1
|
Yang K, Wu J, Xu T, Zhou Y, Liu W, Yang L. Machine learning to predict distant metastasis and prognostic analysis of moderately differentiated gastric adenocarcinoma patients: a novel focus on lymph node indicators. Front Immunol 2024; 15:1398685. [PMID: 39364413 PMCID: PMC11446832 DOI: 10.3389/fimmu.2024.1398685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 08/29/2024] [Indexed: 10/05/2024] Open
Abstract
Background Moderately differentiated gastric adenocarcinoma (MDGA) has a high risk of metastasis and individual variation, which strongly affects patient prognosis. Using large-scale datasets and machine learning algorithms for prediction can improve individualized treatment. The specific efficacy of several lymph node indicators in predicting distant metastasis (DM) and patient prognosis in MDGA remains obscure. Methods We collected data from MDGA patients from the SEER database from 2010 to 2019. Additionally, we collected data from MDGA patients in China. We used nine machine learning algorithms to predict DM. Subsequently, we used Cox regression analysis to determine the risk factors affecting overall survival (OS) and cancer-specific survival (CSS) in DM patients and constructed nomograms. Furthermore, we used logistic regression and Cox regression analyses to assess the specific impact of six lymph node indicators on DM incidence and patient prognosis. Results We collected data from 5,377 MDGA patients from the SEER database and 109 MDGC patients from hospitals. T stage, N stage, tumor size, primary site, number of positive lymph nodes, and chemotherapy were identified as independent risk factors for DM. The random forest prediction model had the best overall predictive performance (AUC = 0.919). T stage, primary site, chemotherapy, and the number of regional lymph nodes were identified as prognostic factors for OS. Moreover, T stage, number of regional lymph nodes, primary site, and chemotherapy were also influential factors for CSS. The nomograms showed good predictive value and stability in predicting the 1-, 3-, and 5-year OS and CSS in DM patients. Additionally, the log odds of a metastatic lymph node and the number of negative lymph nodes may be risk factors for DM, while the regional lymph node ratio and the number of regional lymph nodes are prognostic factors for OS. Conclusion The random forest prediction model accurately identified high-risk populations, and we established OS and CSS survival prediction models for MDGA patients with DM. Our hospital samples demonstrated different characteristics of lymph node indicators in terms of distant metastasis and prognosis.
Collapse
Affiliation(s)
- Kangping Yang
- Department of Gastroenterological Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jiaqiang Wu
- Department of General Surgery, First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tian Xu
- Department of Gastroenterological Surgery, Jiangxi Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang, Jiangxi, China
| | - Yuepeng Zhou
- Department of Gastroenterological Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wenchun Liu
- The Second Department of Internal Medicine, Anfu People's Hospital, Anfu, Jiangxi, China
| | - Liang Yang
- Department of Gastroenterological Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
2
|
Liao Z, Xie Z. Construction of a disulfidptosis-related glycolysis gene risk model to predict the prognosis and immune infiltration analysis of gastric adenocarcinoma. Clin Transl Oncol 2024; 26:2309-2322. [PMID: 38587603 DOI: 10.1007/s12094-024-03457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The pattern of cell death known as disulfidptosis was recently discovered. Disulfidptosis, which may affect the growth of tumor cells, represents a potential new approach to treating tumors. Glycolysis affects tumor proliferation, invasion, chemotherapy resistance, the tumor microenvironment (TME), and immune evasion. However, the efficacy and therapeutic significance of disulfidptosis-related glycolysis genes (DRGGs) in stomach adenocarcinoma (STAD) remain uncertain. METHODS STAD clinical data and RNA sequencing data were downloaded from the TCGA database. DRGGs were screened using Cox regression and Lasso regression analysis to construct a prognostic risk model. The accuracy of the model was verified using survival studies, receiver operating characteristic (ROC) curves, column plots, and calibration curves. Additionally, our study investigated the relationships between the risk scores and immune cell infiltration, tumor mutational burden (TMB), and anticancer drug sensitivity. RESULTS We have successfully developed a prognosis risk model with 4 DRGGs (NT5E, ALG1, ANKZF1, and VCAN). The model showed excellent performance in predicting the overall survival of STAD patients. The DRGGs prognostic model significantly correlated with the TME, immune infiltrating cells, and treatment sensitivity. CONCLUSIONS The risk model developed in this work has significant clinical value in predicting the impact of immunotherapy in STAD patients and assisting in the choice of chemotherapeutic medicines. It can correctly estimate the prognosis of STAD patients.
Collapse
Affiliation(s)
- Zhaohui Liao
- Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, China
| | - Zhengyuan Xie
- Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Donghu District, Nanchang, 330006, China.
| |
Collapse
|
3
|
Kanamathareddy HV, Lakhani A, Augustine A, Thanikaivelu S, Eapen A, John R, Simon B, Masih D, Sarvarasan I, Singh A, Chandramohan A. Prevalence of CT-detected extramural vascular invasion in gastric adenocarcinoma and its correlation with other known prognostic factors. Jpn J Radiol 2024:10.1007/s11604-024-01644-x. [PMID: 39207641 DOI: 10.1007/s11604-024-01644-x] [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: 06/09/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To study the prevalence of extramural vascular invasion (EMVI) in patients with gastric adenocarcinoma (GA) and its association with other prognostic factors. MATERIALS AND METHODS In this retrospective study, consecutive patients with GA who underwent staging CT between January 2021 and December 2022 were included. Two radiologists reviewed the staging CT for EMVI and its grade and documented tumor location, thickness, and TNM stage. Grade 3 and 4 EMVI were reported as ct-EMVI positive and the rest as negative. Similar findings were documented on restaging CT following neoadjuvant chemotherapy (NAC) when available. ct-EMVI was compared with imaging findings on staging and restaging CT, staging laparoscopy findings, peritoneal fluid cytology, and surgical histopathology findings. RESULTS A total of 191 patients (140 males, 51 females) with a mean age of 53 ± 9 years (range 23-93 years) were included. 82.2% had poorly differentiated GA and 17.8% had well/moderately differentiated GA. The majority (95.9%) had T3 (n = 34) and T4 (n = 118) disease on baseline CT. The prevalence of ct-EMVI on staging CT was 65% (n = 124), and 34% and 86% among the T3 and T4 GA, respectively. There was a significant association between ct-EMVI and, tumor thickness, tumor extent, ct-T, N, M stages, and especially peritoneal, lymph nodes, and liver metastases and response to NAC (p < 0.05). CONCLUSION EMVI is seen commonly in staging CT of advanced gastric cancer patients and is significantly associated with TNM stage, peritoneal metastases, and response to neoadjuvant chemotherapy. Thus, ct-EMVI is a significant prognostic imaging biomarker in GA. IRB min no: 15713.
