Factors Affecting Prognosis Of Patients Research Articles

Bioinformatics-based construction of prognosis-related methylation prediction model for pancreatic cancer patients and its application value.

Objective: Pancreatic adenocarcinoma (PAAD) is a highly malignant gastrointestinal tumor with almost similar morbidity and mortality. In this study, based on bioinformatics, we investigated the role of gene methylation in PAAD, evaluated relevant factors affecting patient prognosis, screened potential anti-cancer small molecule drugs, and constructed a prediction model to assess the prognosis of PAAD. Methods: Clinical and genomic data of PAAD were collected from the Tumor Genome Atlas Project (TCGA) database and gene expression profiles were obtained from the GTEX database. Analysis of differentially methylated genes (DMGs) and significantly differentially expressed genes (DEGs) was performed on tumorous samples with KRAS wild-type and normal samples using the "limma" package and combined analysis. We selected factors significantly associated with survival from the significantly differentially methylated and expressed genes (DMEGs), and their fitting into a relatively streamlined prognostic model was validated separately from the internal training and test sets and the external ICGC database to show the robustness of the model. Results: In the TCGA database, 2,630 DMGs were identified, with the largest gap between DMGs in the gene body and TSS200 region. 318 DEGs were screened, and the enrichment analysis of DMGs and DEGs was taken to intersect DMEGs, showing that the DMEGs were mainly related to Olfactory transduction, natural killer cell mediated cytotoxicity pathway, and Cytokine -cytokine receptor interaction. DMEGs were able to distinguish well between PAAD and paraneoplastic tissues. Through techniques such as drug database and molecular docking, we screened a total of 10 potential oncogenic small molecule compounds, among which felbamate was the most likely target drug for PAAD. We constructed a risk model through combining three DMEGs (S100P, LY6D, and WFDC13) with clinical factors significantly associated with prognosis, and confirmed the model robustness using external and internal validation. Conclusion: The classification model based on DMEGs was able to accurately separate normal samples from tumor samples and find potential anti-PAAD drugs by performing gene-drug interactions on DrugBank.

Development and validation of a nomogram to predict overall survival and cancer-specific survival in patients with primary intracranial malignant lymphoma: A Retrospective study based on the SEER database.

Primary intracranial malignant lymphoma (PIML) is a rare form of lymphoma that most often occurs in the brain and has an extremely low 5-year survival rate. Although chemotherapy and radiotherapy are widely used in the clinical management of PIML, the choice of treatment regimen and the actual circumstances of patients remain challenges when assessing survival rates in different patients. Considering this, we obtained clinical treatment and survival information from the Surveillance, Epidemiology, and End Results database (SEER) on patients with lymphoma, the primary site of which was the brain, and performed statistical analyses of the demographic characteristics. Survival analyses were performed using the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors. We identified age, pathology, the Ann Arbor stage, and treatment as the risk factors affecting patient prognosis. The areas under the curve (AUCs) for overall survival at 1, 3, and 5 years were 0.8, 0.818, and 0.81, respectively. The AUCs for cancer-specific survival at 1, 3, and 5 years were 0.8, 0.79, and 0.79. The prediction ability in the development and verification cohorts was in good agreement with the actual values, while we plotted the clinical decision curves for the model, suggesting that the nomogram can provide benefits for clinical decision-making. Our model provides a prognostic guide for patients with PIML and a reliable basis for clinicians.

Five EMT-Related Gene Signatures Predict Acute Myeloid Leukemia Patient Outcome

Background The epithelial mesenchymal transition (EMT) gene has been shown to be significantly associated with the prognosis of solid tumors; however, there is a lack of models for the EMT gene to predict the prognosis of AML patients. Methods First, we downloaded clinical data and raw transcriptome sequencing data from the TCGA database of acute myeloid leukemia (AML) patients. All currently confirmed EMT-related genes were obtained from the dbEMT 2.0 database, and 30% of the TCGA data were randomly selected as the test set. Univariate Cox regression analysis, random forest, and lasso regression were used to optimize the number of genes for model construction, and multivariate Cox regression was used for model construction. Area under the ROC curve was used to assess the efficacy of the model application, and the internal validation set was used to assess the stability of the model. Results A total of 173 AML samples were downloaded, and a total of 1184 EMT-related genes were downloaded. The results of univariate batch Cox regression analysis suggested that 212 genes were associated with patient prognosis, random forest and lasso regression yielded 18 and 8 prognosis-related EMT genes, respectively, and the results of multifactorial COX regression model suggested that 5 genes, CBR1, HS3ST3B1, LIMA1, MIR573, and PTP4A3, were considered as independent risk factors affecting patient prognosis. The model ROC results suggested that the area under the curve was 0.868 and the internal validation results showed that the area under the curve was 0.815. Conclusion During this study, we constructed a signature model of five EMT-related genes to predict overall survival in patients with AML; it will provide a useful tool for clinical decision making.

