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Liao L, Chen J, Liu Z, Liang S, Qin L, Lin X, Pan S, Tan M, Huang L, Ruan Q, Huang Z, Shi C, Xie G. Direct abdominal vein thrombus imaging (DATI): a contrast-free black-blood MR technique for the diagnosis of abdominal vein thrombosis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04335-3. [PMID: 38780634 DOI: 10.1007/s00261-024-04335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To develop and evaluate a direct abdominal vein thrombus imaging (DATI) technique, based on a respiratory navigating SPACE sequence with DANTE black-blood preparation, for diagnosing abdominal vein thrombosis (AVT) without the use of exogenous contrast agents. METHODS We prospectively enrolled 10 healthy subjects and 28 suspected AVT patients who underwent DATI scans on 3.0 T MRI. Contrast-enhanced CT venography (CTV) was also conducted on the suspected AVT patients for comparison. All images were analyzed by two blinded radiologists who independently evaluated randomized images and gave image quality and diagnostic confidence scores (1-poor, 4-excellent) for DATI and CTV. The accuracy (ACC), sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of CTV were calculated using CTV as a standard reference. The diagnostic agreement between DATI and CTV as well as the interobserver agreement were conducted using Cohen κ test. RESULTS The patient study demonstrated that DATI can provide adequate thrombus signal intensity and the contrast between the thrombus to dark venous lumen for the diagnosis of AVT. It offers good to excellent image quality (reader1/reader2: 3.50 ± 0.64/3.42 ± 0.63, κ = 0.872) and diagnostic confidence (reader1/reader2: 3.71 ± 0.53/3.78 ± 0.42, κ = 0.804) for the diagnosis of AVT. Taking CTV as a reference, DATI has high accuracy (96.6%), SE (91.5%), SP (98.0%), PPV (92.3%), and NPV (97.8%). DATA CONCLUSION DATI can provide good to excellent image quality, effective venous blood signal suppression, and definitive thrombus detection for the diagnosis of AVT without the use of exogenous contrast agents.
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Affiliation(s)
- Liping Liao
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Jiayuan Chen
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Zeping Liu
- School of Biomedical Engineering, The Sixth Affiliated Hospital, #A2-607, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, 511436, Guangdong, People's Republic of China
| | - Shengyuan Liang
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Lei Qin
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Xinmei Lin
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Shengzhang Pan
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Mingxia Tan
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Lanbin Huang
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Qizeng Ruan
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China
| | - Zehe Huang
- Department of Radiology, The First People's Hospital of Qinzhou, Qinnan District, Mingyang Road, Qinzhou, 535000, Guangxi, People's Republic of China.
| | - Caiyun Shi
- School of Biomedical Engineering, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangdong, People's Republic of China.
| | - Guoxi Xie
- School of Biomedical Engineering, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangdong, People's Republic of China
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Sun J, Mao F, Liu C, Zhang F, Jiang D, Guo W, Huo L, Zhou L, Lau WY, Shi J, Cheng S. Combined FOLFOX4 with all-trans retinoic acid versus FOLFOX4 with placebo in treatment of advanced hepatocellular carcinoma with extrahepatic metastasis: a randomized, double-blind comparative study. Signal Transduct Target Ther 2023; 8:368. [PMID: 37752117 PMCID: PMC10522582 DOI: 10.1038/s41392-023-01604-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 09/28/2023] Open
Abstract
The majority of hepatocellular carcinoma (HCC) cases are diagnosed at an advanced stage. Currently, there are only a few therapeutic methods available for patients with advanced HCC and extrahepatic metastasis (EHM). Systemic chemotherapy, such as FOLFOX4 (infusions of fluorouracil, leucovorin, and oxaliplatin), has been reported for treating advanced HCC with EHM, but its effectiveness is very poor. In this randomized, double-blind, placebo-controlled study, we aimed to assess the efficacy and safety of FOLFOX4 with all-trans-retinoic acid (ATRA) as a palliative treatment for HCC patients with EHM, compared to FOLFOX4 with a placebo. The primary endpoint was overall survival (OS), and subsequently, an exploratory model was developed based on bioinformatics to predict the efficacy of FOLFOX4-ATRA treatment. A total of 108 patients were randomly assigned in a 1:1 ratio to receive either FOLFOX4-ATRA or FOLFOX4-placebo. The intention-to-treat (ITT) population showed a median OS of 16.2 months for the FOLFOX4-ATRA group, compared with 10.7 months for the FOLFOX4-placebo group (HR 0.56, 95% CI 0.33-0.93; p = 0.025). The median progression-free survival (PFS) was 7.1 months for the FOLFOX4-ATRA group and 4.2 months for the FOLFOX4-placebo group (HR 0.62, 95% CI 0.41-0.94; p = 0.024). A panel of proteins with unique upregulation during complete response (CR) (SOD3, TTR, SSC5D, GP5, IGKV1D-33) and partial response (PR) (TGFB1, GSS, IGHV5-10-1) effectively predicted CR and PR in patients treated with FOLFOX4-ATRA, as compared to FOLFOX4-placebo. The results suggest that FOLFOX4-ATRA is a safe and effective treatment for patients with advanced HCC and EHM in eastern China.
