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   2021|   | Volume 17 | Issue 3  
    Online since July 9, 2021

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Chinese expert consensus of image-guided irreversible electroporation for pancreatic cancer
Yingtian Wei, Yueyong Xiao, Zhongmin Wang, Xiaokun Hu, Guang Chen, Xiaoyi Ding, Yong Fan, Yue Han, Kaiwen Huang, Xuequan Huang, Ming Kuang, Xu Lang, Hailiang Li, Chengli Li, Jiakai Li, Jiaping Li, Maoquan Li, Yinying Lu, Caifang Ni, Lizhi Niu, Junhui Sun, Jinlin Tian, Hao Wang, Liwei Wang, Peihong Wu, Xiaoyan Xie, Wenge Xing, Linfeng Xu, Po Yang, Haipeng Yu, Chunwang Yuan, Bo Zhai, Yanfang Zhang, Jiasheng Zheng, Zhigang Zhou, Xiaoli Zhu, Tianan Jiang, Yingxun Zhang
2021, 17(3):613-618
DOI:10.4103/jcrt.JCRT_1663_20  PMID:34269289
Pancreatic cancer (PC) is a lethal disease with extremely high mortality. Although surgical resection is the optimal therapeutic approach for PC, about 30%–40% of those patients are not candidates for surgical resection when diagnosed. Chemotherapy and radiotherapy also could not claim a desirable effect on PC. The application of interventional radiology approaches is limited by unavoidable damage to the surrounding vessels or organs. By the superiority of mechanism and technology, IRE could ablate the tumor by creating irreversible pores on the membrane of PC cells with other tissues like vessels and pancreatic ducts untouched. This consensus gathers the theoretical basis and clinical experience from multiple Chinese medical centers, to provide the application principles and experience from Chinese experts in the IRE field.
  1,539 81 -
The role of prostate-specific antigen and multiparametric magnetic resonance imaging in the diagnosis of granulomatous prostatitis induced by intravesical Bacillus Calmette–Guérin vaccine therapy in patients with nonmuscle invasive bladder cancer
Zilong Wang, Chenglin Han, Yingkun Xu, Xiao Yu, Weiting Kang, Yuzhu Xiang, Yanhua Yuan, Lianjun Li, Muwen Wang
2021, 17(3):625-629
DOI:10.4103/jcrt.JCRT_1684_20  PMID:34269291
Aims: This study aimed to evaluate the role of serum prostate-specific antigen (PSA) levels and multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of granulomatous prostatitis (GP) induced by intravesical Bacillus Calmette–Guérin vaccine (BCG) therapy in patients with nonmuscle invasive bladder cancer (NMIBC). Subjects and Methods: We retrospectively analyzed eight patients with bladder cancer who underwent intravesical BCG therapy after transurethral resection of bladder tumor (TURBt) cancer. All these eight patients received 12-core transrectal ultrasound-guided prostate systemic biopsies. Clinical data on PSA with T1-weighted imaging (T1WI), T2WI, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) on mpMRI were enrolled in the study. H and E and acid-fast staining was performed to pathologically prove GP. Results: Four of all eight cases were above 4 ng/ml total PSA (tPSA) levels and four cases were within normal ranges, while free PSA/tPSA levels decreased to lower than 16% in all patients. Every patient had hard prostatic nodules through digital rectal examination (DRE). All characters of prostate mpMRI did not show signal intensity (SI) of prostate cancer before BCG therapy but showed abnormal signals after BCG therapy. All nodular lesions showed equal SI on T1WI, lower SI on T2WI, higher SI on DWI, and lower SI on ADC after BCG therapy. Pathologic results were GP and acid-fast staining outcomes were positive in all biopsies. Conclusions: Perioperative serum PSA levels, prostate magnetic resonance imaging, and DRE may help in the diagnosis of GP induced by intravesical BCG therapy. In general, male patients with middle- and high-risk NMIBC are recommended to undertake DRE, PSA, and prostate mpMRI, if possible, before and after TURBt.
  1,379 53 -
Detection significance of miR-3662, miR-146a, and miR-1290 in serum exosomes of breast cancer patients
Sha Li, Meng Zhang, Feng Xu, Ying Wang, Dong Leng
2021, 17(3):749-755
DOI:10.4103/jcrt.jcrt_280_21  PMID:34269309
Context: The potential relationship between exosomal microRNAs (miRNAs) and clinical symptoms in breast cancer patients and the expression levels of exosomal miRNAs in patients undergoing surgery and chemotherapy are still unclear. Aims: The aim of this study was to explore the correlation among exosomal miRNAs and clinical features and treatment in breast cancer patients. Materials and Methods: First, exosomes were isolated from the serum of patients with breast cancer and healthy controls. Next, the features of exosomes were identified by transmission electron microscopy, nanoparticle tracking analysis, and Western blot assays. Then, we detected the expression of the top-ranked miRNAs (miR-3662, miR-16-1, miR-146a, miR-1290, and miR-29c) in sixty breast cancer patients and twenty healthy controls using quantitative real-time polymerase chain reaction. Statistical Analysis Used: The differential expression was measured by the Mann–Whitney U-test. Results: The relative expression of miR-3662, miR-146a, and miR-1290 in serum exosomes was significantly higher in patients than healthy controls. Moreover, significant differences were found in the lymph node metastasis and clinical stage of breast cancer as the miRNA levels changed, but their expression levels in exosomes and sera were not correlated. In addition, exosomal miR-3662, miR-146a, and miR-1290 were shown to be valuable biomarkers to monitor patient condition in the course of surgery and chemotherapy. Conclusions: Exosomal miR-3662, miR-146a, and miR-1290 may have promising predictive value and could be utilized as biomarkers for diagnosis and preventative strategy development.
