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staging systems for predicting survival of patients with hepatocellular carcinoma after surgery

World Journal of Gastroenterology 2010年第41期16卷 5257-5262页

作者： Lei-Bo Xu Jie Wang Chao Liu Ya-Jin Chen Qing-Jia Ou Ji-Sheng Chen Hao-Wei Pang Department of Hepato-Pancreato-Biliary Surgery Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou 510120 Guangdong Province China Department of Emergency Huangpu Branch First Affiliated Hospital of Sun Yat-Sen University Guangzhou 510080 China

AIM: To compare the staging systems for stratifying and predicting the prognosis of patients with hepatocel-lular carcinoma (HCC) after partial hepatectomy (PH). METHODS: Clinical data about 438 HCC patients who underwent PH from January 1991 to December 2004 at our hospital were retrospectively analyzed. tumor stage was evaluated following the Chinese tumor node me-tastasis (TNM) and barcelona clinic liver cancer (BCLC) staging systems, respectively. Survival curves for the HCC patients were plotted using the Kaplan-Meier method and differences were compared by the log-rank test. The accuracy of each system for predicting death of HCC patients was evaluated by calculating the area under the receiver operating characteristic curve. RESULTS: The HCC patients were classified into stag-es Ⅰ-Ⅲ, stages Ⅰ-Ⅳ and stages A-C, according to the 3 staging systems, respectively. Log-rank test showed that the cumulative survival rate was significantly dif-ferent for the HCC patients at 3 Chinese system stag-es, TNM stages Ⅰ and Ⅱ, TNM stages Ⅲ and Ⅳ, and 3 BCLC stages (P staging systems was higher than that of the TNM staging sys-tem for predicting the survival rate of HCC patients. CONCLUSION: The Chinese and BCLC staging systems are better for stratifying and predicting the prognosis of HCC patients after PH than the TNM staging system.

关键词： Hepatocellular carcinoma tumor staging Prognosis Survival Hepatectomy

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Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

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Chinese Journal of Cancer 2016年第12期35卷 673-682页

作者： Yan-Ping Mao Ling-Long Tang Lei Chen Ying Sun Zhen-Yu Qi Guan-Qun Zhou Li-Zhi Liu Li Li Ai-Hua Lin Jun Ma State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer Center Department of Radiation Oncology Sun Yat-sen University Cancer Center Imaging Diagnosis and Interventional Center Sun Yat-sen University Cancer Center Department of Medical Statistics and Epidemiology School of Public HealthSun Yat-sen University

Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.

关键词： Nasopharyngeal carcinoma Intensity-modulated radiotherapy Prognosis Failure pattern tumor staging

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Role of dynamic perfusion magnetic resonance imaging in patients with local advanced rectal cancer

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World Journal of Gastroenterology 2020年第20期26卷 2657-2668页

作者： Davide Ippolito Silvia Girolama Drago Anna Pecorelli Cesare Maino Giulia Querques Ilaria Mariani Cammillo Talei Franzesi Sandro Sironi Department of Diagnostic Radiology H.S.Gerardo MonzaSan Gerardo HospitalUniversity of Milano-BicoccaMonza 20900Italy Department of Diagnostic Radiology Papa Giovanni XXIII HospitalUniversity of Milano-BicoccaBergamo 20110Italy

BACKGROUND The management of rectal cancer patients is mainly based on the use of the magnetic resonance imaging(MRI)technique as a diagnostic tool for both staging and restaging.After treatment,to date,the evaluation of complete response is based on the histopathology assessment by using different tumor regression grade(TRG)features(e.g.,Dworak or Mandard classifications).While from the radiological point of view,the main attention for the prediction of a complete response after chemotherapy treatment focuses on MRI and the potential role of diffusion-weighted images and perfusion imaging represented by dynamiccontrast enhanced MRI.The main aim is to find a reliable tool to predict tumor response in comparison to histopathologic findings.AIM To investigate the value of dynamic contrast-enhanced perfusion-MRI parameters in the evaluation of the healthy rectal wall and tumor response to chemo-radiation therapy in patients with local advanced rectal cancer with histopathologic correlation.METHODS Twenty-eight patients with biopsy-proven rectal adenocarcinoma who underwent a dynamic contrast-enhanced MR study performed on a 1.5 T MRI system(Achieva,Philips),before(MR1)and after chemoradiation therapy(MR2),were enrolled in this study.The protocol included T1 gadolinium enhanced THRIVE sequences acquired on axial planes.A dedicated workstation was used to generate color permeability maps.Region of interest was manually drawn on tumor tissue and normal rectal wall,hence the following parameters were calculated and statistically analyzed:Relative arterial enhancement(RAE),relative venous enhancement(RVE),relative late enhancement(RLE),maximum enhancement(ME),time to peak and area under the curve(AUC).Perfusion parameters were related to pathologic TRG(Mandard’s criteria;TRG1=complete regression,TRG5=no regression).RESULTS Ten tumors(36%)showed complete or subtotal regression(TRG1-2)at histology and classified as responders;18 tumors(64%)were classified as non-responders(TRG3-5).Perfusion MRI parameters were significantl