Effect and Prognosis Factors of Combining Laparoscopic Radical Resection of Colon Adenocarcinoma with Docetaxel Therapy in Treating Middle and Advanced Colon Adenocarcinoma.

Objective The aim of the study is to explore the clinical efficacy and prognosis factors of joint application of laparoscopic radical resection of colon adenocarcinoma (COAD) and docetaxel therapy in treating COAD of middle and advanced stages. Methods The clinical data of 103 COAD patients of middle and advanced stages treated in our hospital from July 2016 to July 2018 were selected for the retrospective analysis, all patients received the treatment scheme of combining laparoscopic radical resection of COAD with docetaxel therapy for the observation of short-term efficacy, follow-up was conducted to record their 3-year survival, and relevant factors affecting patient prognosis were analyzed by the logistic regression model. Results After treatment, the total remission rate of patients was 75.73% (78/103), the total incidence rate of adverse reactions was 16.50% (17/103); patients' level values of various serum tumor markers after treatment were significantly lower than those before treatment (P < 0.001); according to the univariate analysis results, for COAD patients with different tumor diameters, differentiated degrees, TNM stages, perineural invasion degrees, pathological types, and depths of invasion, their modality rates were statistically different (P < 0.05); and the logistic regression analysis showed that tumor diameter ≥5 cm, poor differentiation, TNM stage IV, perineural invasion, pathologically signet-ring cell carcinoma, and T3-invasion were the independent risk factors affecting patient prognosis (P < 0.05). Conclusion Combining laparoscopic radical resection of COAD with docetaxel therapy in treating COAD of middle and advanced stages achieves affirmed short-term efficacy, which can reduce patients' level of serum tumor markers and ensure high safety and good survival prognosis. Tumor diameter, differentiated degree, TNM stage, perineural invasion, pathological type, and T3-invasion are the relevant factors affecting the prognosis of middle and advanced COAD.

Incidence, Survival Analysis and Future Perspective of Primary Peritoneal Mesothelioma (PPM): A Population-Based Study from SEER Database.

Simple SummaryMesotheliomas arising from the lining of the mesothelial cells of the peritoneum are rare. However, they are strongly linked to asbestos exposure, similar to the relatively well-known pleural mesotheliomas. It is slightly more common in men than in women, with the majority of cases seen in Caucasians older than 50 years. Distant spread of tumor, size > 4 cm, and negative lymph node status were observed in our study among the patients with evaluable data. Optimal outcomes are achieved when patients are treated in specialized centers with surgical debulking followed by heated chemotherapy administered intraoperatively. Systemic chemotherapy and radiation are options for the selected patient groups. Patients with poorly differentiated large tumors (>4 cm), Caucasian race, and distant spread of disease outside the abdominal cavity have worse prognosis.Background: Primary peritoneal mesothelioma (PPM) is a rare and aggressive tumor arising from the visceral and parietal peritoneum. The diagnosis and treatment of PPM are often delayed because of non-specific clinical presentation, and the prognosis is worse. The current study investigated the demographic, clinical, and pathological factors affecting patient prognosis and survival in PPM. Methods: Demographic and clinical data of 1998 patients with PPM were extracted from the Surveillance Epidemiology and End Results (SEER) database (1975–2016). The chi-square test, paired t-test, and multivariate analysis were used to analyze the data. Results: The majority of PPM patients were male (56.2%, p < 0.005) and Caucasian (90.4%, p < 0.005, with a mean age of diagnosis was 69 ± 13 years. The grading, histological, and tumor size information were classified as “Unknown” in most of the cases, but when available, poorly differentiated tumors (8.7%), malignant mesothelioma, not otherwise specified (63.4%) and tumors > 4 cm in size (8%), respectively, were most common, p < 0.005. Chemotherapy was administered to 50.6% of patients, followed by resection (29.2%) and radiation (1.5%), p < 0.001. The cohort of PPM had a five-year overall survival of 20.3% (±1.1), compared to 43.5% (±5.9), 25.9% (± 8.4), and 18.7% (±1.6) for those with surgery, radiation, or chemotherapy alone, respectively. Poor differentiation (OR = 4.2, CI = 3.3–4.9), tumor size > 4 cm (OR = 3.9, CI = 3.2–4.5), Caucasian race (OR = 2.9, CI = 2.6–4.4), and distant SEER stage (OR = 2.5, CI = 1.1–3.2) were all linked with increased mortality (p < 0.001). Conclusion: An extremely rare and aggressive peritoneal tumor, PPM may be difficult to identify at the time of diagnosis. Radiation therapy likely to have a limited function in the treatment of this condition, with surgery and chemotherapy being the primary choices. All PPM patients should be enrolled in a nationwide registry to improve our understanding of the pathogenesis and identify factors affecting survival.