  1,014 35 -
Novel nomogram predicting cancer-specific survival and overall survival in patients with primary esophageal small-cell carcinoma: A surveillance, epidemiology, and end results-based study
Jisheng Li, Hejiang Yu, Ling Peng, Li Li, Xiangling Wang, Jing Hao, Na Shao
2021, 17(3):630-637
DOI:10.4103/jcrt.JCRT_1612_20  PMID:34269292
Background: Small-cell carcinoma is a relatively infrequent pathological variety of esophageal cancer. In this study, a novel nomogram model was developed to evaluate the cancer-specific survival (CSS) and overall survival (OS) of patients with primary esophageal small-cell carcinoma (ESmCC). Materials and Methods: In total, 502 patients with primary ESmCC were identified based on data from 1973 to 2015 retrieved from the surveillance, epidemiology, and end results database. Clinical characteristics such as age at diagnosis, gender, race, site, tumor stage, surgery, radiotherapy, and chemotherapy were included for multivariate logistic analyses to predict CSS and OS. Nomogram models for the prediction of CSS and OS in ESmCC patients were tested with the concordance index (C-index) method and calibration curves. Results: From our multivariate analyses, race, stage, chemotherapy, and radiotherapy, but not surgery, were significantly associated with the CSS of ESmCC patients, while age at diagnosis, stage, chemotherapy, and radiotherapy were significantly associated with their OS. Nomograms were developed using age at diagnosis, race, gender, stage, surgery, radiotherapy, and chemotherapy to predict the two survival measures; these nomograms were verified as accurate in predicting OS and CSS in ESmCC patients, with C-index values of 0.736 and 0.731, respectively. Conclusions: By utilizing easily accessible clinicopathological information, we established a simple but useful tool for predicting the CSS and OS of ESmCC patients that could help to make personalized clinical decisions for patients with this rare malignancy. Cancer-specific survival, esophageal small-cell carcinoma, nomogram, overall survival, surveillance, epidemiology, and end results
  954 30 -
Prognostic role of programmed cell death ligand-1 expression in head and neck cancer treated with programmed cell death protein-1/programmed cell death ligand-1 inhibitors: A meta-analysis based on clinical trials
Zilu Huang, Shuohan Zheng, Shirong Ding, Yinghong Wei, Chen Chen, Xing Liu, He Li, Yunfei Xia
2021, 17(3):676-687
DOI:10.4103/jcrt.JCRT_1606_20  PMID:34269299
Purpose: The purpose of our meta-analysis is to clarify whether the biomarker of programmed cell death ligand-1 (PD-L1) could predict the treatment efficacy and prognosis of programmed cell death protein-1 (PD-1)/PD-L1 immune-checkpoint inhibitors (ICIs) in head and neck cancer (HNC) patients. Materials and Methods: We performed the article search in four main online databases. The search deadline was September 8, 2020. To elucidate whether a positive or negative PD-L1 expression correlates with different efficacy and prognosis of PD-1/PD-L1–related therapy in HNC, the relative risk (RR) and 95% confidence interval (95% CI) were pooled. Our meta-analysis assigned the overall survival (OS) at 6 and 12 months and the objective response rate (ORR) for the primary end points. Results: The present meta-analysis included 11 relevant studies, which have 1663 HNC cases who received the treatment of PD-1/PD-L1 ICIs. The pooled results revealed that the high or positive expression of PD-L1 predicted better 6- and 12-month OS in head and neck squamous cell carcinoma (HNSCC) (RR 1.30, 95% CI: 1.02–1.65, P = 0.03; and RR 1.31, 95% CI: 1.05–1.62, P = 0.01). PD-L1 expressors were also relevant with higher ORR in HNC patients who had treatment of PD-1/PD-L1 inhibitors compared to PD-L1 nonexpressors (RR 1.84, 95% CI: 1.41–2.41, P < 0.00001). Conclusions: In summary, PD-L1–positive HNSCC patients portend favorable OS at 6 and 12 months from PD-1/PD-L1 ICIs. Increased ORR also favored to appear in PD-L1 expressors of HNC or recurrent/metastatic HNSCC who received PD-1/PD-L1 ICIs. Therefore, PD-L1 proved to be an appropriate biomarker to predict the clinical efficacy and prognosis of PD-1/PD-L1 ICIs in HNC.
  934 29 -
EGFR tyrosine kinase inhibitors alone or in combination with chemotherapy for non-small-cell lung cancer with EGFR mutations: A meta-analysis of randomized controlled trials
Cui-Min Zhu, Xiang-Yao Lian, Hong-Yan Zhang, Lu Bai, Wen-Jing Yun, Ru-Han Zhao, Qing-Shan Li
2021, 17(3):664-670
DOI:10.4103/jcrt.JCRT_195_20  PMID:34269297
Objective: The objective of this study was to perform a meta-analysis comparing the efficiency of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) with chemotherapy to EGFR TKI treatment alone in patients with EGFR mutation-positive non-small cell lung cancer (NSCLC). Materials and Methods: Following keyword queries in databases and identification of randomized control trials for inclusion, hazard ratios (HRs), relative risks (RRs), and associated 95% confidence intervals (95% CIs) were determined. Results: Ten randomized controlled trials involving 1354 participants with NSCLC were evaluated. We found that a combined approach of chemotherapy with EGFR TKIs significantly improved overall survival (OS) compared with EGFR TKI alone in our patient cohort (HR = 0.47, 95% CI = 0.31–0.72). In addition, a higher overall response rate (ORR) was found for patients who received combined treatment compared to chemotherapy alone (RR = 2.17, 95% CI = 1.51-3.12). Furthermore, concomitant use of chemotherapy with TKIs significantly improved the progression-free survival (PFS) when compared to the use of TKIs alone (HR = 0.68, 95% CI = 0.49-0.95). Moreover, there was a higher ORR among patients who received combined treatment as compared to those who were managed using TKIs only (RR=1.17, 95%CI=1.09-1.25). Conclusion: Our meta-analysis shows that EGFR TKIs with chemotherapy confer better OS and ORR compared to either treatment alone, similarly, the combined treatment showed better PFS and ORR profiles than the use of TKI alone.
  926 36 -
Intermediate stage hepatocellular carcinoma: Comparison of the value of inflammation-based scores in predicting progression-free survival of patients receiving transarterial chemoembolization
Ying Liu, Menting Shi, Shuanggang Chen, Weiqi Wan, Lujun Shen, Binyan Shen, Han Qi, Fei Cao, Ying Wu, Tao Huang, Guanjian Chen, Jinqing Mo, Dongdong Ye, Yinqi Zhang, Ziqing Feng, Weijun Fan
2021, 17(3):740-748
DOI:10.4103/jcrt.jcrt_29_21  PMID:34269308
Context and Aims: The identification of inflammation-related prognostic heterogeneity in intermediate-stage hepatocellular carcinoma (HCC) can reveal more effective first-line treatments. Our study aimed to compare the intermediate-stage HCC patients' different inflammation-based scores in predicting their progression-free survival (PFS) after transarterial chemoembolization (TACE). Materials and Methods: We analyzed retrospectively a total of 128 intermediate-stage HCC patients who received first-line TACE treatment. We used the Cox-proportional hazards modeling to identify the independent prognostic factors. We compared the inflammation-based scores abilities to predict the PFS through the time-dependent receiver operating characteristic curves and area under the curves. Results: The multivariate analysis showed that tumor size and platelet-to-lymphocyte ratio (PLR) were the independent prognostic factors for PFS (P < 0.05). The PLR predicted the intermediate-stage HCC patients' PFS receiving the TACE treatment better than other inflammation-based scores (e.g., the neutrophil-to-lymphocyte ratio, the Glasgow Prognostic Score (GPS), the modified GPS, the Prognostic Index, the Prognostic Nutritional Index, the lymphocyte-to-monocyte ratio, and the systemic immune-inflammation index) (P < 0.05). An easy-to-use novel inflammation score based on tumor size – PLR-size score significantly improved the PFS prediction performance (P < 0.05). Conclusions: As a first-line treatment, TACE was not well suitable for all intermediate-stage HCC patients, while the PLR was a better inflammation-based score than others. Tumor size should be regarded as an essential variable in affecting intermediate-stage HCC patients' first-line treatment strategies.
