Stage T1 Research Articles

The significance of risk stratification through nomogram-based assessment in determining postmastectomy radiotherapy for patients diagnosed with pT1 − 2N1M0 breast cancer

ObjectiveTo explore the high-risk factors affecting the prognosis of pT1 − 2N1M0 patients after mastectomy, establish a nomogram prediction model, and screen the radiotherapy benefit population.MethodThe clinical data of 936 patients with pT1 − 2N1M0 who underwent mastectomy in the fourth hospital of Hebei Medical University from 2010 to 2016 were retrospectively analyzed. There were 583 patients received postmastectomy radiotherapy(PMRT), and 325 patients without PMRT. Group imbalances were mitigated using the propensity score matching (PSM) method, and the log-rank test was employed to compare overall survival (OS) and disease-free survival (DFS) between the cohorts. The efficacy of PMRT across various risk groups was evaluated using a nomogram model.ResultThe median follow-up period was 98 months, Patients who received PMRT demonstrated significantly improved 5-year and 8-year OS and DFS compared to those who did not (P < 0.001). Multivariate analysis revealed that age, primary tumor site, positive lymph node, stage, and Ki-67 level independently influenced OS, while age, primary tumor site, and stage independently affected DFS. PMRT drastically enhanced OS in the high-risk group (P = 0.001), but did not confer benefits in the low-risk and intermediate risk groups (P = 0.057, P = 0.099). PMRT led to a significant improvement in disease-free survival (DFS) among patients in the intermediate and high-risk groups (P = 0.036, P = 0.001), whereas the low-risk group did not experience a significant benefit (P = 0.475).ConclusionAge ≤ 40 years, tumor located in the inner quadrant or central area, T2 stage, 2–3 lymph nodes metastasis, and Ki67 > 30% were the high-risk factors affecting the prognosis of this cohort of patients. In OS nomogram, patients with a risk score of 149 or higher who received PMRT exhibited improved OS. Similarly, in DFS nomogram, patients with a risk score of 123 or higher who received PMRT demonstrated enhanced DFS.

Sperm-carried IGF2: towards the discovery of a spark contributing to embryo growth and development.

Spermatozoa have been shown to carry key RNAs which, according to animal evidence, seem to play a role in early embryo development. In this context, a potential key growth regulator is insulin-like growth factor 2 (IGF2), a highly conserved paternally expressed imprinted gene involved in cell growth and proliferation which, recent observations indicate, is expressed in human spermatozoa. We herein hypothesized that sperm IGF2 gene expression and transmission at fertilization is required to support early embryo development. To test this hypothesis, we analyzed sperm IGF2 mRNA levels in the same semen aliquot used for homologous assisted reproductive technique (ART) in infertile couples and correlated these levels with embryo morphokinetics. To find a mechanistic explanation for the observed results, the transcriptomes of blastocysts obtained after injection of Igf2 mRNA in mouse parthenotes were analyzed. Sperm IGF2 mRNA negatively correlated with time of 2-cell stage (t2), t3, t4, t5, and time of expanded blastocyst (tEB), independently of maternal age, body mass index, anti-Müllerian hormone levels, and oocyte quality. An IGF2 mRNA index >4.9 predicted the ability of the embryos to reach the blastocyst stage on Day 5, with a sensitivity of 100% and a specificity of 71.6% (AUC 0.845; P < 0.001). In the animal study, transcriptome analysis demonstrated that 65 and 36 genes were, respectively, up- and down-regulated in the experimental group compared to the control group. These genes belong to pathways that regulate early embryo development, thus supporting the findings found in humans. This study has the potential to challenge the longstanding tenet that spermatozoa are simply vehicles carrying paternal DNA. Instead, it suggests that IGF2 mRNA in healthy spermatozoa provides critical support for early embryo development. Pre-ART sperm-carried IGF2 mRNA levels may be used as a marker to predict the chances of obtaining blastocysts to be transferred for infertile couples undergoing ART.