Association between quantitative and qualitative image features of contrast-enhanced mammography and molecular subtypes of breast cancer.

The molecular subtype of breast cancer is one of the most important factors affecting patient prognosis. The study aimed to analyze the association between quantitative and qualitative features of contrast-enhanced mammography (CEM) images and breast cancer molecular subtypes. This retrospective double-center study included women who underwent CEM between November 2017 and April 2020. Each patient had at least 1 malignant lesion confirmed by pathology. The CEM images were evaluated by 2 radiologists to obtain quantitative and qualitative image features. The molecular subtypes were studied as dichotomous outcomes, including luminal versus non-luminal, human epidermal growth factor receptor (HER2)-enriched versus non-HER2-enriched, and triple-negative breast cancer (TNBC) versus non-TNBC subtypes. The association between the image features and molecular subtypes was analyzed by multivariate logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) provided. A total of 151 patients with 160 malignant lesions were included in the study. For quantitative features, a higher standard deviation of lesion density was associated with non-luminal (OR =0.88, 95% CI: 0.81 to 0.96, P=0.004) and HER2-enriched breast cancers (OR =1.16, 95% CI: 1.04 to 1.28, P=0.006). The relative degree of enhancement (RDE) and contrast-to-noise ratio (CNR) were not associated with molecular subtypes. However, a higher CNR/lesion size (OR =1.06, 95% CI: 1.01 to 1.12, P=0.012) was associated with luminal subtype cancers, and a higher RDE/lesion size (OR =0.94, 95% CI: 0.88 to 1.00, P=0.035) or a higher CNR/lesion size (OR =0.94, 95% CI: 0.88-1.00, P=0.038) was associated with non-TNBCs. For qualitative features, the presence of calcification was associated with HER2-enriched breast cancers (OR =2.91, 95% CI: 1.10 to 7.67, P=0.031). The presence of architectural distortion was associated with luminal cancer (OR =14.50, 95% CI: 1.91 to 110.14, P=0.010) and non-TNBC (OR =0.05, 95% CI: 0.00 to 0.43, P=0.022). Non-mass enhancement (OR =2.78, 95% CI: 1.08 to 7.14, P=0.033) was associated with HER2-enriched breast cancers. An association remained after adjustments for age, breast thickness, and breast density (all adjusted P<0.050). The quantitative and qualitative imaging features of CEM could contribute to distinguishing breast cancer molecular subtypes.

Clinicopathological features and prognostic factors for uterine myoma.

Objectives:To investigate the clinicopathological features of patients with uterine myoma and to analyze and summarize factors affecting patient prognosis.Methods:This study retrospectively investigated records of uterine myoma patients treated at Huzhou Central Hospital between June 2018 and May 2020. A total of 149 patients were included in this study, including 121 patients with good prognosis and 28 patients with poor prognosis. Clinical and pathological characteristics, including age, average body mass index (BMI), menopausal status, average lesion diameter, presence of hypertension or diabetes mellitus, operation method, myoma type, location, and quantity, number of fibroids, and presence of pelvic adhesion were analyzed via multivariate analysis.Results:Among the 149 patients with uterine uterine myoma, 92 had anterior wall uterine myoma, 36 had posterior wall uterine myoma, and 21 had uterine fundus uterine myoma. In terms of location, 94 cases were intramural and 55 cases were subserosal. Quantity-wise, 107 had 1-3 myomas while 42 had four or more. Moderate or more severe pelvic adhesions were present in 33 cases. Univariate analysis showed significant differences in age, operation method, myoma type, myoma location, myoma number, and pelvic adhesion severity between patients with good and poor prognosis. Multivariate analysis showed that age, surgical method, uterine myoma type, uterine myoma location, uterine myoma quantity, and pelvic adhesion severity were risk factors affecting the prognosis.Conclusion:Many prognostic factors, including age, operation method, myoma type, myoma location, myoma number, and pelvic adhesion severity are linked to uterine myoma patient prognosis.

