RATIONALE AND OBJECTIVES:By comparing conventional ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) features of liver metastases of melanoma (LMM) with those of other common liver metastases from non-melanoma malignancies (non-LMM), a differential diagnosis nomogram was developed and internally validated to explore its clinical application value. MATERIALS AND METHODS:This single-center, retrospective, case-control study enrolled 108 patients with LMM (109 lesions) and 95 patients with non-LMM (109 lesions) at our institution from January 2017 to April 2025. All cases were confirmed by pathological diagnosis. Univariate analysis was performed to compare clinical characteristics and US/CEUS features between groups. Variables with P < 0.05 were entered into a stepwise bidirectional regression model (based on the Akaike information criterion (AIC)) to identify independent risk factors and assess collinearity (using variance inflation factor (VIF)). A nomogram was developed using logistic regression and generalized estimating equations (GEE) and evaluated by the area under the receiver operating characteristic curve (AUC-ROC), bootstrapping (1000 resamples), calibration curves, and decision curve analysis (DCA). RESULTS:The independent risk factors included in the nomogram model were morphology, posterior acoustic enhancement, number, enhancement pattern and wash-out time. The model demonstrated an AUC of 0.892 (95% CI: 0.849-0.935) and a bias-corrected AUC of 0.873 (95% CI: 0.805-0.933) by bootstrapping. Both calibration curves and DCA demonstrated the nomogram's favorable calibration and clinical utility (Hosmer-Lemeshow test, P > 0.05). CONCLUSION:The LMM differential diagnosis nomogram based on US/CEUS features complements clinical screening and facilitates precise diagnosis while aiding in subsequent treatment evaluation and follow-up.

The association between estrogen and hepatocellular carcinoma (HCC) remains controversial. This study explored estradiol (E2)'s effect on HCC recurrence post-minimally invasive treatment and age's critical modifying role. 247 male HCC patients were prospectively enrolled, underwent radiofrequency ablation, and followed up for 36 months. Confounding factors were analyzed via cubic spline regression Cox model, with hierarchical analysis for age-specific effects. E2 and age showed a nonlinear correlation with HCC recurrence, with age identified as a confounding factor for E2. The cutoff values were 53/67 years (age) and 42 pg/ml (E2). For patients <53 years, E2 ≥42 pg/mL was linked to a significantly lower cumulative recurrence rate (CRR, p = 0.002); for 53-67 years (p = 0.065), no significant difference was observed; for >67 years, E2 ≥42 pg/mL was associated with a significantly higher CRR (p < 0.001). Thus, age modulates E2's dual role: protective (<53 years), transitional (53-67 years), and risk-promoting (>67 years).

BackgroundBoth endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) have advantages and disadvantages. However, few surgeons integrate the strengths of both approaches to manage common bile duct stones.Materials and methodsWe retrospectively analyzed the clinical data of 40 patients with gallbladder stones complicated by common bile duct stones, all of whom were treated by our treatment group between June 2024 and December 2024 in the Department of Hepatobiliary Surgery, Wuhan Central Hospital. Based on the surgical approach, the patients were divided into an experimental group (n = 30, combined use of laparoscopy, choledochoscopy, and duodenoscopy) and a control group (n = 10, ERCP followed by laparoscopic cholecystectomy). Data were collected in terms of demographic characteristics (age, gender, body mass index), intraoperative variables (operative time, estimated blood loss, and width of the common bile duct), and postoperative variables (time for postoperative gas passage, postoperative hospital stay, and complications).ResultsIn the experimental group, the mean age of the patients was 63 years. The mean operative time was 152 min. The mean estimated blood loss was 46 mL. Two patients (6.7%) suffered from postoperative pancreatitis. In one patient, the condition was caused by intraoperative stone extraction manipulation. The condition of the two patients improved after symptomatic treatment for pancreatitis was administered. One patient (3.3%) suffered from biliary fistula. Compared with the control group, hospital stay was significantly shorter in the experimental group; however, there was an increase in operative blood loss and operative time. No significant differences were found in the other indices.ConclusionIn the management of gallbladder stones with common bile duct stones, the “single-stage triple-endoscopic approach” represents a minimally invasive treatment with high clinical applicability. It is as safe and effective as traditional treatment regimens, and both ERCP and LCBDE have their own advantages.

