Integration of MRI-Based Radiomics Features, Clinicopathological Characteristics, and Blood Parameters: A Nomogram Model for Predicting Clinical Outcome in Nasopharyngeal Carcinoma

Purpose

This study aimed to develop a nomogram model based on multiparametric magnetic resonance imaging (MRI) radiomics features, clinicopathological characteristics, and blood parameters to predict the progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC).

Methods

A total of 462 patients with pathologically confirmed nonkeratinizing NPC treated at Sichuan Cancer Hospital were recruited from 2015 to 2019 and divided into training and validation cohorts at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) algorithm was used for radiomics feature dimension reduction and screening in the training cohort. Rad-score, age, sex, smoking and drinking habits, Ki-67, monocytes, monocyte ratio, and mean corpuscular volume were incorporated into a multivariate Cox proportional risk regression model to build a multifactorial nomogram. The concordance index (C-index) and decision curve analysis (DCA) were applied to estimate its efficacy.

Results

Nine significant features associated with PFS were selected by LASSO and used to calculate the rad-score of each patient. The rad-score was verified as an independent prognostic factor for PFS in NPC. The survival analysis showed that those with lower rad-scores had longer PFS in both cohorts (p < 0.05). Compared with the tumor–node–metastasis staging system, the multifactorial nomogram had higher C-indexes (training cohorts: 0.819 vs. 0.610; validation cohorts: 0.820 vs. 0.602). Moreover, the DCA curve showed that this model could better predict progression within 50% threshold probability.

Conclusion

A nomogram that combined MRI-based radiomics with clinicopathological characteristics and blood parameters improved the ability to predict progression in patients with NPC.

Adjuvant Chemotherapy May Not Be Necessary for Women with Stage IC1 Epithelial Ovarian Cancer

OBJECTIVE

To determine whether adjuvant chemotherapy improves the prognoses in women with stage IC1 epithelial ovarian cancer (EOC).

METHODS

All eligible women diagnosed with stage IC1 EOC from 2003 to 2019 in Tongji Hospital were included. Patient characteristics, tumor features, surgical types, and chemotherapeutic treatments were collected. Kaplan-Meier analysis and Cox regression analysis were performed to evaluate progression-free survival (PFS) and overall survival (OS).

RESULTS

Of the 140 patients (median age: 47 years old), 13 patients did not receive chemotherapy, and 127 received adjuvant chemotherapy. Kaplan-Meier analysis indicated that adjuvant chemotherapy offered no obvious improvements in PFS or OS. Subgroup analysis was conducted to adjust for the significant difference in incomplete staging surgery between the two groups, and chemotherapy still showed no benefit for survival. Cox regression analysis indicated that incomplete staging surgery was a risk factor for a worse PFS and that adjuvant chemotherapy remained unrelated to the prognosis. The patients were further divided based on the National Comprehensive Cancer Network recommendations: patients for whom observation is optional and chemotherapy would not improve the prognosis; and patients for whom chemotherapy is recommended. The results showed that postoperative chemotherapy had little correlation with survival.

CONCLUSION

Our study suggests that postoperative chemotherapy may be unnecessary for patients with stage IC1 EOC. According to our results, incomplete staging surgery is a significant risk factor for PFS.

Clinical characteristics and survival of patients with normal-sized ovarian carcinoma syndrome: Retrospective analysis of a single institution 10-year experiment

BACKGROUND

Normal size ovarian cancer syndrome (NOCS) is a challenge for clinicians regarding timely diagnosis and management due to atypical clinical and imaging features. It is extremely rare with only a few cases reported in the literature. More data are needed to clarify its biological behavior and compare the differences with abnormal size ovarian cancer.

AIM

To assess the clinical and pathological features of NOCS patients treated in our institution in the last 10 years and to explore risk factors for relapse and survival.

METHODS

Patients who were pathologically diagnosed with NOCS between 2008 and 2018 were included. Papillary serous ovarian carcinoma (PSOC) patients were initially randomly recruited as the control group. Demographics, tumor characteristics, treatment procedures, and clinical follow-up were retrospectively collected. Risk factors for progression-free survival and overall survival were assessed.