Collapse
Affiliation(s)
| | - Aisha Lakhani
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Antony Augustine
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Sonia Thanikaivelu
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Dipti Masih
- Department of General Pathology, Christian Medical College, Vellore, 632004, India
| | - Inian Sarvarasan
- Department of Upper GI Surgery, Christian Medical College, Vellore, 632004, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, 632004, India
| | | |
Collapse
|
4
|
Park J, Jung W, Han K, Kim B, Lee SY, Yoon JM, Lim DH, Shin DW. Association between age-related macular degeneration and risk of incident cancer. Br J Ophthalmol 2024; 108:1249-1256. [PMID: 38418207 DOI: 10.1136/bjo-2023-323874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIMS Age-related macular degeneration (AMD) and cancer may share similar risk factors, indicating possible common pathogenic pathways. We aimed to describe the site-specific cancer risk based on the relationship of AMD with visual disability (VD) status. METHODS This was a population-based cohort study using data from the Korean National Health Insurance Service database (2009-2019) including patients who participated in a national health screening programme in 2009. The subjects were categorised based on the presence of AMD and VD. The occurrence of cancer was identified using principal diagnosis according to the International Classification of Disease, 10th revision codes in claims data. The Cox regression hazard model was used to compare HRs of site-specific cancer. RESULTS Among 4 088 814 participants, 51 596 had AMD of which 3683 subjects had VD. The mean follow-up period was 9.6 years. The overall cancer risk was generally null, but the risk of hypervascular cancer such as thyroid cancer (adjusted HR (aHR) 1.10, 95% CI 1.00 to 1.20) and renal cancer (aHR 1.16, 95% CI 1.00 to 1.33) was higher and the risk of stomach cancer (aHR 0.89, 95% CI 0.84 to 0.94) was lower in the AMD group than in the non-AMD group. CONCLUSION This study demonstrated a possible association between AMD and several cancers. Increased renal and thyroid cancer risk among patients with AMD could indicate that AMD is associated with hypervascular cancer. Further studies in which additional databases are used and the underlying detailed mechanisms evaluated are needed to validate our results.
Collapse
Affiliation(s)
- Junhee Park
- Family Medicine, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Wonyoung Jung
- Family Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea (the Republic of)
| | - Kyungdo Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Korea (the Republic of)
| | - Bongseong Kim
- Statistics and Actuarial Science, Soongsil University, Seoul, Korea (the Republic of)
| | - Seung-Yeon Lee
- Family medicine/ International Health care center, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Je Moon Yoon
- Ophthalmology, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Dong Hui Lim
- Ophthalmology, Samsung Medical Center, Seoul, Korea (the Republic of)
- Clinical Research Design & Evaluation and Digital Health, Samsung Advanced Insitute for Health Sicences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Dong Wook Shin
- Family Medicine, Samsung Medical Center, Seoul, Korea (the Republic of)
- Clinical Research Design & Evaluation and Digital Health, Samsung Advanced Insitute for Health Sicences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea (the Republic of)
| |
Collapse
|
5
|
Shariff H, Luu T, Kavis H, Obuch J. Gastric Signet Ring Cell Adenocarcinoma With Metastasis to the Testicles and Leptomeninges. ACG Case Rep J 2024; 11:e01419. [PMID: 39081301 PMCID: PMC11286243 DOI: 10.14309/crj.0000000000001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024] Open
Abstract
Gastric signet ring cell adenocarcinoma (SRCA) is an aggressive malignancy primarily diagnosed in advanced stages. Metastasis to other organ systems is uncommon, however, associated with poor prognosis. We present a young patient with persistent pain in the testicle. Histopathologic examination of the resected testicle revealed metastatic signet ring adenocarcinoma prompting follow-up endoscopy with biopsy confirming gastric SRCA. After 10 months of systemic chemotherapy, the patient developed worsening headaches, and cerebrospinal fluid cytology confirmed leptomeningeal metastasis. This case underscores the rare manifestation of SRCA and the importance of vigilance for atypical presentations to ensure timely diagnosis and management.
Collapse
Affiliation(s)
| | - Tristan Luu
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA
| | - Haluk Kavis
- Department of Clinical and Laboratory Pathology, Geisinger Medical Center, Danville, PA
| | - Joshua Obuch
- Department of Gastroenterology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA
| |
Collapse
|
6
|
Wang B, Zhao X, Liu Y, Zhang Z, Chen X, Jing F, Chen X, Hua Y, Zhao J. Comparison of 68 Ga-FAPI-04 PET/CT with 18 F-FDG PET/CT for diagnosis and staging of gastric and colorectal cancer. Nucl Med Commun 2024; 45:612-621. [PMID: 38686487 DOI: 10.1097/mnm.0000000000001845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The objective of this study is to evaluate the effectiveness of 68 Ga-FAPI-04 PET/computed tomography (CT) for the diagnosis of primary and metastatic gastric cancer and colorectal cancer lesions as compared with 18 F-FDG PET/CT. MATERIALS AND METHODS Fifty-nine patients who underwent both 18 F-FDG and 68 Ga-FAPI-04 for initial staging or restaging were enrolled. Histopathological findings and clinical imaging follow-up were used as the reference standard. The diagnostic performance and TNM staging of the two tracers were calculated and compared. The maximum standardized uptake value (SUV max ), tumour-to-mediastinal blood pool ratio (TBR) (lesions SUV max /ascending aorta SUV mean ), and tumour-to-normal liver parenchyma ratio (TLR) (lesions SUV max /liver SUV mean ) of primary and metastatic lesions between two imaging modalities were measured and compared using the Wilcoxon signed-rank test and paired t -test. RESULTS The two imaging agents are comparable for the detection of primary tumors. The sensitivity of 68 Ga-FAPI-04 PET/CT was higher than that of 18 F-FDG PET/CT for detecting lymph node metastases, peritoneal metastases, liver metastases, and bone metastases. In the patient-based analysis, the TLR for all lesions was significantly higher with 68 Ga-FAPI-04 PET/CT than with 18 F-FDG PET/CT (all P < 0.05). The accuracy (92.2 vs. 70.3%, P = 0.002) and sensitivity of 68 Ga-FAPI-04 were significantly higher than that of 18 F-FDG (78.6 vs. 71.4%, P = 0.011) in determining the lymph node status. 68 Ga-FAPI-04 has a higher accuracy in staging ( P = 0.041), which is mainly due to the ability of distant metastases detection. CONCLUSION 68 Ga-FAPI-04 PET/CT may be superior in evaluating the diagnostic efficiency and staging accuracy of gastric and colorectal cancer.
