目的分析不同分型乳头状肾细胞癌(pRCC)的临床特征及治疗效果,探讨pRCC预后相关危险因素。方法回顾性收集了中山大学孙逸仙纪念医院2011年1月至2021年10月经微创手术治疗且病理确诊的70例pRCC患者的临床及病理资料。所有患者术前已排除...目的分析不同分型乳头状肾细胞癌(pRCC)的临床特征及治疗效果,探讨pRCC预后相关危险因素。方法回顾性收集了中山大学孙逸仙纪念医院2011年1月至2021年10月经微创手术治疗且病理确诊的70例pRCC患者的临床及病理资料。所有患者术前已排除远处转移,并对患者生存及复发转移情况进行跟踪随访,随访至2021年12月底,以出现疾病进展或任何原因的死亡为终点。采用Kaplan-Meier法绘制生存曲线,COX回归用于多因素分析无进展生存(PFS)的危险因素。结果70例患者均诊断为pRCC,包括21例Ⅰ型及49例Ⅱ型,其中男55例,中位年龄57岁。中位肿瘤直径为4.0 cm(Q_(1)~Q_(3):2.9~6.3 cm)。肿瘤TNM分期:pT_(1)期52例,pT_(2)期7例,pT_(3)期10例及pT_(4)期1例,Ⅰ型及Ⅱ型患者肿瘤直径(4.0 cm vs 4.0 cm)及pT分期差异无统计学意义。Ⅰ型患者中1例伴癌栓,Ⅱ型患者中9例伴癌栓,7例淋巴结转移患者均为Ⅱ型。肿瘤侵犯肾包膜34例,含31例Ⅱ型(P<0.001),Ⅱ型患者WHO/ISUP分级显著高于Ⅰ型(P<0.001)。总体中位随访时间46个月,Ⅰ型和Ⅱ型pRCC患者中位随访时间分别为43个月和51个月。5年无进展生存率分别为100%和67.3%,Kaplan-Meier生存分析示Ⅰ型pRCC患者PFS优于Ⅱ型(P<0.05)。Cox多因素分析发现肿瘤直径与pRCC的PFS相关,此外术前碱性磷酸酶异常亦与Ⅱ型pRCC的PFS相关。结论Ⅱ型pRCC较Ⅰ型核分级更高,更易发生包膜入侵,更易发生疾病进展。直径较大的pRCC患者预后更差,术前碱性磷酸酶异常是Ⅱ型pRCC的独立危险因素。展开更多
Background:Accurate evaluation of lymph node metastasis in bladder cancer(BCa)is important for disease staging,treatment selection,and prognosis prediction.In this study,we aimed to evaluate the diagnostic accuracy of...Background:Accurate evaluation of lymph node metastasis in bladder cancer(BCa)is important for disease staging,treatment selection,and prognosis prediction.In this study,we aimed to evaluate the diagnostic accuracy of com-puted tomography(CT)and magnetic resonance imaging(MRI)for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis.Methods:We retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cys-tectomy.The data regarding size,shape,density,and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal-Wallis test and χ^(2) test.The optimal cutoff value for the size of metastatic node was deter-mined using the receiver operating characteristic(ROC)curve analysis.Results:A total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes.Among 82 imaging-detectable lymph nodes,51 were confirmed to be positive for metastasis.The detection rate of metastatic nodes increased along with more advanced tumor stage(P<0.001).Once the ratio of short-to long-axis diameter≤0.4 or fatty hilum was observed in lymph nodes on imaging,it indicated non-metastases.Besides,lymph nodes with spiculate or obscure margin or necrosis indicated metastases.Furthermore,the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node,with the area under ROC curve of 0.815.Conclusions:The probability of metastatic nodes significantly increased with more advanced T stages.Once lymph nodes are detected on imaging,the characteristic signs should be paid attention to.The short diameter>6.8 mm may indicate metastatic lymph nodes in BCa.展开更多
Background:Clinical outcome of adrenocortical carcinoma(ACC)varies because of its heterogeneous nature and reliable prognostic prediction model for adult ACC patients is limited.The objective of this study was to deve...Background:Clinical outcome of adrenocortical carcinoma(ACC)varies because of its heterogeneous nature and reliable prognostic prediction model for adult ACC patients is limited.The objective of this study was to develop and externally validate a nomogram for overall survival(OS)prediction in adult patients with ACC after surgery.Methods:Based on the data from the Surveillance Epidemiology,and End Results(SEER)database,adults patients diagnosed with ACC between January 1988 and December 2015 were identified and classified into a training set,comprised of 404 patients diagnosed between January 2007 and December 2015,and an internal validation set,com-prised of 318 patients diagnosed between January 1988 and December 2006.The endpoint of this study was OS.The nomogram was developed using a multivariate Cox proportional hazards regression algorithm in the training set and its performance was evaluated in terms of its discriminative ability,calibration,and clinical