BACKGROUND: Lung cancer is a disease with a high incidence rate in Yunnan province, yet there is a paucity of large-scale studies on its clinical epidemiology. This research aims to investigate the epidemiological characteristics of patients who underwent lung cancer surgery at Yunnan Cancer Hospital over the past decade, thereby providing a theoretical basis for the prevention and treatment of lung cancer. METHODS: Clinical data were collected from 15,967 patients who underwent lung cancer surgery at Yunnan Cancer Hospital between 2013 and 2022. A statistical analysis was conducted on the patients' general data, surgical information, pathological types of lung cancer, and other clinical epidemiological characteristics. RESULTS: Among the 15,967 cases of lung cancer, 46.3% were male and 53.7% were female, with the male-to-female ratio ranging from 0.68 to 1.61:1. The median age was 56 years (interquartile range: 49-63), and 37.0% of the patients were in the age group of 50-59 years. Since 2017, there has been an annual increase in the proportion of patients under the age of 60 years. The smoking status of the patients showed that 28.1% were smokers and 71.9% were non-smokers. Qujing city accounted for 41.4% and Kunming city for 23.2% of the cases in Yunnan province, with 29.6% of patients originating from Xuanwei and Fuyuan areas of Qujing city. The distribution of affected lung lobes was as follows: right upper lobe 28.2%, right middle lobe 6.3%, right lower lobe 20.1%, left upper lobe 22.7%, and left lower lobe 16.4%. The use of thoracoscopic surgery increased from 30.8% to 96.3%, with single-port thoracoscopic surgery comprising 61.3%. Lobectomy was performed in 64.2% of cases, wedge resection in 17.2%, and segmentectomy in 12.2%. The proportion of lobectomy decreased from 83.1% to 46.1%. The proportion of patients in stages 0-I increased from 43.5% to 82.8%, while stages II-IV decreased from 56.5% to 17.2%. Adenocarcinoma increased from 75.6% to 88.3%, and squamous cell carcinoma decreased from 21.5% to 8.6%. Among adenocarcinoma patients, 60.9% were female. Among sguamous cell carcinoma patients, 90.6% were male. The peak age for adenocarcinoma was 50-59 years, and for squamous cell carcinoma, it was 60-69 years. The smoking rate was higher among squamous cell carcinoma patients (65.9%) compared to adenocarcinoma patients (22.3%). Adenocarcinoma patients had a higher proportion in stages 0-I (76.3%), while squamous cell carcinoma patients were more prevalent in stages II-III (64.1%). CONCLUSIONS The findings indicate an increasing proportion of female patients with adenocarcinoma, a younger age of onset, a higher proportion of non-smoking lung cancer patients, and an increased proportion of stages 0-I lung cancer. These trends may reflect the epidemiological characteristics of patients undergoing lung cancer surgery in Yunnan and surrounding areas over the past decade.
Humans ; Female ; Male ; Lung Neoplasms/pathology* ; Middle Aged ; China/epidemiology* ; Aged ; Adult ; Aged, 80 and over

Lung cancer is the leading cause of cancer death in the world today, and adenocarcinoma is the most common histopathological type of lung cancer. In May 2021, World Health Organization (WHO) released the 5th edition of the WHO classification of thoracic tumors, which classifies invasive non-mucinous adenocarcinoma (INMA) into lepidic adenocarcinoma, acinar adenocarcinoma, papillary adenocarcinoma, solid adenocarcinoma, and micropapillary adenocarcinoma based on its histological characteristics. These five pathological subtypes differ in clinical features, treatment and prognosis. A complete understanding of the characteristics of these subtypes is essential for the clinical diagnosis, treatment options, and prognosis predictions of patients with lung adenocarcinoma, including recurrence and progression. This article will review the grading system, morphology, imaging prediction, lymph node metastasis, surgery, chemotherapy, targeted therapy and immunotherapy of different pathological subtypes of INMA.
.
Humans ; Lung Neoplasms/pathology* ; Adenocarcinoma of Lung/pathology* ; Adenocarcinoma/pathology* ; Prognosis ; Lymphatic Metastasis ; Neoplasm Staging ; Retrospective Studies

