Objective:To investigate the value of baseline 18F-fluorodeoxyglucose (FDG) PET/CT radiomics features in predicting the prognosis of non-small cell lung cancer (NSCLC) before treatment. Methods:From January 2016 to August 2018, a total of 300 patients with solitary NSCLC (189 males, 111 females, age (62.3±9.0) years) who underwent 18F-FDG PET/CT imaging before treatment in Fourth Hospital of Hebei Medical University were retrospectively analyzed. According to the ratio of 7∶3 (R language), 300 patients were randomly divided into training group ( n=210) and validation group ( n=90). LIFEx software package was used to extract the PET and CT radiomics features of primary focus in 300 NSCLC patients. The least absolute shrinkage and selection operator (LASSO) algorithm combined with Cox proportional hazard regression model were used to select radiomics features and clinical features for predicting overall survival (OS) and progression-free survival (PFS) in training group. Then radiomics model, clinical model and complex model which integrated the two were established and the radiomics score (Rad-score), clinical score and complex score of each patient were calculated. Data of validation group was used to validate each training model. Efficiencies of each model in predicting the prognosis of patients with NSCLC were further evaluated by the concordance index (C-index), and a nomogram was developed based on the best prediction model. Results:In training group, the C-indices of predicting OS and PFS in NSCLC patients of radiomics model were 0.762 and 0.724 respectively, which were 0.834 and 0.780 respectively in clinical model, and were 0.842 and 0.787 respectively in complex model. Cox multivariate analysis showed that both Rad-score and complex score were independent prognostic factors for OS (hazard ratio ( HR): 1.804, 9.996, 95% CI: 1.023-3.184, 4.582-21.808, both P<0.05) and PFS ( HR: 1.771, 5.627, 95% CI: 1.138-2.756, 3.429-9.234, both P<0.05). Conclusions:Pre-treatment 18F-FDG PET/CT radiomics can predict OS and PFS of NSCLC patients. The complex model based on the combination of radiomics and clinical model is effective in predicting the prognosis of NSCLC patients, and the nomogram of complex model is simple and convenient to assist clinical decision-making.

In order to help students understand and master the ultrastructure of the tissue and cells and provide teachers with rich picture resources and teaching materials, Department of Pathology of Jilin University collected and organized pictures of cell and tissue ultrastructure, and then selected typical ultra-structure pictures to carry on the classified annotation in accordance with organ systems to build the ultra structure electronic picture library. The electronic picture library can be used in biological electron micro-scope technique course, online courses establishment and students' autonomous learning.

Background and objectiveIt is so far not clear that how myasthenia gravis (MG) affected the prognosis of thymoma patients. The aim of this assay is to compare the postoperative survival between patients with thymoma only and those with both thymoma and MG.MethodsThe Chinese Alliance for Research in Thymomas (ChART) registry recruited patients with thymoma from 18 centers over the country on an intention to treat basis from 1992 to 2012. Two groups were formed according to whether the patient complicated MG. Demographic and clinical data were reviewed, Patients were fol-lowed and their survival status were analyzed.Results There were 1,850 patients included in this study, including 421 with and 1,429 without MG. Complete thymectomy were done in 91.2% patients in MG group and 71.0% in non-MG group (P<0.05). There were more percentage of patients with the histology of thymoma AB, B1, or B2 (P<0.05) in MG group, and more percentage of patients with MG were in Masaoka stage I and II. The 5 year and 10 year OS rates were both higher in MG group (93%vs 88%; 83%vs 81%,P=0.034) respectively. The survival rate was signiifcantly higher in patients with MG when the Masaoka staging was III/IV (P=0.003). Among patients with advanced stage thymoma (stage III, IVa, IVb), the constitu-ent ratios of III, IVa, IVb were similar between MG and Non-MG group. Histologically, however, there were signiifcantly more proportion of AB/B1/B2/B3 in the MG group while there were more C in the non-MG group (P=0.000). Univariate analyses for all patients showed that MG, WHO classiifcation, Masaoka stage, surgical approach, chemotherapy and radiotherapy and resectability were signiifcant factors, and multivariate analysis showed WHO Classiifcation, Masaoka stage, and resectability were strong independent prognostic indicators.ConclusionAlthough MG is not an independent prognostic factor, the sur-vival of patients with thymoma was superior when MG was present, especially in late Masaoka stage patients. Possible reasons included early diagnosis of the tumor, better histologic types, an overall higher R0 resection and less recurrence.

