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Liu F, Li Q, Xiang Z, Li X, Li F, Huang Y, Zeng Y, Lin H, Fang X, Yang Q. CT radiomics model for predicting the Ki-67 proliferation index of pure-solid non-small cell lung cancer: a multicenter study. Front Oncol 2023; 13:1175010. [PMID: 37706180 PMCID: PMC10497212 DOI: 10.3389/fonc.2023.1175010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose This study aimed to explore the efficacy of the computed tomography (CT) radiomics model for predicting the Ki-67 proliferation index (PI) of pure-solid non-small cell lung cancer (NSCLC). Materials and methods This retrospective study included pure-solid NSCLC patients from five centers. The radiomics features were extracted from thin-slice, non-enhanced CT images of the chest. The minimum redundancy maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) were used to reduce and select radiomics features. Logistic regression analysis was employed to build predictive models to determine Ki-67-high and Ki-67-low expression levels. Three prediction models were established: the clinical model, the radiomics model, and the nomogram model combining the radiomics signature and clinical features. The prediction efficiency of different models was evaluated using the area under the curve (AUC). Results A total of 211 NSCLC patients with pure-solid nodules or masses were included in the study (N=117 for the training cohort, N=49 for the internal validation cohort, and N=45 for the external validation cohort). The AUC values for the clinical models in the training, internal validation, and external validation cohorts were 0.73 (95% CI: 0.64-0.82), 0.75 (95% CI:0.62-0.89), and 0.72 (95% CI: 0.57-0.86), respectively. The radiomics models showed good predictive ability in diagnosing Ki-67 expression levels in the training cohort (AUC, 0.81 [95% CI: 0.73-0.89]), internal validation cohort (AUC, 0.81 [95% CI: 0.69-0.93]) and external validation cohort (AUC, 0.78 [95% CI: 0.64-0.91]). Compared to the clinical and radiomics models, the nomogram combining both radiomics signatures and clinical features had relatively better diagnostic performance in all three cohorts, with the AUC of 0.83 (95% CI: 0.76-0.90), 0.83 (95% CI: 0.71-0.94), and 0.81 (95% CI: 0.68-0.93), respectively. Conclusion The nomogram combining the radiomics signature and clinical features may be a potential non-invasive method for predicting Ki-67 expression levels in patients with pure-solid NSCLC.
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Affiliation(s)
- Fen Liu
- Department of Radiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Qingcheng Li
- Department of Radiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Zhiqiang Xiang
- Department of Radiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaofang Li
- Department of Radiology, The Affiliated Huaihua Hospital, Hengyang Medical School, University of South China, Huaihua, China
| | - Fangting Li
- Department of Radiology, People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Yingqiong Huang
- Department of Radiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Ye Zeng
- Department of Radiology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Huashan Lin
- Department of Pharmaceutical Diagnosis, GE Healthcare, Changsha, China
| | - Xiangjun Fang
- Department of Radiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Qinglai Yang
- Center for Molecular Imaging Probe, Hunan Province Key Laboratory of Tumor Cellular and Molecular Pathology, Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Fu Q, Liu SL, Hao DP, Hu YB, Liu XJ, Zhang Z, Wang WH, Tang XY, Zhang CY, Liu SH. CT Radiomics Model for Predicting the Ki-67 Index of Lung Cancer: An Exploratory Study. Front Oncol 2021; 11:743490. [PMID: 34707991 PMCID: PMC8542688 DOI: 10.3389/fonc.2021.743490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To establish a radiomics signature and a nomogram model based on enhanced CT images to predict the Ki-67 index of lung cancer. Methods From January 2014 to December 2018, 282 patients with lung cancer who had undergone enhanced CT scans and Ki-67 examination within 2 weeks were retrospectively enrolled and analyzed. The clinical data of the patients were collected, such as age, sex, smoking history, maximum tumor diameter and serum tumor markers. Our primary cohort was randomly divided into a training group (n=197) and a validation group (n=85) at a 7:3 ratio. A Ki-67 index ≤ 40% indicated low expression, and a Ki-67 index > 40% indicated high expression. In total, 396 radiomics features were extracted using AK software. Feature reduction and selection were performed using the lasso regression model. Logistic regression analysis was used to establish a multivariate predictive model to identify high and low Ki-67 expression in lung cancer. A nomogram integrating the radiomics score was established based on multiple logistic regression analysis. Area under the curve (AUC) was used to evaluate the prediction efficiency of the radiomics signature and nomogram. Results The AUC,sensitivity, specificity and accuracy of the radiomics signature in the training and validation groups were 0.88 (95% CI: 0.82~0.93),79.2%,84.3%,81.2% and 0.86 (95% CI: 0.78~0.94),74.6%,88.1%,79.8%, respectively. A nomogram combining radiomics features and clinical risk factors (smoking history and NSE) was developed. The AUC, sensitivity, specificity and accuracy were 0.87 (95% CI: 0.80~0.95), 75.0%, 90.2% and 83.5% in the validation group, respectively. Conclusion The radiomics signature and nomogram based on enhanced CT images provide a way to predict the Ki-67 expression level in lung cancer.