Collapse
Affiliation(s)
- Bin Wang
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Zúñiga-Pérez N, Muñoz-Navarro H, Rivera C. Salivary biomarkers for the diagnosis of gastric cancer: a systematic review. REVISTA CIENTÍFICA ODONTOLÓGICA 2024; 12:e199. [PMID: 39119128 PMCID: PMC11304856 DOI: 10.21142/2523-2754-1202-2024-199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/01/2024] [Indexed: 08/10/2024] Open
Abstract
Background Recent advancements reveal saliva as a crucial source of diagnostic biomarkers for various diseases, notably gastric cancer. This systematic review evaluates these biomarkers, emphasizing their clinical applicability and potential in early detection. Methods An extensive electronic search was conducted across PubMed/MEDLINE, Scopus, and Web of Science to identify relevant studies. Salivary biomarkers were analyzed as independent variables, with gastric cancer as the dependent variable. The study adhered to a protocol registered with PROSPERO (CRD42021259519). Results Our analysis identified a range of biomarkers, highlighting three proteins - cystatin-B (CSTB), triosephosphate isomerase (TPI1), and deleted in malignant brain tumors 1 protein (DMBT1) - as particularly accurate for gastric cancer diagnosis. Conclusions Salivary biomarkers hold substantial promise for the early detection of gastric cancer. Future research should aim to refine study design and validation for enhancing the quality and applicability of these biomarkers.
Collapse
Affiliation(s)
- Natalia Zúñiga-Pérez
- Oral and Maxillofacial Histopathology Laboratory, Department of Stomatology, Faculty of Dentistry, Universidad de Talca. Talca, Chile. , , Universidad de Talca Oral and Maxillofacial Histopathology Laboratory, Department of Stomatology Faculty of Dentistry Universidad de Talca Talca Chile
| | - Humberto Muñoz-Navarro
- Oral and Maxillofacial Histopathology Laboratory, Department of Stomatology, Faculty of Dentistry, Universidad de Talca. Talca, Chile. , , Universidad de Talca Oral and Maxillofacial Histopathology Laboratory, Department of Stomatology Faculty of Dentistry Universidad de Talca Talca Chile
| | - César Rivera
- Oral and Maxillofacial Histopathology Laboratory, Department of Stomatology, Faculty of Dentistry, Universidad de Talca. Talca, Chile. , , Universidad de Talca Oral and Maxillofacial Histopathology Laboratory, Department of Stomatology Faculty of Dentistry Universidad de Talca Talca Chile
| |
Collapse
|
8
|
Khandelwal Y, Singh Parihar A, Sistani G, Ramirez-Fort MK, Zukotynski K, Subramaniam RM. Role of PET/Computed Tomography in Gastric and Colorectal Malignancies. PET Clin 2024; 19:177-186. [PMID: 38199915 DOI: 10.1016/j.cpet.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This article focuses on the role of PET/computed tomography in evaluating and managing gastric cancer and colorectal cancer. The authors start with describing the common aspects of imaging with 2-deoxy-2-18F-d-glucose, followed by tumor-specific discussions of gastric and colorectal malignancies. Finally, the authors provide a brief overview of non-FDG tracers including their potential clinical applications, and describe future directions in imaging these malignancies.
Collapse
Affiliation(s)
- Yogita Khandelwal
- Department of Nuclear Medicine, AIIMS Campus, Ansari Nagar East, New Delhi, Delhi 110016, India
| | - Ashwin Singh Parihar
- Mallinckodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
| | - Golmehr Sistani
- Medical Imaging Department, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON L4M 6M2, Canada
| | | | - Katherine Zukotynski
- Department of Medical Imaging, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery & Health Sciences, 160 Oxford Street, Darlinghurst, NSW 2010, Australia
| |
Collapse
|
9
|
Pichioni P, Kokkinovasilis D, Stylianou S, Kipouridis G, Kalogeropoulos A, Al Mogrampi S. Multiple Muscle Metastases as the First Presentation of Gastric Cancer: A Case Report and Review of Literature. Cureus 2024; 16:e55458. [PMID: 38571840 PMCID: PMC10988182 DOI: 10.7759/cureus.55458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
The presence of an abdominal wall mass may serve as the initial presentation of an unknown gastric malignancy. The invasion of the abdominal wall and the occurrence of multiple skeletal muscle metastases originating from gastric cancer are exceedingly uncommon. We present a case of a 45-year-old female patient exhibiting widespread abdominal wall infiltration and skeletal muscle metastases derived from gastric cancer. The primary presentation included a distressing diffuse abdominal mass in the left upper and lower quadrants. Abdominal computed tomography revealed extensive swelling of multiple skeletal muscles within the abdominal wall, raising suspicions of gastric malignancy. Biopsies of the affected muscles, along with upper gastrointestinal tract endoscopy and colonoscopy, were performed. The upper endoscopy examination unveiled a poorly differentiated diffuse-type gastric adenocarcinoma, while the subsequent muscle biopsy confirmed infiltration by the recently diagnosed malignancy. At this stage of the disease, systemic chemotherapy was deemed the optimal choice for our patient. Subsequent abdominal computed tomography showed a decrease in the dimensions of the abdominal wall and other skeletal muscle lesions. Seventeen months after the initial diagnosis, our patient continues to be alive. Additionally, we provide a comprehensive review of the existing literature on similar reported cases of gastric cancer patients with concurrent muscle metastases.