BACKGROUND:Inappropriate selection of patients with early gastric cancer (EGC) for endoscopic submucosal dissection (ESD) may lead to non-curative resection, necessitating additional gastrectomy. Conversely, inappropriate selection for gastrectomy may result in overtreatment, adversely affecting patients' quality of life. Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC. To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients', we specifically assess the suitability of Japanese guidelines in non-Japanese populations. This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan. AIM:To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies. METHODS:A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022. Cases were categorized into three groups: Same-estimated (preoperative therapeutic indication with postoperative pathological criteria matched), underestimated (preoperative ESD indication but postoperative surgical criteria), and overestimated (preoperative surgical indication but postoperative ESD criteria). The rate of discrepancy and associated risk factors were assessed. RESULTS:The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0% (321/430) and 76.0% (278/366), respectively. The overall discrepancy rate was 25.6% (204/796). Multivariate analysis identified tumor location in the upper-third stomach (odds ratio = 2.158, 95% confidence interval: 1.373-3.390, P = 0.001) was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy (odds ratio = 2.005, 95% confidence interval: 1.036-3.879, P = 0.039) was more likely to be overestimated. Significant differences were observed in tumor diameter (P < 0.001), depth of infiltration (P < 0.001), ulcerative findings (P < 0.001), and histologic type (P < 0.001) between preoperative and postoperative evaluations. CONCLUSION:The accuracy of preoperative EGC indications is 74.4%. Upper-third stomach and undifferentiated histology are primary discrepancy predictors. Upper-third tumors are prone to underestimation, while undifferentiated tumors are prone to overestimation.

OBJECTIVES:In this study, we aimed to examine the effects of cancer stem cells (CSCs) on residual hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA), and how to reduce the frequency of carcinoma cells with the CSCs phenotype in residual tumors after RFA. MATERIALS & METHODS:Two HCC cell lines were exposed to 43 °C for 30 min in vitro using a water bath. Cell cycle, EdU assays and plate colony assays were performed to evaluate the proliferation of HCC cells. Cell migration was determined using wound healing and Transwell assays. Sphere formation and in vivo limiting dilution assays were performed to evaluate stemness. In vivo, two tumor-bearing mice were used to evaluate residual tumor growth, and treatments included an extracellular signal-regulated kinase (ERK) inhibitor U0126 and salinomycin (Sal). RESULTS:In vitro, sublethal heat accelerated cancer cell proliferation, migration, and stemness, and induced molecular changes of epithelial-mesenchymal transition (EMT), ERK, and the β-catenin pathway. ERK inhibitor and Sal inhibited the proliferation, migration, and stemness of heat-treated HCC cells. The results showed that, in vivo, the ERK inhibitor + Sal significantly inhibited the growth of residual tumors after incomplete RFA. Compared with incomplete RFA alone, EMT markers, ERK, and the β-catenin pathway were also significantly inhibited after treatment with ERK inhibitor + Sal. CONCLUSIONS:Incomplete RFA can accelerate cell proliferation, migration, and stemness in residual tumors. ERK inhibitor combined with Sal could inhibit cancer cell proliferation, migration, and stemness to synergically inhibit the progression of residual tumor.

Abstract This guideline provides a comprehensive overview of the integrative management protocols for ultrasound imaging of thyroid tumors, addressing indications, operational methods, reporting content, and advanced imaging techniques. It outlines the primary indications for thyroid ultrasound, such as evaluating thyroid enlargement or atrophy and assessing nodule characteristics and quantity. The examination method emphasizes the use of a high-frequency linear-array probe (9–16 MHz) and details patient positioning, scanning planes, and measurement standards. The content covers thyroid morphology, nodule location, echo features, lymph node status, and blood flow. Additionally, the guideline introduces the Thyroid Imaging Reporting and Data System (TI-RADS) classification criteria and management principles for stratifying the malignant risk of nodules, along with guidance on fine-needle aspiration biopsy decisions. It also includes key technical points, indications, and limitations of contrast-enhanced ultrasound and ultrasound elastography, as well as operational procedures, indications, and complication management for ultrasound-guided fine-needle aspiration biopsy. Overall, this guideline aims to enhance the standardization and precision in the diagnosis and treatment of thyroid nodules by providing integrated technical guidance for ultrasound diagnosis, risk assessment, and clinical management of thyroid tumors.

