2022年 · 第102卷第07期

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, accounting for approximately 82% of mesenchymal tumors in the gastrointestinal tract. The incidence of GIST varies in different countries and regions. The incidence rate in North America is (0.68~0.70) /100,000 people per year, the incidence rate in Europe is (1.00~1.45) /100,000 people per year, and the incidence rate in South Korea is about 1.60/100,000 people per year. The data on the incidence of GIST in China is very limited. There are 4 studies conducted only in a single city or province (Shanxi, Taiwan, Hong Kong, Shanghai), and the incidence is (0.40~2.11) per 100,000 people per year, with a wide range of incidence rates. Therefore, this study used nationally representative data from 2013 to 2016 to assess the incidence of GIST in urban population in mainland China and analyze its sex, age and regional distribution characteristics.

At present, clinical diagnosis and treatment guidelines mostly recommend conventional ultrasound as the first choice diagnostic method for hepatocellular carcinoma (HCC) monitoring and screening in patients with liver cirrhosis. However, the liver parenchyma of patients with cirrhosis tends to be rough, and routine ultrasound examination tends to mask or miss tiny nodules. In contrast-enhanced ultrasound with Sonazoid, a persistent and stable Kupffer phase occurs, so a complete scan of the liver can be performed at this time to detect minor lesions. In addition, for newly discovered lesions with low-no enhancement in Kupffer stage, contrast reperfusion imaging can be used to further determine whether the newly detected nodules are HCC. This study was a prospective, multicenter randomized controlled trial to demonstrate that contrast-enhanced ultrasound with Sonazoid, coupled with whole liver scanning during the Kupffer phase, enhances the detection rate of small liver cancer compared to conventional ultrasound. A total of 656 patients with hepatitis B/hepatitis C cirrhosis from 23 institutions were included in this study, and the patients were randomly divided into two groups: routine ultrasound monitoring group and Sonazoid contrast-enhanced ultrasound group. The results showed that at the first detection of HCC, the mean diameter of tumors in the contrast-enhanced ultrasound group was [(13.0±4.1) mm;n=28)] was smaller than that in the conventional ultrasound group [(16.7±4.1) mm;n=26）］（P=0.011）。 Among them, at the first detection of HCC in 38 patients with hepatitis C cirrhosis, the mean diameter of tumors in the contrast-enhanced ultrasound group was [(12.7±3.1) mm;n=20)] was smaller than that in the conventional ultrasound group [(17.6±7.0) mm;n=18）］（P=0.012）； In contrast, the mean diameter of tumors in the contrast-enhanced ultrasound group at the first detection of HCC in 16 patients with hepatitis B cirrhosis was [(13.6 ± 6.0) mm;n=8)] was similar to the mean diameter of the tumor in the conventional ultrasound group [(14.5 ± 2.7) mm;n=8）］（P=0.715）。

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and the third leading cause of cancer-related death. Bisphenotypic hepatocellular carcinoma (DPHCC), as a subtype of HCC, was included in the evidence-based practice guidelines for the pathological diagnosis of primary liver cancer in China in 2015. The preliminary diagnosis of DPHCC by preoperative imaging is crucial for clinical decision-making, because there is evidence that CK7, CK19 positive HCCs have high aggressive, proliferative and migratory abilities. In order to describe the clinical characteristics and prognosis of patients with DPHCC, the study included 50 patients with postoperative pathological diagnosis of DPHCC (observation group) and 50 patients with CK7 and CK19 negative HCC (control group) who attended from January 2015 to December 2018 (all underwent gadoxetate-enhanced MRI). The images of arterial phase, portal phase, delayed phase and hepatobiliary phase were analyzed using radiomics platform, and the minimum absolute contraction and selection operator (LASSO) dimensionality reduction, multilayer perceptron, support vector machine, logistic regression and k-nearest neighbor classifiers were used to distinguish DPHCC from CK7 and CK19 negative HCC. Kaplan Meier survival analysis assessed 1-year disease-free survival (DFS) and overall survival (OS) in the observation and control groups. The results show that the best preoperative diagnostic capability of DPHCC may come from the combination of different stages and classification methods. Logistic regression showed better sensitivity, specificity and accuracy in portal phase (0.740, 0.780, 0.766), delayed phase (0.893, 0.700, 0.798), hepatobiliary phase (0.800, 0.720, 0.756) and multilayer perceptron in portal phase (0.800, 0.720, 0.756). In the observation group, the 1-year DFS was 69% and the OS was 78%. The 1-year DFS and OS of control patients were 83% and 85%, respectively. Kaplan-Meier survival analysis showed no statistically significant differences in DFS and OS between groups (P=0.231, 0.326), but DFS and OS were lower in patients with DPHCC. Radiomic features extracted from gadoxetate disodium-enhanced MRI images can be used to diagnose preoperative DPHCC. DPHCC is more likely to relapse and lead to death than HCC, suggesting that patients with DPHCC need active management after surgery.