RESULTS

A total of 110 NOCS patients were included; 80 (72.7%) had primary adnexal carcinoma, two (1.8%) had mesotheliomas, 18 (16.4%) had extraovarian peritoneal serous papillary carcinoma, and eight (7.3%) had metastatic tumors. Carbohydrate antigen (CA)125 and ascites quantity were lower in the NOCS cohort than in the PSOC group. The only statistically significant risk factors for worse overall survival (P < 0.05) were the levels of CA199 and having fewer than six chemotherapy cycles. The 1-year, 3-year, and 5-year survival rates were 75.5%, 27.7%, and 13.8%, respectively.

CONCLUSION

The clinical symptoms of the NOCS group are atypical, and the misdiagnosis rate is high. Ascites cytology and laparoscopic exploration are valuable in the early diagnosis to avoid a misdiagnosis. The level of CA199 is the most important predictor of overall survival, and more than six cycles of chemotherapy contributes to the increased survival rates of NOCS patients.

Outcomes of patients with pelvic leiomyosarcoma treated by surgery and relevant auxiliary diagnosis

BACKGROUND

Leiomyosarcoma is a subtype of soft tissue sarcoma with adverse outcomes. Leiomyosarcoma accounts for nearly 70% of all uterine sarcomas and is responsible for a considerable proportion of deaths because of uterine cancer. Clinical characteristics and relevant diagnosis of pelvic leiomyosarcoma should be further explored.

AIM

To identify the outcome and relevant perioperative evaluation of patients with pelvic leiomyosarcoma.

METHODS

The Kaplan-Meier method was used to determine progression-free survival and overall survival rates. Factors predictive of outcomes were identified using univariate and multivariate Cox proportional hazards models.

RESULTS

Fifty-one patients with pelvic leiomyosarcoma were enrolled and divided into two groups including uterine leiomyosarcoma and non-uterine leiomyosarcoma. Overall, 28.6% and 45.5% of uterine leiomyosarcoma and non-uterine leiomyosarcoma patients, respectively, had elevated carbohydrate antigen 125 levels, whereas 45.7% and 68.8%, respectively, underwent ultrasonography. Although 68.8% of uterine leiomyosarcoma patients were initially diagnosed with hysteromyoma, 72.7% of non-uterine leiomyosarcoma patients had pelvic and abdominal masses. Moreover, 93.3% of the recurrent lesions were detected using ultrasonography. Patients with International Federation of Gynaecology and Obstetrics (FIGO) stages III–IV disease had poorer progression-free survival values than those with FIGO stages I–II (P = 0.027) disease. FIGO stage was significantly associated with poor progression-free survival in the univariate (hazard ratio = 2.64, P = 0.03) and multivariate (hazard ratio = 2.49, P = 0.048) analyses.

CONCLUSION

Serum tumour biomarkers cannot be used for pelvic leiomyosarcoma diagnosis. FIGO stage is critical to predict the outcome of uterine leiomyosarcoma. Ultrasonography is more reliable for postoperative follow-up than preoperative diagnosis.

CLDN1 expression in cervical cancer cells is related to tumor invasion and metastasis

Even though infection with human papillomaviruses (HPV) is very important, it is not the sole cause of cervical cancer. Because it is known that genetic variations that result from HPV infection are probably the most important causes of cervical cancer, we used human whole genome array comparative genomic hybridization to detect the copy number variations of genes in cervical squamous cell carcinoma. The results of the array were validated by PCR, FISH and immunohistochemistry. We find that the copy number and protein expression of claudin-1 (CLDN1) increase with the progression of cervical cancer. The strong positive staining of CLDN1 in the cervical lymph node metastasis group received a significantly higher score than the staining in the group with no lymph node metastasis of cervical cancer tissues. The overexpression of CLDN1 in SiHa cells can increase anti-apoptosis ability and promote invasive ability of these cells accompanied by a decrease in expression of the epithelial marker E-cadherin as well as an increase in the expression of the mesenchymal marker vimentin. CLDN1 induces the epithelial-mesenchymal transition (EMT) through its interaction with SNAI1. Furthermore, we demonstrate that CLDN1 overexpression has significant effects on the growth and metastasis of xenografted tumors in athymic mice. These data suggest that CLDN1 promotes invasion and metastasis in cervical cancer cells via the expression of EMT/invasion-related genes. Therefore, CLDN1 could be a potential therapeutic target for the treatment of cervical cancer.

