltration in all N0 necks which was 4.5 mm with odds ratio 9.32, sensitivity of 84.7% in N+ necks which makes elective neck dissection an important surgical option for good prognosis of OSCC. Conclusion: Tumor infiltration depth is an important prognosticator in pT1/pT2 cN0 necks. Tumors with depth of infiltration >4.5 mm radiologically or clinically should undergo an elective neck dissection to improve the prognosis of OSCC.

Serosal invasion is an independent negative prognostic factor in certain cancers, including CRC. However, the mechanisms behind serosal invasion are poorly understood. We therefore assumed that epithelial-mesenchymal transition (EMT) might be involved. Our study included 34 patients with CRC, 3 stage pT2, 14 stage pT3 and 17 showing serosal invasion (stage pT4a according to TNM staging system). RNA isolated from formalin-fixed paraffin-embedded tissue samples was analysed for expression of the miR-200 family and their target genes CDKN1B, ONECUT2, PTPN13, RND3, SOX2, TGFB2 and ZEB2 using real-time PCR. We found upregulation of miR-200b and ONECUT2 in CRC pT3 and pT4a compared to normal mucosa, and downregulation of CDKN1B in CRC pT3. Moreover, we observed, downregulation of miR-200b, PTPN13 and ZEB2 in CRC with serosal invasion (pT4a) compared to pT3. Our results suggest the involvement of partial EMT in serosal invasion of CRC. In addition, PTPN13 seems to be one of the important regulators involved in serosal invasion, and ONECUT2 in tumour growth.

ObjectiveTo improve the assessment of primary tumor heterogeneity in magnetic resonance imaging (MRI) of non-small cell lung cancer (NSCLC), we proposed a method using basic measurements from T1- and T2-weighted MRI.MethodsOne hundred and four NSCLC patients with different T stages were studied. Fifty-two patients were analyzed as training group and another 52 as testing group. The ratios of standard deviation (SD)/mean signal value of primary tumor from T1-weighted (T1WI), T1-enhanced (T1C), T2-weighted (T2WI), and T2 fat suppression (T2fs) images were calculated. In the training group, correlation analyses were performed between the ratios and T stages. Then an ordinal regression model was built to generate the tumor heterogeneous index (THI) for evaluating the heterogeneity of tumor. The model was validated in the testing group.ResultsThere were 11, 32, 40, and 21 patients with T1, T2, T3, and T4 disease, respectively. In the training group, the median SD/mean on T1WI, T1C, T2WI, and T2fs sequences was 0.11, 0.19, 0.16, and 0.15 respectively. The SD/mean on T1C (p=0.003), T2WI (p=0.000), and T2fs sequences (p=0.002) correlated significantly with T stages. Patients with more advanced T stage showed higher SD/mean on T2-weighted, T2fs, and T1C sequences. The median THI in the training group was 2.15. THI correlated with T stage significantly (p=0.000). In the testing group, THI was also significantly related to T stages (p=0.001). Higher THI had relevance to more advanced T stage.ConclusionsThe proposed ratio measurements and THI based on MRI can serve as functional radiomic markers that correlated with T stages for evaluating heterogeneity of lung tumors.

Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most. [ABSTRACT FROM AUTHOR]

Objective: To improve the assessment of primary tumor heterogeneity in magnetic resonance imaging (MRI) of non-small cell lung cancer (NSCLC), we proposed a method using basic measurements from T1- and T2-weighted MRI. Methods: One hundred and four NSCLC patients with different T stages were studied. Fifty-two patients were analyzed as training group and another 52 as testing group. The ratios of standard deviation (SD)/mean signal value of primary tumor from T1-weighted (T1WI), T1-enhanced (T1C), T2-weighted (T2WI), and T2 fat suppression (T2fs) images were calculated. In the training group, correlation analyses were performed between the ratios and T stages. Then an ordinal regression model was built to generate the tumor heterogeneous index (THI) for evaluating the heterogeneity of tumor. The model was validated in the testing group. Results: There were 11, 32, 40, and 21 patients with T1, T2, T3, and T4 disease, respectively. In the training group, the median SD/mean on T1WI, T1C, T2WI, and T2fs sequences was 0.11, 0.19, 0.16, and 0.15 respectively. The SD/mean on T1C (p=0.003), T2WI (p=0.000), and T2fs sequences (p=0.002) correlated significantly with T stages. Patients with more advanced T stage showed higher SD/mean on T2-weighted, T2fs, and T1C sequences. The median THI in the training group was 2.15. THI correlated with T stage significantly (p=0.000). In the testing group, THI was also significantly related to T stages (p=0.001). Higher THI had relevance to more advanced T stage. Conclusions: The proposed ratio measurements and THI based on MRI can serve as functional radiomic markers that correlated with T stages for evaluating heterogeneity of lung tumors. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association of T stage and serum carcinoembryonic antigen (CEA) levels in determining oncologic outcomes of rectal cancer.Methods: Patients diagnosed with stage I–II rectal cancer patients were identified from the Surveillance, Epidemiology, and End Results database.Results: In stage T1N0M0 disease, elevated level of serum CEA (C1) was associated with 227.6% increased risk of mortality compared to normal level of serum CEA (C0; hazard ratio = 3.276, 95% confidence interval = 2.781–3.858, P < 0.001).Conclusions: Stage T1N0M0 rectal cancer, when involved in preoperative serum CEA elevation, may be a surrogate of biologically aggressive disease and correlate with unfavorable oncologic outcomes. Moreover, this subgroup of rectal cancer deserves more clinical attention of oncologists.