Collapse
Affiliation(s)
- Polyxeni Pichioni
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | | | - Stylianos Stylianou
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | - Georgios Kipouridis
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | | | - Saant Al Mogrampi
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| |
Collapse
|
10
|
Yin W, Huo Z, Zuo J, Wang H, Chen B, Zhou L. Characterization of m6A methylation modifications in gastric cancer. Aging (Albany NY) 2024; 16:89-105. [PMID: 38206646 PMCID: PMC10817395 DOI: 10.18632/aging.205341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/06/2023] [Indexed: 01/12/2024]
Abstract
Widely recognized as an essential epitranscriptomic modification, RNA N6-methyladenosine (m6A) is involved in both physiological and pathological processes. Here, we want to investigate m6A modification's potential roles in gastric cancer. Gastric cancer samples were selected from TCGA-STAD and GEO (GSE84426, GSE84433) datasets. Based on 18 regulators of m6A, m6A modification patterns were thoroughly evaluated in gastric cancer samples. Principal component analysis algorithms were used to construct the m6Ascore, using which, m6A modification features in tumor somatic mutations and immune checkpoint blockade therapy were analyzed. 34 gastric cancer samples were collected to verify the effectiveness of the m6Ascore. Here, we determined three different m6A modification patterns. m6Acluster-C modification pattern presented immune activation-associated enrichment pathways and have significant survival advantages. Then, in gastric cancer, m6Ascore could act as an independent prognostic biomarker. A significant survival benefit was exhibited in patients with high m6Ascore. Moreover, the modification signature of m6A uncovered in this study would help to predict immune checkpoint blockade therapy's responses. In conclusion, our discoveries all pointed to the fact that modification patterns of m6A were linked to the TME. Moreover, evaluation of individual tumor's m6A modification pattern will help to guide immunotherapy strategies that shows more therapeutic effects.
Collapse
Affiliation(s)
- Wei Yin
- Department of Gastrointestinal Surgery, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an 223300, Jiangsu, China
| | - Zhanwei Huo
- Department of General Surgery, Lianshui People’s Hospital Affiliated to Kangda College of Nanjing Medical University, Huai’an 223300, Jiangsu, China
| | - Jiawei Zuo
- Department of Radiotherapy, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an 223300, Jiangsu, China
| | - Haixiao Wang
- Department of General Surgery, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu, China
| | - Bi Chen
- Department of Rehabilitation, Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing 210000, Jiangsu, China
| | - Liqing Zhou
- Department of Radiotherapy, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an 223300, Jiangsu, China
| |
Collapse
|
11
|
Luo M, Chen G, Xie H, Zhang R, Yang P, Nie R, Zhou Z, Gao F, Chen Y, Xie C. Preoperative diagnosis of metastatic lymph nodes by CT-histopathologic matching analysis in gastric adenocarcinoma using dual-layer spectral detector CT. Eur Radiol 2023; 33:8948-8956. [PMID: 37389605 DOI: 10.1007/s00330-023-09875-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES There still remain challenges to accurate diagnosis of lymph node (LN) involvement in gastric cancer (GC) on conventional CT. This study evaluated the quantitative data derived from dual-layer spectral detector CT (DLCT) for preoperative diagnosis of metastatic LNs compared to conventional CT images. METHODS Patients with adenocarcinoma scheduled for gastrectomy were enrolled in this prospective study from July, 2021, to February, 2022. Regional LNs were labeled on preoperative DLCT. The LNs were located and matched using carbon nanoparticle solution during surgery according to their locations and anatomic landmarks on preoperative images. The matched LNs were randomly split into training and validation cohorts in a ratio of 2:1. The DLCT quantitative parameters in the training cohort were investigated using logistic regression models to identify independent predictors of metastatic LNs, and these predictors were subsequently applied to the validation cohort. Receiver operating characteristic curves were compared between the DLCT parameters and conventional CT images. RESULTS Fifty-five patients were included in the study, with 267 successfully matched LNs (90 metastatic, 177 nonmetastatic). Independent predictors included arterial phase CT attenuation on 70-keV images, venous phase electron density, and clustered feature. These combination predictors had areas under the curve (AUC) of 0.855 and 0.907 in the training and validation cohorts, respectively. Compared to conventional CT criteria alone, the model had higher AUC and accuracy (0.741 vs. 0.907, 75.28% vs. 87.64%; p < 0.01) for LN diagnosis. CONCLUSION Incorporating DLCT parameters improved preoperative diagnosis of LN metastasis in GC, increasing the accuracy of clinical N stage. CLINICAL RELEVANCE STATEMENT Compared to conventional CT criteria, quantitative parameters from dual-layer spectral detector CT showed higher diagnostic efficacy for the preoperative diagnosis of lymph node metastases in gastric cancer, increasing the accuracy of clinical N stage. KEY POINTS • Quantitative parameters from dual-layer spectral detector CT are useful for the preoperative diagnosis of lymph node metastases in gastric adenocarcinoma, increasing the accuracy of clinical N stage. • The values for metastatic lymph nodes are higher than those of nonmetastatic ones. The arterial phase of CT attenuation on 70-keV images, venous phase of electron density, and clustered feature independently predicted lymph node metastases. • Prediction model had area under the curve of 0.907, sensitivity of 81.82%, specificity of 91.07%, and accuracy of 87.64% for the preoperative diagnosis of lymph node metastasis.
Collapse
Affiliation(s)
- Ma Luo
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, P. R. China
| | - Guoming Chen
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Hui Xie
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, P. R. China
| | - Rong Zhang
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, P. R. China
| | - Ping Yang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Runcong Nie
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Zhiwei Zhou
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Fei Gao
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, P. R. China
| | - Yongming Chen
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.
| | - Chuanmiao Xie
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, P. R. China.
| |
Collapse
|
12
|
Giandola T, Maino C, Marrapodi G, Ratti M, Ragusi M, Bigiogera V, Talei Franzesi C, Corso R, Ippolito D. Imaging in Gastric Cancer: Current Practice and Future Perspectives. Diagnostics (Basel) 2023; 13:diagnostics13071276. [PMID: 37046494 PMCID: PMC10093088 DOI: 10.3390/diagnostics13071276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard for tumor (T) and nodal (N) statuses in recent decades. However, thanks to technological improvements, computed tomography (CT) has gained an important role, not only in the assessment of distant metastases (M status) but also in T and N staging. In addition, magnetic resonance imaging (MRI) can contribute to the detection and staging of primary gastric tumors thanks to its excellent soft tissue contrast and multiple imaging sequences without radiation-related risks. In addition, MRI can help with the detection of liver metastases, especially small lesions. Finally, positron emission tomography (PET) is still considered a useful diagnostic tool for the staging of gastric cancer patients, with a focus on nodal metastases and peritoneal carcinomatosis. In addition, it may play a role in the treatment of gastric cancer in the coming years thanks to the introduction of new labeling peptides. This review aims to summarize the most common advantages and pitfalls of EUS, CT, MRI and PET in the TNM staging of gastric cancer patients.
