1.Predictive value of 18F-FDG PET/CT habitat radiomics combining stacking ensemble learning for prognosis in patients with hepatocellular carcinoma
Chunxiao SUI ; Kun CHEN ; Qian SU ; Rui TAN ; Wengui XU ; Xiaofeng LI
Chinese Journal of Nuclear Medicine and Molecular Imaging 2025;45(5):263-268
Objective:To investigate the prognostic value of 18F-FDG PET/CT-based habitat radiomics combined with stacking ensemble learning model in overall survival (OS) of patients with hepatocellular carcinoma (HCC). Methods:A total of 136 HCC patients (114 males, 22 females, age (55.3±10.4) years) who underwent 18F-FDG PET/CT before treatment between January 2018 and January 2023 were retrospectively analyzed. Eighty-five cases from Tianjin First Central Hospital and 51 cases from Tianjin Medical University Cancer Institute and Hospital were used as a training cohort and an external validation cohort, respectively. The tumor volume of interest (VOI) was delineated on PET and CT images, and a total of 4 habitats were segmented by using the Otsu algorithm, including PET high ∩ CT low, PET low ∩ CT low, PET high ∩ CT high, and PET low ∩ CT high. After the feature selection, a total of 36 stacking ensemble learning models were established, and the optimal model was selected based on the calculated concordance index (C-index). Moreover, a combined model was developed by integrating the optimal model with clinical information. The predictive efficacy of those models was assessed by time-dependent ROC curves. Results:The model based on PET high ∩ CT high habitat radiomics features with multilayer perceptron (MLP) classifier had the highest C-index (0.770) in the external validation cohort, and it was regarded as the optimal radiomics model. The combined model incorporating this model with clinical information achieved an improved C-index of 0.815 in the external validation cohort. The combined model outperformed the other models for OS prediction, with a time-dependent AUC of 0.919, 0.900, and 0.862 in predicting the 1-year, 2-year, and 3-year OS, respectively. Conclusions:18F-FDG PET/CT-based habitat analysis outperforms traditional radiomics in OS prediction for HCC patients. By integrating the optimal habitat model with the clinical model, the combined model is able to improve the predictive efficacy.
2.Predictive value of 18F-FDG PET/CT habitat radiomics combining stacking ensemble learning for prognosis in patients with hepatocellular carcinoma
Chunxiao SUI ; Kun CHEN ; Qian SU ; Rui TAN ; Wengui XU ; Xiaofeng LI
Chinese Journal of Nuclear Medicine and Molecular Imaging 2025;45(5):263-268
Objective:To investigate the prognostic value of 18F-FDG PET/CT-based habitat radiomics combined with stacking ensemble learning model in overall survival (OS) of patients with hepatocellular carcinoma (HCC). Methods:A total of 136 HCC patients (114 males, 22 females, age (55.3±10.4) years) who underwent 18F-FDG PET/CT before treatment between January 2018 and January 2023 were retrospectively analyzed. Eighty-five cases from Tianjin First Central Hospital and 51 cases from Tianjin Medical University Cancer Institute and Hospital were used as a training cohort and an external validation cohort, respectively. The tumor volume of interest (VOI) was delineated on PET and CT images, and a total of 4 habitats were segmented by using the Otsu algorithm, including PET high ∩ CT low, PET low ∩ CT low, PET high ∩ CT high, and PET low ∩ CT high. After the feature selection, a total of 36 stacking ensemble learning models were established, and the optimal model was selected based on the calculated concordance index (C-index). Moreover, a combined model was developed by integrating the optimal model with clinical information. The predictive efficacy of those models was assessed by time-dependent ROC curves. Results:The model based on PET high ∩ CT high habitat radiomics features with multilayer perceptron (MLP) classifier had the highest C-index (0.770) in the external validation cohort, and it was regarded as the optimal radiomics model. The combined model incorporating this model with clinical information achieved an improved C-index of 0.815 in the external validation cohort. The combined model outperformed the other models for OS prediction, with a time-dependent AUC of 0.919, 0.900, and 0.862 in predicting the 1-year, 2-year, and 3-year OS, respectively. Conclusions:18F-FDG PET/CT-based habitat analysis outperforms traditional radiomics in OS prediction for HCC patients. By integrating the optimal habitat model with the clinical model, the combined model is able to improve the predictive efficacy.
3.Neoadjuvant sintilimab and apatinib combined with perioperative FLOT chemotherapy for locally advanced gastric cancer: A prospective, single-arm, phase II study.