Background and objectiveTo compare the predictive effect of the Masaoka-Koga staging system and the International Association for the Study of Lung Cancer (IASLC)/the International Thymic Malignancies Interest Group (ITMIG) proposal for the new TNM staging on prognosis of thymic malignancies using the Chinese Alliance for Research in Thymomas (ChART) retrospective database.MethodsFrom 1992 to 2012, 2,370 patients in ChART database were ret-rospectively reviewed. Of these, 1,198 patients with complete information on TNM stage, Masaoka-Koga stage, and survival were used for analysis. Cumulative incidence of recurrence (CIR) was assessed in R0 patients. Overall survival (OS) was evalu-ated both in an R0 resected cohort, as well as in all patients (any R status). CIR and OS were ifrst analyzed according to the Masaoka-Koga staging system. Then, they were compared using the new TNM staging proposal.Results Based on Masaoka-Koga staging system, signiifcant difference was detected in CIR among all stages. However, No survival difference was revealed between stage I and II, or between stage II and III. Stage IV carried the highest risk of recurrence and worst survival. According to the new TNM staging proposal, CIR in T1a was signiifcantly lower comparing to all other T categories (P<0.05) and there is a signiifcant difference in OS between T1a and T1b (P=0.004). T4 had the worst OS comparing to all other T categories. CIR and OS were signiifcantly worse in N(+) than in N0 patients. Signiifcant difference in CIR and OS was detected between M0 and M1b, but not between M0 and M1a. OS was almost always statistically different when comparison was made between stages I-IIIa and stages IIIb-IVb. However, no statistical difference could be detected among stages IIIb to IVb.Conclusion Compared with Masaoka-Koga staging, the IASLC/ITMIG TNM staging proposal not only describes the extent of tumor invasion but also provides information on lymphatic involvement and tumor dissemination. Further study using prospectively recorded information on the proposed TNM categories would be helpful to better grouping thymic tumors for predicting prognosis and guiding clinical management.

Background and objectiveTo evaluate the role of preoperative induction therapy on prognosis of local-ly advanced thymic malignancies.MethodsBetween 1994 and 2012, patients received preoperative induction therapies (IT group) in the Chinese Alliance for Research in Thymomas (ChART) database, were compared with those having surgery di-rectly atfer preoperative evaluation (DS group). All tumors receiving induction therapies were locally advanced (clinically stage III-IV) before treatment and those turned out to be in pathological stage I and II were considered downstaged by induction. Clinical pathological characteristics were retrospectively analyzed. To more accurately study the effect of induction therapies, stage IV patients were then excluded. Only stage I-III tumors in the IT group and stage III cases in the DS group were selected for further comparison in a subgroup analysis.Results Only 68 (4%) out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals (OS) of 49.7% and 19.9%. Seventeen pa-tients (25%) were downstaged atfer induction. Signiifcantly more thymomas were downstaged than thymic carcinomas (38.7%vs 13.9%,P=0.02). Tumors downstaged atfer induction had signiifcantly higher 5-year OS than those not downstaged (93.8%vs 35.6%,P=0.013). For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group (P<0.001), although R0 resection were similar (76.4%vs 73.3%,P=0.63). However, 5-year OS in tumors downstaged atfer induction (93.8%) was similar to those in the DS group (85.2%,P=0.438), both signiifcantly higher than those not downstaged atfer induction (35.6%,P<0.001).ConclusionOnly 68 (4%) out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals (OS) of 49.7% and 19.9%. Seventeen patients (25%) were downstaged atfer induction. Signiifcantly more thymomas were downstaged than thy-mic carcinomas (38.7%vs 13.9%,P=0.02). Tumors downstaged atfer induction had signiifcantly higher 5-year OS than those not downstaged (93.8%vs 35.6%,P=0.013). For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group (P<0.001), although R0 resection were similar (76.4%vs 73.3%,P=0.63). However, 5-year OS in tumors downstaged atfer induction (93.8%) was similar to those in the DS group (85.2%,P=0.438), both signiifcantly higher than those not downstaged atfer induction (35.6%,P<0.001).