Abstract With the wider use of local ablation for hepatocellular carcinoma (HCC), patients who have large tumors close to major hepatic vessels remain a difficult group to treat. In these patients, local tumor progression (LTP) and treatment-related complications are both common. For many years, the evaluation and technical optimization of radiofrequency ablation (RFA) in perivascular HCC have been insufficient, and current guidelines give only general advice rather than clear recommendations. This article is a narrative review with a structured literature search. We searched PubMed, Web of Science, CNKI, and Wanfang from database inception to September 2024 using the keywords “hepatocellular carcinoma, radiofrequency ablation, perivascular tumor, large tumor, heat-sink effect, combined therapy, navigation, artificial intelligence, computational modeling". We mainly included phase I–III clinical studies, randomized controlled trials, observational cohorts, meta-analyses, translational experiments, and modeling studies. The available evidence shows that large perivascular tumors often have uneven heating due to the heat-sink effect. The ablation effect and the risk of vascular or biliary injury are determined by tumor size, vessel diameter and shape, electrode placement, and system power configuration. Perivascular HCC differs clearly from non-perivascular HCC in local control, recurrence pattern, and complication rate. Consequently, RFA alone is generally insufficient and should be considered only within multimodal treatment strategies. At present, the use of multimodal and individualized strategies for large perivascular HCC is still limited, and practical treatment algorithms are lacking. In this review, we discuss how large perivascular HCC should be managed within a multimodal framework, in which non-ablative therapies such as SBRT, transarterial approaches, and systemic treatment constitute the therapeutic backbone, while RFA-based strategies may serve selected adjunctive roles under specific clinical conditions.

OBJECTIVES:The aim of this study was to establish prediction models for gallbladder lesions (GBLs) malignancy risk using contrast-enhanced ultrasound (CEUS) and arrival-time parametric imaging (ATPI). METHODS:From January 2013 to July 2020, a total of 59 patients in Peking University Cancer Hospital with GBLs were retrospectively enrolled in this study. All patients underwent ultrasound (US), CEUS, and subsequent ATPI analysis before receiving surgical treatment and getting a histopathological diagnosis. Univariate and multivariate analyses were used to select the independent predictors for malignancy. CEUS and CEUS + ATPI prediction models were established and displayed by nomogram. Receiver operating characteristic and calibration curves were drawn to evaluate the predictive ability of the models. Decision curve analysis was used to assess the clinical utility of the models. RESULTS:On univariate and multivariate analysis, diameter (p < .001), shape (p = .030), and washout time (p = .011) were included in the CEUS model, whereas diameter (p = .001), washout time (p = .012), and vascular pattern (p < .001) were incorporated into the CEUS + ATPI model. The AUC of the CEUS and CEUS + ATPI models were 0.908 and 0.978, respectively. Both models yielded a good net benefit for almost all threshold probabilities. CONCLUSION:Prediction models based on CEUS and ATPI can markedly enhance diagnostic accuracy of GBLs by providing information such as a more accurate size, shape, arterial vascular pattern, and washout time in a more intuitive and quantitative way.

