Surgery remains the first option for curing early stage lung cancer. However, many patients are diagnosed at an advanced stage, and thus miss the chance to undergo surgery. As such patients derive limited benefits from chemotherapy or radiotherapy, alternatives based on local control have emerged, including iodine-125 seed implantation. The Interstitial Brachytherapy Society, Committee of Minimally Invasive Therapy in Oncology, the Chinese Anti-Cancer Association organized a group of multidisciplinary experts to revise the guidelines for this treatment modality. It aims to standardize iodine-125 seed implantation procedures, inclusion criteria, and outcome assessment to prevent and manage procedure-related complications.

Immune checkpoint blockade with programmed cell death protein-1 (PD-1)/programmed cell death ligand-1 (PD-L1) inhibitors has been standard care for metastatic nonsmall cell lung cancer (NSCLC) and after progression using first-line platinum-containing chemotherapy. Although several management guidelines exist for immune checkpoint inhibitor-induced toxicities, uncommon, complicated, and life-threatening immune-related adverse events remain challenging for oncologists. In this report, we presented a male patient with NSCLC who received pembrolizumab during disease progression. He developed interstitial pembrolizumab-induced organizing pneumonia (OP). The patient received 9 months of anti-PD-1 pembrolizumab when he presented with dry cough and fatigue. The patient developed a solitary nodular lung lesion mimicking a newly occurred metastatic lesion in the lung without a significant circulating tumor marker increase. Sputum analysis was negative for acid-fast bacilli and fungi. A computed tomography-guided percutaneous lung biopsy was conducted and showed alveolar fibrous thickness and various lymphocyte infiltration. Immunotherapy-related OP was identified, and he subsequently responded well to corticosteroids. This case describes a clinical situation, where PD-1-induced OP is radiologically similar to NSCLC disease progression in the lungs. Oncologists should be aware of uncommon pulmonary PD-1/PD-L1 inhibitor toxicity. Lung biopsy may help to distinguish immune-related pneumonitis, lung infections, and progressive nodular lesions.

Objective: The objective of the study is to compare computed tomography (CT)-based I¹²⁵ radioactive seed brachytherapy (RSB) joint three-dimensional conformal radiotherapy (3D-CRT) and stereotactic ablative radiotherapy (SBRT) on early nonsmall cell lung cancer (NSCLC). Methods: The study involved 30 Stage I and II NSCLC patients from March 2014 to June 2017. The patients were divided into two groups: 20 cases with CT-based RSB–3D-CRT (300 cGy × 10) (Group A) and 10 cases with SBRT (8 cGy × 6) (Group B). Their local control rates, 1-year survival rates, and toxic and side effects were compared. Results: The median time of follow-up was 20 months (3–51 months). The 1-year local control rate in Groups A and B was 90% and 80%, respectively (P = 0.70). The 1-year survival rate in Groups A and B was 90% and 90%, respectively (P = 1.00). The indicator of radioactive pneumonia V₂₀ and V₃₀ in Groups A and B was 6.06% and 4.207%, and 11.32% and 7.111%, respectively (P = 0.000024 and 0.00090). Conclusion: Compared with SBRT, RSB–3D-CRT was more aggressive on early NSCLC. It remarkably reduced the indicators (V₂₀ and V₃₀) and the incidence of radioactive pneumonia.

Background: Detection of early-stage lung cancers has increased due to computed tomography (CT). The pathological stages and subtypes of early lung cancer determine the treatment strategy. We aimed to investigate the correlation between CT characteristics and pathological status in early lung adenocarcinoma (ADC). Subjects and Methods: Between June 2018 and December 2019, 415 consecutive patients who underwent surgery for lung ADC with pathological atypical adenomatous hyperplasia (AAH) and ADC in situ (AIS), T1a (mi) N0M0, and T1a–cN0M0 were analyzed. The relationship between CT imaging and pathological status was investigated using Chi-squared or Kruskal–Wallis test and binary logistic regression. Results: When cases of AAH, AIS, and T1a (mi) N0M0 were used as the control group, the lesion size, solid component ratio (SCR), and spiculation were significantly and independently associated with T1a-cN0M0 (P < 0.01). SCR >50% (P < 0.01) and spiculation (P < 0.05) were significantly and independently associated with T1aN0M0. In cases of pathological T1a-cN0M0, SCR >50% was significantly different between adherent wall growth ADC and mucinous ADC (P < 0.01). Conclusions: Some CT characteristics are related to the pathological stage and subtypes of early lung ADC. Larger diameter, spiculation, and SCR >50% are associated with invasive ADC. SCR >50% is positively correlated with mucinous ADC and negatively with adherent growth ADC.