usefulness.The nomogram was then validated using the internal SEER validation,also externally validated using the Cancer Genome Atlas set(TCGA,82 patients diagnosed between 1998 and 2012)and a Chinese multicenter cohort dataset(82 patients diag-nosed between December 2002 and May 2018),respectively.Results:Age at diagnosis,T stage,N stage,and M stage were identified as independent predictors for OS.A nomo-gram incorporating these four predictors was constructed using the training set and demonstrated good calibration and discrimination(C-index 95%confidence interval[CI],0.715[0.679-0.751]),which was validated in the internal validation set(C-index[95%CI],0.672[0.637-0.707]),the TCGA set(C-index[95%CI],0.810[0.732-0.888])and the Chi-nese multicenter set(C-index[95%CI],0.726[0.633-0.819]),respectively.Encouragingly,the nomogram was able to successfully distinguished patients with a high-risk of mortality in all enrolled patients and in the subgroup analyses.Decision curve analysis indicated that the nomogram was clinically useful and applicable.Conclusions:The study presents a nomogram that incorporates clinicopathological predictors,which can accurately predict the OS of adult ACC patients after surgery.This model and the corresponding risk classification system have the potential to guide therapy decisions after surgery.展开更多
Background:The preoperative prediction of muscular invasion status is important for adequately treating bladder cancer(BC)but nevertheless,there are some existing dilemmas in the current preoperative diagnostic accura...Background:The preoperative prediction of muscular invasion status is important for adequately treating bladder cancer(BC)but nevertheless,there are some existing dilemmas in the current preoperative diagnostic accuracy of BC with muscular invasion.Here,we investigated the potential association between the fluorescence in situ hybridization(FISH)assay and muscular invasion among patients with BC.A cytogenetic-clinical nomogram for the individualized preoperative differentiation of muscle-invasive BC(MIBC)from non-muscle-invasive BC(NMIBC)is also proposed.Methods:All eligible BC patients were preoperatively tested using a FISH assay,which included 4 sites(chromosome-specific centromeric probe[CSP]3,7,and 17,and gene locus-specific probe[GLP]-p16 locus).The correlation between the FISH assay and BC muscular invasion was evaluated using the Chi-square tests.In the training set,univariate and multivariate logistic regression analyses were used to develop a cytogenetic-clinical nomogram for preoperative muscular invasion prediction.Then,we assessed the performance of the nomogram in the training set with respect to its discriminatory accuracy and calibration for predicting muscular invasion,and clinica usefulness,which were then validated in the validation set.Moreover,model comparison was set to evaluate the discrimination and clinical usefulness between the nomogram and the individual variables incorporated in the nomogram.Results:Muscular invasion was more prevalent in BC patients with positive CSP3,CSP7 and CSP17 status(OR[95%CI],2.724[1.555 to 4.774],P<0.001;3.406[1.912 to 6.068],P<0.001 and 2.483[1.436 to 4.292],P=0.001,respectively).Radiologydetermined tumor size,radiology-determined clinical tumor stage and CSP7 status were identified as independent risk factors of BC muscular invasion by the multivariate regression analysis in the training set.Then,a cytogenetic-clinical nomogram incorporating these three independent risk factors was constructed and was observed to have satisfactory discrimination in the training(AUC 0.784;95%CI:0.715 to 0.853)and validation(AUC 0.743;95%CI:0.635 to 0.850)set.The decision curve analysis(DCA)indicated the clinical usefulness of our nomogram.In models comparison,using the receiver operator characteristic(ROC)analyses,the nomogram showed higher discriminatory accuracy than any variables incorporated in the nomogram alone and the DCAs also identified the nomogram as possessing the highest net benefits at wide range of threshold probabilities.Conclusion:CSP7 status was identified as an independent factor for predicting muscular invasion in BC patients and was successfully incorporated in a clinical nomogram combining the results of the FISH assay with clinical risk factors.展开更多