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Affiliation(s)
- Juxian Sun
- Department of Hepatic Surgery VI, Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Feifei Mao
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Liu
- Department of Hepatic Surgery VI, Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Fan Zhang
- Department of General Surgery, Fujian Cancer Hospital, Fujian Medical University, Fuzhou, China
| | - Dafeng Jiang
- Department of Oncology, Zhejiang Sian International Hospital, Jiaxing, China
| | - Weixing Guo
- Department of Hepatic Surgery VI, Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lei Huo
- Department of Radiology, Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Liping Zhou
- Department of Hepatic Surgery VI, Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wan Yee Lau
- Department of Hepatic Surgery VI, Third Affiliated Hospital of Naval Medical University, Shanghai, China
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Third Affiliated Hospital of Naval Medical University, Shanghai, China.
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Third Affiliated Hospital of Naval Medical University, Shanghai, China.
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
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3
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Qiu Z, Yu C, Qiu X, Li Q, Li J, Chen Z, Chang S, Zhang S, Fan G, Wang S. Safety and Efficacy of CT-Guided Iodine-125 Brachytherapy for Portal Vein Tumor Thrombus in Hepatocellular Carcinoma. Acad Radiol 2023; 30 Suppl 1:S53-S60. [PMID: 36882354 DOI: 10.1016/j.acra.2023.02.006] [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: 01/17/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 03/08/2023]
Abstract
RATIONALE AND OBJECTIVES Portal vein tumor thrombus (PVTT) seriously reduces the survival of patients with hepatocellular carcinoma (HCC). CT-guided iodine-125 (125I) brachytherapy has the advantage of a high local control rate and is minimally invasive. This study aims to evaluate the safety and efficacy of 125I brachytherapy for treating PVTT in HCC patients. MATERIALS AND METHODS Thirty-eight patients diagnosed with HCC complicated with PVTT and treated with 125I brachytherapy for PVTT were included in this retrospective study. The local tumor control rate, local tumor progression-free survival, and overall survival (OS) were analyzed. Cox proportional hazards regression analysis was performed to identify predictors affecting survival. RESULTS The local tumor control rate was 78.9% (30/38). The median local tumor progression-free survival was 11.6 (95% confidence interval [CI]: 6.7, 16.5) months, and the median overall survival was 14.5 (95% CI: 9.2, 19.7) months. Multivariate Cox analysis showed that age <60 years (hazard ratio [HR] = 0.362; 95% CI: 0.136, 0.965; p = 0.042), type I+II PVTT (HR = 0.065; 95% CI: 0.019, 0.228; p < 0.001), and tumor diameter <5 cm (HR = 0.250; 95% CI: 0.084, 0.748; p = 0.013) were significant predictors of OS. There were no serious adverse events related to 125I seed implantation during the follow-up period. CONCLUSION CT-guided 125I brachytherapy is effective and safe for treating PVTT of HCC, with a high local control rate and no severe adverse events. Patients younger than 60 years old with type I+II PVTT and a tumor diameter less than 5 cm have a more favorable OS.