Background: The background of this study was to explore the success rate and early complications concerning the implantation of totally implantable venous access devices (TIVADs) by percutaneous venipuncture and management strategies for early complications. Materials and Methods: This was a retrospective study of 1923 patients who received TIVAD implantation by percutaneous venipuncture (mostly via the supraclavicular route). The percutaneous access sites were internal jugular vein (810 patients; right/left: 158/652) or proximal right internal jugular vein, brachiocephalic vein, and proximal subclavian vein (1113 patients). Success rates and early complications related to TIVAD placement techniques were summarized, and strategies for managing complications were also analyzed. Results: In 627 patients, TIVAD implantation was first performed by interventional radiologists using a “blind” approach relying on anatomical landmarks, having a 91.9% success rate. In contrast, there was a 100% success rate among the remaining 1296 patients who received ultrasound-guided implantation, a difference which was statistically significant (P < 0.05). Ultrasound-guided implantation was also successful for the 51 patients for whom the first attempt failed using the blind technique. Further, we found that the incidence of early complications was 5.41% (104/1923) and that the occurrence of immediate complications was significantly higher in the blind technique group compared to the ultrasound-guided group (37 vs. 12; P < 0.05). Conclusions: It is safe and feasible to implant TIVADs by supraclavicular venipuncture. Ultrasound guidance combined with X-ray monitoring during operation significantly improves the surgery success rate and reduces the risk of early complications. Unclear anatomical landmarks and vascular variation are the main factors affecting success using a blind (nonguided) technique.

Purpose: To evaluate the efficacy and safety of drug-eluting bead-transcatheter arterial chemoembolization (DEB-TACE) using 100–300 μm versus 300–500 μm CalliSpheres microspheres (CSMs) for treating multiple hepatocellular carcinoma (HCC) with the largest nodule measuring between 5 and 10 cm. Methods: Eighty-one advanced-stage HCC patients treated by DEB-TACE between January 2017 and March 2020 were retrospectively analyzed. There were 48 patients in the 100–300 μm group and 33 patients in the 300–500 μm group. Treatment response, liver function tests, and complications were compared between the two groups. Results: At 6 months, the response rates in the 100–300 μm group were higher than those in the 300–500 μm group (P < 0.05). Disease control rates in the 100–300 μm group were higher than those in the 300–500 μm group at 1, 3, and 6 months (P < 0.05). Progression-free survival (PFS) and overall survival (OS) were longer in the 100–300 μm group (P < 0.05). Visual analog score points were higher in the 300–500 μm group (P < 0.05). There were no significant differences in complications between the two groups. Conclusion: The use of small-diameter CSMs in multiple HCC with the largest nodule size of 5–10 cm provides better treatment response and longer PFS and OS for treating advanced-stage HCC.

Context: In the management of bladder tumors bipolarenergy has been used as a common alternative to the conventional monopolar transurethral resection of the bladder (M-TURB). Aim: This study aims to examine the clinical efficacy and safety of bipolar versus monopolar TURB tumors (TURBTs). Subjects and Methods: We conducted a systematic literature search in the PubMed, Cochrane Library, and Embase databases for the identification of prospective randomized controlled trials (RCTs) that compared the outcomes between the two procedures. The Statistical Tool: Meta-analysis was performed using the software Review Manager 5.3. Results: We identified nine RCTs involving 1193 patients. In terms of the surgical outcomes, there was no significant difference between the bipolar and monopolar TURBT. However, there was significantly reduced bladder perforation (risk ratio [RR] = 0.48; 95% confidence interval [CI] = 0.30–0.77; P = 0.002) and shorter hospital stay (mean difference = 0.43; 95% CI = 0.83–0.03, P = 0.01) in the bipolar TURBT group. There was also a lower incidence of thermal damage, which causes histopathological artifacts for patients treated via bipolar TURBT relative to those treated via monopolar TURBT (RR = 0.66; 95% CI = 0.55–0.78; P < 0.00001). P < 0.05 was considered to be statistically significant. However, after bipolar and monopolar TURBT, we had no sufficient evidence regarding the recurrence rate. Conclusion: This meta-analysis suggests that the use of bipolar technology, which is associated with less bladder perforation and lower thermal artifacts in TURBT is safer and more effective.

