| PurposeRadiofrequency ablation,surgical resection,and liver transplantation are considered to be the curative methods for early-stage HCC.It is widely used because of its characteristics of less trauma,fewer complications and shorter hospital stay.The prognosis of HCC treated with RFA is affected by many factors.Previous studies have mainly focused on liver function and the tumor itself.Recent studies have shown that nutritional status is also a key factor affecting prognosis of tumors.In this study,CONUT score and common clinical biochemical markers were included in the analysis to further clarify the risk factors of RFA through long-term follow-up.Materials and Methods189 patients diagnosed with HCC from 2019.1 to 2021.12 in the National Cancer Center was collected.Patients were divided into two groups(<4:low CONUT group;≥4:high CONUT group)according to the CONUT cut-off value,and the baseline data of patients in the two groups were compared.Univariate and multivariate analysis was used to identify independent risk factors affecting overall survival and recurrence-free survival.ResultsThe cut-off value for CONUT was 4 according to the t-ROC.The median OS in the low CONUT group was 84 months;the median OS in the high CONUT group was 60.3 months.The OS of the two groups was statistically significant different(P<0.001),and the overall survival time of the high CONUT group was shorter.The median RFS for the low CONUT group was 81.8 months,while the median RFS for the high CONUT group was 28 months.The RFS of the two groups was statistically significant different(P=0.0025)and the RFS of the high CONUT group was significantly lower than that of the low CONUT group.CONUT score,recurrence pattern,time of recurrence,first treatment after recurrence,and using sorafenib/lenvatinib were independent risk factors of OS,while CONUT score,maximum tumor diameter were independent risk factors of RFS through univariate and multivariate analysis.Conclusion CONUT score,recurrence pattern,time of recurrence,first treatment after recurrence,and using sorafenib/lenvatinib were independent risk factors of OS,while CONUT score,maximum tumor diameter were independent risk factors of RFS.PurposePrognostic factors of HCC mainly including AFP,liver function,tumor diameter,tumor number,and physical performance status.In recent years,studies have shown that the nutritional status is also an important indicator of tumor prognosis.This study retrospectively analyzed intermediate-stage HCC received TACE.In addition to the common clinical indicators,CONUT scores were included in the analysis,and the prognostic factors were analyzed,and nomograms were developed to predict the overall survival and progression-free survival.Materials and methodsPatients with HCC who underwent TACE treatment from 2015.1 to 2020.1 were collected from the National Cancer Center.All patients were diagnosed with hepatocellular carcinoma by pathological or imaging examinations.Patients were divided into high CONUT group(CONUT score≥4)and low CONUT group(CONUT<4).The Kaplan-Meier method was used to draw the survival curve of the two groups,and the log-rank test was used to compare the survival time.Cox regression was used for univariate and multivariate analysis of OS and PFS.According to the results of multivariate analysis,nomograms was constructed to predict patients’ OS and PFS.The C index,calibration curve and area under the curve were used to evaluate the nomograms.ResultsThe Cut-off value of CONUT score was 4.The median follow-up time was 41.7 months(95%CI:39.2-44.4).The median OS time in the low and high CONUT groups was 44.6 months(95%CI:41.5-48.0)and 38.7 months(95%CI:35.0-42.8),respectively,and the low CONUT group had significantly better OS than the high CONUT group(P=0.033).The median PFS time was 14.2 months(95%CI:12.3-16.4)in the low CONUT group and 12.6 months(95%CI:10.7-14.8)in the high CONUT group,and the PFS in the low CONUT group was significantly longer than that in the high CONUT group(P=0.047).Univariate and multivariate analysis showed that age,tumor number,AFP level and CONUT score were independent risk factors of OS,and tumor number,AFP level,tumor maximum diameter and CONUT score were prognostic risk factors of PFS.Nomograms were developed to predict 5-year OS and 1-year PFS by the results of univariate and multivariate analyses.The C-index of nomogram for predicting OS was 0.794(95%CI:0.747-0.840);the C-index of nomogram for predicting PFS was 0.799(95%CI:0.754-0.845).The calibration curve shows that the predicted results are in good agreement with what actually happened.The AUC for predicting 5-year OS rate was 0.811(sensitivity 0.883,specificity 0.634),and the AUC for predicting 1-year PFS rate was 0.804(sensitivity 0.900,specificity 0.598).ConclusionsAge,tumor number,AFP level,and CONUT score are independent risk factors of OS in intermediate-stage HCC patients treated with TACE.Tumor number,maximum tumor diameter,AFP level,and CONUT score are independent prognostic factors for PFS in intermediate-stage HCC patients treated with TACE.The established nomograms can better predict OS and PFS.PurposeDigital Subtraction Angiography(DSA)is a common and effective method for diagnosing vascular hemorrhage,but the imaging of bleeding is affected by some factors such as respiratory motility,intestinal gas,and DSA instrument conditions.These factors often lead to unclear or uncertain display of bleeding sites in some patients,thus delaying the timing of diagnosis and treatment.This study started from in vitro simulation experiments,and systematically studied the amount