文摘目的分析不同分型乳头状肾细胞癌(pRCC)的临床特征及治疗效果,探讨pRCC预后相关危险因素。方法回顾性收集了中山大学孙逸仙纪念医院2011年1月至2021年10月经微创手术治疗且病理确诊的70例pRCC患者的临床及病理资料。所有患者术前已排除远处转移,并对患者生存及复发转移情况进行跟踪随访,随访至2021年12月底,以出现疾病进展或任何原因的死亡为终点。采用Kaplan-Meier法绘制生存曲线,COX回归用于多因素分析无进展生存(PFS)的危险因素。结果70例患者均诊断为pRCC,包括21例Ⅰ型及49例Ⅱ型,其中男55例,中位年龄57岁。中位肿瘤直径为4.0 cm(Q_(1)~Q_(3):2.9~6.3 cm)。肿瘤TNM分期:pT_(1)期52例,pT_(2)期7例,pT_(3)期10例及pT_(4)期1例,Ⅰ型及Ⅱ型患者肿瘤直径(4.0 cm vs 4.0 cm)及pT分期差异无统计学意义。Ⅰ型患者中1例伴癌栓,Ⅱ型患者中9例伴癌栓,7例淋巴结转移患者均为Ⅱ型。肿瘤侵犯肾包膜34例,含31例Ⅱ型(P<0.001),Ⅱ型患者WHO/ISUP分级显著高于Ⅰ型(P<0.001)。总体中位随访时间46个月,Ⅰ型和Ⅱ型pRCC患者中位随访时间分别为43个月和51个月。5年无进展生存率分别为100%和67.3%,Kaplan-Meier生存分析示Ⅰ型pRCC患者PFS优于Ⅱ型(P<0.05)。Cox多因素分析发现肿瘤直径与pRCC的PFS相关,此外术前碱性磷酸酶异常亦与Ⅱ型pRCC的PFS相关。结论Ⅱ型pRCC较Ⅰ型核分级更高,更易发生包膜入侵,更易发生疾病进展。直径较大的pRCC患者预后更差,术前碱性磷酸酶异常是Ⅱ型pRCC的独立危险因素。
基金funded by the National Natural Science Foundation of China(81572514,U1301221,81472384,81372729,81772719)the Natural Science Foundation of Guangdong Province(2015A030311011)+4 种基金the Major project of Guangzhou Science Technology and Innovation Commission(201604020177)the Major project of Guangdong Science and Technology Department(2017B020227007)the Grant from Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology([2013]163)the Grant from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes(KLB09001)the Grant from Guangdong Science and Technology Department(2015B050501004).
文摘Background:Accurate evaluation of lymph node metastasis in bladder cancer(BCa)is important for disease staging,treatment selection,and prognosis prediction.In this study,we aimed to evaluate the diagnostic accuracy of com-puted tomography(CT)and magnetic resonance imaging(MRI)for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis.Methods:We retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cys-tectomy.The data regarding size,shape,density,and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal-Wallis test and χ^(2) test.The optimal cutoff value for the size of metastatic node was deter-mined using the receiver operating characteristic(ROC)curve analysis.Results:A total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes.Among 82 imaging-detectable lymph nodes,51 were confirmed to be positive for metastasis.The detection rate of metastatic nodes increased along with more advanced tumor stage(P<0.001).Once the ratio of short-to long-axis diameter≤0.4 or fatty hilum was observed in lymph nodes on imaging,it indicated non-metastases.Besides,lymph nodes with spiculate or obscure margin or necrosis indicated metastases.Furthermore,the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node,with the area under ROC curve of 0.815.Conclusions:The probability of metastatic nodes significantly increased with more advanced T stages.Once lymph nodes are detected on imaging,the characteristic signs should be paid attention to.The short diameter>6.8 mm may indicate metastatic lymph nodes in BCa.
基金This work was supported by the Natural Science Foundation of China(81572514,U1301221,81402106,81272808,81825016)the Natural Science Foundation of Guangdong,China(2016A030313244)Grant[2013]163 from Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology,Grant KLB09001 from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes,and grants from the Guangdong Science and Technology Department(2015B050501004,2017B020227007).