Huinian ZHOU ; Bo LONG ; Zeyuan YU ; Junmin ZHU ; Hanteng YANG ; Changjiang LUO ; Wenjuan ZHANG ; Chi DONG ; Xiaoying GUAN ; Long LI ; Gengyuan ZHANG ; Hongtai CAO ; Shigong CHEN ; Linyan ZHOU ; Qichen HE ; Shiying GAN ; Xiangyan JIANG ; Qianlin GU ; Keshen WANG ; Wengui SHI ; Long QIN ; Zuoyi JIAO
Chinese Medical Journal 2024;137(21):2615-2617
4.Predictive value of 18F-FDG PET/CT in molecular subtyping for triple-negative breast cancer
Jianjing LIU ; Haiman BIAN ; Qiang FU ; Ziyang WANG ; Fang YANG ; Dong DAI ; Wei CHEN ; Lei ZHU ; Wengui XU
Chinese Journal of Radiological Medicine and Protection 2024;44(5):421-427
Objective:To explore the predictive value of 18F-FDG PET/CT in molecular subtyping of triple-negative breast cancer. Methods:A retrospective analysis was performed on the clinical and imaging data of 227 breast cancer patients who underwent 18F-FDG PET/CT examination in the Tianjin Medical University Cancer Institute & Hospital from January 1, 2010 to December 31, 2022. Based on the expression levels of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) in the primary breast cancer, the patients were categorized into two groups: triple-negative breast cancer (TNBC) and non-TNBC. Radiomic features were extracted from images of both groups, and a radiomic model was constructed to predict the molecular subtype of the TNBC groups. In addition, the clinical data, CT morphological features, and PET metabolic parameters of both groups were compared to determine the indicators with statistically significant differences and develop a comprehensive radiomic model combined with clinical characteristics. Results:Compared to the non-TNBC group, the TNBC groups exhibited more significant invasiveness in terms of tumor diameter, margins, ipsilateral axillary lymph node metastasis, invasion of neighboring skin or papillae, and PET metabolic parameters ( t = -3.19; χ2 = 7.30, 8.10, 5.34; t = 3.80, 3.30, 3.42, P < 0.05). The constructed 18F-FDG PET/CT radiomic model proved effective in predicting the molecular subtype of the TNBC group, and the receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.83 (95% CI 0.78-0.88), an accuracy of 75.9%, a sensitivity of 74.5%, and a specificity of 77.2%. In contrast, the constructed comprehensive radiomic model displayed an AUC of 0.86 (95% CI 0.81-0.90), an accuracy of 77.2%, a sensitivity of 78.6%, and a specificity of 75.9%. Conclusions:18F-FDG PET/CT plays an important role in predicting molecular subtypes of TNBC. The constructed radiomic model and comprehensive radiomic model can further enhance the prediction efficacy of PET metabolic parameters and accelerate the development of accurate treatment protocols in clinical practice, thus improving the prognosis of breast cancer.
5.Development status of vector-mediated Eg95 vaccine of Echinococcus granulosus
Chinese Journal of Endemiology 2023;42(8):684-688
Cystic echinococcosis (CE), caused by the larva of Echinococcus granulosus (Eg), is one of the key parasitic diseases to prevent and control in China. The Eg95 protein is a recognized vaccine candidate molecule, and the development of vector-mediated Eg95 vaccine is one of the current research hotspots in CE. This article summarizes the development status of Eg95 vaccine such as vaccinia virus, orf virus, goatpox virus, rabies virus, Salmonella typhimurium, Bacille Calmette-Guerin, Agrobacterium tumefaciens and Bifidobacteria bifidum, in order to provide valuable information for the immune prevention of CE.
6.Application and consideration of esophagogastric anastomosis with seromuscular flap tech-nique in laparoscopic proximal gastrectomy
Chuying WU ; Jianhua XU ; Jian′an LIN ; Wenjin ZHONG ; Wengui KANG ; Jintian WANG ; Junxing CHEN ; Huida ZHENG ; Kai YE
Chinese Journal of Digestive Surgery 2023;22(S1):101-105
In the past few years, there has seen an increase in the detection rate of early upper gastric cancer. Early upper gastric cancer is of good prognosis. How to further enhance the postoperative quality of life of patients has increasingly become an issue of concern. This has naturally given rise to function-preserving proximal gastrectomy. However, due to its damage to the original structure of cardia and its vicinity, proximal gastrectomy is prone to postoperative reflux. To prevent postoperative reflux, various ways of digestive tract reconstruction have emerged one after another, but the optimal way thereof remains controversial. Therefore, reducing postoperative reflux through an appropriate way of digestive tract reconstruction has been taken as a focus of proximal gastrectomy. Esophagogastric anastomosis with seromuscular flap technique, as a way of digestive tract reconstruction, builds an "artificial cardia" on the basis of guarantee of normal entry of food into the digestive tract, and functions against postoperative reflux. For its good anti-reflux effect, eso-phagogastric anastomosis with seromuscular flap technique has gradually become a research focus. On top of the latest research progress at home and abroad and relevant evidence-based medicine, the authors provide on the principles, key points, improvement, postoperative status, and applica-tion of esophagogastric anastomosis with seromuscular flap technique in laparoscopic proximal gastrectomy.