Efficacy of neoadjuvant chemotherapy combined with prophylactic intraperitoneal hyperthermic chemotherapy for patients diagnosed with clinical T4 gastric cancer who underwent laparoscopic radical gastrectomy: a retrospective cohort study based on propensity score matching

BackgroundClinical T4 (cT4) stage gastric cancer presents with frequent postoperative recurrence and poor prognosis. This study is to evaluate the oncological efficacy of laparoscopic radical total gastrectomy combined with postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with cT4N + M0 gastric cancer who received neoadjuvant chemotherapy.MethodsWe reviewed the clinicopathological data of 174 patients with clinical T4 gastric cancer who underwent neoadjuvant chemotherapy followed by laparoscopic radical total gastrectomy between June 2017 and December 2021. Among them, 142 were included in the non-HIPEC group, and 32 in the HIPEC group. Patients in both groups were paired based on propensity score in a 2:1 ratio to assess disparities in tumor recurrence and long-term survival.ResultsAfter matching, there were no significant differences in the clinicopathological data between the two groups. The peritoneum (16.1%) and distant organs (10.9%) were the most frequent locations for recurrence. Prior to matching, the recurrence rates were similar at all sites for both groups. Compared with those in the non-HIPEC cohort, the recurrence rates at all sites, the lung, and the peritoneum were notably lower in the HIPEC cohort. Prior to matching, the 3-year overall survival and disease-free survival rates were similar between the two groups; following matching, the HIPEC group exhibited notably greater survival rates than did the non-HIPEC group. The disparities in survival rates between the groups became even more pronounced after conducting a stratified analysis among patients with stage III disease.ConclusionsNeoadjuvant chemotherapy combined with prophylactic HIPEC after laparoscopic radical gastrectomy can effectively reduce the rate of peritoneal metastasis in patients with cT4N + M0 advanced gastric cancer and significantly improve the prognosis of such patients, which is of great clinical value.

A new surgical strategy for T4 stage posterior buccal carcinoma: anatomical unit resection

Objective: To investigate the effect of anatomical unit resection on the overall survival rate of patients with T4 stage posterior buccal carcinoma. Methods: We conducted a retrospective study on 79 patients with T4 stage posterior buccal squamous cell carcinoma underwent radical surgery for buccal mucosa cancer and reconstruction with free anterolateral thigh flap in the Department of Oral and Maxillofacial Surgery, the Second Xiangya Hospital, Central South University from March 2014 to December 2019. The 74 patients were males and the 5 patients were females, aged from 28 to 72 years old. The 40 patients in control group underwent traditional extended resection (1.5-2.0 cm safe margin), and 39 patients in the experimental group underwent anatomical unit resection. The clinicopathological parameters of patients were collected and followed up regularly. The overall survival rate was assessed by Log-rank and Cox proportional risk regression model. Multivariate analysis was performed by linear regression model. Results: There were significant differences between experimental group and control group in overall survival rates (61.53% vs 27.50%, χ2=6.624, P=0.010) and local disease control rates (74.36% vs 27.50%, χ2=17.350, P<0.001). Multiple linear regression analysis showed that local disease control rate was significantly correlated with anatomical unit resection (t=3.880, P<0.001) and lymph node metastasis (t=2.619, P=0.011), and also Cox proportional hazards regression model analysis identified that overall survival rate was significantly correlated with anatomical unit resection (Z=2.421, P=0.016) and lymph node metastasis (Z=2.793, P=0.005). Conclusion: For posterior buccal carcinoma with multiple anatomical units involved, anatomical unit resection can significantly reduce local recurrence and improve overall survival rate of patients.

Intracorporeal urinary diversion offers the advantage of delaying postoperative renal function injury in patients undergoing robot-assisted radical cystectomy.

To analyze changes in renal function and associated risk factors in patients with bladder cancer undergoing robot-assisted radical cystectomy (RARC) with intracorporeal or extracorporeal urinary diversion (ICUD or ECUD). Clinical-pathological data was extracted from electronic medical records of 266 patients with bladder cancer who underwent RARC at our institution between August 2015 and August 2022. Postoperative renal function was assessed using the estimated glomerular filtration rate (eGFR). Patients were classified into ECUD and ICUD groups based on the surgical approach. Significant differences in eGFR were observed between the two groups at 1, 2, and 3 years postoperatively. Moreover, 112 patients (42.1%) experienced long-term renal function injury. Independent risk factors for long-term renal function injury included the type of surgical approach, ureteroenteric anastomotic strictures, and pathological stage T3 or above. In terms of short-term renal function, 30 cases of acute kidney injury (AKI) were observed, with an incidence rate of 11.3%. No difference in AKI incidence was found between the groups. Postoperative AKI and chronic kidney injury are prevalent complications following RC. This study highlights that pathological stage, ureteroenteric anastomotic strictures, and ECUD significantly impact long-term renal function, but the type of urinary diversion (ileal conduit or orthotopic neobladder) had no effect on renal function, and ICUD was superior in terms of long-term renal injury rate. Therefore, precise preoperative assessment and the selection of appropriate surgical approach are crucial for preserving renal function in patients with bladder cancer.