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Affiliation(s)
- Zhenkang Qiu
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Chunpeng Yu
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Xiaofei Qiu
- Qingdao Municipal Center For Disease Control & Prevention, Qingdao Institute of Preventive Medicine, Qingdao, Shandong Province, China
| | - Qun Li
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Jian Li
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Zhao Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Chang
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Shuo Zhang
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Gang Fan
- Department of Interventional Medicine, Jimo District Qingdao Hospital of Traditional Chinese Medicine, Qingdao, Shandong, China
| | - Song Wang
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China.
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Yuan Y, He W, Yang Z, Qiu J, Huang Z, Shi Y, Lin Z, Zheng Y, Chen M, Lau WY, Li B, Yuan Y. TACE-HAIC combined with targeted therapy and immunotherapy versus TACE alone for hepatocellular carcinoma with portal vein tumour thrombus: a propensity score matching study. Int J Surg 2023; 109:1222-1230. [PMID: 37026861 PMCID: PMC10389515 DOI: 10.1097/js9.0000000000000256] [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: 09/11/2022] [Accepted: 01/22/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The long-term survival of patients with hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) is poor. Systemic therapy, transcatheter arterial chemoembolization (TACE), and hepatic artery infusion chemotherapy are widely used in HCC patients with PVTT. This study aims to explore the efficacy of combining systemic therapy with transarterial-based therapy in HCC patients with PVTT. MATERIALS AND METHODS The authors retrospectively reviewed data of HCC patients with PVTT treated with combination therapy (TACE-hepatic artery infusion chemotherapy with tyrosine kinase inhibitors and PD-1 inhibitors) or TACE alone in SYSUCC from 2011 to 2020. The overall survival (OS), progression-free survival, and overall response rate were compared. Propensity score matching was used to minimize confounding bias. RESULTS A total of 743 HCC patients with PVTT received combination therapy ( n =139) or TACE alone ( n =604). After propensity score matching, the overall response rate was significantly higher in the combination group than in the TACE group [42.1% vs. 5.0%, P < 0.001 (response evaluation criteria in solid tumours); 53.7% vs. 7.8%, P < 0.001 (modified response evaluation criteria in solid tumours)]. The combination group showed significantly better OS than the TACE group (median OS not reached vs. 10.4 months, P < 0.001). The median progression-free survival of the combination and TACE groups was 14.8 and 2.3 months ( P < 0.001), respectively. Tumour downstaging followed by salvage liver resection was significantly more common for the combination therapy group than for TACE group (46.3% vs. 4.5%, P < 0.001). After salvage liver resection, 31.6% (30/95) and 1.7% (3/179) of the patients achieved a pathological complete response in the combination and TACE groups, respectively ( P < 0.001). The grade 3/4 adverse events rates were similar between the two groups (28.1% vs. 35.9%, P =0.092). CONCLUSION Compared with TACE alone, combination therapy was safe enough and resulted in survival benefits. This is a promising treatment option for HCC patients with PVTT.