Purpose: It is not yet verified whether incomplete radiofrequency ablation (iRFA) induces tumor progression and hypoxia related to tumor dormancy. This study showed the relationship between iRFA and tumor dormancy. Materials and Methods: To identify the candidate genes in the control and iRFA-treated colon cancer cells, microarray datasets GSE138224 were downloaded from Gene Expression Omnibus database. Using NetworkAnalyst, the differentially expressed genes (DEGs) were identified, function enrichment analyses were performed, and the protein–protein interaction (PPI) network and key PPI network were constructed. Results: A total of 656 DEGs were identified, comprising 637 downregulated and 19 upregulated genes. The enriched functions and pathways of the upregulated DEGs include an immune effector process, regulation of tyrosine phosphorylation of signal transducer and activator of transcription (STAT) protein, tyrosine phosphorylation of STAT protein, JAK-STAT cascade, and regulating JAK-STAT cascade, and CCL5 gene participated in regulating the JAK-STAT signaling pathway. The downregulated DEGs were mainly enriched in extracellular matrix–receptor interaction, PI3K-Akt signaling, Wnt signaling, transforming growth factor-beta signaling, and mitogen-activated protein kinase signaling pathways. There are three key PPI networks of DEGs (degree ≥10 and hub genes >3). The dormancy-related genes Bmp4 and Ccl5 were regarded as hub genes in the PPI network with Bmp4 as a downregulated gene and CCL5 as an upregulated gene. Conclusion: The identified DEGs and function enrichment analyses in this study aid the understanding of molecular mechanisms underlying the relationship between iRFA and tumor dormancy.

Objective: To investigate the safety and therapeutic efficacy of adjuvant cytokine-induced killer (CIK) cells to minimally invasive therapies in unresectable hepatocellular carcinoma (u-HCC). Materials and Methods: Hundred patients diagnosed with having u-HCC in our department from January 1, 2001, to July 31, 2018, were recruited. Forty-three patients received microwave ablation (MWA) and transcatheter arterial chemoembolization (TACE) together with autologous CIK cell treatment (TACE + MWA + CIK group), whereas 57 patients received TACE and MWA only (TACE + MWA group). Postprocedural complications and cumulative therapeutic effects were assessed in all patients. The disease control rate, median survival time (MST), and cumulative survival rate were compared between the cohorts using the Kaplan–Meier method and unpaired Student's t-tests. Results: The overall response (complete response [CR] + partial response [PR]) rate was 74.42% (32/43) and 77.19% (44/57) for TACE + MWA + CIK and TACE + MWA groups, respectively (P = 0.243). Those of the TACE + MWA + CIK group had better rates of disease control (CR + PR + stable disease) in contrast to the TACE + MWA group (87.72% vs. 79.07%, respectively) but this failed to achieve statistical significance (P = 0.748). Based on the Kaplan–Meier survival graphs, those of the TACE + MWA + CIK groups possessed markedly increased overall survival (41 months vs. 24 months, P = 0.002) and progression-free survival (17 months vs. 10 months, P = 0.023) rates in compared to the TACE + MWA group. Survival rates were raised also TACE + MWA + CIK group than in TACE + MWA group (P = 0.002), with a MST of 6.13 ± 0.83 months and 11.61 ± 1.59 months in the TACE + MWA + CIK and TACE + MWA groups, respectively. Patients in the TACE + MWA + CIK group were not reported to have any severe complications. Conclusion: CIK cell immunotherapy as an adjuvant to TACE and MWA enhanced long-term prognosis and improved quality of life in patients with u-HCC. This regimen may be recommended as a novel treatment regime in u-HCC patients.

Purposes: To investigate the impact of postoperative complication on long-term survival in gastric cancer patients after curative resection. Methods: A total 663 gastric cancer patients undergoing potentially curative resection during January 2010 to November 2014 were studied. Complications were classified according to the Clavien-Dindo severity classification. Results: Postoperative complications occurred in 138 of 663 cases (20.8%). Multivariate analysis identified >65 years old (P = 0.001), male (P = 0.035), and total gastrectomy (P = 0.037) as independent risk factors for postoperative complications. The 5-year overall survival rate was 48.7% in the no complication group, which was significantly better than that in the complication group (42.7%, P = 0.01). Further stratified analysis by cancer staging revealed that decline in 5-year overall survival due to postoperative complication existed among stage I (P = 0.032), II (P = 0.041), and III (P = 0.001) patients. Cox proportional hazards model showed that increasing pT (P = 0.013) and pN (P = 0.001) grade, advanced pTNM (P = 0.001) stage, total gastrectomy (P = 0.001), and postoperative complication (P = 0.006) were independent prognostic factors. Conclusion: Postoperative complications have a significant negative impact on the long-term survival in gastric cancer patients even if the tumor is resected curatively.

