Rezultatele imediate şi la distanţă ale bolnavilor operaţi radical de cancer gastric cu pilorostenoză

Pe un lot de 113 bolnavi de cancer gastric cu pilorostenoză operaţi radical s-a evaluat supravieţuirea imediată şi la distanţă în conformitate cu stadiul şi volumul intervenţiei chirurgicale (gastrectomie, rezecţie gastrică subtotală radicală), cu rezultatele tratamentului combinat (chirurgical chimioterapic), forma histologică şi gradul de diferenţiere a procesului tumoral. Astfel, s-a constatat că supravieţuirea la distanţă (peste 5 ani) corelează în mod direct cu stadiul procesului tumoral. Cei 24 de bolnavi ce au supravieţuit peste 5 ani s-au încadrat în stadiile T1-2-3N0-2M0. Nici un bolnav cu stadiul T4N0-2M0 nu a supravieţuit peste 5 ani. La fel s-a înregistrat o supravieţuire mai bună şi în conformitate cu forma histologică şi, în special, cu gradul de diferenţiere a tumorii. Din cei 24 de bolnavi, care au supravieţuit peste 5 ani, 22 s-au încadrat în gradul înalt sau moderat de diferenţiere. Doar 2 bolnavi (unul nediferenţiat şi cel de al 2-lea – în „inel cu pecete”) au supravieţuit peste 5 ani. Formele histologice cu un nivel înalt de diferenţiere, îndeosebi, adenocarcinomul înalt diferenţiat, oferă o rată medie de supravieţuire de 5 ani, mult mai mare comparativ cu restul formelor histologice

Dynamics of exopancreatic indexes regarding the volume of radical operation in case of gastric cancer and the conservativ treatment

Catedra Hematologie şi Oncologie USMF „Nicolae Testemiţanu” IMSP Institutul Oncologic, laboratorul gastropulmonologieIn our study we have included 11 patients with gastric cancer radicaly operated, who manifested an acute pancreatitis in the postoperative period. The patients have been examined in the aspect of changing the enzimatic indexes: α-amilase, lipase, C-reactive protein and pancreatic amilase (P-amilase). The first group consisted of 4 patients with direct and large injury of pancreas within the radical enlarged and combined operations, were treated with contrical and sandostatin. The second group was formed of 7 patients, who ungergone radical enlarged operations, were treated only with contrical, so being motivated the easier evolution of acute postoperative pancreatitis, due to a minimal injury of pancreas. The radical enlarged and combined operations in gastric cancer increase the period of hyperfermentemia and increase the risk of severe evolution of acute postoperative pancreatitis. Values of plasmatic amilase to grow up beginning from the operation day and during the first two days after operation, but the period of hyper-α-amilazemia is longer in case of radical enlarged and combined operations. Values of lipase grow too during the first days after operations, despite the data from literature, but the period of hiperlipazemia is longer in cases of radical enlarged and combined operations. C-reactive protein increases during the first postoperative days and maintains until the moment when patients go home. In cases of radical enlarged operations with minimal injury of pancreas, contrical is recommended to be administered intraoperatively and during the first postoperative days it is enough for reglation of exopancreatic disorders. In cases of radical enlarged and combined operation with large direct injury of pancreas or parapancreatic tissue, the administration of sandostatine in the first days after operations is recommended. În studiul clinic am inclus 11 pacienți operați radical pe motiv de cancer gastric, care au manifestat, în perioada postoperatorie, pancreatită acută. Bolnavii au fost investigați în aspectul modificării indicilor enzimatici: α-amilaza, lipaza, proteina C-reactivă și amilaza pancreatică (Pamilaza). Grupul I format din 4 pacienți cu traumatizarea mai profundă a pancreasului în cadrul operațiilor lărgite (limfodisecţie D1 –D3) şi combinate, au fost tratați cu contrical și sandostatin. Grupul II format din 7 pacienți, au suportat operații radicale lărgite, tratați doar cu contrical, astfel fiind argumentată evoluția ușoară a PAPO, rezultată în urma unui traumatism minimal al organului. Operațiile radicale lărgite şi combinate pe motiv de cancer gastric majorează durata hiperfermentemiei și crește riscul evoluției PAPO spre forme severe. Valorile amilazei plazmatice cresc chiar din ziua operației și primele 2 zile ale perioadei postoperatorii, iar durata hiper-α-amilazemiei este mai mare în cazul operațiilor radicale lărgite şi combinate. Valorile lipazei sporesc la fel din primele zile după operație, spre deosebire de datele literaturii, iar durata hiperlipazemiei este mai mare în cazul operațiilor radicale lărgite şi combinate. Proteina Creactivă crește în primele 10 zile postoperator și se menține până la externare. În cadrul operațiilor lărgite, unde traumatismul pancreasului este mai mic, contricalul administrat intraoperator și în primele zile postoperatorii este suficient pentru reglarea disfuncției exopancreasului. În cazul operațiilor radicale lărgite, în timpul cărora are loc un traumatism mai masiv şi direct al pancreasului, sau a țesutului parapancreatic, este argumentată administrarea și a sandostatinei, îndeosebi, din primele zile după operație