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Affiliation(s)
- Yichuan Yuan
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Wei He
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Zhiwen Yang
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Jiliang Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Zhenkun Huang
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Yunxing Shi
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Zhu Lin
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Yun Zheng
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Minshan Chen
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Binkui Li
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Yunfei Yuan
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou
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Kim SH, Moon DB, Park YH, Lee SG, Kim KH, Hwang S, Ahn CS, Ha TY, Song GW, Jung DH, Park GC, Kim M, Na BG, Yang G, Kim SM, Oh RK. Favorable Prognostic Factors for Survival Outcomes of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis After Hepatectomy. Ann Surg Oncol 2023:10.1245/s10434-023-13316-7. [PMID: 37043034 DOI: 10.1245/s10434-023-13316-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/17/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND This study aimed to investigate prognostic factors of recurrence and survival associated with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). PATIENTS AND METHODS This retrospective study included 161 patients with HCC with PVTT who underwent hepatectomy between January 2003 and January 2014 at the Asan Medical Center. Regression analyses were conducted to identify favorable predictive factors for overall survival (OS) and recurrence-free survival (RFS). RESULTS The median follow-up was 15.9 months, while 1-, 3-, and 5-year OS was 65.0%, 38.4%, and 36.0%, respectively, and 1-year RFS was 25.5%. There were no significant differences in OS and RFS between the patients with portal vein invasion (Vp) 1-2 and Vp3-4 PVTT. Patients with intrahepatic recurrence had significantly better overall survival than patients with extrahepatic recurrence. Transcatheter arterial chemoembolization and radiofrequency ablation were the most effective treatments for intrahepatic metastasis, and surgery was the most effective treatment for extrahepatic metastasis. On multivariate analysis, absence of esophageal varices, maximal tumor size < 5 cm, tumor location in single lobe, and anatomical resection were favorable prognostic factors for OS and R0 resection, and absence of microvascular invasion was a favorable prognostic factor for RFS. CONCLUSION The long-term outcome of patients with HCC with PVTT can be improved under consideration of favorable prognostic factors including absence of esophageal varices, maximal tumor size < 5 cm, tumor location in single lobe, and anatomical resection, R0 resection, and absence of microvascular invasion. In addition, recurrent HCC required aggressive management to prolong overall survival.
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Affiliation(s)
- Sang-Hoon Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yo-Han Park
- Division of Hepatobiliary Surgery, Department of Surgery, On Hospital, Busan, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minjae Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeong-Gon Na
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geunhyeok Yang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Min Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Rak-Kyun Oh
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wang K, Xiang YJ, Yu HM, Cheng YQ, Liu ZH, Zhong JY, Feng S, Ni QZ, Zhu HF, Pan WW, Li JJ, Liang C, Zhou HK, Meng Y, Lau WY, Cheng SQ. Intensity-modulated radiotherapy combined with systemic atezolizumab and bevacizumab in treatment of hepatocellular carcinoma with extrahepatic portal vein tumor thrombus: A preliminary multicenter single-arm prospective study. Front Immunol 2023; 14:1107542. [PMID: 36875125 PMCID: PMC9978499 DOI: 10.3389/fimmu.2023.1107542] [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: 11/26/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
Background and aims The efficacy and safety of systemic atezolizumab and bevacizumab (atezo/bev) in treatment of patients with unresectable hepatocellular carcinoma (HCC) have been demonstrated. However, the efficacy of this treatment in patients with HCC and extrahepatic portal vein tumor thrombus (ePVTT) is not satisfactory. This study aimed to study the efficacy and safety of combining intensity-modulated radiotherapy (IMRT) with systemic atezo/bev in treatment of these patients. Methods This multicenter prospective study included patients with ePVTT treated with IMRT combined with atezo/bev from March to September 2021 in three centers in China. The outcomes of this study included objective response rate (ORR), overall survival (OS), progression-free survival (PFS), time to progression (TTP), and association between response and tumor mutational burden (TMB). Treatment-related adverse events (TRAEs) were analyzed to assess safety. Results Of 30 patients in this study, the median follow-up was 7.4 months. Based on the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, the ORR was 76.6%, the median OS for the entire cohort was 9.8 months, the median PFS was 8.0 months, and the median TTP was not reached. This study failed to establish a significant correlation between TMB with any of the following outcomes, including ORR, OS, PFS or TTP. The most common TRAEs at all levels were neutropenia (46.7%), and the most common grade 3/4 TRAE was hypertension (16.7%). There was no treatment-related deaths. Conclusions IMRT combined with atezo/bev showed encouraging treatment efficacy with an acceptable safety profile, making this treatment to be a promising option for HCC patients with ePVTT. Further studies are required to support the findings of this preliminary study. Clinical trial registration http://www.chictr.org.cn, Identifier ChiCTR2200061793.