Abstract Background To explore the effect of b-value distributions on the repeatability and diagnostic performance of the ADC value in rectal cancer patients using multiple b-values and mono-exponential model diffusion-weighted imaging (DWI). Methods Thirty-two preoperative rectal cancer patients, without receiving neoadjuvant therapy, were scanned on a 3 Tesla magnetic resonance imaging scanner using DWI with 10 b-values ranging from 0 to 2000 s/mm2. The apparent diffusion coefficient (ADC) value was calculated using a mono-exponential model and 31 b-value combinations consisting of 2 to 10 b-values were explored. Regions of interest with the maximum cross-sectional tumour size were outlined on the ADC map by two independent observers. Intraclass correlation coefficients (ICC), coefficient of variation (CV), and Bland-Altman plots between the two observers were calculated and evaluated to determine repeatability. Areas under receiver operating characteristic curves (AUCs) were evaluated for rectal cancer characterization. Correlations between the mean ADC values and T stage were assessed using the Spearman correlation coefficient (ρ). α (= ICC + AUC + |ρ|- CV - |bias|) was defined and used to assess the optimal b-value distribution. Results Postoperative pathology tests revealed 4 patients with T1, 10 patients with T2, and 18 patients with T3 stages. There were no significant difference in age and sex between the two groups (T1–2 vs. T3). Excellent reproducibility was observed for ADC values between two observers with ICC and CV values ranging from 0.920 to 0.998, and 1.475 to 5.568%, respectively. The mean percent difference and ρ between the paired measurements was ranged from − 2.7 to 1.2% and from − 0.759 to − 0.407, respectively. The b-value combinations with the top three α values were b(0, 1000 s/mm2), b(500, 1500, 2000 s/mm2) and b(100, 1000, 1500 s/mm2) for α = 2.581, 2.571 and 2.569, respectively. Conclusions The number of b-values and their distributions influenced the repeatability of the ADC values and their diagnostic performance. The optimal b-value combination was 0 and 1000 s/mm2 for DWI examination of rectal cancer patients.

Xiao Shi,1,2,* Nai-Si Huang,1,2,* Rong-Liang Shi,1,2,* Wen-Jun Wei,1,2 Yu-Long Wang,1,2 Qing-Hai Ji1,2 1Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China *These authors contributed equally to this work Purpose: The prognostic value of primary tumor surgery (PTS) in minor salivary-gland carcinoma (MiSGC) with distant metastasis (DM) at diagnosis has never been investigated. In this study, we aimed to provide the first evidence.Patients and methods: The Surveillance, Epidemiology, and End Results (SEER) database was employed to identify MiSGC patients with DM at diagnosis. The prognostic value of PTS was evaluated by Kaplan–Meier methods, log-rank analyses, and multivariate Cox proportional-hazard regression models.Results: Of the 152 eligible patients included in our study, 50 (32.9%) had undergone PTS. Kaplan–Meier analyses showed that the PTS group had >20% increase in 1- and 2-year overall survival (OS) and cancer-specific survival (CSS) compared with their counterparts without PTS (PTS group vs no-PTS group, 1-year OS 66.1% vs 43.9%, 1-year CSS 69.9% vs 44.9%, 2-year OS 56.6% vs 24.2%, 2-year CSS 59.9% vs 25.7%). Compared with the no-PTS group, multivariate analyses also demonstrated a significantly decreased risk of overall mortality (HR 0.601, 95% CI 0.379–0.952; P=0.031) and cancer-specific mortality (HR 0.547, 95% CI 0.336–0.891; P=0.015) in the PTS group. Subgroup multivariate analyses revealed patients with T1–T3 oropharynx, nasal cavity, or paranasal sinus primary MiSGC, especially adenoid cystic carcinoma, might benefit from PTS (all P

Objective: To investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with diffusion-weighted imaging (DWI) in the diagnosis of preoperative TN stage and benign and malignant mesenteric lymph nodes. Methods: 80 patients with rectal cancer who were received by Benxi Central Hospital Affiliated to China Medical University and Shengjing Hospital Affiliated to China Medical University from February 2017 to October 2019 were selected, they were scanned with conventional Magnetic resonance imaging (MRI), DCE-MRI and DWI to obtain the quantitative parameters of DCE-MRI and DWI [transfer constant (Ktrans), extravascular extracellular volume fraction(Ve), rate constant of backflux (Kep) and apparent diffusion coefficient (ADC)]. DCE-MRI and DWI parameters of different T, N stages and different properties of mesenteric lymph nodes were compared, and its diagnostic efficacy in T, N stages and properties of mesenteric lymph nodes. Results: The levels of Ktrans, Kep and Ve in rectal cancer were higher than that in normal intestinal wall, and ADC was lower than that in normal intestinal wall (P<0.05). The levels of Ktrans, Kep and Ve in T Ⅲ - Ⅳ, N1 and mesangial malignant lymph nodes were higher than that in TⅠ～Ⅱ group, N0 group and mesangial benign lymph node group (P<0.05), the levels of Ktrans, Kep, Ve in patients with TNM stage N1 were higher than that in patients with N0, and ADC was lower than that in patients with N0 (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of combined diagnosis were higher. Conclusion: DCE-MRI combined with DWI is of high value in the preoperative diagnosis of T, N stage and mesenteric lymph nodes of rectal cancer. [ABSTRACT FROM AUTHOR]