  862 12 -
Comparative analysis of bile culture and blood culture in patients with malignant biliary obstruction complicated with biliary infection
Chengli Wang, Haipeng Yu, Ji'an He, Mei Li, Lei Zhang, Yan Xu, Wei Gao, Xueling Yang, Xiuying Guo, Zhi Guo
2021, 17(3):726-732
DOI:10.4103/jcrt.JCRT_1705_20  PMID:34269306
Objective: This study is aimed to provide a clinical basis for the identification and treatment of patients with malignant biliary obstruction (MBO) complicated with biliary infection by comparing pathogenic bacteria detected in bile and blood cultures from these patients. Materials and Methods: A total of 380 patients with MBO who received percutaneous transhepatic cholangic drainage from January 2004 to January 2019 were included in the study. A total of 90 patients were diagnosed with having MBO complicated with biliary infection, and bile and blood culture were simultaneously performed on these patients. The patients included 58 men and 32 women, ranging in age from 33 to 86 years old, with a mean age of 60.69 years. Results: The detection rate using bile bacterial culture in patients with MBO complicated with biliary infection was significantly higher than that using blood culture, and there were significant differences in the two kinds of bacterial culture found positive bile and blood cultures from the same patients. Gram-positive cocci were dominant in the bile cultures and Gram-negative bacilli were dominant in the blood cultures. Therefore, it is necessary to conduct simultaneous bile bacterial culture and blood culture for patients with MBO complicated with biliary infection, especially those with severe or critical diseases. Conclusions: It is vital to enable simultaneous bile bacterial culture and blood culture in patients with MBO complicated with biliary infection. Existing guidelines for the diagnosis and treatment of benign biliary infection are not applicable to patients with MBO complicated with biliary infection.
  838 19 -
A practical screening strategy for Lynch syndrome and Lynch syndrome mimics in colorectal cancer
Zhi-Gang Yao, Bei-Bei Lv, Hai-Yan Jing, Wen-Jing Su, Jia-Mei Li, Hui Fan, Miao-Qing Zhao, Ye-Jun Qin, Xi-Chao Sun
2021, 17(3):790-796
DOI:10.4103/jcrt.jcrt_214_21  PMID:34269315
Objectives: The objective of the study is to provide an efficient and practical screening strategy to distinguish a broader spectrum of Lynch syndrome (LS) and LS mimics-associated colorectal cancer (CRC), including Lynch-like syndrome (LLS), constitutional mismatch repair-deficiency, familial CRC type X (FCCTX), and polymerase proofreading-associated polyposis syndrome. Materials and Methods: 1294 cases of CRC samples were detected mismatch repair (MMR) status using immunohistochemistry (IHC) staining, in which the cases with MLH1-deficient CRC underwent BRAF mutation analysis by IHC. Following the personal and/or family history survey, next-generation sequencing (NGS) was used to detect gene variants. Results: 1294 CRC patients were dichotomized into tumors caused by a deficient MMR (dMMR) system and a proficient MMR (pMMR) system after MMR status analysis. 45 patients with suspected sporadic dMMR CRC were then separated from MLH1-deficient CRC though BRAF mutation status analysis by IHC. Following the personal and/or family history survey for 1294 patients, as well as germline genetic testing by NGS, 34 patients were diagnosed as LS (8 cases), SLS (13 cases), LLS ( 6 cases), FCCTX (3 cases), and sporadic CRC (4 cases). Conclusions: Our screening strategy, which consists of clinical and molecular analyses, is expected to improve the screening efficiency and management for the LS and LS mimics.
  828 21 -
Short-term efficacy and safety of callispheres drug-loaded microsphere embolization in primary hepatocellular carcinoma
Jinpeng Li, Nan Wang, Congcong Shi, Qingran Liu, Jinlong Song, Xin Ye
2021, 17(3):733-739
DOI:10.4103/jcrt.JCRT_1848_20  PMID:34269307
Background: Drug-eluting beads transarterial chemoembolization (DEB-TACE) is a newly developed local regional therapy for improving the efficacy and safety of conventional transarterial chemoembolization (cTACE), which is now universally used to treat patients with unresectable liver cancer.Cohort studies, clinical trials, and meta-analysis have shown DEB-TACE to be associated with favorable treatment responses, prolonged survival, and at least similar safety profile when compared with cTACE. Aims and Objectives: This study was to evaluate the short term clinical efficacy, side effects, and risk factors affecting the clinical effectiveness of CalliSpheres drug loaded bead transcatheter arterial chemoembolization (DEB TACE) in the treatment of primary hepatocellular carcinoma (HCC). Materials and Methods: A total of 172 consecutive patients with HCC undergoing DEB TACE (loaded with doxorubicin) from January 2017 to December 2018 were prospectively enrolled. Short term local tumor response was evaluated by the modified RECIST criteria. Postoperative complications and liver function disorders were analyzed based on examinations and clinical symptoms. Results: The median follow up period was 310 days. Based on the modified response evaluation criteria in solid tumors criteria, objective response rates(complete response [CR] + partial response [PR]) were 78.7%, 71.6%, and 63.2%, and disease control rates(CR + PR + stable disease) were 95.3%, 92.1%, and 85.9% at 2, 4, and 6 months posttreatment, respectively. Multivariate logistic regression analysis showed that nodule number >3, high BCLC stage, no vascular leak, and previous conventional TACE treatment were associated with poor ORR (P < 0.05). Postoperation, liver function showed transient changes. Postoperative complications were tolerated and relieved by symptomatic treatment. The average interval of TACE before D TACE was 43 days, compared with 70 days for average interval of DEB TACE. The average hospital stay was 1.87 days. Conclusion: DEB TACE has improved short term efficacy and lower incidence of complications in primary HCC and prolongs the interval of TACE. It significantly increases the ORR, especially in patients with no extra hepatic metastasis pretreatment. DEB usage actually improves treatment efficacy and provides more benefits to patients. KEY WORDS: Drug-loaded bead-transcatheter arterial chemoembolization, hepatocellular carcinoma, microsphere embolization
  812 16 -
A nomogram to predict microvascular invasion in early hepatocellular carcinoma
Hongguang Li, Tao Li, Jinhua Hu, Jun Liu
2021, 17(3):652-657
DOI:10.4103/jcrt.JCRT_1714_20  PMID:34269295
Aim: To construct an integrated nomogram combining protein induced by vitamin K antagonist-II (PIVKA-II), alpha fetoprotein (AFP) and other clinical factors to detect microvascular invasion (MVI) in early hepatocellular carcinoma (HCC) patients with single nodule. Methods: One hundred and eleven early HCC patients were enrolled in the present study and 43 early HCC patients were diagnosed with MVI. Serum levels of PIVKA-II, AFP and other laboratory indicators were detected. Chi-squared test, t-test and logistic regression were employed in statistic analysis. A nomogram combining independent predictors was constructed and internal validated. Results: In early HCC patients with MVI, PIVKA-II serum level was significantly higher than those without MVI (385.97 mAU/ml vs 67.08 mAU/ml; P < 0.01), as well as AFP serum level (81.6 ng/mL vs 9.15 ng/mL P = 0.001). PIVAK-II, AFP serum levels and tumor size were independent risk factors for MVI in early HCC, which was employed to develop a logistic regression model. The area under the ROC curve (AUROC) of the model was 0.74 (95%CI 0.65 - 0.84). A nomogram combining PIVKA-II, AFP and tumor size was constructed and calibration curves showed that the model was accurate in predicting the risk of MVI in early HCC patients. Conclusion: The present study indicates that a preoperative nomogram combining PIVKA-II, AFP and tumor size could estimate the preoperative probability of MVI in early HCC patients, which may help clinicians in choosing treatment options and prognosis evaluation.