Collapse
|
13
|
Jia K, Wang Y, Yang B, Wang H. Revisit the rare clinical cases of upper urinary tract metastases from gastrointestinal tumors. Asian J Surg 2023; 46:1103-1104. [PMID: 36041898 DOI: 10.1016/j.asjsur.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Keyang Jia
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yaoqian Wang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China; Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Bo Yang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China; Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Han Wang
- Department of Gastroenterology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| |
Collapse
|
14
|
Li J, Cong L, Sun X, Li X, Chen Y, Cai J, He M, Zhang X, Tang L. CT characteristics for predicting prognosis of gastric cancer with synchronous peritoneal metastasis. Front Oncol 2023; 12:1061806. [PMID: 36713539 PMCID: PMC9874217 DOI: 10.3389/fonc.2022.1061806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction To explore the CT characteristics for the prediction of long term survival in gastric cancer patients with synchronous peritoneal metastasis (PM). Materials and methods Sixty-six patients diagnosed as gastric cancer with synchronous peritoneum metastasis were enrolled in this retrospective study. Ten anatomic peritoneal regions were evaluated to check for the signs of PM on CT. One positive area equaled one score. The CT characteristic-based PM score (CT-PMS) was the sum of the total points assigned to all 10 regions, with a range of 0-10. The triple tract dilatation (TTD) sign caused by peritoneal metastasis, the presence of extensive lymph node metastasis (ELM), and the grade of ascites were recorded. The overall survival (OS) was used as the prognostic indicator. The performance of the CT characteristics was assessed by the Kaplan-Meier analysis and Cox proportional hazards model, while its reproducibility was evaluated by Kappa statistic and weighted Kappa statistic. Results Patients with a CT-PMS of 3-10 had significantly poorer OS (P = .02). Patients with either the presence of TTD sign, or ELM had a trend toward unfavorable OS (both P = .07), and when CT-PMS of 3-10 was detected simultaneously, the survival was further reduced (P = .00 for TTD sign; P = .01 for ELM). The grade of ascites failed to show a significant correlation with OS. The interobserver reproducibility for assessing the CT-PMS, the presence of TTD sign, the presence of ELM, and the grade of ascites had a substantial to almost perfect agreement. Conclusion The prognosis of gastric cancer patients with PM has a correlation with the extent of metastasis dissemination on baseline CT. A CT-PMS of 3-10 is associated with a worse prognosis than that of 0-2. The presence of TTD sign and ELM may help further select patients with extraordinarily poor prognoses.
Collapse
Affiliation(s)
- Jiazheng Li
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lin Cong
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xuefeng Sun
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China,Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoting Li
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yang Chen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jieyuan Cai
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Meng He
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaotian Zhang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China,*Correspondence: Xiaotian Zhang, ; Lei Tang,
| | - Lei Tang
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China,*Correspondence: Xiaotian Zhang, ; Lei Tang,
| |
Collapse
|
15
|
Lesion or Pseudolesion? A Comprehensive Description of Perfusion-Based Liver Alterations on Contrast-Enhanced Computed Tomography and Literature Review. J Comput Assist Tomogr 2023; 47:9-23. [PMID: 36584106 DOI: 10.1097/rct.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Pseudolesions on contrast-enhanced computed tomography represent a diagnostic challenge for radiologists because they could be difficult to distinguish from true space-occupying lesions. This article aims to provide a detailed overview of these entities based on radiological criteria (hyperattenuation or hypoattenuation, localization, morphology), as well as a brief review of the hepatic vascular anatomy and pathophysiological process. Relevant examples from hospital case series are reported as helpful hints to assist radiologists in recognizing and correctly diagnosing these abnormalities.
Collapse
|
16
|
Gastric adenocarcinoma: A review of the TNM classification system and ways of spreading. RADIOLOGIA 2023; 65:66-80. [PMID: 36842787 DOI: 10.1016/j.rxeng.2022.10.011] [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: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 02/28/2023]
Abstract
Gastric cancer is the fifth most common cancer in the world. The most common histologic subtype is adenocarcinoma. Gastric adenocarcinomas are staged using the American Joint Committee on Cancer's 8th TNM classification. The perigastric ligaments, mesentery, omentum, and potential spaces between the parietal and visceral peritoneal linings play are important structures for staging. The spread of disease is influenced by the location of the tumor within the stomach, as well as by the anatomy related to the ligaments and lymph vessels. CT is the imaging modality of choice for the preoperative clinical staging of gastric cancer, and it is essential for planning treatment. To be able to do an adequate imaging workup, radiologists need to know the different pathways through which gastric cancer can spread: lymphatic, subperitoneal, direct invasion, transperitoneal, hematogenous, and extramural venous invasion.
Collapse
|
17
|
Muacevic A, Adler JR, Aswani Y, Bairy A, Narvel H. Obstructive Jaundice as the Initial Manifestation of Gastric Adenocarcinoma. Cureus 2022; 14:e32478. [PMID: 36644047 PMCID: PMC9835852 DOI: 10.7759/cureus.32478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
A 52-year-old female presented with epigastric pain, yellowing of the sclera, and vomiting for three weeks. Laboratory investigations revealed markedly elevated serum bilirubin and alkaline phosphatase levels, accompanied by a modest rise in transaminases. A clinical diagnosis of obstructive jaundice was established. Ultrasound of the abdomen depicted a mass in the region of the head of the pancreas. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an infiltrative gastric mass spreading across the gastroduodenal junction and involving the ampulla of Vater. Owing to comorbid conditions and widespread lymphadenopathy, a palliative gastrojejunostomy with excision biopsy was performed. Histopathology confirmed an undifferentiated gastric adenocarcinoma.