Objective: The objective of this study was to evaluate the degradation characteristics and embolic effect of gelatin microspheres (GMSs) produced domestically in China through an experimental study comparing the embolization of rabbit renal arteries using GMSs and tris-acryl microspheres. Materials and Methods: Sixteen healthy adult New Zealand white rabbits were randomly divided into two groups. Group A was embolized with GMSs produced in China with a diameter of 150–200 μm (n = 8), and Group B was embolized with tris-acryl microspheres with a diameter of 100–200 μm (n = 8). The renal arteries were embolized through femoral artery puncture and catheterization. Renal artery angiography rechecks and hematoxylin and eosin staining of tissue sections were performed at 1 day, 4 days, 7 days, and 14 days after embolization, respectively, to observe vascular recanalization, degradation of microspheres, and embolic effect. Results: Group A: Digital subtraction angiography showed complete recanalization at 14 days. The changes in embolic necrotic areas at different time points after embolization were similar in the two groups. At 4 days after embolization, changes in glomerular structure were observed in the kidney on the embolic side. At 7 days after embolization, atrophy, degeneration, and necrosis of the glomeruli, as well as degeneration and inflammatory cell infiltration of the renal tubules, were observed in the kidney on the embolic side. At 14 days after embolization, extensive atrophy and hyalinization of the glomeruli were observed, and local renal tissue showed patchy fibrosis with calcification of internal tissue. Hyperplasia of fibrillar connective tissue was observed in the renal interstitium. Conclusion: The GMSs produced domestically in China can be completely degraded after embolizing blood vessels for 14 days. The GMSs are similar to tris-acryl microspheres in arterial embolization effect and are safe and effective.

Purpose: The objective of our study was to prospectively evaluate the feasibility, effectiveness, and safety of 1.0T open multiparametric magnetic resonance (MR)-guided and monitored microwave ablation (MWA) of liver cancer. Materials and Methods: Fifty-six liver lesions (12 – initial hepatocellular carcinoma, 34 – recurrent hepatocellular carcinoma, and 10 – metastatic liver cancers) in 45 patients were treated with MWA ablation using MR guidance and monitoring. The mean diameter of the liver lesions was 1.7 ± 0.9 cm (range, 0.5–4.6 cm). The 56 liver lesions were divided into 3 groups according to diameter: the <1.0 cm group (17 lesions), the 1.0–2.0 cm group (19 lesions), and the >2.0 cm group (20 lesions). Technical success, technical effectiveness, local tumor progression, procedure duration, and complications were assessed. Primary technical effectiveness was assessed 3 months after the MWA, while local tumor progression was assessed more than 3 months after the MWA. The follow-up time for assessment of treatment response ranged from 12 to 30 months (median, 23 months). Results: The technical success rate was 100%. Primary technical effectiveness was achieved in 52/56 (92.8%) lesions. Local tumor progression was detected in three tumors after initial technical effectiveness. The median duration of the intervention per tumor was 66 min (range, 40–156 min). There were no significant differences between lesion groups in the technical success rate, primary technical effectiveness rate, or local tumor progression rate. There were no major complications following the ablation therapy. Conclusions: 1.0T open multiparametric MR-guided and MR-monitored MWA for liver cancer is safe and feasible and decreases the risk of local tumor progression; it also provides good primary technique effectiveness rates and is especially suitable when ultrasound and CT facilitated treatments are inappropriate.

Objectives: The objective is to assess the accuracy of high-resolution (HR) enhanced magnetic resonance imaging (MRI) images in the preoperative evaluation of biliary and vascular invasion in hilar cholangiocarcinomas. Methods: This retrospective study included 36 patients with hilar cholangiocarcinoma who underwent enhanced HR-MRI with an effective section thickness of 1.2 mm at 3.0 T before surgery. Combined HR-MRI and magnetic resonance cholangiopancreatography (MRCP) images were compared with MRCP in evaluating the extent of biliary infiltration according to the Bismuth–Corlette classification. To determine the suitable criterion for HR-MRI in predicting vessel invasion, Labeling 180 and 90 of circumferential contact of the tumor with the vessel were used to predict the invasion. The correlation between imaging findings and surgical and histopathological records was statistically analyzed. Results: The accuracy in detecting biliary neoplastic invasion was higher for combined HR-MRI images (97.2%) than MRCP images (86.1%). HR-MRI images increased the accuracy in delineation of the tumor biliary extent (P < 0.05). The accuracy of Labeling 90 (98.6% in portal venous system and 98.0% in hepatic arterial system) was higher than that of Labeling 180 (96.5% in portal venous system and 94.6% in hepatic arterial system). However, there was no significant statistic difference between them (P > 0.05). Interobserver agreement was high with respect to biliary tract, portal venous, and hepatic arterial system involvement. Conclusions: Enhanced HR-MRI images showed excellent capability for assessing tumor extent and vascular invasion in hilar cholangiocarcinomas. More than 90° of circumferential contact of the tumor with the vessel on HR-MRI may be an appropriate criterion for predicting invasion.