7.Development status of vector mediated Eimeria surface antigen vaccine
Chinese Journal of Endemiology 2022;41(5):414-419
Eimeria is the pathogen of chicken coccidiosis. Vaccine control is one of the hotspots of current study. Its surface antigen is an effective vaccine candidate molecule. This paper summarizes the development status of Eimeria surface antigen vaccine mediated by Bacille Calmettle-Guerinl (BCG), Lactococcus lactis (LL), Lactobacillus plantarum (LP), Salmonella typhimurium (St), Bacillus subtilis (Bs), Enterococcus faecalis (Efs), Escherichia coli (Ec), Cyanobacterium (Cb), Pichia, Leishmania tarentolae (Lt), viruses such as Fowlpox virus (FPV), Herpesvirus of turkey (HVT), Vaccinia virus (VV) and insect Buculovirus, in order to provide reference basis for development and application of new vaccines.
8.Clinical efficacy of laparoscopic-assisted intersphincteric resection with different surgical approaches for low rectal cancer
Junxing CHEN ; Jianhua XU ; Jian'an LIN ; Wengui KANG ; Wenjin ZHONG ; Chuying WU ; Jintian WANG ; Pengcheng WANG ; Yanxin CHEN ; Kai YE
Chinese Journal of Digestive Surgery 2022;21(6):779-787
Objective:To investigate the clinical efficacy of laparoscopic-assisted inters-phincteric resection (ISR) with different surgical approaches for low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 90 patients with low rectal cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2020 were collected. There were 58 males and 32 females, aged (60±9)years. Of 90 patients, 60 cases underwent laparoscopic assisted ISR with transpelvic approach, 30 cases underwent laparoscopic assisted ISR with transabdominal and transanal mixed approach. Observation indicators: (1) clinicopathological characteristics of patients with transpelvic approach and mixed approach; (2) intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach; (3) postoperative complications of patients with transpelvic approach and mixed approach; (4) follow-up. Follow-up was conducted by telephone interview and outpatient examination once every 3 months within postoperative 3 years, once every six months in the postoperative 3 to 5 years and once a year after postoperative 5 years to detect tumor recurrence and metastasis, and survival of patients.Follow-up was up to March 2021 or patient death. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the non-parametric Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was performed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed by the non-parametric rank sum test. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and survival analysis was performed by the Log-Rank test. Results:(1) Clinicopathological characteristics of patients with transpelvic approach and mixed approach. The sex (males, females), distance from the distal margin of tumor to anal margin were 34, 26, (4.5±0.5)cm for patients with transpelvic approach, versus 24, 6, (3.5±0.5)cm for patients with mixed approach, respectively, showing significant differences between them ( χ2=4.75, t=8.35, P<0.05). (2) Intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach. The operation time, volume of intraoperative blood loss, distance from the postoperative anastomosis to anal margin were (187±9)minutes, 50(range, 20?200)mL, (3.4±0.7)cm for patients with transpelvic approach, versus (256±12)minuets, 100(range, 20?200)mL, (2.6±0.7)cm for patients with mixed approach, showing significant differences between them ( t=?26.99, Z=?2.48, t=4.67, P<0.05). None of the 90 patients had a positive distal margin. The stoma reversal rates of patients with transpelvic and mixed approach were 93.3%(56/60) and 90.0%(27/30), respectively. Of the 60 patients with transpelvic approach, 3 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. Of the 30 patients with mixed approach, 2 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. The 1-, 3-month Wexner scores after stoma reversal were 15(range, 12?17), 12(range, 10?14) for patients with transpelvic approach, versus 16(range, 14?18), 14(range, 12?16) for patients with mixed approach, showing significant differences between them ( Z=?4.97, ?5.49, P<0.05). The 6-month Wexner score after stoma reversal was 10(range, 9?12) for patients with transpelvic approach, versus 11(range, 8?12) for patients with mixed approach, showing no significant difference between them ( Z=?1.59, P>0.05). (3) Postoperative complications of patients with transpelvic approach and mixed approach. The complications occurred to 16 patients with transpelvic approach and 9 patients with mixed approach, respectively, showing no significant difference between them ( χ2=0.11, P>0.05). Cases with postoperative anastomotic fistula, cases with anastomotic bleeding, cases with anastomotic stenosis, cases with intestinal obstruction, cases with incision infection, cases with urinary retention, cases with pelvic infection, cases with pulmonary infection, cases with incisional hernia, cases with chylous fistula, cases with abdominal and pelvic abscess were 5, 2, 1, 7, 0, 1, 5, 3, 1, 1, 1 for patients with transpelvic approach, versus 6, 3, 2, 2, 2, 1, 2, 3, 1, 1, 1 for patients with mixed approach, showing no significant difference between them ( P>0.05). The same patient could have multiple postoperative complications. (4) Follow-up. All the 90 patients were followed up for 27(range, 6?62)months. The follow-up time of 60 patients with transpelvic approach was 27(range, 8?62)months. The follow-up time of 30 patients with mixed approach was 28(range, 6?53)months. Of the 60 patients with transpelvic approach, 3 cases had local recurrence, 4 cases had liver metastasis, 3 cases had lung metastasis, and all of them survived with tumor. Of the 30 patients with mixed approach, 1 case had local recurrence, 2 cases had liver metastasis, 1 case had lung metastasis, and all of them survived with tumor. There was no death. The 3-year disease-free survival rates of patients with transpelvic approach and mixed approach were 84.7% and 87.9%, respectively, showing no significant difference between them ( χ2=0.39, P>0.05). Conclusions:Lapa-roscopic assisted ISR via transpelvic approach or mixed approach for low rectal cancer are safe and feasible. Compared with transanal mixed approach, the transpelvic approach of laparoscopic-assisted ISR has shorter operation time, less volume of intraoperative blood loss and longer distance from the postoperative anastomosis to anal margin.