  801 12 -
Computed tomography-guided percutaneous microwave ablation for pulmonary multiple ground-glass opacities
Guoliang Xue, Zhichao Li, Gang Wang, Zhigang Wei, Xin Ye
2021, 17(3):811-813
DOI:10.4103/jcrt.jcrt_531_21  PMID:34269319
With the wide application of low-dose computed tomography (CT) and high-resolution CT, the increasing cases of pulmonary nodules are identified through routine thoracic imaging examination, many of which are presented as multiple ground-glass opacities (GGOs). The multiple GGOs could be divided into four pathological types and usually got different combined mutation patterns, suggesting that each GGO is an independent event and should be treated separately. However, there is no established guideline to the treatment of multiple GGOs so far. Here, we report a multiple GGOs case with a different mutation pattern treated by CT-guided percutaneous microwave ablation.
  796 14 -
Changes in thyroid antibody and T lymphocyte subsets after radiofrequency ablation of thyroid nodules in patients with autoimmune thyroiditis
Xiaoyin Tang, Ping Li, Bo Zhai, Xiaoli Zhu
2021, 17(3):638-643
DOI:10.4103/jcrt.JCRT_1421_20  PMID:34269293
Settings and Design: The aim was to study the changes in thyroid antibody and T lymphocyte subsets after radiofrequency ablation (RFA) of thyroid nodules in patients with autoimmune thyroiditis. Subjects and Methods: Patients (n = 135) with autoimmune thyroiditis and thyroid nodules were treated by RFA. The indices of thyroid function and thyroid antibody and T lymphocyte subsets were examined preoperation and on the 1st day and the 1st month after ablation. Any complications were recorded. Statistical Analysis: The software SPSS 17.0.0 (version: 2008-8-23) running under Windows 8 was used for statistical analysis. The measurement data were expressed as x ± s, with P < 0.01 indicating a significant difference in the statistical data. Results: Levels of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were in the normal range before ablation, and no significant changes occurred on the 1st day or in the 1st month after ablation. The change in the percentage of CD8+T cells and the absolute value of B cells were not statistically significant (P > 0.01), and the values were in the normal range. Compared with values recorded preoperation, the value of TG-Ab, TPO-Ab, CD4+/CD8+, the percentage of CD4+T cells, the absolute values of lymphocytes, T cells, CD4+T cells, and CD8+T cells decreased significantly at the 1st day after ablation (P < 0.01) and then recovered to preoperative levels during the first 30 days after ablation (P > 0.01). Within 1 month after ablation, none of the patients had complications such as active bleeding, infection, recurrent laryngeal nerve injury, parathyroid gland injury, skin scald, and so on. Conclusions: After RFA of thyroid nodules in patients with autoimmune thyroiditis, thyroid function is not affected and no serious complications occurred. TG-Ab and TPO-Ab levels can be significantly decreased, and the distribution of T lymphocyte subsets can be changed in the short term after ablation.
  772 29 -
The combination therapy with the cytotoxic T lymphocyte-associated antigen-4 and programmed death 1 antibody-induced asthma in a patient with advanced melanoma
Weiran Xu, Bin Lian, Chuanliang Cui, Jun Guo
2021, 17(3):808-810
DOI:10.4103/jcrt.jcrt_419_21  PMID:34269318
The combination of programmed death 1 (PD-1) inhibitors and cytotoxic T lymphocyte-associated antigen-(CTLA-4) inhibitors have markedly improved the survival of melanoma patients. We report the case of a patient with advanced melanoma who developed asthma during anti-PD-1 and anti-CTLA-4 combination therapy. The patient was a 57-year-old woman enrolled in a clinical trial regarding novel CTLA-4 antibody and sintilimab treatment. The patient was diagnosed with asthma after three cycles of therapy. Subsequently, she was treated with corticosteroids, shortcostero β2 agonists, and antihistamines. The symptoms were relieved after 7 days. This is the first report of asthma in a patient treated with combination immunotherapy to the best of our knowledge. The mechanism remains to be further explored.
  684 26 -
Multiregion sequencing and subclonal analysis reveal intratumoral heterogeneity in esophageal squamous cell carcinoma
Dongni Gao, Zicheng Zhang, Qiwei Yang, Baosheng Li
2021, 17(3):756-763
DOI:10.4103/jcrt.jcrt_270_21  PMID:34269310
Purpose: The aim of this study was to investigate intratumoral genomic heterogeneity and subclonal structure of esophageal squamous cell carcinoma (ESCC). Materials and Methods: Multiregion whole-exome sequencing was performed on 24 surgically acquired tumor samples from five untreated ESCC patients collected in 2019 to determine the heterogeneity of mutational landscape within tumors. Phylogenetic analysis and mutation process analysis were used to explore the distribution and dynamic changes of mutation spectrum, and subclone analysis was used to explore the subclonal composition and spatial structure of ESCC. Results: An average of 60.2% of mutations were found heterogenous. TP53 and NOTCH1 mutations were confirmed to be early events, and mutations unique in different tumor regions showed a pattern of branching evolution. A large proportion of mutations were associated with abnormal activity of the apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like (APOBEC) family, and significant differences in mutation types between trunk and branch variants were found. Subclonal structure exhibited spatial correspondence and spatial limitations, and different genomic features were characterized between close and distant clones. Conclusions: There is significant intratumoral genomic heterogeneity in the five ESCCs, and their subclonal structure is related to spatial locations.
  682 19 -
BCL6B hypermethylation predicts metastasis and poor prognosis in early-stage hepatocellular carcinoma after thermal ablation
Xin Li, Mingzhou Guo, Lili Yang, Zhigang Cheng, Xiaoling Yu, Zhiyu Han, Fangyi Liu, Qiang Sun, Xianjing Han, Jie Yu, Ping Liang
2021, 17(3):644-651
DOI:10.4103/jcrt.JCRT_1504_20  PMID:34269294
Aims: The aim of this study was to evaluate the role of BCL6B methylation in the progression of early-stage hepatocellular carcinoma (HCC) after thermal ablation. Settings and Design: This is a retrospective study and written informed consent was obtained from all patients or their legal guardians. Subjects and Methods: Between October 2008 and December 2013, 73 patients with early-stage HCC within the Milan criteria, who received thermal ablation, were recruited. Statistical Analysis Used: Based on methylation-specific polymerase chain reaction, the relationship between BCL6B methylation and patient characteristics and prognosis was analyzed using univariate, multivariate, and Kaplan–Meier analysis. Results: The median follow-up period was 56 (8–110) months. For the BCL6B unmethylated group, the 1-, 3- and 5-year metastasis and overall survival (OS) rates after thermal ablation were 10.0%, 10.0%, and 40.0% and 100%, 100% and 90.0%, respectively. The 1-, 3-, and 5-year metastasis and OS rates of the methylated group were 23.8%, 66.7% and 88.9% and 66.2%, 71.4% and 41.3%, respectively. Levels of absolute count lymphocyte, serum cholinesterase and albumin in the BCL6B unmethylated group were higher than those in the methylated group (P = 0.020, 0.000, and 0.009, respectively). Kaplan–Meier analysis revealed that BCL6B methylation was related to metastasis and poor prognosis (P = 0.001 and 0.018, respectively). Univariate analysis revealed that BCL6B methylation was a risk factor for metastasis and poor prognosis (odds ratio [OR]: 5.663; 95% confidence interval [CI], 1.745–18.375, P = 0.004 and OR: 3.734; 95% CI, 1.151–12.110, P = 0.028, respectively). Multivariate analysis revealed that BCL6B methylation was an independent risk factor for metastasis (OR: 3.736; 95% CI, 1.000–13.963,P = 0.05) and not for prognosis (OR: 2.780; 95% CI, 0.835–9.250,P = 0.096). Conclusions: BCL6B methylation could be a valuable prognostic factor for metastasis and poor prognosis in early-stage HCC after thermal ablation, which is an independent risk factor for metastasis. Our findings provide insights for combining ablation and epigenetic therapy for patients with HCC.