Objective:To explore the effect of timing of infliximab (IFX) treatment on transmural healing (TH) in Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. Consecutive adult patients with active CD prescribed IFX in the Sixth Affiliated Hospital of Sun Yat-sen University from Janurary to September 2019 were recruited. Patients underwent intestinal ultrasound evaluation at baseline and 14 weeks after IFX initiation. According to the time from diagnosis to IFX initiation, patients were divided into early therapy group (≤12 months) and late therapy group (>12 months) . The differences of transmural healing (TH) and mucosal healing (MH) at 14th week between 2 groups were analyzed. TH was defined as bowel wall thickness (BWT) ≤3 mm in any segments, with normal stratification and bowel wall vascularity, and without mesenteric fat proliferation. MH was defined as the simplified endoscopic score for CD≤2 points and without ulceration.Results:Fifty-four patients were enrolled, including 28 in early therapy group and 26 in late therapy group, and there were no significant differences in baseline BWT[6.0 (5.3, 7.0) mm vs. 7.0 (5.0, 8.0) mm, Z = -0.668, P = 0.504] and simplified endoscopic score for CD[ (12.86 ± 9.26) points vs. (12.89 ± 7.46) points, t = -0.012, P = 0.991] between the two group. At 14th week, the decrease of BWT [3.0 (1.3, 3.0) mm vs. 1.0 (0, 2.0) mm, Z = -2.922, P = 0.003], the rate of TH [39.3% (11/28) vs. 11.5% (3/26) , χ 2 = 5.405, P = 0.020] and MH [52.2% (12/23) vs. 20.8% (5/24) , χ 2 = 4.997, P = 0.025] in early therapy group were significantly higher than those in late therapy group, respectively. Conclusion:Compared with late initiation of IFX treatment after diagnosis, patients with CD who initiate IFX treatment earlier are more likely to achieve TH.

Objective:To explore the effect of timing of infliximab (IFX) treatment on transmural healing (TH) in Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. Consecutive adult patients with active CD prescribed IFX in the Sixth Affiliated Hospital of Sun Yat-sen University from Janurary to September 2019 were recruited. Patients underwent intestinal ultrasound evaluation at baseline and 14 weeks after IFX initiation. According to the time from diagnosis to IFX initiation, patients were divided into early therapy group (≤12 months) and late therapy group (>12 months) . The differences of transmural healing (TH) and mucosal healing (MH) at 14th week between 2 groups were analyzed. TH was defined as bowel wall thickness (BWT) ≤3 mm in any segments, with normal stratification and bowel wall vascularity, and without mesenteric fat proliferation. MH was defined as the simplified endoscopic score for CD≤2 points and without ulceration.Results:Fifty-four patients were enrolled, including 28 in early therapy group and 26 in late therapy group, and there were no significant differences in baseline BWT[6.0 (5.3, 7.0) mm vs. 7.0 (5.0, 8.0) mm, Z = -0.668, P = 0.504] and simplified endoscopic score for CD[ (12.86 ± 9.26) points vs. (12.89 ± 7.46) points, t = -0.012, P = 0.991] between the two group. At 14th week, the decrease of BWT [3.0 (1.3, 3.0) mm vs. 1.0 (0, 2.0) mm, Z = -2.922, P = 0.003], the rate of TH [39.3% (11/28) vs. 11.5% (3/26) , χ 2 = 5.405, P = 0.020] and MH [52.2% (12/23) vs. 20.8% (5/24) , χ 2 = 4.997, P = 0.025] in early therapy group were significantly higher than those in late therapy group, respectively. Conclusion:Compared with late initiation of IFX treatment after diagnosis, patients with CD who initiate IFX treatment earlier are more likely to achieve TH.