Previous studies on the immune function after radiofrequency ablation (RFA) mainly focused on the immune microenvironment in residual tumors. Thus, we investigate the impact of complete RFA (cRFA) and incomplete RFA (iRFA) on the immune microenvironment of distant tumors, determining whether combination with immunotherapy can improve outcomes. Using a bilateral subcutaneous CT26 murine model, one tumor underwent cRFA or iRFA while the contralateral tumor served as a distant site. Immune profiling by ribonucleic acid (RNA) sequencing, flow cytometry, and immunohistochemistry was performed at days 3 and 9 post-RFA (6 mice per group). Based on transcriptomic findings, anti-CTLA-4 therapy was evaluated following cRFA. Tumor growth and survival were additionally assessed (8 mice per group). Infiltration of CD8+ T-cells post-RFA increased at day 3 compared with controls (p = 0.049), while decreasing at day 9 after cRFA. Additionally, the ratio between pro-inflammatory and anti-inflammatory macrophages (M1/M2) decreased at day 9 (p = 0.034), suggesting an immunosuppressive microenvironment. RNA-seq demonstrated that CTLA-4 significantly upregulated 9 days after cRFA. Combined cRFA+anti-CTLA-4 increased distant tumor CD8+ T-cells, and distant tumor growth in this group was significantly decreased versus cRFA alone (p = 0.040). Complete RFA is associated with a delayed immunosuppressive shift in distant tumors. Targeting CTLA-4 following ablation may partially mitigate this effect and enhance systemic tumor control. The combination of anti-CTLA-4 targeted therapy and complete radiofrequency ablation demonstrated a synergistic anti-tumor immunotherapy effect, which provided a potentially better therapeutic strategy for preventing tumor recurrence after radiofrequency ablation.

OBJECTIVE:To evaluate the response to neoadjuvant therapy in patients with colorectal liver metastases (CRLMs) using ultrasound(US) and contrast-enhanced ultrasound(CEUS), with correction to the tumor regression grade (TRG) of pathological results. METHODS:This study included patients with resectable CRLMs admitted from February to December 2022. After at least 4 cycles neoadjuvant therapy, all the patients received US and CEUS examinations within two weeks before hepatectomy. CEUS clips were postprocessed with color parameter imaging (CPI) and microflow imaging (MFI) analysis. Logistic regression analyses were used to develop an evaluation Nomogram. Ultrasound-based model was constructed to discriminate between the response (TRG1/2/3) and nonresponse (TRG4/5) groups at the lesion level. The model's predictive ability was evaluated using the C index and calibration curve, with decision curve analysis assessing the Nomogram's added value. RESULTS:The study analyzed 105 CRLM lesions (the lesion with the highest diameter analyzed for each patient), with 43.8% showing a response to therapy. Univariate analysis identified calcification on US (p = 0.039), CEUS enhancement degree (p < 0.001), CEUS enhancement pattern (p<0.001), CEUS washout type (p < 0.001), CEUS necrosis (p < 0.001), CPI feeding artery (p = 0.003) and MFI pattern (p < 0.001) were significantly associated with TRG. The multivariate analysis showed CEUS enhancement pattern (p = 0.026), CEUS washout type (p = 0.018) and CEUS necrosis (p = 0.005) were independently associated with the neoadjuvant therapy response. A Nomogram with the three independent predictors was developed, with an AUC of 0.898. CONCLUSION:The ultrasound-based model provided accurate evaluation of pathological tumor response to preoperative chemotherapy in patients with CRLM, and may help to decide the individualized treatment strategy.

Sonazoid, a combined blood pool and Kupffer-cell agent, can be specifically phagocytosed by Kupffer cells in the liver, allowing lesion detection and characterization of focal liver lesions (FLLs) at the post-vascular phase, apart from the vascular phase, which is similar to that of other second-generation ultasound (US) contrast agents. Sonazoid contrast-enhanced US (CEUS) is currently approved for use in some Asian countries. With the increasing use of Sonazoid CEUS for FLLs in clinical practice, developing consensus or guidelines to help standardize its use is required. The expert consensus aimed to review recent evidence and make evidence-based recommendations for radiologists and clinicians involved in the management of liver diseases regarding the use of Sonazoid CEUS in the surveillance or detection, characterization of FLLs, CEUS for interventional and intraoperative use, and tumor treatment response evaluation in patients with FLLs. This consensus was conducted without using artificial intelligence tools in accordance with the TITAN Guidelines 2025.

