Objective To analyze predictive factors on survival in patients with completely resected high-risk Ⅱ/Ⅲ stage colorectal cancer after adjuvant chemotherapy.Methods According to random number table, 76 cases with completely resected high-risk Ⅱ/Ⅲ stage colorectal cancer after adjuvant chemotherapy were selected, who newly diagnosed and hospitalized in 2004. Their disease-free and overall survivals were followed up.Thymidylate synthase gene polymorphism and microsatellite instability were tested in these cases with microdissection combined with polymerase chain reaction and capillary electrophoresis. Correlation of these factors including clinical characteristics, thymidylate synthase gene polymorphism and microsatellite instability to survival was analyzed with SPSS13.0 software. Results Histologic grades and evaluated lymph node number had significantly difference between two groups of distinct prognosis (χ2 = 7.827, P =0.003 and χ2 = 9.265, P =0.018, respectively), which were also independent predictors on survival proved by COX regression analysis (χ2 = 40.472, P =0.000 and χ2 = 39.528, P =0.000, respectively).Kaplan-Meier survival analysis showed that the median disease-free and overall survival of poor-differentiated adenocarcinoma patients were significantly shorter than those of high and intermediate-differentiated ones (27.67 vs 61.13months, χ2 = 45.015, P =0.000 and 43.13 vs 64.21 months, χ2 = 35.514, P =0.000, respectively), as well, the median disease-free and overall survival of patients with the evaluated lymph node number less than 11 were poorer than those of more than 11 ( 45.65 vs 68.47 months, χ2 = 23.134, P =0.011 and 53.10 vs 70.18months, χ2 = 22.896, P =0.013, respectively).Conclusion Poor-differentiated adenocarcinoma and evaluated lymph node number less than 11 may be predictors on poor survival in patients with completely resected highrisk Ⅱ/Ⅲ stage colorectal cancer after adjuvant chemotherapy.

Objective To study PTEN protein expression and clinical significance in patients with diffuse large B cell lymphoma. Methods Immunohistochemical staining was used to determine the PTEN protein expression in 40 cases of primary diffuse large B lymphoma tissuse. The results were analyzed by Kaplan-Merie survival analysis, Log-Rank test and Logistic regression analysis. Results PTEN protein was positive in 16 cases and negative in 24 cases. There was no significant difference between two groups in twoyear overall survival rate(62.5 % vs 66.7 %, P >0.05). Survival analysis showed that patient' s survival time gradually were reduced with extended time between PTEN protein-positive group and negative group, lower in PTEN-positive group than the negative group, but there was no significant difference in survival curve (P >0.05) in the two groups. We compared characteristics of patients between PTEN protein positive and negative groups,including molecular type, patient' s age, stage, LDH, physical score and extranodular invasion, there was no significant difference among them. PTEN protein was not correlated with prognosis, while International Prognosis Index(IPI) was still a risk factor (OR >1). Conclusion PTEN protein expression may not predict the outcome in diffuse large B cell lymphoma, but IPI still is a predictor.

Objective To explore the prognostic significance of p53 mutation protein in patients with diffuse large B-cell lymphoma for the purpose of individualized therapy. Methods Newly diagnosed 62 cases were randomly chosen from our hospital, p53 mutation protein and CD10, bcl-6, MUM1 were tested by immunohistochemistry. Correlation of p53 mutation protein with patients ' characteristics, genotype and survival were analysed in the study. Results p53 mutation protein was found in 48.4 % (30/62) of patients.Its expression was only related to initial treatment response (x2 =20.365, P =0.040), including complete remission rate of 33.3 % (10/30) in positive group and 59.4 % (19/32) in negative group, and non-germinal center genotype (x2=31.023, P =0.021) with 83.3 % in positive group and 56.2 % in negative group. No other correlation was not verified with clinical features. Multivariate survival analysis showed that p53 mutation protein was an independent predictor for shorter progress-free and overall survival in positive group (x2 =30.784, P =0.005 and x2 =35.276, P =0.006). Conclusion p53 mutation protein should be an independent predictor with poor prognosis and to direct personalized therapy.