A novel and faster method of manual grading to measure choroidal thickness using optical coherence tomography

PurposeChoroidal thickness (CT) measurements are typically obtained from manual segmentation of optical coherence tomography (OCT) B-scans. This method is time-consuming. We aimed to describe a novel and faster technique to obtain CT measurements.Patients and methodsIn a prospective cohort study of 200 healthy eyes, Spectral-Domain OCT with enhanced depth imaging were performed with the Spectralis OCT using standardised imaging protocols. The OCT scans were independently graded by reading centre-certified graders. The standard method of manual adjustment of segmentation boundaries was performed. The new method consisted of adjusting the lower segmentation line to the choroid-scleral boundary to generate the combined choroid-retina thickness, and subtracting the original retinal thickness (RT) from it to measure CT. Mean CT in the respective Early Treatment Diabetic Retinopathy Study (ETDRS) subfields was measured via the two methods, and were compared with intraclass correlation coefficients (ICC) and Bland-Altman plots.ResultsThe mean central subfield CT was 324.4 μm using the original method, compared with 328.8 μm using the new method, with a mean difference of 4.5 μm (range: -14.0 to +4.0 μm; P<0.001), and ICC for agreement of 0.9996 (P<0.001). Similar comparability was achieved for mean CT across other ETDRS subfields, with mean differences ranging from 2.4 to 3.7 μm, and ICCs ranging from 0.9993 to 0.9995 (all P<0.001).ConclusionsMean CT can be measured by subtracting the original RT from the combined choroid-retina thickness. Only one segmentation line needs to be adjusted, instead of two, reducing time required for segmentation. This method is faster and reliable.

[Effects of conditionally replicating adenovirus Adv5/dE1A-Aschk1 on isolated human umbilical endothelial cells]

BACKGROUND & OBJECTIVE

Replicating adenovirus, with the favorable features of efficient transduction and multiple in malignant cells, represent a promising option for gene therapy. Its influence on vascular endothelia in vivo is an important indicator for safety evaluation. This study was to explore the effects of conditionally replicating adenovirus Adv5/dE1A-Aschk1 on proliferating and resting endothelial cells.

METHODS

Human umbilical vein endothelial cells (HUVECs) were isolated by filling umbilical veins with digestive enzyme solution. HUVECs were cultured and observed with immunofluorescent staining and under electron microscope to identify endothelial cells. The oncolytic effects of Adv5/dE1A-Aschk1 on HeLa and endothelial cells were measured by cytopathic effect assay (CPE)û its effect on the proliferation of endothelial cells was measured by MTT assay. Cell apoptosis after treatment of Adv5/dE1A-Aschk1 alone or in combination with irradiation was measured by flow cytometry (FCM).

RESULTS

Highly purified endothelial cells were isolated. Adv5/dE1A-Aschk1 lysed HeLa cells in a replication-dependent fashion, but did not exhibit detectable cytopathic effects on resting endothelial cells at a multiplicity of infection (MOI) of 500. The inhibitory effect of Adv5/dE1A-Aschk1 on the proliferation of endothelial cells increased with the increase of viral titer. When treated with Adv5/dE1A-Aschk1 at a MOI of 100 for 96 h, the proliferation inhibition rate of proliferating HUVECs was (22.0+/-2.5)%, but that of resting HUVECs was (13.0+/-2.3)%. When treated with Adv5/dE1A-Aschk1 combined irradiation, the apoptosis rate of resting HUVECs was (23.1+/-2.5)%, and that of proliferating HUVECs was (35.7+/-3.0)%.