Collapse
|
18
|
Adenocarcinoma gástrico: revisión del TNM y de las vías de diseminación. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
19
|
Determinants of clinical outcomes of gastric cancer patients treated with neoadjuvant chemotherapy: a sub-analysis of the PRODIGY study. Gastric Cancer 2022; 25:1039-1049. [PMID: 35920999 DOI: 10.1007/s10120-022-01325-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this post hoc analysis of the PRODIGY study, we aimed to investigate factors associated with survival outcomes and provide evidence for designing optimal perioperative treatment strategies for gastric cancer patients receiving neoadjuvant chemotherapy. PATIENTS AND METHODS A total of 212 patients in the neoadjuvant chemotherapy group of the PRODIGY study were included as the study population. The prognostic impact of clinicopathologic factors, including the initial radiological clinical stage (cStage) and post-neoadjuvant chemotherapy pathological stage (ypStage), was analyzed. RESULTS The median age was 58 years. The majority of patients (77.4%) had cStage III disease, and about 10% and 25% had ypStage 0 and I disease, respectively. According to the initial cStage, progression-free survival (PFS) and overall survival (OS) were significantly different (P < 0.01). PFS and OS were also different according to the ypStage (P < 0.01). In multivariate analyses, cStage IIIC disease (vs. cStage II) and ypStage II and III disease (vs. ypStage 0/I) were independent factors for poor survival outcomes. Based on the patterns of PFS and OS according to both cStage and ypStage, three patient groups were defined. These groups showed distinct PFS and OS (P < 0.01) with 5-year PFS rates of 95.7%, 77.9%, and 31.3% and 5-year OS rates of 95.7%, 82.4%, and 42.5%, respectively. CONCLUSIONS Both initial cStage and ypStage were independent factors for survival outcomes of gastric cancer patients treated with neoadjuvant chemotherapy. Efforts should be made to develop optimal peri-operative treatment strategies for patients at different risks according to cStage and ypStage.
Collapse
|
20
|
Zhang S, Wang W, Xu T, Ding H, Li Y, Liu H, Huang Y, Liu L, Du T, Zhao Y, Chen Y, Qiu L. Comparison of Diagnostic Efficacy of [68Ga]Ga-FAPI-04 and [18F]FDG PET/CT for Staging and Restaging of Gastric Cancer. Front Oncol 2022; 12:925100. [PMID: 35847877 PMCID: PMC9283765 DOI: 10.3389/fonc.2022.925100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose This study aimed to compare the potential diagnostic efficacy of gallium68-fibroblast-activation protein inhibitor ([68Ga]Ga-FAPI-04) and fluorine18-fluorodeoxyglucose ([18F]-FDG) positron emission tomography-computed tomography (PET/CT) for primary tumors, lymph nodes, and distant metastatic lesions of gastric cancer (GC), and to explore the effects of [68Ga]Ga-FAPI-04 and [18F]-FDG on tumor staging and restaging in GC. Methods This single-center retrospective study (NCT2100044131) was conducted at the Affiliated Hospital of the Southwest Medical University between June 2020 and December 2021. Images of patients with GC who were pathologically confirmed and underwent contemporaneous [18F]-FDG and [68Ga]Ga-FAPI-04 PET/CT within 1 week were analyzed. The diagnostic efficacy of [68Ga]Ga-FAPI-04 PET/CT and [18F]-FDG PET/CT for TNM staging of GC was compared using McNemar test. The maximum standard uptake value (SUVmax) of each lesion in the two imaging types was compared using the Mann-Whitney U test. Results In total, 25 patients with GC (mean age, 56 ± 12 years) were evaluated. [68Ga]Ga-FAPI-04 PET/CT exhibited higher sensitivity compared to [18F]-FDG PET/CT for detecting primary tumors (18/19 [94.74%] vs. 13/19 [68.42%], χ2 = 6.866, P < 0.01), lymph node metastasis (75/77 [97.40%] vs. 32/77 [41.56%], χ2 = 2.888, P =0.089), and distant metastases (275/283 [97.17%] vs. 122/283 [43.11%], χ2 = 11.858, P < 0.01). [68Ga]Ga-FAPI-04 accumulation was significantly higher than that of [18F]FDG in tumors (median SUVmax, 10.28 vs 3.20; U=59.00, P < 0.01), lymph node metastasis metastases (median SUVmax, 9.20 vs 3.15; U=53.50, P < 0.01), and distant metastases (median SUVmax, 8.00 vs 4.20; U=200.00, P < 0.01). Compared to [18F]-FDG PET/CT, [68Ga]Ga-FAPI-04 PET/CT resulted in new oncological findings in 14/25 patients and corrected tumor staging or restaging in 7/25 patients. Conclusion Our preliminary results regarding the impact of [68Ga]Ga-FAPI-04 PET/CT on tumor staging highlight the potential of this approach for increasing the accuracy of GC diagnosis, which may facilitate treatment decision-making.
Collapse
Affiliation(s)
- Shumao Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Wei Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Tingting Xu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Haoyuan Ding
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Yi Li
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Huipan Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Yinxue Huang
- Department of Geriatric Psychiatry, The Fourth People’s Hospital of Chengdu, Chengdu, China
- Department of Geriatric Psychiatry, The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Lin Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Tao Du
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Yan Zhao
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
- *Correspondence: Yue Chen, ; Lin Qiu,
| | - Lin Qiu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China
- *Correspondence: Yue Chen, ; Lin Qiu,
| |
Collapse
|
21
|
He L, Qian X, Ge P, Fan D, Ma X, Wu Q, Sun J, Yang L, Shen J, Xu L. NOL6 Regulates the Proliferation and Apoptosis of Gastric Cancer Cells via Regulating TP53I3, CDK4 and MCM7 Expression. Front Oncol 2022; 12:708081. [PMID: 35494047 PMCID: PMC9039204 DOI: 10.3389/fonc.2022.708081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background Gastric cancer (GC) is a prevalent cancer with high mortality and strong invasiveness, and the entire regulatory networks of GC is still unclear. Objective The aim of this study was to explore the specific mechanism of the effect of nucleolar protein 6 (NOL6) on the proliferation and apoptosis of GC cells. Methods The human gastric adenocarcinoma cell line HGC-27 and AGS were cultured. qRT-PCR was used to verify the expression level of NOL6 in GC cells; MTT and EdU were used to test cell proliferation; TUNEL staining and Flow cytometry were used to detect cell apoptosis; The downstream genes and pathways following NOL6 knockdown were explored through the microarray assay and ingenuity pathway analysis, and the downstream genes were finally verified by qRT-PCR and Western blotting. The xenograft mice were used to investigate the effect of NOL6 on GC in vivo. Results TCGA data analysis showed that NOL6 expression level was higher in GC cells than adjacent normal cells. Over-expression of NOL6 increased proliferation and colony formation, and inhibited the apoptotic rate in AGS and HGC-27 cells, while NOL6 knockdown induced the opposite effects. Through microarray assay and IPA analysis, NOL6-related downstream genes and critical signaling pathways were found. And we verified the relationship between downstream genes and GC. Additionally, NOL6 knockdown could decrease the weight and volume of tumor in the mice. Conclusion NOL6 knockdown could inhibit cell proliferation and induce cell apoptosis of GC, suggesting that NOL6 may serve as a potential therapeutic target for treating GC.