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Affiliation(s)
- Qing Fu
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shun Li Liu
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Da Peng Hao
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ya Bin Hu
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue Jun Liu
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zaixian Zhang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wen Hong Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Yan Tang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chuan Yu Zhang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shi He Liu
- The Affiliated Hospital of Qingdao University, Qingdao, China
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Cai HJ, Fang JH, Cao N, Wang W, Kong FL, Sun XX, Huang B. Dermatofibrosarcoma metastases to the pancreas: A case report. World J Clin Cases 2019; 7:3316-3321. [PMID: 31667185 PMCID: PMC6819281 DOI: 10.12998/wjcc.v7.i20.3316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/12/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In general, malignant tumors metastasize to the pancreas in < 1% of cases. Most patients miss the opportunity for further surgery due to distant metastases; however, for fibrosarcomas, aggressive surgery may be helpful even if distant metastases occur. Hence, we report such a case and share some valuable information about the disease.
CASE SUMMARY A 45-year-old man was admitted with recurrent epigastric pain for 10 days. The abdominal pain was mainly related to bloating with nausea, but no other associated symptoms. No particular signs were found on abdominal examination or laboratory testing. In 2003, a local distal expanded resection of the primary fibrosarcoma in the left chest wall was performed. Then, a left pneumonectomy was performed in 2017 due to diffuse metastases from the fibrosarcoma to the left lung. Enhanced computed tomography (CT) and magnetic resonance imaging of the upper abdomen suggested multiple masses of different sizes involving the head and tail of the pancreas; no local lymph node enlargement was noted. The postoperative pathologic diagnosis revealed a fibrosarcoma of the pancreas. A CT re-examination 6 mo postoperatively showed no local recurrence or distant metastases.
CONCLUSION A fibrosarcoma is a rare low-grade malignant tumor, and metastases to the pancreas are even rarer. Patients with a history of a fibrosarcoma should consider the possibility of metastasis when a pancreatic neoplasm is demonstrated. Surgical resection is the preferred treatment.
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Affiliation(s)
- Huai-Jie Cai
- The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jian-Hua Fang
- The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Nan Cao
- The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Wei Wang
- The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Fan-Lei Kong
- The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Xi-Xi Sun
- Department of Ultrasound, Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310023, Zhejiang Province, China
| | - Bin Huang
- Department of Ultrasound, Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310023, Zhejiang Province, China
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Benz K, Kozmacs C, Piwowarczyk A, Jackowski J. Prosthetic rehabilitation for a patient treated for embryonal rhabdomyosarcoma. J Prosthet Dent 2018; 120:299-302. [PMID: 29551375 DOI: 10.1016/j.prosdent.2017.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/09/2017] [Accepted: 10/14/2017] [Indexed: 10/17/2022]
Abstract
A female patient, now aged 17 years, was diagnosed with rhabdomyosarcoma (RMS) in the right pterygopalatine fossa when she was 3 years old. The RMS was successfully treated by excision, but the subsequent radiation and polychemotherapy resulted in the complete anesthesia of the distribution area of the right trigeminal nerve and loss of vision in the right eye. The patient also experienced pain in the mandibular joints and masticatory muscles. Panoramic radiographs displayed a multiple agenesia of the permanent teeth and underdeveloped apices. Treatment involved the fabrication of a complete maxillary denture. A removable device was fabricated to evaluate her response to an occlusal vertical dimension increase of 6 mm and provide a stable intercuspal position. After wearing the prosthesis for 6 months, the patient reported that she was completely free of symptoms.