CONCLUSIONS

HUVECs may be taken as a good target for the research of conditionally replicating adenovirus. The viral titer for injuring endothelial cells is much higher than that for killing tumor cells, so Adv5/dE1A-Aschk1 has a wide range of therapeutic dosage. As compared with resting HUVECs, proliferating HUVECs are more likely to be lysed by Adv5/dE1A-Aschk1.

Walking while memorizing: age-related differences in compensatory behavior

This study investigated predictions of the life-span theory of selection, optimization, and compensation, focusing on different patterns of task priority during dual-task performance in younger and older adults. Cognitive (memorizing) and sensorimotor (walking a narrow track) performance were measured singly, concurrently, and when task difficulty was manipulated. Use of external aids was measured to provide another index of task priority. Before dual-task testing, participants received extensive training with each component task and external aid. Age differences in dual-task costs were greater in memory performance than walking, suggesting that older adults prioritized walking over memory. Further, when given a choice of compensatory external aids to use, older adults optimized walking, whereas younger adults optimized memory performance. The results have broad implications for systemic theories of cognitive and sensorimotor aging, and the costs and benefits of assistive devices and environmental support for older populations.

The role of inhibition in the regulation of sequential action

We investigated the regulation of sequential action using a new paradigm. Participants learned a sequence of seven stimulus categories and then monitored for them during successive displays. All displays were instances of these categories, presented in pseudorandom order. On each trial, participants monitored for an instance of Category 1, pressed a key on a computer keyboard, then monitored for an instance of Category 2, pressed a key on the keyboard, and so on for all seven categories. Thus, a perfect trial contained exactly seven responses. Intrusion errors were classified as a function of ordinal distance from the current serial position (n). Fewer intrusion errors were made at near serial positions than at far ones, suggesting a gradient of lateral inhibition. In addition, more intrusions were made on n + 1 categories than n - 1 categories, suggesting greater availability of intended than completed goals. In accord with current models of sequential action, the results indicate lateral and self-inhibition as important mechanisms in regulation of sequential action.

Distractibility, circadian arousal, and aging: a boundary condition?

Two studies assessed the presence of a synchrony effect between peak circadian arousal and time of testing for both older and younger adults. Participants performed a reading aloud task that included distracting words that were either present or absent and, if present, were either thematically related or unrelated to the target text. As well, the distracting material was presented in either spatially predictable or unpredictable locations. In each experiment, older and younger adults were tested at optimal versus nonoptimal times. Both experiments showed age differences in susceptibility to distraction, replicating earlier findings (e.g., M. C. Carlson, L. Hasher, R. T. Zacks, & S. L. Connelly, 1995). Neither showed differences due to time of testing, suggesting a boundary condition for cognitive disruptions associated with circadian arousal patterns.

Distractibility, circadian arousal, and aging: a boundary condition?

Two studies assessed the presence of a synchrony effect between peak circadian arousal and time of testing for both older and younger adults. Participants performed a reading aloud task that included distracting words that were either present or absent and, if present, were either thematically related or unrelated to the target text. As well, the distracting material was presented in either spatially predictable or unpredictable locations. In each experiment, older and younger adults were tested at optimal versus nonoptimal times. Both experiments showed age differences in susceptibility to distraction, replicating earlier findings (e.g., M. C. Carlson, L. Hasher, R. T. Zacks, & S. L. Connelly, 1995). Neither showed differences due to time of testing, suggesting a boundary condition for cognitive disruptions associated with circadian arousal patterns.

Age differences in the interpretation of misaligned "You-Are-Here" maps

"You-Are-Here" (YAH) maps, common in shopping malls and office buildings, are difficult to interpret if not aligned with their surroundings. Younger and older adults made direction decisions after viewing simple maps representing a university campus. YAH arrows were either upright and coordinated with viewer position or contra-aligned 180 degrees. Contra-alignment caused subjects, especially older adults, to take more time and be less accurate. Women were slower on contra-aligned maps, although no less accurate, than men. The need to mentally realign such incongruent maps in order to make correct direction decisions can cause serious difficulty for older adults trying to navigate through large, complex environments.