Collapse
Affiliation(s)
- Lei He
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohan Qian
- Medical Center for Digestive Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pingping Ge
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dong Fan
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Ma
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiong Wu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin Sun
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lihua Yang
- Medical Center for Digestive Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lijian Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
22
|
Radiological criteria for selecting candidates for neoadjuvant chemotherapy for gastric cancer: an exploratory analysis from the PRODIGY study. Gastric Cancer 2022; 25:170-179. [PMID: 34476643 DOI: 10.1007/s10120-021-01243-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this exploratory analysis from the PRODIGY study, we aimed to define the radiological criteria to identify patients with gastric cancer who may derive maximal clinical benefit from neoadjuvant chemotherapy. PATIENTS AND METHODS There were 246 patients allocated to receive surgery followed by adjuvant S-1 (SC group) and 238 allocated to receive neoadjuvant chemotherapy (CSC group). As the PRODIGY's radiological method of lymph node (LN) evaluation considers short diameter and morphology (the size and morphology method), a method considering only short diameter was also employed. In the SC group, the correlation between radiologic and pathologic findings was analyzed. The hazard ratio (HR) for the progression-free survival (PFS) of the CSC group was analyzed in subgroups with different cT/N stages. RESULTS cT4 disease showed a sensitivity of 85.6% for detecting pT4 and had a low proportion of pathologic stage (pStage) I disease (4.5%). Among the criteria determined by different cT/N stages by each method of LN positivity, those involving cT4Nany or cT4N + by both methods had a minimal proportion of pStage I disease (≤ 5%), while cT4Nany by both methods and cT4N + by the size and morphology method exhibited ≥ 75.9% sensitivity for detecting pStage III disease. The relative risk reduction in PFS of the CSC group was greatest in patients meeting the cT4Nany criterion defined by both methods (HR 0.67, 95% confidence interval 0.48-0.93). CONCLUSIONS The cT4Nany criterion, regardless of the radiological method used for LN evaluation, may help select patients with resectable gastric cancer for neoadjuvant chemotherapy.
Collapse
|
23
|
Duan H, Xu D, Lu R, Wang S, Xie R, Wang S. Characterizing omental PET/CT findings for differentiating tuberculous peritonitis from peritoneal carcinomatosis. Abdom Radiol (NY) 2021; 46:5574-5585. [PMID: 34549331 DOI: 10.1007/s00261-021-03286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To characterize and investigate PET/CT findings in the omentum in the differentiation of tuberculous peritonitis (TBP) and peritoneal carcinoma (PC). METHODS Thirty-nine patients with TBP and 113 patients with PC who underwent PET/CT were retrospectively enrolled. The omental uptake intensity, distribution characteristics, contracture, size and boundary of soft-tissue lesions, and CT patterns were reviewed. RESULTS Absent and focal FDG uptake in the lesser omentum was more common in the PC patients (P = 0.034 and P = 0.017, respectively), and diffuse FDG uptake in the lesser omentum was more common in the TBP patients (P < 0.001). An apron-like pattern in the greater omentum commonly occurred in the TBP patients (P = 0.004). Micronodules (< 5 mm) were more common in the TBP patients (P < 0.001), and masses (> 3 cm) were more common in the PC patients (P = 0.001). Smudged and nodular patterns occurred more frequently in the TBP patients than in the PC patients (P < 0.001 and P = 0.003, respectively), and the caked pattern occurred more frequently in the PC patients (P < 0.001). There was no significant difference in the FDG uptake intensity and the boundary of soft-tissue lesions between the TBP and PC patients (P = 0.191 and P = 0.061, respectively). CONCLUSION Diffuse FDG uptake, an apron-like pattern, micronodules, and a smudged and nodular pattern might be significant differential features of TBP. Absent and/or focal FDG uptake, mass, and a caked pattern might be significant differential features of PC.
Collapse
Affiliation(s)
- Hongli Duan
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Dongdong Xu
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Rencai Lu
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Siyu Wang
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Ran Xie
- Yunnan Cancer Hospital, PET/CT Center, 519 Kunzhou Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China.
| | - Shaobo Wang
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China.
| |
Collapse
|
24
|
Saiz Martínez R, Dromain C, Vietti Violi N. Imaging of Gastric Carcinomatosis. J Clin Med 2021; 10:5294. [PMID: 34830575 PMCID: PMC8624519 DOI: 10.3390/jcm10225294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 01/17/2023] Open
Abstract
Diagnosing the absence or presence of peritoneal carcinomatosis in patients with gastric cancer, including its extent and distribution, is an essential step in patients' therapeutic management. Such diagnosis still remains a radiological challenge. In this article, we review the strengths and weaknesses of the different imaging techniques for the diagnosis of peritoneal carcinomatosis of gastric origin as well as the techniques' imaging features. We also discuss the assessment of response to treatment and present recommendations for the follow-up of patients with complete surgical resection according to the presence of risk factors of recurrence, as well as discussing future directions for imaging improvement.
Collapse
Affiliation(s)
| | - Clarisse Dromain
- Department of Radiology, Lausanne University Hospital and University of Lausanne, 1015 Lausanne, Switzerland;
| | - Naik Vietti Violi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, 1015 Lausanne, Switzerland;
| |
Collapse
|
25
|
Awiwi MO, Ramanan RV, Elshikh M, Vikram R. Imaging of Gastric Carcinoma. Part One: Diagnosis and Staging. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1735217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractGastric cancer is one of the leading causes of death from malignancy. Despite the enormous advancement in medical oncology over the past decade, surgical resection of early tumors remains the most effective treatment. Accurate interpretation of radiologic imaging studies is crucial for staging local disease spread, predicting possible lymphatic involvement, and identifying metastatic disease, thereby guiding management plans. This article reviews imaging patterns of the normal stomach along with appearances of gastric cancer, its local spread patterns and distant metastasis, and also describes key features pertaining to preoperative staging.