  677 19 -
Anlotinib followed by transarterial chemoembolization and radiofrequency ablation is a safe and effective initial treatment for hepatocellular carcinoma patients with portal vein tumor thrombus: A retrospective case series study
Jianpeng Wang, Xishan Li, Fengjie Wang, Degang Shi, Jiren Zhang
2021, 17(3):619-624
DOI:10.4103/jcrt.JCRT_1253_20  PMID:34269290
Background: Portal vein tumor thrombus (PVTT) remains a poor prognostic factor occurring in about 10%–40% of patients with hepatocellular carcinoma (HCC) for the optimal treatment is controversial. Anlotinib is an novel small molecule inhibitor that has a broad spectrum of inhibitory activities on tumor angiogenesis and growth. However, so far, no studies have reported the use of anlotinib in the treatment of HCC patients with PVTT. Here, we evaluated the safety and efficacy of anlotinib, followed by transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for the treatment of patients with HCC and PVTT. Materials and Methods: A total of 145 consecutive HCC patients who underwent TACE in combination with RFA were enrolled in the retrospective study. Twenty-eight patients were diagnosed with PVTT and received anlotinib as basic treatment. The adverse events (AEs) were graded according to the National Cancer Institute Common Terminology Criteria for AEs Version 4.0. Time to tumor progression (TTP) and overall survival (OS) were calculated using the Kaplan–Meier method. Results: The most common toxicities related to anlotinib were pharyngalgia (53.6%), fatigue (42.9%), and hand–foot skin reaction (39.3%). The median OS was 13 months (range: 3–18 months) with 1-year OS rate of 64.3%. The median TTP was 7 months (range: 1–12 months) with 6-month rate of 46.4%. Conclusion: Anlotinib followed by TACE and RFA is a safe and effective initial treatment modality for HCC patients with PVTT. Anlotinib may be a promising therapeutic option for relieving and/or stabilizing HCC with PVTT.
  636 54 -
Overexpression of replication protein A3 is associated with unfavorable outcome in bladder urothelial carcinoma
Dingqi Sun, Keqin Zhang, Qiang Fu, Hui Zhang, Shuai Liu, Haoran Wang, Zhen Xu, Jinhua Wang
2021, 17(3):771-776
DOI:10.4103/jcrt.jcrt_275_21  PMID:34269312
Purpose: The replication protein A3 (RPA3) is a subunit of the RPA protein complex, which plays an essential role in multiple processes of DNA metabolism. However, the involvement of RPA3 bladder urothelial carcinoma (UC) prognosis has not yet been elucidated. The aim of our study is to investigate the prognostic role of RPA3 expression in patients with bladder UC. Materials and Methods: Bladder UC tissue specimens from 155 consecutively treated patients who underwent surgery between 2013 and 2018 were evaluated. The RPA3 expression was determined by immunohistochemistry, Western blot, and correlated with clinicopathological parameters. The prognostic significance of RPA3 expression was explored using the univariate and multivariate survival analysis of 155 patients who were followed. Results: A total of 155 tissue specimens “of patients” who were regularly followed with the mean 39.6 months (from 4 to 71 months). The expression of RPA3 was significantly associated with tumor grade (P = 0.031) and stage (P = 0.021), as well as tumor size (P = 0.034). In univariate analysis, RPA3 overexpression showed an unfavorable influence on recurrence-free survival with statistical significance (P < 0.01). TNM stage and grade also showed strong statistical relation with adverse recurrence-free survival (P < 0.01, P = 0.030). Multivariate analysis revealed that grade, stage, and RPA3 reactivity (P = 0.025, P < 0.01, P = 0.016) were identified as independent prognostic factors for recurrence-free survival in patients with bladder UC. Conclusions: These results of this study proved that elevated expression of RPA3 was associated with worse clinical outcome in bladder UC patients. This finding suggested that RPA3 served as a potential prognostic biomarker, which could be useful to predict cancer evolution and may represent a novel therapeutic target for the intervention of bladder UC patients.
  670 19 -
Ultrasound-guided percutaneous microwave ablation of bilateral renal cell carcinomas: Focus upon safety and efficacy
Ruimin Zhang, Erpeng Qi, Ping Liang, Zhigang Cheng, Shuilian Tan, Zhiyu Han, Fangyi Liu, Jie Yu, Xiaoling Yu
2021, 17(3):803-807
DOI:10.4103/jcrt.jcrt_1906_20  PMID:34269317
Objective: To retrospectively review the safety and efficacy of ultrasound (US)-guided percutaneous microwave ablation (MWA) of bilateral renal cell carcinomas (BRCCs). Patients and Methods: In this study, eight patients of BRCCs with 20 lesions seen from November 2012 to October 2018 were enrolled retrospectively. The patients were treated with US -guided percutaneous MWA and were followed up with contrast-enhanced US and computed tomography or magnetic resonance imaging. Results: Technical success was achieved 20 tumors. The 18 lesions were performed to ablate 90%; 2 lesions were repeated because of detecting residual ablated tumor. Except six patients were noted fever, no severe complications occurred. The median follow-up time was 24 months (range 7–59 months). Among the eight patients, there was no local tumor recurrence in 6 of 8 completely ablated tumor lesions. One patient was retreated by MWA 6 months after ablation, and another was retreated after 19 months due to local tumor recurrence. No patients have obvious change of renal function and lost their life. Conclusion: US-guided percutaneous MWA is a beneficial treatment for BRCC.
  670 16 -
Ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma originating in the caudate lobe: A pilot clinical study
Yuan Peng, Dan Cui, Weijian Li, Ming Ding, Yaoping Shi, Tao Wang, Donghua Shi, Jiachang Chi, Ping Li, Bo Zhai
2021, 17(3):764-770
DOI:10.4103/jcrt.JCRT_1851_20  PMID:34269311
Objective: This study aimed to evaluate the efficacy, feasibility, and tolerability of ultrasound (US)-guided percutaneous microwave ablation (MWA) for treating hepatocellular carcinoma (HCC) originating in the caudate lobe. Materials and Methods: The treatment and survival parameters of 32 patients with HCC in the caudate lobe, who met the inclusion criteria and had received US-guided percutaneous MWA in our department from November 2010 to October 2015, were retrospectively analyzed. Imaging examination (contrast-enhanced computed tomography or magnetic resonance) 1 month after MWA was used to evaluate the efficacy of US-guided MWA. Results: Thirty-two patients underwent percutaneous MWA for caudate lobe HCC. The average tumor size was 3.42 ± 0.27 (range: 1–6.8) cm. The initial complete ablation (CA) rate was 87.5% (28/32), and the total CA rate was 96.88% (31/32). Furthermore, the median length of hospitalization was 4 days (range: 2–10 days), and no major complication was observed in this study. The overall survival rates were 87.5%, 50%, and 28.13% at 1, 2, and 3 years, respectively. The progression-free survival after MWA was 93.75%, 53.15%, and 28.13% at 6, 12, and 18 months, respectively. Conclusions: US-guided percutaneous MWA was a safe and effective treatment. It is a promising alternative therapy for HCC originating in the caudate lobe.