Background:Peritoneal lesions present diagnostic challenges, necessitating precise imaging techniques. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) offers a promising approach for accurate diagnosis, aiding in optimal patient management and treatment planning. Objective:This study aims to assess the diagnostic efficacy of EUS-FNA in peritoneal lesions to offer insight in guiding optimal patient management. Methods:A prospective observational study was conducted, and a total of 58 patients who underwent EUS-FNA of the peritoneum at our hospital between October 2021 and November 2021 were included. The ultrasound diagnostic instrument facilitated puncture guidance, with 2-5 punctures performed in various parts of the selected peritoneal lesion areas. The analysis encompassed evaluating the sensitivity, specificity, positive predictive value, and negative predictive value of biopsy for diagnosing peritoneal-associated lesions, alongside assessing the number of punctures, puncture satisfaction, and incidence of postoperative complications. Results:The included patients undergoing EUS-FNA revealed that 41 (70.69%) had malignant lesions, while 17 (29.31%) presented with benign lesions. The diagnostic accuracy of EUS-FNA for peritoneal lesions was determined to be 94.83%, with a diagnostic sensitivity of 97.30% for malignant tumors, specificity of 90.48%, positive predictive value of 94.74%, and negative predictive value of 95%. Lesions exhibited a size range of 2.5cm × 2.9cm to 15.2cm × 9.8cm. Each patient underwent 2-5 punctures (3.3 ± 1.4), with a puncture satisfaction rate of 96.55%. The incidence of postoperative complications following EUS-FNA was found to be 3.45%. Conclusion:EUS-FNA exhibits substantial diagnostic utility for peritoneal-related lesions, marked by exceptional accuracy, sensitivity, specificity, and favorable safety. Its clinical adoption is warranted, promising improved patient care and management.

PURPOSE:To investigate the safety and efficacy of percutaneous ultrasound-guided radiofrequency ablation (RFA) for the treatment of patients with colorectal liver metastases (CRLM) ≥5 lesions. METHODS:A retrospective study was conducted on 492 patients with CRLM who underwent RFA in our center from January 2018 to July 2023. The clinical baseline characteristics of the CRLM ≥ 5 group and CRLM < 5 group were balanced by propensity score matching. Survival curves were assessed using the Kaplan-Meier and log-rank test. Univariate and multivariate Cox regression analyses were used to determine prognostic factors. RESULTS:A total of 69 patients were enrolled after 1:2 matching, including 23 patients in CRLM ≥ 5 group and 46 patients in CRLM < 5 group. The 1-, 3- and 5-year overall survival (OS) rates were 87.0%, 24.9%, 24.9% in CRLM ≥5 group and 97.8%, 51.6%, 37.4% in CRLM < 5 group, respectively. The OS of CRLM ≥ 5 group was shorter than that of CRLM < 5 group (median survival 21.0 ± 3.7 months vs 44.0 ± 7.9 months, p = 0.007). The rates of intrahepatic progression-free survival (ihPFS) at 1-, 3- and 5-years were 17.4%, 0%, 0% in CRLM ≥5 group and 53.9%, 29.9%, 29.9% in CRLM < 5 group, respectively. The ihPFS was shorter in CRLM ≥5 group than in CRLM < 5 group (median time 4.0 ± 1.2 months vs 17.0 ± 6.7 months, p < 0.001). The number of CRLM and extrahepatic metastases were independent risk factors for OS. The number of CRLM and tumor size were independent risk factors for ihPFS. No major complications occurred in either group. CONCLUSION:Radiofrequency ablation is safe and effective for the treatment of CRLM ≥5 lesions.