文摘Background:Clinical outcome of adrenocortical carcinoma(ACC)varies because of its heterogeneous nature and reliable prognostic prediction model for adult ACC patients is limited.The objective of this study was to develop and externally validate a nomogram for overall survival(OS)prediction in adult patients with ACC after surgery.Methods:Based on the data from the Surveillance Epidemiology,and End Results(SEER)database,adults patients diagnosed with ACC between January 1988 and December 2015 were identified and classified into a training set,comprised of 404 patients diagnosed between January 2007 and December 2015,and an internal validation set,com-prised of 318 patients diagnosed between January 1988 and December 2006.The endpoint of this study was OS.The nomogram was developed using a multivariate Cox proportional hazards regression algorithm in the training set and its performance was evaluated in terms of its discriminative ability,calibration,and clinical usefulness.The nomogram was then validated using the internal SEER validation,also externally validated using the Cancer Genome Atlas set(TCGA,82 patients diagnosed between 1998 and 2012)and a Chinese multicenter cohort dataset(82 patients diag-nosed between December 2002 and May 2018),respectively.Results:Age at diagnosis,T stage,N stage,and M stage were identified as independent predictors for OS.A nomo-gram incorporating these four predictors was constructed using the training set and demonstrated good calibration and discrimination(C-index 95%confidence interval[CI],0.715[0.679-0.751]),which was validated in the internal validation set(C-index[95%CI],0.672[0.637-0.707]),the TCGA set(C-index[95%CI],0.810[0.732-0.888])and the Chi-nese multicenter set(C-index[95%CI],0.726[0.633-0.819]),respectively.Encouragingly,the nomogram was able to successfully distinguished patients with a high-risk of mortality in all enrolled patients and in the subgroup analyses.Decision curve analysis indicated that the nomogram was clinically useful and applicable.Conclusions:The study presents a nomogram that incorporates clinicopathological predictors,which can accurately predict the OS of adult ACC patients after surgery.This model and the corresponding risk classification system have the potential to guide therapy decisions after surgery.
基金National Key Research and Development Program of China,Grant/Award Number:2018YFA0902803National Natural Science Foundation of China,Grant/Award Numbers:81825016,81961128027,81772719,81772728+6 种基金Key Areas Research and Development Program of Guangdong,Grant/Award Number:2018B010109006Science and Technology Planning Project of Guang dong Province,Grant/Award Number:2017B020227007Guangdong Special Support Program,Grant/Award Number:2017TX04R246special fund for basic scientific research operating expenses of Sun Yat-sen university,Grant/Award Number:19ykyjs29Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology,Grant/Award Number:[2013]163Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes,Grant/Award Number:KLB09001Guangdong Science and Technology Department,Grant/Award Number:2017B030314026。
文摘Background:The preoperative prediction of muscular invasion status is important for adequately treating bladder cancer(BC)but nevertheless,there are some existing dilemmas in the current preoperative diagnostic accuracy of BC with muscular invasion.Here,we investigated the potential association between the fluorescence in situ hybridization(FISH)assay and muscular invasion among patients with BC.A cytogenetic-clinical nomogram for the individualized preoperative differentiation of muscle-invasive BC(MIBC)from non-muscle-invasive BC(NMIBC)is also proposed.Methods:All eligible BC patients were preoperatively tested using a FISH assay,which included 4 sites(chromosome-specific centromeric probe[CSP]3,7,and 17,and gene locus-specific probe[GLP]-p16 locus).The correlation between the FISH assay and BC muscular invasion was evaluated using the Chi-square tests.In the training set,univariate and multivariate logistic regression analyses were used to develop a cytogenetic-clinical nomogram for preoperative muscular invasion prediction.Then,we assessed the performance of the nomogram in the training set with respect to its discriminatory accuracy and calibration for predicting muscular invasion,and clinica usefulness,which were then validated in the validation set.Moreover,model comparison was set to evaluate the discrimination and clinical usefulness between the nomogram and the individual variables incorporated in the nomogram.Results:Muscular invasion was more prevalent in BC patients with positive CSP3,CSP7 and CSP17 status(OR[95%CI],2.724[1.555 to 4.774],P<0.001;3.406[1.912 to 6.068],P<0.001 and 2.483[1.436 to 4.292],P=0.001,respectively).Radiologydetermined tumor size,radiology-determined clinical tumor stage and CSP7 status were identified as independent risk factors of BC muscular invasion by the multivariate regression analysis in the training set.Then,a cytogenetic-clinical nomogram incorporating these three independent risk factors was constructed and was observed to have satisfactory discrimination in the training(AUC 0.784;95%CI:0.715 to 0.853)and validation(AUC 0.743;95%CI:0.635 to 0.850)set.The decision curve analysis(DCA)indicated the clinical usefulness of our nomogram.In models comparison,using the receiver operator characteristic(ROC)analyses,the nomogram showed higher discriminatory accuracy than any variables incorporated in the nomogram alone and the DCAs also identified the nomogram as possessing the highest net benefits at wide range of threshold probabilities.Conclusion:CSP7 status was identified as an independent factor for predicting muscular invasion in BC patients and was successfully incorporated in a clinical nomogram combining the results of the FISH assay with clinical risk factors.