  638 24 -
Combination of thermal ablation and activated functional killer cells immunotherapy for cancer: A retrospective study
Yunfang Li, Yuanming Li, Zhixin Bie, Bin Li, Jie Ma, Xiaoguang Li
2021, 17(3):797-802
DOI:10.4103/jcrt.jcrt_26_21  PMID:34269316
Purpose: The purpose was to evaluate the effect of thermal ablation combined with activated functional killer (AFK) cells immunotherapy for patients with malignant tumors. Materials and Methods: A cohort of 10 patients with malignancies received thermal ablation combined with AFK cells immunotherapy. Progression-free survival (PFS), overall survival, laboratory test, and postoperative complications were assessed. Results: The success rate of the combination therapy was 100% and no severe complications occurred. Five patients maintained in PFS (50%) during the follow-up. The median PFS was 11 months (range 3.5–16.75 months). The hemoglobin (P = 0.023), hematocrit (P = 0.034), and lymphocyte ratio (P = 0.023); neutrophil-to-lymphocyte ratio (P = 0.038), neutrophil ratio (P = 0.016), albumin (P = 0.006), and alkaline phosphatase (P = 0.029); CA-125 (P = 0.033); and D-dimer (P = 0.011) changed significant after ablation. Whereas the white blood cell count (P = 0.003), neutrophil count (P = 0.024), lymphocyte count (P =0.003), monocyte ratio (P = 0.008), and eosinophil ratio (P = 0.005) changed significantly after combination therapy. The lymphocytes (P = 0.001) in the surviving patients increased more significantly after treatment. After the combination therapy, the percentage of CD3 + cells (P = 0.016) and CD3+ CD8+ cells (P = 0.002) increased, while CD3-CD16+ CD56+ (P = 0.002) and CD4+/CD8+ (P = 0.016) decreased. Conclusion: Combination of thermal ablation and AFK cells immunotherapy is a safe and effective method for patients with malignancy. And adoptive immunotherapy with AFK cells may be helpful to prevent recurrence after thermal ablation in patients with advanced cancer.
  574 17 -
Preoperative computed tomographic-guided percutaneous coil localization of pulmonary nodules: 184 Cases in Single-center
Xujian Han, Zhenjia Li, Hui Gu, Honglu Shi, Weitao Dou, Ximing Wang
2021, 17(3):671-675
DOI:10.4103/jcrt.JCRT_1736_20  PMID:34269298
Objectives: The aim of this study was to evaluate the feasibility, accuracy, and safety of computed tomographic (CT)-guided coil localization before video-assisted thoracoscopic surgery. Methods: One hundred and eighty-four consecutive patients with 200 pulmonary nodules who underwent CT-guided percutaneous coil localization before thoracoscopic surgery were retrospectively analyzed in this study. Success rate for localization, complication rates, CT findings, and pathological results of the lesions, as well as the data related to surgery were all recorded and analyzed. Results: All 184 patients with 200 lesions completed localization and resection. The success rate of the coil localization on lesion baseline was 99.0% (198/200) and 98.9% (182/184) on patient baseline. The number of wedge resection, segmental resection, and lobectomy were 179 (89.5%), 19 (9.5%), and 2 (1.0%), respectively. The malignancy rates in a lesion-based analysis were 83.5% (91.1% in ground-glass nodules, 91.4% in part-solid nodules, and 37.9% in solid nodules). No serious complications occurred in all localization procedures. Conclusion: Preoperative CT-guided percutaneous coil localization is a safe and effective method to facilitate high success rates for both wedge and segmental resection for peripheral pulmonary nodules.
  574 14 -
Colonic metastasis from hepatocellular carcinoma after treated by ablation and transarterial chemoembolization manifested by intestinal obstruction: A case report and review of the literature
Mengjuan Mu, Jie Yu, Ping Liang, Xiaoling Yu, Zhigang Cheng
2021, 17(3):814-817
DOI:10.4103/jcrt.JCRT_217_20  PMID:34269320
Hepatocellular carcinoma (HCC) with gastrointestinal tract metastasis is a rare condition. Recently, we encountered one case of HCC with direct invasion to the colon, which was manifested by intestinal obstruction. The patient was an 86-year-old man who underwent multiple transarterial chemoembolization and microwave ablation treatment for HCC lesions for 10 years. Two months after last palliative microwave ablation, computed tomography showed a 7.0-cm liver tumor directly invading the hepatic flexure of colon with the symptom of right abdominal pain and discontinuous nausea and vomiting. HCC colon metastasis with intestinal obstruction was diagnosed. Intestinal adhesion lysis and colostomy were performed. The patient survived 10 months after surgery and died of tumor progression.
  522 24 -
Trans-jugular intrahepatic portosystemic shunt in patients with hepatic cellular carcinoma: A preliminary study
Hong Dong, Cunjing Zhang, Zheng Li, Haiyan Yang, Yongzheng Wang, Jibing Liu, Bin Liu, Shuzhi Mao
2021, 17(3):784-789
DOI:10.4103/jcrt.jcrt_467_21  PMID:34269314
Purpose: To analyze the effects of trans-jugular intrahepatic portosystemic shunt (TIPS) on portal hypertension and liver function in patients with hepatocellular carcinoma (HCC). Materials and Methods: Thirteen patients with hemorrhage caused by portal hypertension and HCC who received TIPS and antitumor treatment were retrospectively analyzed. Trans-arterial chemoembolization, microwave ablation, target therapy, and immunetherapy or combined therapy were performed to treat HCC. Child-Pugh score was applied to estimate liver functions before and after TIPS. Shunting patency, overall survival (OS), and progression-free survival were analyzed. Results: The median age was 58 (interquartile range: 52.5–62.5) years. The ratio with ascites before and after TIPS was 84.6% (11/13) and 7.7% (1/13), with P < 0.001. The ratio with Child-Pugh A before and after TIPS were 61.5% (8/13) and 84.6% (11/13) respectively, with P = 0.179. Mean portal vein pressure before and after TIPS was 27.85 ± 7.02 mmHg and 16.23 ± 6.61 mmHg, respectively, with P = 0.001. Two-year shunting patency rate was 61.5%. Median OS was 29.8 ± 11.5 months (95% confidence interval [CI] 22.8–36.7), and median progression-free survival was 20.2 ± 13.2 months (95% CI 12.2–28.1). Conclusion: TIPS could reduce ascites, down-regulate the Child-Pugh score, and give a chance for further anti-tumor therapy.