Aims: To investigate the diagnostic value of lung-specific X protein (LUNX) messenger ribonucleic acid (mRNA) expression in peripheral blood of patients with nonsmall cell lung cancer (NSCLC) in micrometastasis. Materials and Methods: Peripheral blood samples of 112 patients with NSCLC were collected, and the expression of LUNX, cytokeratin 19 (CK19), and carcinoembryonic antigen (CEA) mRNA was measured by reverse transcription-polymerase chain reaction (RT-PCR). Results: The expression of LUNX, CK19, and CEA mRNA was increased in peripheral blood of patients with NSCLC compared with that of patients with benign lung disease (P < 0.05), and the sensitivity of LUNX mRNA was higher than that of CK19 and CEA mRNA (P < 0.05). LUNX-positive expression was also associated with lymph node metastasis, tumor–node–metastasis (TNM) staging, and reduced 5-year survival rate of patients in our cohort (P < 0.05). Further, the 5-year survival improved for those LUNX-positive patients who became LUNX negative following adjuvant chemotherapy compared to those who remain LUNX positive (P < 0.05). Multivariate analysis showed that lymph node metastasis, TNM stage, and LUNX mRNA expression in peripheral blood were independent prognostic factors. Conclusion: The detection of LUNX expression in peripheral blood of patients with NSCLC by RT-PCR is a highly specific and sensitive detection method for tumor micrometastasis that may be used for molecular diagnosis of tumor micrometastasis. LUNX mRNA expression in peripheral blood is an independent factor affecting prognosis of NSCLC and thus may reliably predict NSCLC prognosis and guide appropriate adjuvant chemotherapy treatment.

Objective: The objective of this study was to evaluate whether whole-uterine magnetic resonance imaging (MRI) radiomic features can predict myometrial invasion (MI) depth in endometrial cancer (EC). Materials and Methods: The preoperative 3.0 T magnetic resonance examinations of EC patients were retrospectively reviewed. Whole-uterus segmentation was performed, and features were extracted based on sagittal T2-weighted imaging (T2WI) and axial diffusion-weighted imaging (DWI). The logistic regression (LR) classifier algorithm was used to establish the radiomic model, which was verified by ten times five-fold cross-validation. The areas under the receiver operating characteristic (ROC) curves (AUCs) were assessed by the DeLong test to compare differences among the models based on different sequences. The LR model was compared with the subjective diagnosis results by the Chi-square test. Results: Of the 163 EC patients included, 44 had deep myometrial invasion (DMI). The feature consistency of the whole uterus was higher than that of the lesion (P < 0.05). The sagittal T2WI, axial DWI, and combined models had AUCs of 0.76, 0.80, and 0.85 in the validation set, respectively. The DeLong test showed that there were no significant differences in AUCs among the models (P > 0.05). The single-sequence LR models had lower specificity and accuracy than the corresponding subjective diagnostic results (P < 0.05), while the sensitivity was higher (P > 0.05). The combined model included 24 radiomic features, and the accuracy, sensitivity, and specificity were 0.83, 0.77, and 0.85 for DMI, respectively. There was no significant difference compared with subjective diagnosis (P > 0.05). Conclusion: Whole-uterine MRI radiomic features based on sagittal T2WI and axial DWI show potential in predicting MI in EC.

Objective: The objective of this study is to further clarify the correlation between colorectal cancer (CRC) and human papillomavirus (HPV) through literature search and meta-analysis, which is conducive to the formulation of further prevention programs. Methods: Searching Web of Science, PubMed, MEDLINE, Scopus, and CENTRAL for studies investigating the relationship between CRC and HPV. All analyses were performed through Revman (version 5.3, the Cochrane Collaboration, Oxford, UK). Data from selected studies were extracted into two by two tables. Moreover, all included studies were weighted and summarized. Results: Eighteen studies were included. The expression of HPV in CRC tissues was obviously higher than that in nonmalignant tissues (odds ratio [OR] = 5.56, 95% confidence interval [CI] = 3.18–9.72, Z = 6.02, P < 0.00001). The expression of HPV in CRC tissues and adenoma tissues showed no significant abnormalities (OR = 1.74, 95% CI = 0.92–3.29, Z = 1.70, P = 0.09). The expression of HPV in CRC tissues was obviously higher than that in normal tissues (OR = 7.23, 95% CI = 3.89–13.42, Z = 6.27, P < 0.00001). Conclusion: HPV infection in CRC tissues was obviously higher than that in nonmalignant tumor tissues and normal colon tissues, but there were no statistically significant abnormalities between CRC tissues and adenoma tissues.