Apelin (APLN) is a biomarker contributing to the diagnosis and prognosis of hepatocellular carcinoma

Liver cancer, classified as a malignant hepatic tumor, can be divided into two categories: primary, originating within the liver, and secondary, resulting from metastasis to the liver from other organs. Hepatocellular carcinoma (HCC) is the main form of primary liver cancer and the third leading cause of cancer-related deaths. The diagnosis and prognosis of HCC using current methods still face numerous challenges. This study aims to develop novel diagnostic and prognostic models while identifying new biomarkers for improved HCC treatment. Diagnostic and prognostic models for HCC were constructed using traditional binary classification methods and machine learning algorithms based on the TCGA database (Downloaded in August 2023). The mechanisms by which APLN (Apelin) affects HCC were investigated using single-cell sequencing data sourced from the GEO database (GSE149614). The diagnostic models yielded by various algorithms could effectively distinguished HCC samples from normal ones. The prognostic model, composed of four genes, was constructed using LASSO and Cox regression algorithms, demonstrating good performance in predicting the three-year survival rate of HCC patients. The HCC biomarker Apelin (APLN) was identified in this study. APLN in liver cancer tissues mainly comes from endothelial cells and is associated with the carcinogenesis of these cells. APLN expression is significantly upregulated in liver cancer tissues, marking it as a viable indicator of endothelial cell malignancy in HCC. Furthermore, APLN expression was determined to be an independent predictor of tumor endothelial cell carcinogenesis, unaffected by its modifications such as single nucleotide variation, copy number variation, and methylation. Additionally, liver cancers characterized by high APLN expression are likely to progress rapidly after T2 stage. Our study presents diagnostic and prognostic models for HCC with appreciably improved accuracy and reliability compared to previous reports. APLN is a reliable HCC biomarker and contributes to the establishment of our models.

Correlation of preoperative sonographic staging and postoperative histopathologic staging in patients with invasive breast cancer.

To assess the accuracy of preoperative sonographic staging in patients with primary invasive breast cancer. We retrospectively analyzed a prospectively kept service database of patients with newly diagnosed, unifocal, cT1-3, invasive breast cancer. All patients were diagnosed at a single center institution between January 2013 and December 2021. Clinical T stage was assessed preoperatively by ultrasound and correlated with the definite postoperative pathologic T stage. Demographics, clinical and pathological characteristics were collected. Factors influencing accuracy, over- and underdiagnosis of sonographic staging were analyzed with multivariable regression analysis. A total of 2478 patients were included in the analysis. Median patients' age was 65years. 1577 patients (63.6%) had clinical T1 stage, 864 (34.9%) T2 and 37 (1.5%) T3 stage. The overall accuracy of sonography and histology was 76.5% (n = 1896), overestimation was observed in 9.1% (n = 225) of all cases, while underestimation occurred in 14.4% (n = 357) of all cases. Accuracy increased when clinical tumor stage cT was higher (OR 1.23; 95% CI 1.10-1.38, p ≤ 0.001). The highest accuracy was seen for patients with T2 stage (82.8%). The accuracy was lower in Luminal B tumors compared to Luminal A tumors (OR 0.71; 95% CI 0.59-0.87, p ≤ 0.001). We could not find any association between sonographic accuracy in HER2 positive patients, and demographic characteristics, or tumor-related factors. Our unicentric study showed a high accuracy of sonography in predicting T stage, especially for tumors with clinical T2 stage. Tumor stage and biological tumor factors do affect the accuracy of sonographic staging.

A National Cancer Database Analysis of the Characteristics and Outcome of Colon Cancer According to Type of Preexisting Adenoma

BackgroundThe vast majority of colon cancers occur in pre-existing adenomas. Little is known about the impact of adenoma type on behavior and outcome of subsequent carcinomas. The present study aimed to assess characteristics, behavior, and outcome of colon adenocarcinoma based on histologic type of pre-existing adenoma. MethodsUS-National Cancer Database was searched between 2005 and 2019 for patients with colonic adenocarcinoma with known adenoma type who underwent colectomy. Patients were divided into 3 groups according to type of adenoma in which carcinoma developed: tubular adenoma (TA), villous adenoma (VA), and tubulovillous adenoma (TVA)-associated carcinomas. The main outcome of the study was 5-year overall survival (OS). Results66,854 patients were included. 79.3% of carcinomas originated from TVA, 10.2% from VA, and 0.5% from TA. Patients with adenocarcinoma in VA were more often female whereas carcinomas in TA affected patients of Asian race more often. Approximately one-third of carcinomas in villous and tubulovillous adenomas were in the cecum whereas one-third of carcinomas in tubular adenomas were in the sigmoid colon. More TA-associated carcinomas were of clinical T1-2 stage (30.2% vs. 20.8%; P < .001), clinical N0 stage (69% vs. 62.2%, P < .001), and high grade (15.9% vs. 11.5%, P < .001) compared to VA-associated carcinomas. Patients with TA-associated carcinomas had longer mean OS than patients with VA and TVA-associated carcinomas (130.1 vs. 116.9 vs. 123.5 months, P < .0001). ConclusionsAdenocarcinomas that arose in TA had more T1-2 stage and N0 stage, higher grade, and longer OS than did adenocarcinomas that arose in VA and TVA.