Clinical analysis of 109 cases of lacrimal gland pleomorphic adenoma

To monitor the prognosis of patients with lacrimal gland pleomorphic adenoma (LGPA) following surgical resection within the past 10y. The factors affecting patient prognosis are analyzed and the experience of surgical treatment is summarized. In this retrospective, comparative case series, clinical records from 109 cases of LGPA treated chiefly at the same institution between November 2009 and May 2019 were reviewed. All 109 patients underwent surgery, histopathological examination, and imaging examination. For patients who underwent surgery for the first time, LGPA could be resected completely, including tumor and capsule tissues, using a surgical approach via the eyebrow arch or double eyelid crease. The ratio of males to females was 1:1.60, the ages ranged from 19 to 74 years old with a mean age of 43.64±13.07 years old, and the ratio of left to right eyes was 1:1.37. A total of 109 patients underwent surgical excision and five of these received radiotherapy after malignant transformation. Of these patients, 15 were lost to follow up within the April 1, 2020 deadline and 1 was diagnosed as a recurring pathology. The 5-year recurrence rate for 86 patients who underwent initial surgery was 7.27%. Single factor analysis revealed that the course of disease, bone destruction, invasion of surrounding tissues, tumor size, capsule integrity, and expression of Ki-67 were statistically significant (P<0.05). Binomial Logistic regression analysis showed that capsule integrity was a risk factor influencing recurrence (P=0.008). LGPA has a risk of recurrence and potential for malignant transformation. Complete removal of the tumor and capsule in the initial surgery is a key factor in preventing recurrence.

Establishment and validation of prognosis model for patients with cerebral contusion

Background And ObjectiveCerebral Contusion (CC) is one of the most serious injury types in patients with traumatic brain injury (TBI). In this study, the baseline data, imaging features and laboratory examinations of patients with CC were summarized and analyzed to develop and validate a prediction model of nomogram to evaluate the clinical outcomes of patients.MethodsA total of 426 patients with cerebral contusion (CC) admitted to the People’s Hospital of Qinghai Province and Affiliated Hospital of Qingdao University from January 2018 to January 2021 were included in this study, We randomly divided the cohort into a training cohort (n = 284) and a validation cohort (n = 142) with a ratio of 2:1.At Least absolute shrinkage and selection operator (Lasso) regression were used for screening high-risk factors affecting patient prognosis and development of the predictive model. The identification ability and clinical application value of the prediction model were analyzed through the analysis of receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA).ResultsTwelve independent prognostic factors, including age, Glasgow Coma Score (GCS), Basal cistern status, Midline shift (MLS), Third ventricle status, intracranial pressure (ICP) and CT grade of cerebral edema,etc., were selected by Lasso regression analysis and included in the nomogram. The model showed good predictive performance, with a C index of (0.87, 95% CI, 0.026–0.952) in the training cohort and (0.93, 95% CI, 0.032–0.965) in the validation cohort. Clinical decision curve analysis (DCA) also showed that the model brought high clinical benefits to patients.ConclusionThis study established a high accuracy of nomogram model to predict the prognosis of patients with CC, its low cost, easy to promote, is especially applicable in the acute environment, at the same time, CSF-glucose/lactate ratio(C-G/L), volume of contusion, and mean CT values of edema zone, which were included for the first time in this study, were independent predictors of poor prognosis in patients with CC. However, this model still has some limitations and deficiencies, which require large sample and multi-center prospective studies to verify and improve our results.

NTRK Fusion Genes in Thyroid Carcinomas: Clinicopathological Characteristics and Their Impacts on Prognosis.