  512 18 -
Prognostic nomogram for hepatocellular carcinoma patients after transarterial chemoembolization based on des-γ-carboxy prothrombin reactivity and modified Response Evaluation Criteria in Solid Tumors
Su-Ming Zhao, Li-Wei Qiu, Hui Zhao, Wei-Wei Gu, Xiao-Hu Yang, Zhu-Xing Gu, Rong-Feng Shi, Cai-Fang Ni
2021, 17(3):707-714
DOI:10.4103/jcrt.JCRT_651_20  PMID:34269303
Aims: The aim of this study was to construct a nomogram that will predict the overall survival (OS) of hepatocellular carcinoma (HCC) patients after transarterial chemoembolization (TACE). Materials and Methods: Imaging data, clinical characteristics, and serum des-γ-carboxy prothrombin (DCP) levels of 93 HCC patients treated with TACE were collected. Lasso regression, random forest, and other methods were used to screen the OS-related variables and construct the Cox prognosis model. The model was visualized by nomogram, and the net benefit of the clinical decision was assessed by decision curve analysis (DCA). Results: It was found that DCP level after TACE was an important predictor of OS in HCC patients. The OS of the patients with lower serum DCP levels after TACE was significantly better than the group with higher levels (P = 0.003). The Cox prognostic model was constructed using four predictors including DCP reactivity (P = 0.001), modified Response Evaluation Criteria in Solid Tumors (mRECIST, P = 0.005), Child-Pugh class (P = 0.018), and portal vein thrombosis (P = 0.039). The C-index of the nomogram for OS of patients after TACE was 0.813. The clinical decision-making net benefits based on the nomogram were better than the decision-making based on the TNM stage system. Conclusion: DCP reactivity and mRECIST are the key predictors of prognosis in HCC patients that received TACE as their initial treatment. The nomogram constructed with these two indicators as the core could predict the OS of HCC patients after TACE and help in clinical decision-making.
  514 13 -
Comparison of three-dimensional-printed template-guided and traditional implantation of 125I seeds for gynecological tumors: A dosimetric and efficacy study
Weiming Kang, Hongtao Zhang, Yansong Liang, Enli Chen, Jinxin Zhao, Zhen Gao, Juan Wang
2021, 17(3):688-694
DOI:10.4103/jcrt.JCRT_1565_20  PMID:34269300
Objective: The objective of the study was to compare the dose parameter and clinical efficacy of three-dimensional-printed template (3D-PT)-guided and traditional 125I seed implantation in treatment of gynecological tumors. Materials and Methods: A total of 28 patients with gynecological tumors treated with radioactive seed implantation in Hebei General Hospital from January 2016 to December 2018 were retrospectively analyzed. Twelve patients (template group) were guided by 3D-PT and the remaining 16 patients (traditional group) were guided by computed tomography (CT) with traditional technique. Preoperative treatment plan (preplan) was completed through a treatment planning system. In the template group, 3D-PT was printed according to preplan and seeds were implanted under the guidance of 3D-PT and CT. In the traditional group, seeds were implanted under the guidance of single CT directly according to the preplan. Postoperative verification plan (post-plan) was completed. Dose–volume histogram (DVH) was calculated and D80, D90, V90, V100, and V150 were obtained according to DVH. Then, deviation of the dosimetric parameters D80, D90, V90, V100, and V150 between the preplan and postplan were compared within the two groups. The difference and percentage of difference of the above dosimetric parameters between the preplan and postplan within the two groups were calculated using the formula Xd = Xpost-plan– Xpre-plan, and Xd% = (Xpost-plan– Xpre-plan)/Xpre-plan × 100%. Doses were calculated to determine whether the differences there were statistically significant. Efficacy evaluation was completed according to RECISIT 1.1. Local control rate and effective rate of 2-months postplan were compared between the two groups. Survival analysis was completed by the Kaplan–Meier method. The patients were followed up for 12 months, and their survival rate was calculated and compared. Results: There was no significant difference between the two groups for all the parameters, except for D80 of the preplan and postplan in the traditional group (P = 0.000). All the differences and percentage of difference were calculated and it was found that the Xd difference of D80 (P = 0.035), D90 (P = 0.023), V90 (P = 0.047), V100 (P = 0.032), and V150 (P = 0.031), as well as the Xd% difference of D80 (P = 0.032), D90 (P = 0.034), V90 (P = 0.042), V100 (P = 0.036), and V150 (P = 0.044) of the two groups was statistically significant, thus indicating that the dosimetric parameter fluctuation in the template group was more stable. The result of the curative effect after 2 months were as follows: the local control rate and effective rate of the template group were 100% (12/12) and 83.3% (10/12), while those of the traditional group were 100% (16/16) and 81.2% (13/16). There was no statistically significant difference in the curative effect between the two groups. After 6–27 months (median = 12 months) of follow-up, the median survival time of the template group and traditional group were 17 (10–23) and 16 (11–20) months, respectively, and the 1-year overall survival rate was 63% and 79% (P = 0.111), respectively, with no statistically significant difference observed. Conclusion: 3D-PT-guided 125I seed implantation is safe and effective in the treatment of gynecological tumors.
  502 19 -
Advantages of interstitial radioactive seed implantation for the treatment of Stage III pancreatic cancer
Baodong Gai, Qingchun Li, Pu Shao, Dongyan Yang
2021, 17(3):702-706
DOI:10.4103/jcrt.JCRT_803_20  PMID:34269302
Objective: The objective of the study was to identify the advantages of interstitial radioactive seed implantation for the treatment of Stage III pancreatic cancer. Materials and Methods: Clinical data of 160 patients with pancreatic cancer implanted with radioactive seeds were retrospectively analyzed. Patients were grouped according to tumor size, lymph node metastasis, and tumor invasion to important blood vessels, and survival time statistics were obtained. Results: The mean postoperative survival time (months) was 24.80 for Stage I, 12.89 for Stage II, 13.51 for Stage III, and 7.49 for Stage IV patients, and the difference between Stage II and Stage III patients was not statistically significant. The efficacy of radioactive seed implantation therapy for pancreatic cancer was strongly associated with tumor size and number of lymph node metastases but not significantly associated with tumor invasion to blood vessels. Conclusions: Radioactive seed implantation obviously advantageous for the treatment of Stage III pancreatic cancer.
  506 13 -
Efficacy comparison between microwave ablation combined with radiation therapy and radiation therapy alone for locally advanced nonsmall-cell lung cancer
Pengyuan Song, Wei Sun, Min Pang, Weina He, Weihua Zhang, Lijun Sheng
2021, 17(3):715-719
DOI:10.4103/jcrt.JCRT_633_20  PMID:34269304
Purpose: Comparing the efficacy and complications of microwave ablation (MA) combined with intensity-modulated radiation therapy (IMRT) and IMRT alone for locally advanced peripheral nonsmall-cell lung cancer (NSCLC). Methods: Retrospective analysis was conducted on 76 patients with locally advanced peripheral NSCLC undergoing chemotherapy and metastatic lymph node radiation therapy from June 2014 to June 2016. Either MA or IMRT was used to treat primary lesions. Thirty-four cases were treated with MA (MA group), 42 cases were treated with IMRT (IMRT group), and comparisons were made of the 1–3-year progression-free survival (PFS) and complications of the two groups. Results: The PFS of the MA group at 1, 2, and 3 years were 70.59% (24/34), 47.06% (16/34), and 35.29% (12/34), and the PFS of the IMRT group at the same intervals were 71.43% (30/42), 52.38% (22/42), and 35.71% (15/42), with no significant difference (χ2 = 0.006, P = 0.936) (χ2 = 0.213, P = 0.645) (χ2 = 0.001, P = 0.970). Radiation-induced lung injury (RILI) occurred in 14.70% (5/34) of MA group patients, which was significantly lower than in the IMRT group 40.48% (17/42), but without grade II or above RILI. Conclusion: MA combined with IMRT in the treatment of locally advanced peripheral NSCLC was not inferior to the clinical effect of radiation therapy alone, and radiation lung injury incidence was also lower.