Clinical impact of pancreatic invasion in T1-stage distal bile duct cancer and prognostic factors associated with long-term survival: A multicenter study.

The eighth edition of the AJCC staging system introduced a shift in the staging of distal bile duct cancer (DBC), emphasizing the depth of invasion over adjacent organ invasion. This study aimed to evaluate the clinical impact of pancreatic invasion in pT1-stage DBC and identify prognostic factors for long-term survival. This multicenter retrospective analysis encompassed DBC patients who underwent pancreaticoduodenectomy between 2009 and 2019 in six Korean tertiary centers, specifically those with final pathology confirming AJCC eighth edition T1 stage and intrapancreatic bile duct tumor origin. Primary endpoints were five-year recurrence-free survival (RFS) and overall survival (OS). Secondary objectives included the identification of prognostic determinants. This study involved 287 patients, comprising 190 without and 97 with pancreatic invasion. Pancreatic invasion did not significantly influence five-year OS and RFS rates (OS: without pancreatic invasion 69.9% vs. with pancreatic invasion 54.1%, p = .25; RFS: 56.3% vs. 55.4%, p = .97). Multivariate analysis highlighted male gender, age, lymphovascular invasion, and N stage as significant OS determinants. Notably, male gender, ampulla of Vater invasion, lymphovascular invasion, and N1 stage were also associated with RFS. In pT1 DBC, pancreatic invasion demonstrates no substantial impact on long-term prognosis, in accordance with the depth-based paradigm of the eighth edition AJCC staging system. The prognostic factors influencing OS were identified as male gender, age, lymphovascular invasion, and nodal metastasis.

623. PERIOPERATIVE THERAPY FOR LIMITED-STAGE SMALL CELL ESOPHAGEAL CARCINOMA: A RETROSPECTIVE COHORT STUDY

Abstract Background The optimal treatment strategy for limited-stage small cell esophageal carcinoma (LS-SCEC) remains uncertain, we aimed to evaluate the efficacy of perioperative therapy in those patients. Methods From June 2005 to November 2022, a total of 156 patients with LS-SCEC who underwent esophagectomy were included in the current study. The primary endpoint was overall survival, and secondary endpoints included progression-free survival. Pathologic staging was determined based on the 8th American Joint Committee on Cancer (AJCC) TNM staging system for esophageal carcinoma. Survival curves were created using the Kaplan-Meier method and compared using the log-rank test. Prognostic factors analysis was carried out using both univariate and multivariate Cox regression models, as well as propensity score matching (PSM) analysis. Statistical significance was defined as P value &amp;lt; 0.05 in a two-tailed test. Results Among 156 LS-SCEC patients, the median age was 62 years (interquartile range [IQR], 56-67), with 120 (76.9%) being males. Thirty-three (21.2%) patients received neoadjuvant chemotherapy; and 2 (1.3%) received neoadjuvant chemoradiotherapy. Seventy-six (48.7%) received adjuvant chemotherapy, 2 (1.3%) received adjuvant radiotherapy, and 13 (8.3%) received adjuvant chemoradiotherapy. Only 7 (4.5%) patients achieved pathological complete remission after neoadjuvant therapy. Following surgery, 33 (21.2%) patients were categorized stage I, 40 (25.6%) as stage II, 61 (39.1%) as stage III, and 22 (14.1%) as stage IV. The median follow-up time of the entire cohort was 72 months. The median disease-free survival (mDFS) was 12.0 months (95% CI, 10.2–13.8 months), and the median overall survival (mOS) was 21.0 months (95% CI, 16.2–25.8 months). The 5-year OS rate was 25.9%, and the DFS rate was 21.9%. Univariate analysis revealed that clinical T stage (P=0.011), clinical N stage (P=0.009), pathological T stage (P=0.027), pathological N stage (P=0.001), pathological TNM stage (P=0.002), adjuvant therapy (P&amp;lt;0.001), and neural invasion (P=0.001) were significant prognostic factors for overall survival. In multivariate analysis, clinical T stage (P=0.049), neural invasion (P=0.002), N stage (P=0.006), and adjuvant therapy (P=0.001) were identified as independent prognostic factors. Furthermore, a PSM analysis was conducted to evaluate the impact of neoadjuvant chemotherapy on LS-SCEC patients. Following PSM, 64 patients were matched, with 32 in each group. Both univariate and multivariate analyses indicated that neoadjuvant chemotherapy could enhance the OS of LS-SCEC patients, with a 5-year OS rate of 37.7% compared to 0.0% in the non-neoadjuvant chemotherapy group (P&amp;lt;0.001, HR=0.319, 95% CI: 0.168-0.604). Subgroup analyses further supported the benefit of neoadjuvant chemotherapy for patients with clinical stages T3-4 and nodal positive (N+), where improved outcomes were observed (P=0.001 and 0.013 respectively). Additionally, subgroup analyses revealed that adjuvant chemoradiotherapy was identified as the optimal treatment model for patients with nodal positive status (adjuvant chemoradiotherapy vs. chemotherapy: OS P=0.01, DFS P=0.004) and those categorized as pathological stage III-IV (adjuvant chemoradiotherapy vs. chemotherapy: OS P=0.03, DFS P=0.017). Conclusions Perioperative therapy is essential for patients with LS-SCEC. Patients with clinical stage T3-4 and nodal positive should undergo neoadjuvant chemotherapy. All patients should receive adjuvant therapy, and adjuvant chemoradiotherapy is recommended for those with nodal involvement or pathologic TNM stages III-IV.