Differentiation of Clear Cell Renal Cell Carcinoma from other Renal Cell Carcinoma Subtypes and Benign Oncocytoma Using Quantitative MDCT Enhancement Parameters

Background and objectives: The use of non-invasive techniques to predict the histological type of renal masses can avoid a renal mass biopsy, thus being of great clinical interest. The aim of our study was to assess if quantitative multiphasic multidetector computed tomography (MDCT) enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. Materials and Methods: A total of 154 renal tumors were retrospectively analyzed with a four-phase MDCT protocol. We studied attenuation values using the values within the most avidly enhancing portion of the tumor (2D analysis) and within the whole tumor volume (3D analysis). A region of interest (ROI) was also placed in the adjacent uninvolved renal cortex to calculate the relative tumor enhancement ratio. Results: Significant differences were noted in enhancement and de-enhancement (diminution of attenuation measurements between the postcontrast phases) values by histology. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924–0.995) and 0.827 (95% CI: 0.752–0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The 3D analysis allowed the differentiation of ccRCC from chromophobe RCC (chrRCC) with a AUC of 0.643 (95% CI: 0.555–0.724). Wash-out values proved useful only for discrimination between ccRCC and oncocytoma (43.34 vs 64.10, p < 0.001). However, the relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929–0.993) and 0.799 (95% CI: 0.721–0.864), respectively. Conclusions: Our observations point out that imaging features may contribute to providing prognostic information helpful in the management strategy of renal masses

Preoperative Predicting the WHO/ISUP Nuclear Grade of Clear Cell Renal Cell Carcinoma by Computed Tomography-Based Radiomics Features

Nuclear grade is important for treatment selection and prognosis in patients with clear cell renal cell carcinoma (ccRCC). This study aimed to determine the ability of preoperative four-phase multiphasic multidetector computed tomography (MDCT)-based radiomics features to predict the WHO/ISUP nuclear grade. In all 102 patients with histologically confirmed ccRCC, the training set (n = 62) and validation set (n = 40) were randomly assigned. In both datasets, patients were categorized according to the WHO/ISUP grading system into low-grade ccRCC (grades 1 and 2) and high-grade ccRCC (grades 3 and 4). The feature selection process consisted of three steps, including least absolute shrinkage and selection operator (LASSO) regression analysis, and the radiomics scores were developed using 48 radiomics features (10 in the unenhanced phase, 17 in the corticomedullary (CM) phase, 14 in the nephrographic (NP) phase, and 7 in the excretory phase). The radiomics score (Rad-Score) derived from the CM phase achieved the best predictive ability, with a sensitivity, specificity, and an area under the curve (AUC) of 90.91%, 95.00%, and 0.97 in the training set. In the validation set, the Rad-Score derived from the NP phase achieved the best predictive ability, with a sensitivity, specificity, and an AUC of 72.73%, 85.30%, and 0.84. We constructed a complex model, adding the radiomics score for each of the phases to the clinicoradiological characteristics, and found significantly better performance in the discrimination of the nuclear grades of ccRCCs in all MDCT phases. The highest AUC of 0.99 (95% CI, 0.92–1.00, p < 0.0001) was demonstrated for the CM phase. Our results showed that the MDCT radiomics features may play a role as potential imaging biomarkers to preoperatively predict the WHO/ISUP grade of ccRCCs