Background and objectiveVideo-assisted thoracoscopic surgery (VATS) theoretically offers advantages over open thymectomy for clinically early-stage (Masaoka-Koga stage I and II) thymic malignancies. However, longterm outcomes have not been well studied. We compared the postoperative outcomes and survival from a cohort study based on the database of the Chinese Alliance for Research in Thymomas (ChART).MethodsBetween 1994 and 2012, data of 1,117 patients hav-ing surgery for clinically early-stage (Masaoka-Koga stage I and II) tumors were enrolled for the study. Among them, 241 cases underwent VATS thymectomy (VATS group), while 876 cases underwent open thymectomy (Open group). Univariate analyses were used to compare the clinical character and perioperative outcomes between the two groups. And multivariate analysis was performed to determine the independent predictive factors for long-term survival.Results Compared with the Open group, the VATS group had higher percentage of total thymectomy (80.5%vs 73.9%,P=0.028), resection rate (98.8%vs 88.7%,P<0.001) and less recurrence (2.9%vs 16.0%,P<0.001). Five-year overall survival was 92% atfer VATS and 92% atfer open thymectomy, with no signiifcant difference between the two groups (P=0.15). However, 5-year disease free survival were 92% in VATS group and 83% in Open group (P=0.011).Cox proportional hazards model revealed that WHO classiifcation, Masaoka-Koga stage and adjuvant therapy were independent predictive factors for overall survival, while surgical approach had no signiifcant impact on long-term outcome.ConclusionhTis study suggests that VATS thymectomy is an effective approach for clinically early-stage thymic malig-nancies. And it may offer better perioperative outcomes, as well as equal oncological survival.

Background and objectiveTo evaluate the surgical outcomes of tumor resection with or without total thymectomy for thymic epithelial tumors (TETs) using the Chinese Alliance for Research in Thymomas (ChART) retrospec-tive database.Methods Patients without preoperative therapy, who underwent surgery for early-stage (Masaoka-Koga stage I and II) tumors, were enrolled for the study. They were divided into thymectomy and thymomectomy groups according to the resection extent of the thymus. Demographic and surgical outcomes were compared between the two patients groups. Results A total of 1,047 patients were enrolled, with 796 cases in the thymectomy group and 251 cases in the thymomec-tomy group. Improvement rate of myasthenia gravis (MG) was higher atfer thymectomy than atfer thymomectomy (91.6%vs 50.0%,P<0.001). Ten-year overall survival was similar between the two groups (90.9% atfer thymectomy and 89.4% atfer thymomectomy,P=0.732). Overall, recurrence rate was 3.1% atfer thymectomy and 5.4% atfer thymomectomy, with no sig-niifcant difference between the two groups (P=0.149). Stratiifed analysis revealed no signiifcant difference in recurrence rates in Masaoka-Koga stage I tumors (3.2%vs 1.4%,P=0.259). However in patients with Masaoka-Koga stage II tumors, recurrence was signiifcantly less atfer thymectomy group than atfer thymomectomy (2.9%vs 14.5%,P=0.001).Conclusion hTymectomy, instead of tumor resection alone, should still be recommended as the surgical standard for thymic malignancies, especially for stage II tumors and those with concomitant MG.

Background and objectivePostoperative radiotherapy (PORT) for thymic tumor is still controversial. The object of the study is to evaluate the role of PORT for stage I/II/III thymic tumor.MethodsThe database of Chinese Al-liance of Research for Thymomas (ChART) was retrieved for patients with stage I/II/III thymic tumor who underwent surgi-cal therapy without neoajuvant therapy between 1994 and 2012. Univariate and multivariate survival analyses were performed. Cox proportional hazard model was used to determine the hazard ratio for death.Results 1,546 stage I/II/III patients were identiifed from ChART database. Among these patients, 649 (41.98%) underwent PORT. PORT was associated with gender, histologic type (World Health Organization, WHO), surgical extent, complete resection, Masaoka stage and adjuvant che-motherapy. The 5-yr and 10-yr overall survival (OS) rates and disease-free survival (DFS) rate for patients underwent surgery followed by PORT were 90% and 80%, 81% and 63%, comparing with 96% and 95%, 92% and 90% for patients underwent surgery alone (P=0.001,P<0.001) respectively. In univariate analysis, age, histologic type (WHO), Masaoka stage, complete-ness of resection, and PORT were associated with OS. Multivariable analysis showed that histologic type (WHO)(P=0.001), Masaoka stage (P=0.029) and completeness of resection (P=0.003) were independently prognostic factors of OS. In univari-ate analysis, gender, myasthenia gravis, histologic type (WHO), Masaoka stage, surgical approach, PORT and completeness of resection were associated with DFS. Multivariable analysis showed that histologic type (WHO) (P<0.001), Masaoka stage (P=0.005) and completeness of resection (P=0.006) were independently prognostic factors of DFS. Subgroup analysis showed that patients with incomplete resection underwent PORT achieved the better OS and DFS (P=0.010, 0.017, respectively). However, patients with complete resection underwent PORT had the worse OS and DFS (P<0.001,P<0.001, respectively). ConclusionThe current retrospective study indicated that PORT atfer incomplete resection could improve OS and DFS for patients with stage I/II/III thymic tumor. But for those atfer complete resection, PORT may not help improve prognosis on the whole.