Objective:To evaluate the diagnostic value of relative lesion length in differentiating extrahepatic bile duct infiltrating cholangiocarcinoma with inflammation.Methods:From October 2014 to February 2018, 24 cases of infiltrating extrahepatic cholangiocarcinomas confirmed operatively and pathologically and 23 cases of extrahepatic bile duct inflammation confirmed clinically from the Third People′s Hospital of Datong City were respectively enrolled in this study. Upper abdomen MR and/or CT image data of all patients were respectively reviewed. The extrahepatic duct wall was defined as wall thickening with obvious enhancement. The length of the lesion was measured. L lesion/L duct was referred as the ratio of the lengths of lesion to extrahepatic bile duct (common hepatic duct+common bile duct)was calculated. The difference in the average values of L lesion/L ductbetween the cholangiocarcinomas group and inflammation group was analyzed with t test, and the differential diagnostic efficacy of L lesion/L ductratio was analyzed with receiver operating characteristic curve (ROC) test. Results:Significant difference was found in the length of lesion between the extrahepatic cholangiocarcinoma group [(22.01±1.86) mm] and the cholangitis group [(47.36±2.81) mm] ( P<0.01). The average ratio of L lesion/L ductwere 0.26±0.02 for the cholangiocarcinomas group and 0.54±0.03 for the inflammation group, respectively ( P<0.01). The area under the ROC curve of L lesion/L duct in diagnosis of the infiltrating extrahepatic cholangiocarcinomas was 0.92. With <0.40 as cut-off point, the diagnostic sensitivity and specificity were 87.5% and 82.6%, respectively. Conclusion:The L lesion/L ductmight be taken as an important diagnostic sign in differentiation between infiltrating extrahepatic cholangiocarcinomas and extrahepatic bile duct inflammation.

Objective To observe the value of MRI in evaluation on the morphology and function of iliococcygeal muscles in fertile and nulliparous women.Methods Totally 50 healthy fertile women (fertile group,further divided into cesarean section subgroup and spontaneous delivery subgroup according to the mode of delivery) and 17 nulliparous healthy women (nulliparous group) underwent MR scanning in both natural and increased abdominal pressure state.Iliococcygeus thickness (ICT),coronal iliococcygeal angle (cICA) and sagittal iliococcygeal angle (sICA) of different states were measured and compared between the groups.Results In the natural state,the right and bilateral average sICA in the fertile group were larger than those in nulliparous group (both P＜0.05),while no statistical difference of ICT,right,left and bilateral average cICA and left sICA were found between two groups (all P＞0.05);the bilateral average sICA in spontaneous delivery subgroup was larger than that in cesarean section subgroup (P＜0.05).In increased abdominal pressure state,left,right sICA and bilateral average sICA in fertile group were larger than those in nulliparous group (all P＜0.05),while there was no statistical difference of ICT and cICA between two groups (all P＞0.05);no statistical difference of ICT,cICA nor sICA was found between spontaneous delivery subgroup and cesarean section subgroup (all P＞0.05).Conclusion MRI can accurately evaluate morphological and functional changes of iliococcygeal muscle in females.

Objective To explore the correlation between ostiomeatal complex(OMC)variation, nasal septum deviation and nasosinusitis with CT imaging.Methods The clinical and imaging data of 256 patients undergoing nasal and paranasal CT examination from June 1, 2015 to May 30, 2016 were retrospectively analyzed. Patients with paranasal sinus fractures, tumors and artifacts were not included in this study.Taking the image of standard coronal MPR built with thin axial sections at the level of middle of semilunar fissure as observing image,and the direction,location and extent of OMC variations were observed and recorded. The patients were divided into two groups according to the presence or absence of nasal septum deviation.OMC mutation,the incidence of unilateral mutation,incidence of paranasal sinusitis and the incidence of unilateral bilateral nasal sinusitis between the two groups was analyzed by χ2test with two independent samples. Then according to the presence or absence of OMC mutation, the patients were divided into two groups.The incidence of paranasal sinusitis and bilateral paranasal sinusitis were compared between the two groups. Results Two hundred and fifty six cases of CT imging of parannasal sinus were included in the study,96 cases were with nasal septum deviation, 160 were with non-deviation of nasal septum. The incidence rate of OMC variation between the two groups showed significant difference(χ2=38.40,P<0.05).The incidence rate of unilateral and bilateral OMC variation showed significant difference(χ2=13.70,P<0.05),among which 54 were unilateral variations,50(92.6%)variations were located at the same side of nasal deviation(side of the nasal cavity widened).The incidence rate of sinusitis between the two groups showed non-significant difference(χ2=0.50,P>0.05).The incidence rate between unilateral and bilateral nasosinusitis showed non-significant difference(χ2=2.25,P>0.05).Of the 256 cases,128 were with OMC variations,and 128 were with non-OMC variation.The incidence rate of nasosinusitis between the two groups showed non-significant difference(χ2=0.56,P>0.05). The incidence rate between unilateral and bilateral nasosinusitis showed non-significant difference(χ2=3.57,P>0.05). Conclusion Ipsilateral OMC variation occurred in nasal septum deviation might be a compensation to nasal cavity widening while not a obstructive factor in causing nasosinusitis.