Objective To evaluate the value of MSCT in the diagnosis of extrahepatic cholangiocarcinoma.Methods The MSCT appearances of extrahepatic cholangiocarcinoma confirmed by pathology in 27 cases were analyzed retrospectively.Among them,20 patients underwent plain and four-phase dynamic contrast-enhanced CT scans including early arterial phase,late arterial phase,portal phase and delay phase,7 patients only underwent contrast-enhanced CT scans.Results 15 lesions were located in the hilar and 12 lesions were located in the common bile duct.CT features of cholangiocarcinomas in this group were varied with its position and growth pattern.Besides the direct sign such as delay enhancement,the indirect findings were also specific such as hepatic lobe atrophy,dilated bile duct,etc.Conclusion MSCT is of great value in diagnosis of extrahepatic cholangiocarcinoma.

Objective To study the radiological appearance and pathological features of breast phyllodes tumors(PTs), and to enhance the knowledge of the tumor.Methods Clinical and imaging findings were reviewed retrospectively in 65 women with PTs confirmed by surgical pathology.61 patients had preoperative MRI and/or sonography, and 44 had preoperative mammography.Then these findings were compared with the pathological results.Results (1)The percentages of benign, borderline and malignant PTs were 32.3%(21/65), 43.1%(28/65) and 24.6%(16/65), respectively,and the mean maximum diameters of these lesions were (4.75±2.62) cm, (5.37±3.11) cm and (4.96±3.82) cm, respectively.There were no statistical difference in lesion''s size among these three types(F=0.247,P=0.782).(2)On the mammograms of these 44 PTs(including 16 cases of benign type, 18 cases of borderline and 10 cases of malignant type), the appearances of radiolucent halo and calcification among these three types showed statistically significant differences(both P<0.05).(3)On the sonography of these 61 PTs(including 19 cases of benign type, 26 cases of borderline and 16 cases of malignant type), the shape among these three types showed statistically significant difference(P<0.05).(4)On the MRI of these 61 PTs(including 21 cases of benign type, 24 cases of borderline and 16 cases of malignant type), internal hypointense septations on T2WI and time intensity curves showed statistically significant differences among these three types(both P<0.05).Conclusion Some radiological appearances of PTs can be used to help determine the histologic subtypes of breast PTs preoperatively.

Objective:To investigate the feasibility and safety of laparoscopic liver tumor resection in children.Methods:The clinical data of 6 children undergoing laparoscopic liver tumor resection from June 2018 to March 2020 in the Affiliated Tumor Hospital, Zhengzhou University were retrospectively analyzed.Results:There were 4 males and 2 females among the 6 cases, with the average age of (7±2)years.All the children were admitted to the hospital with a liver occupying examination due to physical discomfort.Preoperative diagnosis: 3 cases of hepatoblastoma, 1 case of primary liver cancer, 1 case of hepatic adenoma and 1 case of hepatic nodular hyperplasia.All the children successfully completed laparoscopic liver tumor resection without conversion to open surgery.Among them, 3 children obtained left hemihepatectomy, 1 child underwent hepatic left lobectomy, 1 child was given VI hepatectomy, and 1 child accepted hepatic caudate lobectomy.The operation time was(90±9)min, and the average intraoperative blood loss was (83±26) mL.All children had no blood transfusion during or after operation.There were no bleeding, bile leakage, infection and liver failure after operation.All children had no gastric tube before surgery and the fluid diet was given on the first day after operation, and the postoperative median hospital stay was 4(3-5) days.The pathology were consis-tent with the preoperative diagnosis, and the resections were all radical operation resections.The follow-up period was from 2 to 23 months, and all the children recovered well and no recurrence was observed.Conclusions:Laparoscopic liver tumor resection in children is safe and feasible, which can minimize trauma, reduce intraoperative bleeding and shorten the hospital stay without increasing the incidence of postoperative complications.Laparoscopic liver tumor resection in children has certain advantages.

