目的建立一个基于临床特征和术前计算机断层扫描(CT)影像组学的预测模型辅助诊断囊腔型肺癌。方法回顾性分析2020年1月至2021年12月在青岛大学附属医院及济宁医学院附属医院接受手术治疗的患者,纳入病变中含有囊腔的患者296例,并分为囊腔型肺癌和良性病变两组。从术前CT图像上提取病灶的影像组学特征,并综合分析临床病理特征。将上述特征进行筛选后以随机森林算法构建诊断模型,其中来自青岛大学附属医院的214例患者进行训练和内部验证(D1)。其余82例来自济宁医学院附属医院的患者作为独立的外部验证队列(D2)。通过受试者工作特征曲线(ROC)、校准曲线及决策曲线分析(DCA)对模型的分类能力进行评估。结果囊腔型肺癌组患者年龄高于良性病变组(60.12±9.95 vs 50.86±13.66,P<0.001),其余临床特征差异无统计学意义。影像组学特征经筛选后获得形状平坦度、稳健平均绝对偏差、差异方差等5种影像组学纹理特征。临床与影像组学特征融合后构建随机森林模型在D1(AUC 0.97)和D2(AUC 0.74)上均显示出较好的诊断效能,在D1中的准确性、敏感性与特异性分别为0.92、0.85和0.99。结论构建并外部验证了一个实用的诊断模型,可以比较准确地区分囊腔型肺癌和囊腔样良性病变。这种创新的方法可作为囊腔型肺癌的一种新的无创诊断工具。
目的:评估PD-L1表达(CPS)和TILs密度对ESCC免疫联合化疗疗效的预测能力,验证TIME分型体系,探索其临床转化潜力。方法:回顾性分析2017年1月至2024年12月青岛大学附属医院收治的238例初治ESCC患者,均接受PD-1/PD-L1抑制剂联合化疗。通过免疫组化检测PD-L1表达(CPS)和TILs密度,基于PD-L1 (CPS ≥ 10)和TILs (≥20%)将TIME分为四型(PD-L1+/TIL+、PD-L1+/TIL−、PD-L1−/TIL+、PD-L1−/TIL−)。采用Fisher-Freeman-Halton检验等统计学方法评估各型ORR差异,并用Kaplan-Meier法及Log-rank检验分析生存数据。结果:PD-L1阳性(CPS ≥ 10)和TILs高浸润(≥20%)患者ORR更高(PD-L1+ vs. PD-L1−: 34.9% vs. 20.8%, P = 0.030;TIL+ vs. TIL−: 42.7% vs. 7.4%, P +/TIL+) ORR最高(44.55%),显著优于其他亚型(vs. IV型:P −/TIL−) ORR最低(12.50%)。生存分析显示,II型中位OS (37.4个月)和PFS (23.1个月)显著优于I型和IV型(Log-rank P Objective: To assess the predictive value of PD-L1 expression (CPS) and TILs density for ICI-chemotherapy efficacy in ESCC patients and validate the TIME classification system. Methods: Retrospective analysis of 238 treatment-naïve ESCC patients receiving PD-1/PD-L1 inhibitors combined with chemotherapy from January 2017 to December 2024. PD-L1 (CPS) and TILs density were evaluated by immunohistochemistry. TIME was classified into four subtypes based on PD-L1 (CPS ≥ 10) and TILs (≥20%). ORR differences were assessed using Fisher-Freeman-Halton test, and survival data were analyzed using Kaplan-Meier and Log-rank tests. Results: PD-L1 positivity (CPS ≥ 10) and high TILs infiltration (≥20%) were associated with higher ORR (PD-L1+ vs. PD-L1−: 34.9% vs. 20.8%, P = 0.030;TIL+ vs. TIL−: 42.7% vs. 7.4%, P +/TIL+) had the highest ORR (44.55%) which was significantly better than other subtypes (vs. Type IV: P −/TIL−) had the lowest ORR (12.50%). Survival analysis showed that Type II had significantly longer median OS (37.4 months) and PFS (23.1 months) compared with Type I an