Objective To investigate the value of morphological features in differentiating between tuberculous hydronephrosis and non-tuberculous obstructive hydronephrosis.Methods The abdominal enhanced-CT examination data of 33 patients with renal tuberculosis and 37 patients with non-tuberculous obstructive hydronephrosis were retrospectively collected.All patients were examined in Peking University First Hospital from September 2009 to November 2016 and confirmed by surgical pathology or clinical manifestation.The longest diameter and largest area of all dilated calices,the anteroposterior longest diameter and the area of renal pelvis at the renal hilum level were measured.The standard deviation of dilated calyx's longest diameter and largest area in each case,the ratio of the mean value of dilated calyx's longest diameter to the anteroposterior longest diameter of renal pelvis and the ratio of the mean value of dilated calyx's largest area to the area of renal pelvis were calculated.These data were compared between the two groups with the t test.Based on the ratio of dilated calyx's longest diameter and largest area to those of renal pelvis,receiver operating characteristic (ROC) curves were used to calculate cut-off values for diagnosis of tuberculous hydronephrosis.Results The standard deviation of dilated calyx's longest diameter and largest area were significantly different in the renal tuberculosis group and the non-tuberculosis group (P＜0.01).The ratio of dilated calyx's longest diameter and largest area to those of renal pelvis of tuberculosis group were significantly larger than those of non-tuberculous group (P＜0.01).ROC analysis of the ratio of dilated calyx's longest diameter to that of renal pelvis showed that the area under the curve was 0.87 (95％ confidence interval 0.77-0.94),the best cut-off point was 0.73,with 81.8％ sensitivity (27/33) and 81.1％ specificity (30/37).ROC analysis of the ratio of dilated calyx's largest area to that of renal pelvis,the area under the curve was 0.90 (95％ confidence interval 0.80-0.95),the best cut-off point was 0.42,with 81.8％ sensitivity (27/33) and 86.5％ specificity (30/37).Conclusions In tuberculous hydronephrosis,the dilatation of calices is more obvious than renal pelvis,and the size of dilated renal calices is remarkably different.In non-tuberculous obstructive hydronephrosis,the dilatation of renal pelvis is more obvious than calices,and the size of dilated renal calices is similar.The morphological differences are helpful in differentiating tuberculous and non-tuberculous hydronephrosis.