Objective:To investigate the clinical value of iodine density map and low keV virtual monoenergetic images (VMI) derived from dual-layer spectral detector CT (DLCT) for the pancreatic neuroendocrine tumors (pNETs) detection.Methods:From January to June 2019, data of 23 pathologically confirmed patients of pNETs were retrospectively analyzed. All of the patients underwent pancreas enhanced DLCT scanning within 1 week before surgery. The conventional polyenergetic images (PI), iodine density map and 40, 50, 60, 70 keV VMI were generated. One resident radiologist with 3 years’ experience and one senior radiologist with over 10 years’ experience interpreted the images for the lesion detection independently using the following image series: PI, VMI (40-70 keV), PI combined with iodine density map. Lesion detection rates were recorded and compared among different image series. The CT value and noise of lesion, normal pancreatic parenchyma, and abdominal subcutaneous fat were measured in PI and VMI in both arterial and portal vein phases. The contrast-to-noise ratio (CNR) of lesion was calculated. The CT value of lesion and normal pancreatic parenchyma, CNR of lesion, and image noise were compared using repeated one-way ANOVA test. Subjective image quality was assessed with a 5-point scale and compared with Friedman test.Results:A total of 26 lesions were confirmed from 23 patients. For resident radiologist and senior radiologist, the detection rates of pNETs lesion using PI were 76.9% (20/26) and 84.6% (22/26) respectively, and both improved to 92.3% (24/26) using image series of 40 and 50 keV VMI. For senior radiologist, the pNETs lesion detection rate was further improved to 96.2% (25/26) using image series of PI with iodine map. The CT value of lesion and normal pancreatic parenchyma, CNR, and image noise had statistical differences among PI and VMI (40-70 keV) in both arterial and portal vein phase ( P<0.001). The mean CT attenuation and CNR of lesion in VMI increased significantly as the energy level decreased.The CNR of lesion in all VMI (40-70 keV) was significantly higher than that in PI. The median of subjective scores of image quality in PI and VMI (40-70 keV) were 3, 3, 4, 4, and 5 respectively, and the difference was statistically significant (χ2=66.393, P<0.001). Conclusions:The low keV VMI derived from DLCT can increase the CT value and CNR of pNETs, and the lesion detection rate can be improved combined with iodine density map. The CNR of pNETs is the highest in 40 keV VMI, and image noise is still lower than that of PI, so 40 keV VMI is recommended for clinical application.

Objective:To explore the image quality of 40 keV virtual monoenergetic images (VMI) derived from dual-layer spectral detector CT （DLCT） pancreas dynamic enhanced scanning and its optimal window setting.Methods:From January to July 2019, 28 patients who underwent pancreas enhanced DLCT scan within one week before surgery and pathologically confirmed of pancreatic neuroendocrine tumors (pNETs) were retrospectively enrolled. Conventional polyenergetic images (PI) and 40 keV virtual monoenergetic images （VMI 40 keV） were generated after scanning.CT value of normal pancreatic parenchyma, lesion, abdominal subcutaneous fat, abdominal aorta and portal vein were measured in PI and VMI 40 keV. The contrast-to-noise ratio (CNR) of the pNETs lesion was calculated. All these objective results were compared between VMI 40 keV and PI using paired ttest. Individual window settings （W-Ind, including window width and window level） of VMI 40 keVwere recorded. Calculated window settings （W-Calc） were mathematically calculated via regression analysis and optimized window settings （W-Opt） were obtained.Subjective image quality was assessed with a 5-point scale and compared among VMI 40 keV with different window settings (W-Std, W-Ind, W-Calc and W-Opt) using Friedman test, and compared PI with standard abdominal window setting (W-Std) and VMI 40keV with W-Opt settings using Wilcoxon test.The maximum diameter of lesion was measured and compared with one-way ANOVA analysis among PI and VMI 40 keV with different windows settings. Results:For VMI 40 keV in both arterial phase and portal vein phase, the CT attenuation [(464.0±136.7), (375.4±79.2) HU] of pNETs lesion were statistically significantly higher than those in PI [（168.8±38.0), (140.5±23.5) HU] （ t=-16.107,-22.225, P<0.001）, CNR （16.5±11.1, 10.9±6.1） were also statistically significantly higher than those in PI （4.5±2.9, 3.0±1.9） （ t=-7.838, -9.781， P<0.001）,while with lower image noise in VMI 40 keV[（11.8±1.5),(11.8±1.4) HU] than PI （13.1±1.5,12.9±1.3 HU）（ t=6.356,3.891， P<0.001）. The subjective score for PI with W-Std and VMI 40 keV with W-Std, W-Ind, W-Calc, W-Opt in arterial phase were 4（1）, 1（0）, 5（0）, 5（0.75）, 5（1）, and which in portal vein phase were 3.5（1）, 1（0）, 5（0）, 5（0）, 5（1）.The subjective score of VMI 40 keV with different window settings had statistical differences （χ 2=76.143,76.000， P<0.001）. Compared to the image quality of PI with W-Std settings, VMI 40 keV with W-Opt settings have higher objective score （ Z=4.685, 4.235， P<0.001）. The maximum diameter of lesion has no statistical difference among PI and VMI 40 keV with different window settings （ F=0.008, 0.004， P>0.999） in both arterial phase and portal vein phase. Conclusions:The VMI 40 keV in pancreas dynamic enhancement scanning derived from dual-layer spectral detector CT have higher image quality than PI. Due to changes of CT value of tissue in VMI 40 keV, it is recommended to optimize window settings （window width/window level， 880/230 HU for arterial phase and 840/260 HU for portal vein phase） to obtain the best image quality.