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Affiliation(s)
- Korbinian Benz
- Consultant, Department of Oral Surgery and Dental Emergency Care, Faculty of Health, School of Dentistry Witten/Herdecke University, Wtten, Germany; and Center for Rare Diseases Ruhr, Competence Center of the Ruhr-University Bochum and Witten/Herdecke University, North Rhine-Westphalia, Germany.
| | - Carla Kozmacs
- Doctor and Research Assistant, Department of Prosthodontics and Dental Technologies, Faculty of Health, School of Dentistry Witten/Herdecke University, North Rhine-Westphalia, Germany
| | - Andree Piwowarczyk
- Professor and Chairman, Department of Prosthodontics and Dental Technologies, Faculty of Health, School of Dentistry Witten/Herdecke University, Witten, Germany; and Center for Rare Diseases Ruhr, Competence Center of the Ruhr-University Bochum and Witten/Herdecke University, North Rhine-Westphalia, Germany
| | - Jochen Jackowski
- Professor and Chairman, Department of Oral Surgery and Dental Emergency Care, Faculty of Health, School of Dentistry Witten/Herdecke University, North Rhine-Westphalia, Germany; and Center for Rare Diseases Ruhr, Competence Center of the Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
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Choi PJ, Iwanaga J, Tubbs RS, Yilmaz E. Surgical Interventions for Advanced Parameningeal Rhabdomyosarcoma of Children and Adolescents. Cureus 2018. [PMID: 29541566 PMCID: PMC5844646 DOI: 10.7759/cureus.2045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Owing to its rarity, rhabdomyosarcoma of the head and neck (HNRMS) has seldom been discussed in the literature. As most of the data is based only on the retrospective experiences of tertiary healthcare centers, there are difficulties in formulating a standard treatment protocol. Moreover, the disease is poorly understood at its pathological, genetic, and molecular levels. For instance, 20% of all histological assessment is inaccurate; even an experienced pathologist can confuse rhabdomyosarcoma (RMS) with neuroblastoma, Ewing’s sarcoma, and lymphoma. RMS can occur sporadically or in association with genetic syndromes associated with predisposition to other cancers such as Li-Fraumeni syndrome and neurofibromatosis type 1 (von Recklinghausen disease). Such associations have a potential role in future gene therapies but are yet to be fully confirmed. Currently, chemotherapies are ineffective in advanced or metastatic disease and there is lack of targeted chemotherapy or biological therapy against RMS. Also, reported uses of chemotherapy for RMS have not produced reasonable responses in all cases. Despite numerous molecular and biological studies during the past three decades, the chemotherapeutic regimen remains unchanged. This vincristine, actinomycin, cyclophosphamide (VAC) regime, described in Kilman, et al. (1973) and Koop, et al. (1963), has achieved limited success in controlling the progression of RMS. Thus, the pathogenesis of RMS remains poorly understood despite extensive modern trials and more than 30 years of studies exploring the chemotherapeutic options. This suggests a need to explore surgical options for managing the disease. Surgery is the single most critical therapy for pediatric HNRMS. However, very few studies have explored the surgical management of pediatric HNRMS and there is no standard surgical protocol. The aim of this review is to explore and address such issues in the hope of maximizing the number of options available for young patients with HNRMS.