Objective To determine the diagnostic value and necessity of excretory phase of CT urogrphy (CTU). Methods One hundred and one cases with 197 sides of cohort CTU studies were enrolled from PACS system retrospectively, and 44 cases had the records of radiation dosage. Three different seniority senior radiologists reviewed the images and diagnosed 2 times blindly with the clinical information. At the first time, plane scan, contrast enhanced renal cortical phase and renal parenchymal phase images (Diag. A) were reviewed. At the second time, with 3 kinds of images mentioned above plus excretive phase images (Diag. B) were reviewed, with interval of 3 months between the two reviews. With Diag. B as reference standard, accordance rate of diagnoses of Diag. A was calculated. The difference of the 3 rediologists's accordance rates were analyzed with Chi-square test, and the lesions with accordance rate ≤80% were recorded. The cases of 197 urinary tracts were divided into 4 groups: lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion. The filling of contrast media in the urinary tract was recorded with 5-scale scoring system. The differences of the urinary tract filling among the 4 groups were analyzed with Kruskal-Wallis test. The effective radiation dosages of CTU with and without excretory phase scan were recorded and calculated, and the difference was analyzed with t test. Result The diagnostic accordance rate of CTU with and without excretory phase of the 3 radiologists was 95.4%(188/197), 93.9%(185/197), 92.4%(182/197)respectively(χ2=1.60, P>0.05). Lesions with diagnostic rate≤80%were parapelvic cyst and caliceal diverticulum. The median score of urinary tracts filling in the lesions of renal pelvic and ureter, lesions of bladder, lesions of kidney and extra-urinary tract, without lesion group were 2, 3, 3, 4, and the differences were significant (HC=31.7, P<0.05). The effective radiation dosages of CTU with and without excretory phase scan were (32.36±11.04)mSv and (41.47±14.27) mSv respectively (t=3.35, P<0.01). Conclusions No significant effect of excretive phase imaging is found on the diagnosis of most urinary system diseases. Poor contrast filling and high rate of failure of filling of the urinary tract with intra luminal pathologies, and increase of the radiation dosage make the excretory phase scan in CTU less useful and it should be used carefully and selectively.

Objective To evaluate the rules and features of the pseudoenhancement phenomenon of renal cysts during the multi-phases of contrast enhanced MSCT scan.Methods Ninety one patients with 112 simple renal cysts with B-ultrasound,CT examination,improved clinically enrolled in this retrospective study.The attenuation of the renal cysts were measured blindly in the images of CT plain scan and scans of arterial,venal and secrete phases,and the attenuation change of the cysts between pre-and post-enhanced scans were calculated; the accuracies of pseudoenhancement judging were calculated with 10 HU,15 HU and 18 HU as a threshold;the size were recorded; degree of intra renal parenchyma of the cyst were also confirmed,and so renal cysts were divided into three groups:type Ⅰ,Ⅱ and Ⅲ; The differences of attenuation among 3 enhancement phases,different size,different type were analyzed statistically with the Kruskal-wallis rank sum test,the correlation between the diameter and the pseudoenhancement in each enhancement phases were analyzed statistically with Spearman test.Results The attenuation median of the 112 cysts in plain scan,arterial,venal and secrete phase was 6.0 HU,11.0 HU,12.0 HU and 12.0 HU respectively,there was significant difference(x2=53.32,P＜0.01).The attenuation of the cysts in enhanced phases was higher than unenhanced.The range of attenuation change of the cysts between pre-and postenhanced scans was-10 to 31 HU,the number of cysts in groups of pseudoenhancement of 1 to 5 HU and 6 to 10 HU in each enhanced phase was dominant.The pseudoenhancement median of arterial,venal and secrete phase was 4.0 HU,5.0 HU and 6.0 HU respectively,There was significant difference among three groups(x2=10.062,P＜0.01).Taking 10 HU,15 HU and 18 HU as threshold for judging pseudoenhancement,the accuracy was 83.0％(239/288),95.1％(274/288) and 96.9％(279/288) respectively; Pseudoenhancement of small cysts(≤10 mm) was higher than other groups in each enhancement phase,and there was significant difference(P＜0.05).Type Ⅰ,Ⅱ and Ⅲ renal cysts were 62,23 and 27 respectively,the pseudoenhancement median of type Ⅰ renal cyst was 5.0 HU,6.0 HU and 8.0 HU respectively in arterial,venous,and excretion phase,which were higher than Type Ⅱ and Ⅲ (P＜0.05).It showed low negative correlation between pseudoenhancemen and diameter in arterial,venous and secrete phase(r =-0.326,-0.332 and-0.447,P＜ 0.01).Conclusion The pseudoenhancement correlated with the renal cyst size,the type and the enhance phases,which should be considered when making diagnosis.