251. THE COMPARISON OF UNIPORTAL VERSUS MULTIPORTAL VIDEO-ASSISTED THORACIC SURGERY FOR ESOPHAGEAL CANCER: A PROPENSITY-WEIGHTED ANALYSIS

Abstract Background Uniportal video-assisted thoracoscopic surgery (VATS) has been widely used, however, there are few studies on uniportal VATS for esophagectomy. Methods Data from patients with clinical stage T1–3/N0/M0 thoracic esophageal cancer who underwent surgery between January 2017 and December 2020 were retrospectively collected and retrospectively analyzed. Inverse probability of treatment weighting (IPTW) analysis was performed to assess the outcomes. Results Overall, 55 patients who underwent uniportal, and 212 patients who underwent multiportal, VATS were identified. Surgery-related postoperative complications (Clavien-Dindo grades 1–2) occurred less frequently after uniportal than multiportal VATS in both crude and IPTW models (10.1% versus 28.8%, respectively; P = 0.018). The median postoperative length of stay was 9 (9–10) days in the uniportal VATS and 10 (9–14) days in the multiportal VATS group (P = 0.006 after IPTW). Upon IPTW analysis, in uniportal and multiportal VATS groups, the rates of pneumonia (grades 1-2) were 7.3% and 23.2% (P = 0.037). The visual analog scale (VAS) was administered on postoperative first 7 days and were significantly lower in the uniportal VATS group (P &amp;lt; 0.001). No surgical mortality was observed in the uniportal VATS group, and the survival benefit between the two groups was comparable before (P = 0.320) and after IPTW (P = 0.824). Conclusion Uniportal VATS for esophagectomy resulted in a lower rate of postoperative complications with less postoperative pain, and is practical for treating patients with esophageal cancer.

Impact ofCOVID-19 Pandemic on the Clinical and Pathologic Characteristics ofColorectal Cancer: A Retrospective Multicenter Study in South Korea.

The COVID-19 pandemic has influenced various aspects of colorectal cancer (CRC) patient care, including diagnosis, treatment, and outcomes. This study assesses the pandemic's impact on CRC patients. We performed a retrospective analysis of medical records for CRC patients who underwent surgery at five hospitals affiliated with Hallym University from January 2017 to December 2022. Patients were divided into two groups: the pre-COVID group (2017-2019) and the COVID group (2020-2022). Among 2038 patients, 987 (48.4%) were in the pre-COVID group, and 1051 (51.6%) were in the COVID group. The COVID group had more patients with two or more comorbidities (P < 0.001) and a higher incidence of rectal cancer (P = 0.010). While the rates of laparoscopic surgeries were similar, the COVID group had increased emergency surgeries (P = 0.005) and diversion procedures (P = 0.002). Additionally, the COVID group faced more overall complications (P < 0.001) and severe complications (Grade III-V, P = 0.004). There was a rise in lymphovascular invasion (P < 0.001) and T4 stage tumors (P < 0.001) within the COVID group. Despite these differences, both groups had similar 2-year overall survival rates (P = 0.409). Although patients treated during the COVID period experienced more frequent stoma formation, complications, and adverse prognostic factors, there were no differences in short-term oncologic outcomes, which was likely due to the follow-up period being insufficient to detect differences in OS.