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Affiliation(s)
- Kang Wang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yan-Jun Xiang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Hong-Ming Yu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yu-Qiang Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Zong-Han Liu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Jing-Ya Zhong
- Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, China
| | - Shuang Feng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University Shanghai, Shanghai, China
| | - Qian-Zhi Ni
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.,CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Hong-Fei Zhu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wei-Wei Pan
- Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, China.,G60 STI Valley Industry & Innovation Institute, Jiaxing University, Jiaxing, China
| | - Jing-Jing Li
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Chao Liang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong-Kun Zhou
- The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing University, Jiaxing, China
| | - Yan Meng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University Shanghai, Shanghai, China
| | - Wan Yee Lau
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.,Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.,Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, China.,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,The First Hospital of Jiaxing Affiliated Hospital of Jiaxing University, Jiaxing University, Jiaxing, China
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7
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Feng LH, Zhu YY, Zhou JM, Wang M, Wang L, Xu WQ, Zhang T, Mao AR, Cong WM, Dong H, Wang L. A Practical Risk Classification of Early Recurrence in Hepatocellular Carcinoma Patients with Microvascular invasion after Hepatectomy: A Decision Tree Analysis. Ann Surg Oncol 2023; 30:363-372. [PMID: 36151430 DOI: 10.1245/s10434-022-12598-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE This study was designed to establish risk classifications for early recurrence in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) after hepatectomy. METHODS The data of 563 HCC patients with MVI after hepatectomy from two hospitals were retrospectively reviewed. Kaplan-Meier curves and Cox proportional hazards regression models were used to analyse early recurrence. The risk classification for early recurrence was established by using classification and regression tree (CART) analysis and validated by using two independent validation cohorts from two hospitals. RESULTS Multivariate analysis revealed that four indices, namely, infection of chronic viral hepatitis, MVI classification, tumour size, and serum alpha-fetoprotein (AFP), were independent prognostic factors for early recurrence in HCC patients with MVI. By CART analysis, MVI classification and serum AFP became the nodes of a decision tree and 3-stratification classifications that satisfactorily determined the risk of early recurrence were established. The area under the time-dependent receiver operating characteristic curve (AUC) values of the classification for early recurrence at 0.5, 1.0, and 2.0 years were 0.75, 0.73, and 0.71, respectively, which were all significantly higher than three common classic HCC stages (BCLC stage, Chinese stage, and TNM stage). The calibration curves showed good agreement between predictions by classification for early recurrence and actual survival outcomes. These prediction results also were confirmed in the independent internal and external validation cohorts. CONCLUSIONS The 3 stratification classifications enabled satisfactory risk evaluation of early recurrence in HCC patients with MVI after hepatectomy.
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Affiliation(s)
- Long-Hai Feng
- Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Yao Zhu
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Jia-Min Zhou
- Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Miao Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Wang
- Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Wei-Qi Xu
- Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ti Zhang
- Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - An-Rong Mao
- Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Ming Cong
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.
| | - Hui Dong
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.
| | - Lu Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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8
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Yuan P, Song J, Wang F, Zhu G, Chen B. Combination of TACE and Lenvatinib as a promising option for downstaging to surgery of initially unresectable intrahepatic cholangiocarcinoma. Invest New Drugs 2022; 40:1125-1132. [PMID: 35793038 DOI: 10.1007/s10637-022-01257-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Conversion therapy has been widely applied in various cancer types including intrahepatic cholangiocarcinoma (ICC). The aim of this retrospective study was to evaluate the efficacy and safety of transarterial chemoembolization combined with lenvatinib (TACE-L) as a novel conversion therapy in patients with initially unresectable ICC. METHODS Enrolled in this retrospective study were patients with unresectable ICC who received TACE-L between January 2015 and May 2018. The patients were evaluated every 2 months for possible secondary resection. RESULTS Of the 44 eligible patients, 28 (63.6%) were successfully downstaged to receive surgical resection and the other 16 patients were included into the unsuccessfully downstaged group. The overall adverse events during TACE-L were moderate, including 12 patients (27.3%) with Grade 3 or 4 toxicities. Of the 28 downregulated patients, 23 (82.1%) achieved an R0 resection, and 6 (21.4%) had Clavien-Dindo grade ≥ 3 complications, including one postoperative death. Kaplan-Meier curves showed that the successfully downstaged patients had better overall survival (OS) than the unsuccessfully downstaged patients (P = 0.006). Multivariable analysis identified successful TACE-L conversion therapy as a significantly favorable prognostic factor for OS. CONCLUSIONS TACE-L proves to be a safe and efficacious conversion therapy modality that allows for secondary resectability in patients with initially unresectable ICC.