of bleeding that angiography can display and the setting conditions of DSA that affect the imaging of bleeding.Then we deeply studied the color coding technology based on parametric imaging,and explored its application value in the determination of bleeding points in in vitro simulation experiments.Then,we further conducted validation in clinical practice,confirming its application value in clinical cases of HCC-related bleeding.Materials and MethodsThis study is systematically divided into three parts:in vitro simulation experiments,algorithms and applications of color-coded parametric imaging,and clinical validation.1.In vitro simulation experiment.In this study,an in vitro simulation experiment was designed to simulate bleeding.The effective number of experiments and experimental conditions were obtained through orthogonal experiments,and the optimal instrument setting conditions that affected the display of simulated bleeding points were analyzed.2.Color coding parametric imaging development algorithm and application research.Color-coded parametric imaging includes image enhancement,image blood vessel segmentation,time-intensity curve fitting,and image pseudo-color processing.First,the dynamic video of angiography is readed,and then image processing is performed on the read video frame image to extract the pixel points of the blood vessel area.A time-intensity fit curve was calculated for each pixel in the proposed in vitro simulated bleeding area.The time-intensity curve combines the dynamic process of contrast agent imaging and the process of video or video density change,which contains rich quantitative information.The parameter data of each pixel point obtained by calculating the time-intensity curve is used as the gray value of each pixel point,and finally the dynamic process is converted into a static color image output.Imaging using 5 color parameters(1)AUC:the time-integration of the single-pixel time-intensity curve;(2)time to peak:the time for a single-pixel contrast agent to reach the peak of the time-intensity curve;(3)arrival time:the time when the intensity curve of the single-pixel contrast agent first appeared to increase significantly;(4)transit time:the time from the first appearance of the single-pixel contrast agent to the first appearance of a large increase to the first large decrease;(5)contrast agent flow rate:The speed of contrast agent flow in a single pixel.The above parameters were color-coded to form a two-dimensional color-coded distribution,and then the images of the in vitro simulation experiments were analyzed respectively.Two groups of observers(experienced and inexperienced observers)compared the ability to identify broken ends under different parameter images,and screened out the best color parameter imaging that could identify broken ends.3.Clinical validation research.Twenty cases of HCC-related bleeding from 2019.1 to 2021.12 in National Cancer Center were retrospectively collected.Two groups of observers confirmed the ability and value of color parametric imaging images to identify hemorrhage.Results1.The in vitro simulation experiment of hemorrhagic images found that the instrument setting conditions that significantly affected the hemorrhage display were:the speed and time of contrast agent injection(P=0.024;P=0.033).2.Using 5 color parameters(AUC,peak time,arrival time,transit time,contrast agent flow rate)to compare the identification breakpoint rates of 27 groups of in vitro experiments.For the two groups of observers,the time-of-arrival color parameter imaging with the highest rate of identifying breakpoints,which was significantly higher than other color parametric imaging,and the difference was statistically significant(p<0.001).Comparing the combined time-of-arrival color parameter imaging and DSA image with the DSA image,the difference between the experienced group and the inexperienced group was statistically significant(P=0.004,P=0.003).Combining the time of arrival color parameter imaging and DSA image can improved ability to identify breakpoints than DSA images alone.Regarding the effect of combining time-of-arrival color parameter imaging and DSA sequence images on identifying hemorrhages,74.1%(20 cases)of the experienced group thought it was easier to identify hemorrhages(P<0.001),and 55.6%(15 cases)of the inexperienced group thought it was easier to identify hemorrhages(P<0.001).3.In the clinical cases of hepatocellular carcinoma-related hemorrhage,the difference between the experienced group and the inexperienced group in identifying hemorrhage combined with time-of-arrival color parameter imaging was statistically significant(P=0.002,P=0.001).Simultaneous reference to the time-of-arrival color parameter imaging images and DSA sequence images helps to improve the success rate of identifying hemorrhages.In the experienced group,65%(13 cases,P<0.001)thought it was easier to identify bleeding,and 35%(7 cases,P=0.008)in the inexperienced group thought it was easier to identify bleeding.ConclusionIn vitro simulation experiments finally confirmed that the instrument setting conditions that affect the bleeding display are the speed and time of contrast agent injection.In vitro simulation experiments confirmed that time-of-arrival color-coded parametric imaging had the best ability to identify breakpoints.Both in vitro simulation experiments and clinical cases show that the combination of time-of-arrival color parameter imaging and DSA sequence images is easier and more confident than DSA images alone to identify hemorrhages. |
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