Background: Mucinous adenocarcinoma (MA) is a distinct histotype of rectal cancer, possibly having prognostic differences with adenocarcinoma (AD). We investigated the prognostic significance of mucinous histology in patients with Stage II rectal cancer. Patients and Methods: Eligible patients were retrieved from the Surveillance, Epidemiology, and End Results database from 2004 to 2017, and the survival difference between AD and MA patients in the overall and subgroup populations (divided by age) was compared. Multivariate Cox proportional hazard regression analysis was performed to assess whether the mucinous histotype was an independent prognostic factor. Results: A total of 10, 910 patients with Stage II rectal cancer were enrolled and divided into a young group (≤55 years, n = 3248) and an old group (>55 years, n = 7662). Patients with MA exhibited a lower cancer-specific survival rate than those with common AD in the overall population and the young group, but not in the old group. The analysis revealed that the mucinous histotype was an independent prognostic factor in the young group, but not in the old group. Moreover, after excluding patients with risk factors (including poorly differentiated or undifferentiated tumor grade, T4 stage, <12 lymph nodes examined, and elevated preoperative carcinoembryonic antigen level), prognosis of the mucinous histotype was poorer in the young group than that in the old group. Conclusion: The mucinous histotype was an independent prognostic factor in young patients with Stage II rectal cancer. The presence of mucinous histology reflected poor prognosis, especially in the low-risk young population.

Context: Pancreatic cancer portal hypertension (PCPH) is a rare cause of gastrointestinal bleeding. This study retrospectively assessed gastrointestinal bleeding risk factors in 57 PCPH patients diagnosed via multidetector computed tomography (MDCT). Materials and Methods: The data of patients with pancreatic cancer from January 2008 to January 2018 at Qingdao Municipal Hospital were reviewed. PCPH patients were screened with MDCT and followed up. MDCT findings (e.g., the location of the venous obstruction, type of variceal veins pathway, and splenomegaly) were recorded. Variceal hemorrhage was recorded. The MDCT findings and clinical data of the PCPH patients were used in this analysis to explore the risk factors of variceal hemorrhage using binary logistic regression and multivariate logistic regression model. Results: Fifty-seven of the 182 patients were diagnosed with PCPH. A total of 7 draining routes and 11 types of varices were found. Of these patients, eight experienced variceal hemorrhage. Univariate analysis showed that splenomegaly (odds ratio [OR] = 10.364, P = 0.003) was significantly associated with an increased risk of variceal hemorrhage. Multivariate analysis showed that splenomegaly (OR = 66.491, 95% confidence interval: 2.790–1584.643, P = 0.009) was an independent influencing factor for variceal hemorrhage in PCPH patients. Conclusions: Patients with pancreatic cancer have high morbidity of PCPH. The splenomegaly is more prone to hemorrhage. Splenomegaly was an independent risk factor of variceal hemorrhage. MDCT can provide insight into the stenosis and occlusion of the portal vein system and the drainage routes of variceal veins and is one of the best ways to diagnose PCPH.

Objectives: The objectives of this study were to prospectively compare individualized dietary counseling with or without oral nutritional supplements (ONSs) in nasopharyngeal carcinoma (NPC) patients undergoing concurrent chemoradiotherapy (CCRT) in a Phase II, randomized trial. Materials and Methods: Between June 2014 and August 2016, Stage II–IVb NPC patients were randomly enrolled. The primary endpoint was change in body weight between during CCRT, and the secondary endpoints were change in body mass index (BMI) and fat-free mass index (FFMI). Results: Fifty-two patients were randomized; 19 patients in the control group and 23 in the ONS group were eligible for analysis. Weight, BMI, and body composition parameters significantly decreased from baseline to week 6. FFMI was significantly better in patients with ONS intake >2/3 planed than the control group (P = 0.028). Weight and BMI maintenance was slightly better in patients with total intake >2/3 planed (P = 0.170 and P= 0.229, respectively). The mean Patient-Generated Subjective Global Assessment score was also better in the ONS group at the end of CCRT (P = 0.053). Conclusions: ONSs with individualized dietary counseling may be beneficial in patients with enough intake, and further prospective studies with large groups of patients are warranted.