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Affiliation(s)
- Peng Yuan
- Department of Hematology and Oncology (Key Discipline of Jiangsu Medicine), Medical School, Zhongda Hospital, Southeast University, 210009, Nanjing, Jiangsu Province, P.R. China
| | - Jinhua Song
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu Province, P.R. China
| | - Fei Wang
- Department of Hematology and Oncology (Key Discipline of Jiangsu Medicine), Medical School, Zhongda Hospital, Southeast University, 210009, Nanjing, Jiangsu Province, P.R. China
| | - Guangyu Zhu
- Department of Interventional Radiology, Medical School, Zhongda Hospital, Southeast University, 210009, Nanjing, Jiangsu Province, P.R. China
| | - Baoan Chen
- Department of Hematology and Oncology (Key Discipline of Jiangsu Medicine), Medical School, Zhongda Hospital, Southeast University, 210009, Nanjing, Jiangsu Province, P.R. China.
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9
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Liang Y, Xu F, Wang Z, Tan C, Zhang N, Wei X, Jiang X, Wu H. A gadoxetic acid-enhanced MRI-based multivariable model using LI-RADS v2018 and other imaging features for preoperative prediction of macrotrabecular-massive hepatocellular carcinoma. Eur J Radiol 2022; 153:110356. [PMID: 35623312 DOI: 10.1016/j.ejrad.2022.110356] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To identify imaging features of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) using LI-RADS v2018 and other imaging features and to develop a gadoxetic acid-enhanced MRI (EOB-MRI)-based model for pretreatment prediction of MTM-HCC. MATERIALS AND METHODS A total of 93 patients with pathologically proven HCC (39 MTM-HCC and 54 non-MTM-HCC) were retrospectively evaluated with EOB-MRI at 3 T. Imaging analysis according to LI-RADS v2018 was evaluated by two readers. Univariate and multivariate analyses were performed to determine independent predictors for MTM-HCC. Different logistic regression models were built based on MRI features, including model A (enhancing capsule, blood products in mass and ascites), model B (enhancing capsule and ascites), model C (blood products in mass and ascites), and model D (blood products in mass and enhancing capsule). Diagnostic performance was assessed by receiver operating characteristic (ROC) curves. RESULTS After multivariate analysis, absence of enhancing capsule (odds ratio = 0.102, p = 0.010), absence of blood products in mass (odds ratio = 0.073, p = 0.030), and with ascites (odds ratio = 55.677, p = 0.028) were identified as independent differential factors for the presence of MTM-HCC. Model A yielded a sensitivity, specificity, and AUC of 35.90% (21.20,52.80), 94.44% (84.60, 98.80), and 0.731 (0.629, 0.818). Model A achieved a comparable AUC than model D (0.731 vs. 0.699, p = 0.333), but a higher AUC than model B (0.731 vs. 0.644, p = 0.048) and model C (0.731 vs. 0.650, p = 0.005). CONCLUSION The EOB-MRI-based model is promising for noninvasively predicting MTM-HCC and may assist clinicians in pretreatment decisions.
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Affiliation(s)
- Yingying Liang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University; School of Medicine, South China University of Technology, 1Panfu Road, Guangzhou, Guangdong Province 510180, China.
| | - Fan Xu
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, 396 Tongfu road, Guangzhou, Guangdong Province 510220, China.
| | - Zihua Wang
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province 528000, China.
| | - Caihong Tan
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University; School of Medicine, South China University of Technology, 1Panfu Road, Guangzhou, Guangdong Province 510180, China.
| | - Nianru Zhang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University; School of Medicine, South China University of Technology, 1Panfu Road, Guangzhou, Guangdong Province 510180, China.