Hepatocellular carcinoma (HCC) is mostly treated by surgery combined with interventional therapy, chemotherapy, radiotherapy and local treatment. However, it often relapses after the operation. And the prognosis of advanced patients is poor, and the effective rate of chemotherapy and molecular targeted therapy is low. Recent studies indicated that the occurrence and progress of HCC are closely related to the immune function of the body. Immunotherapy, as a new type of tumor therapy, has drawn much attention. By improving the immunogenicity of tumor cells and the killing sensitivity of effector cells, it stimulates the immune function of the body, prolongs the progression-free survival time and the overall survival time of patients, and becomes an integral part of the comprehensive treatment of liver cancer. This article reviewd the progress in immunotherapy of HCC in the recent years.

Objective:To study the safety and efficacy of liquid isolation assisted technology in ultrasound-guided percutaneous radiofrequency ablation for hepatocellular carcinoma adjacent to liver surfaces.Methods:A retrospective study was conducted on 246 patients with hepatocellular carcinoma near liver surfaces treated by radiofrequency ablation from November 2016 to November 2019 at the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University. There were 182 males and 64 females, aged (56.7±9.2) years. The patients were divided into the liquid isolation group with liquid isolation assisted technology for radiofrequency ablation ( n=131) and the conventional treatment group with conventional radiofrequency ablation ( n=115). The complication, one-time complete ablation and progression-free survival rates were compared between the two groups. Results:The incidence of intraoperative complications in the liquid isolation group was 21.4% (28/131), versus 20.9% (24/115) in the conventional treatment group. There was no significant difference between the two groups ( P>0.05). The incidence of postoperative complications in the liquid isolation group was 20.6% (27/131), which was significantly lower than that in the conventional treatment group 33.9% (39/115) ( P<0.05). The incidence of postoperative pain in the liquid isolation group was 6.1% (8/131), which was significantly lower than that in the conventional treatment group 15.7% (18/115) ( P<0.05). For the 131 patients in the liquid isolation group, there were 183 tumors near to liver surfaces. For the 115 patients in the conventional treatment group, there were 142 lesions near to liver surfaces. The one-time complete ablation rate in the liquid isolation group was 94.0% (172/183), which was significantly higher than the 75.4% (107/142) in the conventional treatment group ( P<0.05). The progression-free survival rate in the liquid isolation group was significantly better than that in the conventional treatment group ( P<0.05). Conclusion:The liquid isolation technique increased the one-time complete ablation rate of liver cancer adjacent to liver surfaces, reduced the incidence of postoperative complications and improved prognosis.