Background and objectiveTo study the role of postoperative chemotherapy and its prognostic effect in Masaoka-Koga stage III and IV thymic tumors.Methods Between 1994 and 2012, 1,700 patients with thymic tumors who underwent surgery without neoajuvant therapy were enrolled for the study. Among them, 665 patients in Masaoka-Koga stage III and IV were further analyzed to evaluate the clinical value of postoperative chemotherapy. TheKaplan-Meier method was used to obtain the survival curve of the patients divided into different subgroups, and theCox regression analysis was used to make multivariate analysis on the factors affecting prognosis. A Propensity-Matched Study was used to evaluate the clinical value of chemotherapy.Results Two-hundred-twenty-one patients were treated with postoperative chemotherapy, while the rest 444 cases were not. The two groups showed signiifcant differences (P<0.05) regarding the incidence of myasthenia gravis, World Health Organization (WHO) histological subtypes, pathological staging, resection status and the use of postopera-tive radiotherapy. WHO type C tumors, incomplete resection, and postoperative radiotherapy were signiifcantly related to increased recurrence and worse survival (P<0.05). Five-year and 10-year disease free survivals (DFS) and recurrence rates in patients who underwent surgery followed by postoperative chemotherapy were 51% and 30%, 46% and 68%, comparing with 73% and 58%, 26% and 40% in patients who had no adjuvant chemotherapy atfer surgery (P=0.001,P=0.001, respectively). In propensity-matched study, 158 pairs of patients with or without postoperative chemotherapy (316 patients in total) were se-lected and compared accordingly. Similar 5-year survival rates were detected between the two groups (P=0.332). Conclusion Pathologically higher grade histology, incomplete resection, and postoperative radiotherapy were found to be associated with worse outcomes in advanced stage thymic tumors. At present, there is no evidence to show that postoperative chemotherapy may help improve prognosis in patients with Masaoka-Koga-Koga stage III and IV thymic tumors.

OBJECTIVETo analyze the imaging characteristics of hepatic epithelioid hemangioendothelioma (EHE) and their correlation with histopathological findings.

METHODSCT and MRI imaging and histopathological characteristics of five patients with hepatic EHE were retrospectively reviewed and the correlation of their imaging characteristics with pathological findings was analyzed.

RESULTSA total of 92 lesions were found in the 5 patients, all presenting with multiple nodules. All the 92 lesions were located within a 2-cm zone heneath the hepatic capsule, i.e., the shortest distance from the horder of lesions to the hepatic capsule. 28 of the 92 lesions showed the "capsular retraction" sign. 36 lesions were found in three patients receiving MRI. 77.8% of the 36 lesions demonstrated the "halo" sign on a fat-suppression T2- weighted image, while 91.7% after contrast enhancement. A peripheral dark rim was found in 91.7% of the lesions on a fat-suppression T2-weighted image. In addition, 36.1% of the lesions showed slight internal or edge enhancement at the hepatohiliary phase. In the two patients receiving CT examination, 7 of 56 lesions demonstrated the "halo" sign.

CONCLUSIONSHepatic EHE may manifest as nodular lesions with predilection of peripheral subcapsular growth and nodular confluence, together with "halo" sign and " capsular retraction". The peripheral dark rim on a fat-suppression T2-weighted image and slight enhancement at the hepatobiliary phase can help to improve the accuracy of diagnosis and differential diagnosis of this hepatic tumor. MRI is superior to CT imaging to denict their intra-lesional characteristics.

Hemangioendothelioma, Epithelioid ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Liver Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Neoplasms, Multiple Primary ; diagnosis ; diagnostic imaging ; pathology ; Physical Examination ; Retrospective Studies ; Tomography, X-Ray Computed