Introduction:It is challenging to diagnose liver masses in the context of a rough liver background using computed tomography and magnetic resonance imaging. Perfluorobutane CEUS microbubble, an ultrasound (US) contrast agent, has a unique phase called the Kupffer phase. This study aimed to explore whether the diagnostic ability of Kupffer-CEUS is affected by the rough liver background. Methods:A prospective analysis was conducted on patients with access to histological pathology of FLLs and liver parenchyma from 23 centers between August 2020 and March 2021. Kupffer-CEUS was performed on 552 patients, who were divided into two groups (normal and abnormal) based on the pathological results of liver parenchyma, and the abnormal group was further divided into four groups (sight liver fibrosis, serious liver fibrosis, fatty liver, mixed). Kupffer-CEUS was divided into vascular phase and vascular and Kupffer phase. Results:In Kupffer-CEUS, differences in diagnostic efficiency of FLLs between normal and abnormal liver backgrounds were not statistically significant. However, in patients with abnormal liver backgrounds, the specificity (57.45% vs. 74.47%, p = 0.008) and accuracy (89.81% vs. 96.92%, p < 0.001) of the vascular phase in distinguishing malignant from benign lesions were statistically lower than those of the vascular and Kupffer phase (V&KP). Subgroup analysis revealed that the sensitivity, specificity, and accuracy of V&KP in screening FLLs were all higher than those of vascular phase, except for the accuracy in patients with serious liver fibrosis (98.51% vs. 94.06, p < 0.001). Conclusion:This study indicated that although there is no obvious restriction on the choice of Kupffer-CEUS methods when diagnosing liver masses in patients with normal or abnormal liver backgrounds, Kupffer phase CEUS can effectively reduce the misdiagnosis of FLLs. Particularly for patients with serious liver fibrosis, contrast-enhanced US combined with the Kupffer phase can provide a more accurate diagnosis than conventional contrast-enhanced ultrasonography.

Background: High-intensity focused ultrasound (HIFU) represents a therapeutic medical procedure that operates by inducing ablation and mechanical disruption. Despite its established efficacy, its potential impact on tumor chemotherapy remains uncertain. Long noncoding RNA (lncRNA) MAFA-AS1 facilitated cancer cell proliferation and fostering drug resistance, but the precise significance and functional implications of MAFA-AS1 in the context of ovarian cancer (OC) remain largely unexplored. The objective of this experiment is to further investigate the potential of HIFU in inhibiting the chemotherapy resistance mechanism of OC. Materials and Methods: Five types of human ovarian cancer cells were employed in this study. There were four different groups, namely MAFA-AS1 siRNA, si-NC, pcDNA3.1-HIF-1 (hypoxiainducible factor-1), and pcDNA3.1-control. Quantitative real-time PCR, cell proliferation assay, apoptosis assay, western blot assay, subcellular fractionation, aerobic glycolysis analysis, RNA immunoprecipitation (RIP), and luciferase reporter assay were conducted for experimentation and validation. Results: Significant upregulation of MAFA-AS1 in OC cells was observed. Through loss-of-function experiments based on HIFU, we unraveled its oncogenic functions in OC. MAFA-AS1 was discovered to bind to HIF-1 mRNA, thereby enhancing its expressed stability. Further investigations revealed an interaction between MAFA-AS1 and fat mass and obesity-associated protein (FTO), positively modulating HIF-1 mRNA stability in an FTO -dependent manner. Importantly, MAFA-AS1 exerts its effects on OC by acting through HIF-1. Conclusion: The study underscores the role of MAFA-AS1 in promoting aerobic glycolysis and chemical resistance in OC by up-regulating HIF-1 expression, suggesting that targeting MAFA-AS1 holds promise as a therapeutic strategy for OC patients undergoing chemotherapy.