关键词： Rectal neoplasm Chemotherapy Radiotherapy tumor staging Treatment response Magnetic resonance imaging

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Radiomics approach for preoperative identification of stages Ⅰ-Ⅱand Ⅲ-Ⅳ of esophageal cancer

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Chinese Journal of Cancer Research 2018年第4期30卷 396-405页

作者： Lei WU Cong Wang Xianzheng Tan Zixuan Cheng Ke Zhao Lifen Yan Yanli Liang Zaiyi Liu Changhong Liang School of Medicine South China University of Technology Guangzhou 510006 China Department of Radiology Guangdong General HospitalGuangdong Academy of Medical Sciences Guangzhou 510080 China School of Automation Science and Engineering South China University of Technology Guangzhou 510641 China

Objective： To predict preoperative staging using a radiomics approach based on computed tomography （CT）images of patients with esophageal squamous cell carcinoma （ESCC）.Methods： This retrospective study included 154 patients （primary cohort： n： t 14; validation cohort： n：40） withpathologically confirmed ESCC. All patients underwent a preoperative CT scan from the neck to abdomen. Highthroughput and quantitative radiomics features were extracted from the CT images for each patient. A radiomicssignature was constructed using the least absolute shrinkage and selection operator （Lasso）. Associations betweenradiomics signature, tumor volume and ESCC staging were explored. Diagnostic performance of radiomicsapproach and tumor volume for discriminating between stages Ⅰ-Ⅱand Ⅲ-Ⅳ was evaluated and compared usingthe receiver operating characteristics （ROC） curves and net reclassification improvement （NRI）.Results= A total of 9,790 radiomics features were extracted. Ten features were selected to build a radiomicssignature after feature dimension reduction. The radiomics signature was significantly associated with ESCCstaging （P〈0.001）, and yielded a better performance for discrimination of early and advanced stage ESCC comparedto tumor volume in both the primary [area under the receiver operating characteristic curve （AUC）： 0.795 vs. 0.694,P=0.003; NRI=0.424）] and validation cohorts （AUC： 0.762 vs. 0.624, P=0.035; NRI=0.834）.Conclusions： The quantitative approach has the potential to identify stage Ⅰ-Ⅱand Ⅲ-Ⅳ ESCC beforetreatment.

关键词： Esophageal cancer tumor staging diagnostic imaging tumor volume

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POST-OPERATIVE staging AND SURVIVAL BASED ON THE REVISED TNM staging SYSTEM FOR NON-SMALL CELL LUNG CANCER

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Chinese Journal of Cancer Research 2000年第4期12卷 278-281页

作者：吴一龙黄植蕃王思愚杨学宁 Lung Cancer Research Center Third Hospital Sun Yat-sen University of Medical Sciences Guangzhou China

Objective: To study the factors affecting post-operative staging and survival in non-small cell lung cancer (NSCLC) patients based on the revised TNM staging system adopted by the UICC in 1977. Methods: Data were collected from 1757 consecutively operated NSCLC patients, including those receiving complete tumor excision, tumor debulking and exploratory thoractomy from April 1969 through Dec. 1993. the end point of follow-up was Nov. 30, 1998. Cumulative survival and its influencing factors were analyzed by Kaplan-Meier and Cox model of SPSS software. Results: In this series, 30 patients (1.7%) were lost from follow-up. The 5-year cumulative survival was 88.0% for patients in stage I A, and 53.9% in stage IB, 33.5% in stage II, 14.7% in stage III A, 5.5% in stage IIIB and 7.0% in stage IV. The overall 5-year survival rate was 28.2%. The 5-year survivals were 39.8%, 14.4% and 4.2% in patients treated with completely tumor resection, tumor debulking and explorative thoractomy, respectively. The 10-year survival rate was 31.4%, 9.5% and 0, respectively. Factors affecting long-term cumulative survival, in the order of decreasing significance, were the type of operation, lymph node status, staging, size and pathological type of the primary tumor. Conclusion: the revised staging system for NSCLC is superior to that used since 1986 as far as the end results of treatment in patients in different stage and the staging specificity are concerned. The T3N1M0 classification and the definition of Ml need to be further studied.

关键词： Surgery tumor staging Survival analysis Non-small cell lung cancer

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