9.Value of 18F-FDG PET/CT in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma
Qiang FU ; Jianjing LIU ; Xiaofeng LI ; Wei CHEN ; Wengui XU
Chinese Journal of Nuclear Medicine and Molecular Imaging 2022;42(10):588-592
Objective:To explore the value of 18F-FDG PET/CT in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma. Methods:A retrospective analysis including 100 patients (77 males, 23 females, age (51.0±12.4) years) with nasopharyngeal carcinoma and 107 patients(61 males, 46 females, age (52.3±18.2) years) with nasopharyngeal lymphoma after 18F-FDG PET/CT at Tianjin Medical University Cancer Institute and Hospital from October 2011 to December 2019 was performed. All patients were confirmed by pathology. Differences of clinical data, PET metabolic parameters and CT morphology between nasopharyngeal carcinoma group and nasopharyngeal lymphoma group were compared (independent-sample t test or Mann-Whitney U test). Multiple regression analysis and ROC curve analysis were used to evaluate the efficacy of the combined features in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma. Results:As for nasopharyngeal carcinoma group and nasopharyngeal lymphoma group, there were statistically significant differences in SUV max (10.86±3.99 vs 14.81±7.24; t=-4.90, P=0.001), peak of SUV (SUV peak; 7.84±3.13 vs 10.86±5.66; t=-4.79, P=0.001), and total lesion glycolysis (TLG; 39.00(19.98, 62.56) vs 56.75(33.02, 102.06) g; z=-3.24, P=0.001). However, the diagnostic efficiencies were low (AUCs: 0.657, 0.646, 0.636, respectively). Multiple regression model showed that SUV max combined with multiple morphological and clinical features (gender, lesion location, with or without involvement of surrounding structures, cervical lymph node metastasis, parapharyngeal involvement and spleen involvement) could improve the differential diagnosis efficiency significantly (AUC=0.900). Conclusion:18F-FDG PET/CT metabolic parameter SUV max combined with CT morphological and clinical features have high diagnostic efficiency in the differential diagnosis of nasopharyngeal malignant tumors.
10.Controversy and consensus of laparoscopic pylorus-preserving gastrectomy for early gastric cancer
Chuying WU ; Kai YE ; Jianhua XU ; Jian′an LIN ; Wenjin ZHONG ; Wengui KANG ; Jintian WANG ; Junxing CHEN
Chinese Journal of Digestive Surgery 2022;21(11):1475-1481
In recent years, the detection rate of early gastric cancer in China has increased. Early gastric cancer has a good prognosis, and how to further improve the postoperative quality of life for patients has become an increasingly concerned problem in the treatment of early gastric cancer. Therefore, function preserving gastrectomy has emerged. Function preserving gastrectomy aims to reduce the resection scope and preserve part of the gastric function on the premise of radical tumor resection. As a representative of function preserving gastrectomy, pylorus-preserving gastrec-tomy is suitable for early gastric cancer in middle segment. Compared with distal gastrectomy, laparoscopic pylorus-preserving gastrectomy not only has the advantage of less trauma, but also can reduce the incidence of postoperative dumping syndrome, bile reflux gastritis and gallstones, and improve postoperative nutritional status. However, the practice of pylorus-preserving gastrectomy is still in controversial. Based on the new Japanese guidelines for the treatment of gastric cancer, and combined with the latest domestic and foreign research trends and relevant evidence-based medicine basis, the authors review the definition and indications, safety, advantages, technical points, digestive tract reconstruction methods, postoperative complications and other aspects of laparoscopic pylorus-preserving gastrectomy.

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