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Affiliation(s)
- Paul J Choi
- Clinical Anatomy, Seattle Science Foundation
| | | | | | - Emre Yilmaz
- Swedish Medical Center, Swedish Neuroscience Institute
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Is Distraction Osteogenesis of the Irradiated Craniofacial Skeleton Contraindicated? J Craniofac Surg 2017; 28:1236-1241. [PMID: 28665865 DOI: 10.1097/scs.0000000000003683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Craniofacial distraction osteogenesis (DO) is a common treatment modality today. Despite its numerous advantages, however, concerns have been expressed regarding the use of DO in the irradiated setting. METHODS A systematic review was performed to identify all published reports of patients who underwent DO of the irradiated craniofacial skeleton. The following parameters were of particular interest: postoperative complications, specifically, insufficient bone formation, fracture, and hardware exposure (intraoral and cutaneous), as well as the need for additional bone grafting. RESULTS The initial search retrieved a total of 183 articles of which 20 articles (38 patients) met predetermined inclusion criteria. The most common site of distraction was the mandible (76.3%). The median radiation dose was 50.7 Gy (range, 30-70 Gy). Bone defects ranged from 30 to 80 mm (median, 42.5 mm). Complications were encountered in 19 patients (50%), with insufficient bone formation being most common (9 patients; 23%). The overall incidence of complications was not significantly associated with radiation dosage (P = 0.79). The remaining procedural and demographic variables also failed to meet statistical significance when compared against the overall complication rate (P = 0.27-0.97). CONCLUSION The complication rate associated with craniofacial DO of the irradiated skeleton does not appear to be substantially higher than what is reported for DO in the nonirradiated setting. As such, patients should be offered this treatment modality, particularly in light of the fact, that it offers the option to decrease patient morbidity as well as treatment complexity.
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Gonçalves LM, Gonçalves TMSV, Rodrigues AHC, Lanza MD, do Nascimento PRG, Girundi FMDS. Intra- and extraoral prostheses retained by zygoma implants following resection of the upper lip and nose. J Prosthodont 2014; 24:172-7. [PMID: 24981971 DOI: 10.1111/jopr.12178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 11/29/2022] Open
Abstract
Upper lip cancers are infrequent lesions, being aggressive unless diagnosed and treated early. After the surgical resection, maxillofacial defects require special care in rehabilitation. This article describes the maxillofacial rehabilitation of an edentulous patient diagnosed with upper lip squamous cell carcinoma. The treatment consisted of a large amount of upper lip and nose tissue resection, followed by chemoradiotherapy. After the first surgical healing, zygoma implants were inserted in a two-step procedure. The maxillary and nasal prostheses were installed and fixed by a titanium framework. After 6 years follow-up, no recurrences were observed, and the patient did not develop metastases. Tissues around implants were in good health, and the prostheses remained well-fitted. The use of implant-retained prostheses improved the quality of life, and the patient was extremely satisfied with the final result. The implant-retained prostheses are well accepted by the patient, improving comfort and safety during function while recovering her esthetic apperance.
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Affiliation(s)
- Letícia Machado Gonçalves
- Graduate and Post Graduate Program in Dentistry, Ceuma University-UniCEUMA, São Luís, Maranhão, Brazil
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Caran EMM, Barone TR, Barone JR, Lopes NNF, Alves MTS, França CM. Facial reconstruction surgery 10 years after treatment for hemangiopericytoma: planning considerations and clinical outcomes. J COSMET LASER THER 2014; 16:201-4. [PMID: 24684496 DOI: 10.3109/14764172.2014.910081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper describes the surgical correction of ankylosis of the right temporomandibular joint and reconstruction of the middle and lower thirds of the right side of the face in a young man who had undergone treatment for hemangiopericytoma 10 years earlier, which led to serious functional, esthetic, and psychological problems and diminished his quality of life. The results of reconstruction surgery with alloplastic material (Medopor®) and surgical planning with fibrotic tissue due to radiation and the risk of osteoradionecrosis are discussed.
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Affiliation(s)
- Eliana Maria Monteiro Caran
- Department of Pediatrics, Pediatric Oncology Institute, GRAACC, Medical School of São Paulo, Federal University of São Paulo - UNIFESP , São Paulo, SP , Brazil
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20:148-51. [PMID: 22555614 DOI: 10.1097/moo.0b013e328351a36c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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