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University; School of Medicine, South China University of Technology, 1Panfu Road, Guangzhou, Guangdong Province 510180, China.
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University; School of Medicine, South China University of Technology, 1Panfu Road, Guangzhou, Guangdong Province 510180, China.
| | - Hongzhen Wu
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University; School of Medicine, South China University of Technology, 1Panfu Road, Guangzhou, Guangdong Province 510180, China.
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10
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Wu Y, Cheng M, Huang S, Pei Z, Zuo Y, Liu J, Yang K, Zhu Q, Zhang J, Hong H, Zhang D, Huang K, Cheng L, Shao W. Recent Advances of Deep Learning for Computational Histopathology: Principles and Applications. Cancers (Basel) 2022; 14:cancers14051199. [PMID: 35267505 PMCID: PMC8909166 DOI: 10.3390/cancers14051199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 01/10/2023] Open
Abstract
Simple Summary The histopathological image is widely considered as the gold standard for the diagnosis and prognosis of human cancers. Recently, deep learning technology has been extremely successful in the field of computer vision, which has also boosted considerable interest in digital pathology analysis. The aim of our paper is to provide a comprehensive and up-to-date review of the deep learning methods for digital H&E-stained pathology image analysis, including color normalization, nuclei/tissue segmentation, and cancer diagnosis and prognosis. The experimental results of the existing studies demonstrated that deep learning is a promising tool to assist clinicians in the clinical management of human cancers. Abstract With the remarkable success of digital histopathology, we have witnessed a rapid expansion of the use of computational methods for the analysis of digital pathology and biopsy image patches. However, the unprecedented scale and heterogeneous patterns of histopathological images have presented critical computational bottlenecks requiring new computational histopathology tools. Recently, deep learning technology has been extremely successful in the field of computer vision, which has also boosted considerable interest in digital pathology applications. Deep learning and its extensions have opened several avenues to tackle many challenging histopathological image analysis problems including color normalization, image segmentation, and the diagnosis/prognosis of human cancers. In this paper, we provide a comprehensive up-to-date review of the deep learning methods for digital H&E-stained pathology image analysis. Specifically, we first describe recent literature that uses deep learning for color normalization, which is one essential research direction for H&E-stained histopathological image analysis. Followed by the discussion of color normalization, we review applications of the deep learning method for various H&E-stained image analysis tasks such as nuclei and tissue segmentation. We also summarize several key clinical studies that use deep learning for the diagnosis and prognosis of human cancers from H&E-stained histopathological images. Finally, online resources and open research problems on pathological image analysis are also provided in this review for the convenience of researchers who are interested in this exciting field.
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Affiliation(s)
- Yawen Wu
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Michael Cheng
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.C.); (J.Z.); (K.H.)
- Regenstrief Institute, Indiana University, Indianapolis, IN 46202, USA
| | - Shuo Huang
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Zongxiang Pei
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Yingli Zuo
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Jianxin Liu
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Kai Yang
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Qi Zhu
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Jie Zhang
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.C.); (J.Z.); (K.H.)
- Regenstrief Institute, Indiana University, Indianapolis, IN 46202, USA
| | - Honghai Hong
- Department of Clinical Laboratory, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510006, China;
| | - Daoqiang Zhang
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
| | - Kun Huang
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.C.); (J.Z.); (K.H.)
- Regenstrief Institute, Indiana University, Indianapolis, IN 46202, USA
| | - Liang Cheng
- Departments of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Correspondence: (L.C.); (W.S.)
| | - Wei Shao
- MIIT Key Laboratory of Pattern Analysis and Machine Intelligence, College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, China; (Y.W.); (S.H.); (Z.P.); (Y.Z.); (J.L.); (K.Y.); (Q.Z.); (D.Z.)
- Correspondence: (L.C.); (W.S.)
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