Aims: The aim of this study is to compare the efficacy and safety of percutaneous radiofrequency ablation (RFA) under general anesthesia or local anesthesia plus intraoperative analgesia in the treatment of hepatocellular carcinoma (HCC) at unusual regions. Subjects and Methods: From July 2012 to October 2019, 83 consecutive patients with 107 HCC lesions were treated with interventional radiology therapy. The lesions were located at some unusual regions such as diaphragmatic surface, hepatic hilum, hepatic subcapsular region, tissues near inferior vena cava, and tissues near the colon. General anesthesia was applied in 57 cases (general anesthesia group) and local anesthesia plus intraoperative analgesia was used in 26 cases (local anesthesia group). All patients were treated with transcatheter arterial chemoembolization, followed immediately by RFA. The rate of tumor inactivation, time used for placing RF needles to the scheduled sites, pain score, and complications were analyzed. Statistical Analysis Used: All continuous variables were tested for the normal/nonnormal distribution by Kolmogorov–Smirnov test. The t-test was used to analyze the normal distribution variables; the Mann–Whitney U-test was used to measure nonnormal distribution variables; and the Chi-square test for categorical variables. P < 0.05 was considered statistically significant. Results: The treatments were successful in all patients, including 51 cases of complete response (CR) and 6 cases of partial response (PR) in the general anesthesia group and 18 cases of CR and 8 cases of PR in the local anesthesia group (P = 0.049). The time used for placing the needles to the scheduled sites was 1–5 min (mean 2 min) in the general anesthesia group and 2–9 min (mean 4 min) in the local analgesia group (P < 0.001). The pain scores ranged from 0 to 2 points (mean 1 point) in the general anesthesia group and 2–9 points (mean 5 points) in the local anesthesia group (P < 0.001). With regard to complications, seven cases had pneumothorax and four cases had slight hepatic subcapsular hemorrhage in the general anesthesia group and four cases of pneumothorax and three cases of slight hepatic subcapsular hemorrhage in the local anesthesia group, and the difference was not statistically significant between the two groups (P = 0.715). Conclusions: For HCC located at unusual regions, general anesthesia is superior to local anesthesia plus intraoperative analgesia in percutaneous RFA in reducing the difficulty of the procedure and improving the safety of RFA.

Aims: The aims of the study were to compare the efficacy and safety between transcatheter arterial chemoembolization (TACE) combined with ¹²⁵I seed implantation (TACE-¹²⁵I) or with apatinib (TACE-Apatinib) in HCC-portal vein tumor thrombosis (PVTT) patients. Setting and Design: We retrospectively evaluated the medical records of consecutive patients with HCC-PVTT who had undergone treatment with either TACE-¹²⁵I or TACE-Apatinib between January 2018 and June 2019. Materials and Methods: The response was assessed at the last follow-up, and the outcomes were compared between the two groups. Progression-free survival (PFS), overall survival (OS), and treatment-related complications were evaluated. Statistical analysis used the 2-sample Student's t-test and Fisher's exact test. Results: This study enrolled 48 patients; 21 were treated with TACE-Apatinib and 27 with TACE-¹²⁵I. For PVTT, the disease control rate (DCR) was 23.81% in the TACE-Apatinib group and 77.78% in the TACE-¹²⁵I group. The objective response rate (ORR) in the TACE-Apatinib group was remarkably lower. The DCR of intrahepatic lesions was 85.71% in the TACE-Apatinib group and 81.48% in the TACE-¹²⁵I group. There was no statistically significant difference in the ORR of intrahepatic lesions. Median OS was significantly longer in the TACE-¹²⁵I group (13.3 vs. 10.8 months). Similarly, the median PFS was significantly longer in the TACE-¹²⁵I group (9.7. vs. 6.6 months). Multivariate and univariate analyses showed that TACE-¹²⁵I was an independent prognostic factor for OS. Conclusions: Compared with TACE-Apatinib, TACE-¹²⁵I seed implantation can effectively prolong PVTT progression, PFS, and OS in HCC patients with PVTT.