Radiomics machine learning algorithm facilitates detection of small pancreatic neuroendocrine tumors on CT

PurposeThe purpose of this study was to develop a radiomics-based algorithm to identify small pancreatic neuroendocrine tumors (PanNETs) on CT and evaluate its robustness across manual and automated segmentations, exploring the feasibility of automated screening. Materials and methodsPatients with pathologically confirmed T1 stage PanNETs and healthy controls undergoing dual-phase CT imaging were retrospectively identified. Manual segmentation of pancreas and tumors was performed, then automated pancreatic segmentations were generated using a pretrained neural network. A total of 1223 radiomics features were independently extracted from both segmentation volumes, in the arterial and venous phases separately. Ten final features were selected to train classifiers to identify PanNETs and controls. The cohort was divided into training and testing sets, and performance of classifiers was assessed using area under the receiver operator characteristic curve (AUC), specificity and sensitivity, and compared against two radiologists blinded to the diagnoses. ResultsA total of 135 patients with 142 PanNETs, and 135 healthy controls were included. There were 168 women and 102 men, with a mean age of 55.4 ± 11.6 (standard deviation) years (range: 20–85 years). Median PanNET size was 1.3 cm (Q1, 1.0; Q3, 1.5; range: 0.5–1.9). The arterial phase LightGBM model achieved the best performance in the test set, with 90 % sensitivity (95 % confidence interval [CI]: 80–98), 76 % specificity (95 % CI: 62–88) and an AUC of 0.87 (95 % CI: 0.79–0.94). Using features from the automated segmentations, this model achieved an AUC of 0.86 (95 % CI: 0.79–0.93). In comparison, the two radiologists achieved a mean 50 % sensitivity and 100 % specificity using arterial phase CT images. ConclusionRadiomics features identify small PanNETs, with stable performance when extracted using automated segmentations. These models demonstrate high sensitivity, complementing the high specificity of radiologists, and could serve as opportunistic screeners.

Endoscopic Resection of Stage T1 Colorectal Adenocarcinoma Followed by Surgical Intervention: a Single-center Retrospective Study

BackgroundDomestic and international guidelines recommend endoscopic resection for stage T1 colorectal adenocarcinoma with indications. However, completion surgery remains imperative for patients exhibiting high-risk factors subsequent to endoscopic procedures.ObjectiveTo investigate the evidence, pathological features, and surgical outcomes of completion surgery in patients with T1 colorectal adenocarcinoma following endoscopic resection.MethodsWe retrospectively collect data on the clinical features and treatment outcomes of patients with stage T1 colorectal adenocarcinoma who underwent endoscopic resection followed by surgical resection and those who initially completed surgical intervention at Peking University International Hospital between January 2019 and October 2022, with the aim of assessing the necessity and feasibility of surgical intervention.ResultsSeventeen patients (Group A) with high-risk factors following endoscopic procedure, especially with deep submucosal invasion and vascular or lymphatic invasion, experienced further surgical resection. The median interval between endoscopic resection and completion surgery was 23.71 days ± 15.89. Sixteen patients (Group B) underwent radical resection without any prior interventions. The surgical approach involves integration of laparoscopy and colonoscopy for precise localization and quantitative diagnosis, followed by radical surgery. The two groups demonstrated significant differences statistically with reference to tumor diameter (1.65 cm ± 0.77 vs 3.36 cm ± 1.39, P = 0.000) and the attainment of standard lymph node count (cases of detected lymph nodes larger than or equal to 12, 5 vs 12, P = 0.015). Postoperative complications and hospital stay manifested no significant disparity statistically in two groups. Patients who underwent completion surgery had no inferior outcomes compared with those who underwent direct surgery in terms of 5-year disease-free survival (Log rank test: P = 0.083, Breslow test: P = 0.089). The two groups also exhibited no significant differences statistically in the context of overall survival (Log rank test: P = 0.652, Breslow test: P = 0.758).ConclusionCompletion surgery is a safe and feasible treatment option for T1 colorectal adenocarcinoma patients with high-risk factors, particularly those with deep submucosal invasion and vascular or lymphatic invasion following endoscopic treatment. Furthermore, subsequent treatment should be chosen based on a comprehensive analysis of the patient’s history of abdominal surgery, willingness, and pathological features.