Collapse
Affiliation(s)
- Muhammad O. Awiwi
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Texas, United States
| | | | - Mohamed Elshikh
- Department of Radiology, The University of Texas Medical Branch, Texas, United States
| | - Raghunandan Vikram
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Texas, United States
| |
Collapse
|
26
|
Qiao X, Li Z, Li L, Ji C, Li H, Shi T, Gu Q, Liu S, Zhou Z, Zhou K. Preoperative T 2-weighted MR imaging texture analysis of gastric cancer: prediction of TNM stages. Abdom Radiol (NY) 2021; 46:1487-1497. [PMID: 33047226 DOI: 10.1007/s00261-020-02802-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/20/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore the capability of algorithms to build multivariate models integrating morphological and texture features derived from preoperative T2-weighted magnetic resonance (MR) images of gastric cancer (GC) to evaluate tumor- (T), node- (N), and metastasis- (M) stages. METHODS A total of 80 patients at our hospital who underwent abdominal MR imaging and were diagnosed with GC from December 2011 to November 2016 were retrospectively included. Texture features were calculated using T2-weighted images with a manual region of interest. Morphological characteristics were also evaluated. Classifiers and regression analyses were used to build multivariate models. Receiver operating characteristic (ROC) curve analysis was performed to assess diagnostic efficacy. RESULTS There were 8, 10, and 3 texture parameters that showed significant differences in GCs at different overall (I-II vs. III-IV), T (1-2 vs. 3-4), and N (- vs. +) stages (all p < 0.05), respectively. Mild thickening was more common in stages I-II, T1-2, and N- GCs (all p < 0.05). An irregular outer contour was more commonly observed in stages III-IV (p = 0.001) and T3-4 (p = 0.001) GCs. T3-4 and N+ GCs tended to be thickening type lesions (p = 0.005 and 0.032, respectively). The multivariate models using the naive bayes algorithm showed the highest diagnostic efficacy in predicting T and N stages (area under the ROC curves [AUC] = 0.900 and 0.863, respectively), and the model based on regression analysis had the best predictive performance in overall staging (AUC = 0.839). CONCLUSION Multivariate models combining morphological characteristics with texture parameters based on machine learning algorithms were able to improve diagnostic efficacy in predicting the overall, T, and N stages of GCs.
Collapse
Affiliation(s)
- Xiangmei Qiao
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Zhengliang Li
- State Key Lab of Novel Software Technology, Nanjing University, Nanjing, 210046, China
| | - Lin Li
- Department of Pathology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Changfeng Ji
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Hui Li
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Tingting Shi
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Qing Gu
- State Key Lab of Novel Software Technology, Nanjing University, Nanjing, 210046, China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Kefeng Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| |
Collapse
|
27
|
Jacob E, Smucker L, Crouse R, Allard-Picou A. Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection. World J Surg Oncol 2021; 19:83. [PMID: 33743738 PMCID: PMC7981802 DOI: 10.1186/s12957-021-02191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric cancer is the fifth most common cancer worldwide, with an incidence of 6.72 per 100,000 people. Thirty-two percent of gastric cancer patients will live 5 years after diagnosis. Single-site metastasis is noted in 26% of patients with gastric cancer, most commonly in the liver (48%), peritoneum (32%), lung (15%), and bone (12%). Here, a case is presented in which a single skeletal muscle metastasis appeared after appropriate resection and treatment. CASE PRESENTATION A 63-year-old man underwent neoadjuvant chemotherapy and a multivisceral en bloc R0 resection. Final pathology showed no evidence of lymph node metastasis with 31 negative lymph nodes. Four months postoperatively, the patient was found to have a rapidly growing biopsy-proven extremity soft tissue gastric metastasis within the brachioradialis muscle. He subsequently underwent metastasectomy and immunotherapy. CONCLUSION This case is a rare example of an isolated extremity metastasis of gastric adenocarcinoma in the setting of an R0 resection of the primary tumor and negative nodal disease on final pathology, suggestive of hematogenous spread. We review the biology, workup, and management of gastric cancer and highlight new advancements in the treatment of this aggressive cancer.
Collapse
Affiliation(s)
- Elizabeth Jacob
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
| | - Levi Smucker
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA.
| | - Ryan Crouse
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
| | - Ayana Allard-Picou
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
- Columbia University College of Physicians and Surgeons, New York City, USA
| |
Collapse
|
28
|
Park S, Moon SK, Lim JW. Mechanism of metastasis to the spermatic cord and testis from advanced gastric cancer: a case report. BMC Gastroenterol 2020; 20:119. [PMID: 32312237 PMCID: PMC7171798 DOI: 10.1186/s12876-020-01269-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The spermatic cord and testis are very rare sites for metastasis from gastric cancer. Although several mechanisms have been suggested to explain this unusual metastasis, the actual mechanism remains unclear. We report a case of right spermatic cord and testicular metastasis, review its imaging findings, and suggest a mechanism of tumor spread. CASE PRESENTATION A 61-year-old man complained of a palpable mass in the right inguinal area. He had been treated with distal gastrectomy with chemotherapy for advanced gastric cancer 5 years ago. Computed tomography, ultrasound, and magnetic resonance imaging showed a mass surrounding the right spermatic cord, involving the right testis. Another mass was observed in the aortocaval space, presumed to be a metastatic lymph node. The imaging features of the right testicular lesion were different than those of the primary testicular cancer. The lesions at both sites showed similar radiologic features of abundant internal necrosis, which is consistent with metastatic lesions. Pathology confirmed metastatic adenocarcinoma. He underwent a series of chemotherapy sessions, and all metastatic masses had partially decreased in size at the 5-month outpatient follow-up. CONCLUSIONS The imaging features of testicular mass and spermatic cord involvement are important clues for accurate differential diagnosis of metastasis from other primary tumors in patients with a history of stomach cancer. This unusual metastasis can be explained via retrograde tumor spread along the lymphatic channels in terms of concurrent aortocaval lymph node metastasis. A suspicion of metastasis should not be overlooked, even if a patient has undergone curative treatment, including surgery and adjuvant chemotherapy, many years ago.
Collapse
Affiliation(s)
- Soyoung Park
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Joo Won Lim
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| |
Collapse
|