BACKGROUND:KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases (CLMs). Emerging evidence suggests a potential interaction between these two variables that may influence clinical outcomes. AIM:To investigate the association of KRAS mutations with recurrence in patients with CLM who underwent radiofrequency ablation (RFA) according to the primary tumor location. METHODS:This retrospective study analyzed 164 patients with KRAS-determined CLM treated with percutaneous RFA between January 2012 and December 2018. The clinicopathological characteristics, recurrence patterns, and survival outcomes were systematically evaluated. RESULTS:A total of 164 patients (mean age: 58.0 ± 9.8 years, range: 34-83 years) who underwent percutaneous RFA of 325 CLMs (mean size: 2.2 ± 1.0 cm, range: 0.7-5.0 cm) were included in the study. Eighty-nine (54.3%) patients had wild-type KRAS, and 75 (45.7%) patients had mutated KRAS. Compared with wild-type patients, patients with KRAS mutations presented significantly higher local tumor progression rates (30.7% vs 14.6%, P = 0.013). Among 126 patients (76.8%) who experienced post-RFA recurrence, 61.6% developed intrahepatic metastases, and 53.7% developed extrahepatic metastases. Primary tumor location significantly modified KRAS-related outcomes: Compared with wild-type patients, left-sided colorectal cancer (CRC) patients with KRAS mutations presented higher intrahepatic recurrence rates (77.2% vs 52.5%, P = 0.003) and shorter median intrahepatic recurrence-free survival (15 vs 25 months, P = 0.007). No significant differences in KRAS expression were detected in right-sided tumors. CONCLUSION:KRAS mutation status predicts differential recurrence patterns after CLM ablation, with significant prognostic implications, specifically in left-sided CRCs. These findings underscore the importance of integrating molecular profiling and primary tumor characteristics in therapeutic decision-making for patients with metastatic CRC.

ObjectiveThe purpose of the study described was to establish prediction models to initially screen the beneficiary patients with unresectable hepatocellular carcinoma (HCC) in the treatment of anti-vascular endothelial growth factor (VEGF) agents plus anti-programmed cell death-1 (PD-1) antibody.MethodsA total of 62 patients were enrolled in this study. All patients underwent ultrasound (US), color ddoppler flowing imaging (CDFI), contrast-enhanced ultrasound (CEUS) and laboratory examinations within 2 wk before the treatment. Tumor response was assessed according to mRECIST criteria. Univariate and multivariate analyses were used to select the independent predictors. US + CDFI, CEUS and FULL models were established. Three models were displayed by nomography. Receiver operating characteristic (ROC) and calibration curves were drawn to evaluate the predictive ability of models. Decision curve analysis (DCA) was used to assess the clinical utility of models.ResultsOn univariate and multivariate analysis, the US boundary (p = 0.037), halo (p = 0.002) and CDFI (p = 0.024) were included in the US + CDFI model. CEUS boundary (p = 0.001) and washout time (p < 0.001) were included in the CEUS model. The number of lesions (p = 0.104), halo on US (p = 0.014), CDFI (p = 0.057) and washout time on CEUS (p = 0.015) were incorporated into the FULL model. The C indices of the US + CDFI, CEUS and FULL models were 0.918, 0.920 and 0.973. CEUS and FULL models yielded a good net benefit for almost all threshold probabilities.ConclusionNomograms based on US, CDFI, CEUS and clinical characteristics could help to non-invasively predict the response to treatment with anti-PD-1 antibodies plus anti-VEGF agents.

Conventional endoscopy is widely used in the diagnosis of early gastric cancers (EGCs), but the graphical features were loosely defined and dependent on endoscopists’ experience. We aim to establish a more accurate predictive model for infiltration depth of early gastric cancer including a standardized colorimetric system, which demonstrates promising clinical implication. A retrospective study of 718 EGC cases was performed. Clinical and pathological characteristics were included, and Commission Internationale de l’Eclariage (CIE) standard colorimetric system was used to evaluate the chromaticity of lesions. The predicting models were established in the derivation set using multivariate backward stepwise logistic regression, decision tree model, and random forest model. Logistic regression shows location, macroscopic type, length, marked margin elevation, WLI color difference and histological type are factors significantly independently associated with infiltration depth. In the decision tree model, margin elevation, lesion located in the lower 1/3 part, WLI a*color value, b*color value, and abnormal thickness in enhanced CT were selected, which achieved an AUROC of 0.810. A random forest model was established presenting the importance of each feature with an accuracy of 0.80, and an AUROC of 0.844. Quantified color metrics can improve the diagnostic precision in the invasion depth of EGC. We have developed a nomogram model using logistic regression and machine learning algorithms were also explored, which turned out to be helpful in decision-making progress.