LungPath: artificial intelligence-driven histologic pattern recognition for improved diagnosis of early-stage invasive lung adenocarcinoma.

Early-stage invasive lung adenocarcinoma (ADC) characterized by a predominant micropapillary or solid pattern exhibit an elevated risk of recurrence following sub-lobar resection, thus determining histological subtype of early-stage invasive ADC prior surgery is important for formulating lobectomy or sub-lobar resection. This study aims to develop a deep learning algorithm and assess its clinical capability in distinguishing high-risk or low-risk histologic patterns in early-stage invasive ADC based on preoperative computed tomography (CT) scans. Two retrospective cohorts were included: development cohort 1 and external test cohort 2, comprising patients diagnosed with T1 stage invasive ADC. Electronic medical records and CT scans of all patients were documented. Patients were stratified into two risk groups. High-risk group: comprising cases with a micropapillary component ≥5% or a predominant solid pattern. Low-risk group: encompassing cases with a micropapillary component <5% and an absence of a predominant solid pattern. The overall segmentation model was modified based on Mask Region-based Convolutional Neural Network (Mask-RCNN), and Residual Network 50 (ResNet50)_3D was employed for image classification. A total of 432 patients participated in this study, with 385 cases in cohort 1 and 47 cases in cohort 2. The fine-outline results produced by the auto-segmentation model exhibited a high level of agreement with manual segmentation by human experts, yielding a mean dice coefficient of 0.86 [95% confidence interval (CI): 0.85-0.87] in cohort 1 and 0.84 (95% CI: 0.82-0.85) in cohort 2. Furthermore, the deep learning model effectively differentiated the high-risk group from the low-risk group, achieving an area under the curve (AUC) of 0.89 (95% CI: 0.88-0.90) in cohort 1. In the external validation conducted in cohort 2, the deep learning model displayed an AUC of 0.87 (95% CI: 0.84-0.88) in distinguishing the high-risk group from the low-risk group. The average diagnostic time was 16.00±3.2 seconds, with an accuracy of 0.82 (95% CI: 0.81-0.83). We have developed a deep learning algorithm, LungPath, for the automated segmentation of pulmonary nodules and prediction of high-risk histological patterns in early-stage lung ADC based on CT scans.

Progressive melting of surface water and unequal discharge of different DOM components profoundly perturb soil biochemical cycling

Freeze-thaw (FT) events profoundly perturb the biochemical processes of soil and water in mid- and high-latitude regions, especially the riparian zones that are often recognized as the hotspots of soil-water interactions and thus one of the most sensitive ecosystems to future climate change. However, it remains largely unknown how the heterogeneously composed and progressively discharged meltwater affect the biochemical cycling of the neighbor soil. In this study, stream water from a valley in the Chinese Loess Plateau was frozen at –10°C for 12 hours, and the meltwater (at +10°C) progressively discharged at three stages (T1 ∼ T3) was respectively added to rewet the soil collected from the same stream bed (Soil+T1 ∼ Soil+T3). Our results show that: (1) Approximately 65% of the total dissolved organic carbon and 53% of the total NO3--N were preferentially discharged at the first stage T1, with enrichment ratios of 1.60 ∼ 1.94. (2) The dissolved organic matter discharged at T1 was noticeably more biodegradable with significantly lower SUVA254 but higher HIX, and also predominated with humic-like, dissolved microbial metabolite-like, and fulvic acid-like components. (3) After added to the soil, the meltwater discharged at T1 (e.g., Soil+T1) significantly accelerated the mineralization of soil organic carbon with 2.4 ∼ 8.07-folded k factor after fitted into the first-order kinetics equation, triggering 125 ∼ 152% more total CO2 emissions. Adding T1 also promoted significantly more accumulation of soil microbial biomass carbon after 15 days of incubation, especially on the FT soil. Overall, the preferential discharge of the nutrient-enriched meltwater with more biodegradable DOM components at the initial melting stage significantly promoted the microbial growth and respiratory activities in the recipient soil, and triggered sizable CO2 emission pulses. This reveals a common but long-ignored phenomenon in cold riparian zones, where progressive freeze-thaw can partition and thus shift the DOM compositions in stream water over melting time, and in turn profoundly perturb the biochemical cycles of the neighbor soil body.