Objective: To evaluate targeted magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion prostate biopsy versus systematic prostate biopsy and the two approaches combined for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in our center. Patients and Methods: From September 2018 to June 2020, a total of 161 patients with PI-RADS ≥3 were enrolled in this study. They were randomly to undergo either systematic prostate biopsy (systematic group) or targeted MRI/TRUS fusion prostate biopsy + systematic prostate biopsy (combined group). The clinical data and pathological results of biopsies were analyzed. Results: The detection rate of PCa by targeted MRI/TRUS fusion prostate biopsy was higher than systematic prostate biopsy (38/81 vs. 33/81) in combinated group, but there was no significantly difference. The PCa detection rate in combinated group was significantly higher than systematic group (47/81 vs. 34/80, P = 0.049). There were 40 patients in combinated group and 22 patients in systematic group diagnosed as csPCa, respectively. The ratio of detected csPCa was much higher in combinated group (P = 0.032). In Gleason score no more than 6, the detected ratio of targeted MRI/TRUS fusion prostate biopsy was significantly lower than systematic biopsies in combinated group (P = 0.044). While, in Gleason score higher than 6, the detected ratios of targeted MRI/TRUS fusion prostate biopsy were all higher than systematic biopsies. Conclusions: Among patients with PI-RADS ≥ 3, targeted MRI/TRUS fusion prostate biopsy is superior to systematic prostate biopsy in the detection rate of PCa and csPCa, but it still misses some PCa patients, including csPCa. Combining targeted MRI/TRUS fusion prostate biopsy and systematic prostate biopsy can led to more detection of all PCas, especially csPCa.

Purpose: Transcatheter arterial chemoembolization (TACE) is the first-line therapy for unresectable hepatocellular carcinoma (HCC). However, its therapeutic effects are hampered by the poor distribution of anticancer drugs in tumors. iRGD, a novel tumor-penetrating peptide, enhances the penetration distance and therapeutic efficacy of anticancer drugs. Herein, we evaluated the therapeutic effects of iRGD coupled with TACE in the rabbit VX2 liver tumor model. Subjects and Methods: This study had two stages: tumor permeability assay and anticancer efficacy evaluation. In the tumor permeability assay, we coadministered TACE with either iRGD + lipiodol-doxorubicin emulsion (LDE) or LDE in the rabbit VX2 liver tumor model. We evaluated the doxorubicin (DOX) distribution at predetermined times by immunofluorescence microscopy. To evaluate anticancer efficacy, we administered saline, LDE, or iRGD + LDE to tumor-grafted rabbits. We measured tumor volume using magnetic resonance scanning. We quantified the expression levels of Bax, Bcl-2, and cleaved caspase-3 using Western blot (WB) analysis and determined the apoptosis rate in tumor cells using transferase-mediated dUTP nick-end labeling assay. Results: The iRGD + LDE infusion significantly increased the DOX concentration and DOX penetration in tumors compared with the LDE infusion (P < 0.05). The antitumor efficacy of the iRGD + LDE in tumor inhibition was higher than that of the other treatments (P < 0.05). Besides, iRGD + LDE induced more apoptosis (P < 0.05). Conclusions: We demonstrated that iRGD coadministered with TACE is effective against HCC.

Spontaneous regression (SR) of hepatocellular carcinoma (HCC) is a rare phenomenon but its true incidence is much higher than expected. We report a recurrent HCC who experienced SR both in intrahepatic lesion and lung metastasis. Serum alpha-fetoprotein decreased dramatically from more than 1000 μg/L to normal range. In addition, we reviewed 11 similar case reports published in recent 5 years. We find that the interval from diagnosis to the recognition of SR is very short (4 m, 1–14 m). Therefore, we speculate the mechanism of SR should be a severe systemic reaction, and immune activation is the most likely conjecture.

Humerus is the long bone second-most commonly affected by metastases. An impending pathologic humeral fracture requires rigid surgical stabilization to prevent it from fully fracturing. In the present study, we report a case of a 71-year-old male patient with a visual analog score of 10 (indicating extreme pain) and an impending pathologic fracture that allowed for combined treatment with percutaneous microwave ablation and simultaneous injection of bone cement during Kirschner wire insertion. The procedure was performed successfully with no complications. The patient reported pain relief and improved quality of life and functional status 1 day, 7 days, 1 month, and 2 months after his procedure.

Increasing evidence support that microwave ablation (MWA) induces spontaneous abscopal regression of the tumor, also called as the abscopal effect. Although the abscopal effect after MWA is a rare event, several studies have suggested that this effect is the result of the activation of the immune system induced by the death of immunogenic tumor cells. Here, we have presented the case of a 65-year-old woman with primary endometrial cancer who developed bilateral pulmonary metastases. After local MWA of one lesion in her right lung, progressive regression of the other lesions in the right and left lungs was recorded. This case supports the hypothesis that the abscopal effect is attributable to the activation of the systemic immune response.