  478 15 -
The clinical efficacy of computed tomography-guided 125I particle implantation combined with arterial infusion chemotherapy in the treatment of pancreatic cancer
Liang Yang, Chuang Li, Zhe Wang, Jinyu Wu, Jun Zhou, Ruoyu Wang
2021, 17(3):720-725
DOI:10.4103/jcrt.JCRT_563_20  PMID:34269305
Aims: This study aimed to investigate the clinical value of 125I radioactive particle implantation combined with regional arterial chemotherapy perfusion in the treatment of pancreatic cancer. Subjects and Methods: The clinical data of 23 patients with pancreatic cancer were retrospectively analyzed, and the patients were divided into two groups. In the observation group, 11 patients were injected with radioactive particles in combination with regional arterial chemotherapy. In the control group, 12 patients were treated with simple regional arterial perfusion chemotherapy. Curative effect, pain relief, survival period, and adverse reactions were compared between the two groups. Results: The proportion of patients was significantly higher in the observation group (complete remission + partial remission) (72.73%) than in the control group (41.67%). The 6-month and 9-month survival rates in the experimental group were 91.7% and 50%, respectively, while those in the control group were 63.6% and 18.2%, respectively, with significantly statistical difference. The 12-month survival rate in the experimental group was 16.7% and was significantly higher than that in the control group (8.3%). The experimental group should greater improvement in pain symptoms than the control group, and there was no statistical difference between the two groups except in complications of 125I radioactive particle implantation. Conclusions: We conclude that 125I radioactive particle implantation combined with regional arterial perfusion chemotherapy is an effective and comprehensive treatment for advanced pancreatic cancer.
  414 15 -
Factors influencing postembolization syndrome in patients with hepatocellular carcinoma undergoing first transcatheter arterial chemoembolization
Jing-Jing He, Xi-Xi Yin, Ting Wang, Min-Ying Chen, Xi-Long Li, Xin-Jing Yang, Hong-Yan Shao
2021, 17(3):777-783
DOI:10.4103/jcrt.jcrt_132_21  PMID:34269313
Context: Postembolization syndrome (PES) is the most common complication in patients with hepatocellular carcinoma (HCC) who had undergone transcatheter arterial chemoembolization (TACE). PES was defined as fever, nausea and/or vomiting, and abdominal pain and these symptoms develop within 1–3 days after TACE. However, few studies have explored the factors influencing PES in patients with TACE for the first time. Aims: We explored the factors influencing PES in patients with HCC undergoing TACE for the first time. Settings and Design: The present study was a hospital-based study conducted in the tertiary care hospital of Guangzhou with a retrospective study design. Subjects and Methods: In this single-center retrospective study, a total of 242 patients with HCC were included in the first TACE program between November 1, 2018 and November 31, 2019. Statistical Analysis Used: T-test and Chi-square test revealed the factors affecting the occurrence of PES. Correlation analysis (Spearman) explored the relationship between these factors and PES. Binary logistics analyzed the predictive factors of PES. Results: The probability of PES in patients with HCC undergoing TACE for the first time was 55.45%. Types of embolic agents (r = 0.296), types of microspheres (r = 0.510), number of microspheres (r = 0.130), maximum diameter of microspheres used (r = 0.429), type of drug (r = 0.406), and drug loading (r = 0.433) were positively correlated with PES (P < 0.05). Serum albumin was negatively correlated with PES (P = 0.008, r = −0.170). Binary logistic regression analysis revealed that drug loading microspheres (odds ratio [OR] = 0.075, 95% confidence interval [CI] = 0.031–0.180) and serum albumin (OR = 0.182, 95% CI = 0.068–0.487) were the protective factors influencing PES, while drug loading was the risk factor of PES (OR = 1.407, 95% CI = 1.144–1.173). Conclusions: Drug loading microspheres, serum albumin, and drug loading were the predictors of PES after the first TACE.
  240 23 -
Benign pathologies results from lung nodule percutaneous biopsies: How to differentiate true and false benign?
Lei Li, Xiao-Liang Xu, Kai Feng, Xin-Qiang Liu, Jing Yang
2021, 17(3):658-663
DOI:10.4103/jcrt.JCRT_1245_20  PMID:34269296
Objectives: The objective was to identify predictors of true negatives in lung nodules (LNs) with computed tomography-guided percutaneous biopsy (CTPB)-based benign pathological results. Materials and Methods: We included 90 total patients between January 2013 and December 2017 that had CTPB-based nonspecific benign pathologies and used these patients as a training group to accurately identify true-negative predictors. A validation group of 50 patients from January 2018 to June 2019 to confirm predictor reliability. Results: CTPB was conducted on 90 LNs from the training group. True-negative and false-negative CTPB-based pathologies were obtained for 79 and 11 LNs, respectively. CTPB-based benign results had a negative predictive value of 87.8% (79/90). Univariate and multivariate analyses revealed younger age (P = 0.019) and CTPB-based chronic inflammation with fibroplasia (P = 0.010) to be true-negative predictors. A predictive model was made by combining these two prognostic values as follows: score = −7.975 + 0.112 × age −2.883 × CTPB-based chronic inflammation with fibroplasia (0: no present; 1: present). The area under receiver operator characteristic (ROC) curve was 0.854 (P < 0.001). To maximize sensitivity and specificity, we selected a cutoff risk score of −0.1759. The application of this model to the validation group yielded an area under the ROC curve of 0.912 (P < 0.001). Conclusions: Our predictive model showed good predictive ability for identifying true negatives among CTPB-based benign pathological results.
  148 17 -
Computed tomography-guided lung biopsy: A meta-analysis of low-dose and standard-dose protocols
Ping Zhang, Jing-Mei Liu, Ying-Ying Zhang, Rong Hua, Feng-Fei Xia, Yi-Bing Shi
2021, 17(3):695-701
DOI:10.4103/jcrt.JCRT_1274_20  PMID:34269301
Objectives: The aim of the study was to compare the relative diagnostic utility of low-dose computed tomography (LDCT) and standard-dose computed tomography (SDCT)-guided lung biopsy approaches. Materials and Methods: The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published through August 2020. Data pertaining to endpoints including technical success, diagnostic performance, operative time, radiation dose, and complications, were extracted, and meta-analysis was performed using RevMan v5.3. Results: Three retrospective analyses and three randomized controlled trials, were included. The studies included 1977 lung lesions across 1927 patients who underwent LDCT-guided lung biopsy, and 887 lung lesions across 879 patients who underwent SDCT-guided lung biopsy. No significant differences were observed between these LDCT and SDCT groups with respect to the rates of technical success (99.0% vs. 99.5%, odds ratio [OR]: 1.82, P = 0.35,), diagnostic yield (79.6% vs. 76.2%, OR: 0.93, P = 0.47), diagnostic accuracy (96.1% vs. 96.1%, OR: 0.93, P = 0.69), operative time (mean difference [MD]: 1.04, P = 0.30), pneumothorax (19.9% vs. 21.3%, OR: 0.92, P = 0.43) or hemoptysis (4.6% vs. 5.8%, OR: 1.14, P = 0.54). Patients in the LDCT group received a significantly lower radiation dose (MD: ‒209.87, P < 0.00001) than patients in the SDCT group. Significant heterogeneity was observed with respect to the operative duration and radiation dose endpoints (I2 = 84% and 100%, respectively). Conclusions: Relative to SDCT-guided lung biopsy, an LDCT-guided approach is equally safe and can achieve comparable diagnostic efficacy while exposing patients to lower doses of radiation.
  154 7 -