Association between tumor size and prognosis in patients with small bowel adenocarcinoma-a SEER-based study

BackgroundThe association between small-bowel adenocarcinoma (SBA) tumor size and prognosis is unclear, and we used the Surveillance, Epidemiology, and End Results (SEER) database to assess the prognostic value of SBA tumor size. MethodsPatients with postoperative SBA were selected from the SEER database, and overall survival (OS) and cancer-specific survival (CSS) were used as outcome variables. Tumor size was used as a categorical and continuous variable, respectively, to adjust for confounders and analyze the association between SBA tumor size and prognosis using Cox proportional hazard regression, and the results were visualized using restricted cubic splines (RCS). Spearman correlation coefficient was used to evaluate the statistical correlation between tumor size and tumor invasion depth (T-stage). Kaplan-Meier survival curves were used to estimate OS at different T stages. ResultsWhen the tumor size was analyzed as a quantitative variable, the adjusted covariate model showed that the HR was 1.008 (P = 0.04) for OS and 1.021 (P = 0.03) for CSS. And regardless of OS or CSS, when the tumor size < 3–4 cm, there was a close linear relationship between tumor size and HR. What's more, in the SEER database, the 5-year survival rates of T1, T2, T3 and T4 patients were 81.8 %, 81.1 %, 66.0 % and 50.9 % (P < 0.001) according to AJCC T-stage. However, in the modified T-stage (mT), these rates were 82.8 %, 70.6 %, 60.7 % and 39.8 % (P < 0.001). When patients within each of the AJCC T stages were stratified by mT stages, significant survival heterogeneity was observed within each of the AJCC T1 to T4 stages(P < 0.001). ConclusionWhen tumor size is used in a quantitative way, tumor size is an independent predictor of poor outcome in patients with SBA. Furthermore, we established a modified T-stage based on tumor size and depth of invasion.

Sentinel Lymph Node Biopsy Evaluation in Early Stage T1, T2, N0, Squamous Cell Carcinoma of the Oral Cavity with Methylene Blue Dye

Sentinel Lymph Node Biopsy Evaluation in Early Stage T1, T2, N0, Squamous Cell Carcinoma of the Oral Cavity with Methylene Blue Dye

Lymph node dissection does not affect the survival of patients with tumor node metastasis stages I and II colorectal cancer.

The effect of the number of lymph node dissections (LNDs) during radical resection for colorectal cancer (CRC) on overall survival (OS) remains controversial. To investigate the association between the number of LNDs and OS in patients with tumor node metastasis (TNM) stage I-II CRC undergoing radical resection. Patients who underwent radical resection for CRC at a single-center hospital between January 2011 and December 2021 were retrospectively analyzed. Cox regression analyses were performed to identify the independent predictors of OS at different T stages. A total of 2850 patients who underwent laparoscopic radical resection for CRC were enrolled. At stage T1, age [P < 0.01, hazard ratio (HR) = 1.075, 95% confidence interval (CI): 1.019-1.134] and tumour size (P = 0.021, HR = 3.635, 95%CI: 1.210-10.917) were independent risk factors for OS. At stage T2, age (P < 0.01, HR = 1.064, 95%CI: 1.032-1.098) and overall complications (P = 0.012, HR = 2.297, 95%CI: 1.200-4.397) were independent risk factors for OS. At stage T3, only age (P < 0.01, HR = 1.047, 95%CI: 1.027-1.066) was an independent risk factor for OS. At stage T4, age (P < 0.01, HR = 1.057, 95%CI: 1.039-1.075) and body mass index (P = 0. 034, HR = 0.941, 95%CI: 0.890-0.995) were independent risk factors for OS. However, there was no association between LNDs and OS in stages I and II. The number of LDNs did not affect the survival of patients with TNM stages I and II CRC. Therefore, insufficient LNDs should not be a cause for alarm during the surgery.

Identification of candidate biomarkers and prognostic analysis of recurrence in colorectal cancer.

Colorectal cancer (CRC) is one of the most common digestive tract malignant tumors, which has a high mortality rate especially for patients with CRC recurrence. However, the pathological mechanism of recurrence of CRC is unclear. In this study, we integrated multiple cohort datasets and databases to clarify and verify potential key candidate biomarkers and signal transduction pathways in recurrence of CRC. As results, 628 DEGs were identified from GSE33113 and GSE2630 datasets and their function and pathway were analyzed. 14 hub genes related to CRC recurrence were screened from and their influence on survival were analyzed. Two key genes (IL1B and DDAH1) regarded as prognostic factors were further screened. Relapse-free survival results indicated the interaction between IL1B and DDAH1 genes and B cells was the most obvious and correlated with survival, with statistical significance (P< 0.05). Specially, cox regression analysis suggested that patients with T1 and N0 stages had a higher risk of recurrence than patients with T2 and N1. This work would provide potential value for prognosis, and would promote molecular targeting therapy for CRC recurrence.