Simple SummaryNTRK fusion genes are important but not well studied molecular markers in thyroid cancer. Their identification could help improve diagnosis and prognosis, and determine appropriate treatment. The aims of this study were to identify NTRK fusion-positive thyroid tumors in a large cohort of different thyroid tumors, to characterize these tumors by molecular, clinical and pathological features and to evaluate the impact of NTRK-rearranged tumors on prognosis of the disease. A suitable approach for selective NTRK fusion gene testing in thyroid cancer samples was created and utilized. In a cohort of 59 NTRK-rearranged carcinomas, characteristic features were described and recommendations for surgery and prognostic factors were determined thanks to the long-term follow-up of patients.Chromosomal rearrangements of NTRK genes are oncogenic driver mutations in thyroid cancer (TC). This study aimed to identify NTRK fusion-positive thyroid tumors and to correlate them with clinical and pathological data and determine their prognostic significance. The cohort consisted of 989 different TC samples. Based on the detected mutation, samples were triaged, and those that were positive for a BRAF, HRAS, KRAS, NRAS, RET, RET/PTC or PAX8/PPARγ mutation were excluded from further analyses. NTRK fusion gene testing was performed in 259 cases, including 126 cases using next-generation sequencing. NTRK fusion genes were detected in 57 of 846 (6.7%) papillary thyroid carcinomas and in 2 of 10 (20.0%) poorly differentiated thyroid carcinomas. A total of eight types of NTRK fusions were found, including ETV6/NTRK3, EML4/NTRK3, RBPMS/NTRK3, SQSTM1/NTRK3, TPM3/NTRK1, IRF2BP2/NTRK1, SQSTM1/NTRK1 and TPR/NTRK1. NTRK fusion-positive carcinomas were associated with the follicular growth pattern, chronic lymphocytic thyroiditis and lymph node metastases. NTRK1-rearranged carcinomas showed a higher frequency of multifocality and aggressivity than NTRK3-rearranged carcinomas. Tumor size, presence of metastases, positivity for the NTRK3 or NTRK1 fusion gene and a late mutation event (TERT or TP53 mutation) were determined as factors affecting patient prognosis. NTRK fusion genes are valuable diagnostic and prognostic markers.

Focus on patients with early esophageal cancer-a prognostic nomogram.

BackgroundEsophageal cancer is a common cancer of the digestive system, with high morbidity and poor prognosis. However, while the prognosis of early esophageal cancer is relatively good, there is no effective model to accurately predict the prognosis of early esophageal cancer. The Aims of this study are to explore risk factors for the prognosis of early esophageal cancer and to establish a prediction nomogram for patients.MethodsSurveillance, Epidemiology and End Results (SEER) Stat 8.3.5 was used to collect 2,351 cases of early esophageal cancer from 2004 to 2015 in the SEER database. Early esophageal cancer is defined as a lesion that is confined to the lamina propria and the muscularis mucosa. Prognostic factors were analyzed with the log-rank method and a Cox proportional hazard model by SPSS (v25.0). Independent prognostic factors were used to construct a nomogram with a Cox proportional hazard model. The C-index was used to evaluate the prediction effect of the nomogram. The internal validity of the nomogram was tested by discrimination and calibration using a bootstrap method with 1,000 resamplings.ResultsThe median survival time was 30 months, and the 1-, 3-, and 5-year survival rates were 65.2%, 46.8%, and 41.6%, respectively. The male to female ratio was 3:1, and 85.33% of all patients were white. Univariate analysis showed that risk factors affecting patient prognosis included age (χ2=430.631, P<0.001), sex (χ2=48.1, P<0.001), marital status (χ2=107.597, P<0.001), race (χ2=58.928, P<0.001), primary site (χ2=98.675, P<0.001), tumor grade (χ2=116.421, P<0.001), surgery (χ2=1,259.33, P<0.001) and histologic type (χ2=231.062, P<0.001). Using multivariate analysis, we found that age (HR=1.787, 95% CI: 1.58–2.03), marital status (HR=0.774, 95% CI: 0.69–0.87), tumor grade (HR=1.241, 95% CI: 1.14–135), and surgery (HR=0.356, 95% CI: 0.33–0.39) were independent prognostic factors for patients with early esophageal cancer. We constructed the nomogram with the above independent factors, and the C-index value was 0.788.ConclusionsThis study obtained the latest epidemiological information on early esophageal cancer and determined that age, marital status, tumor grade and surgery were independent prognostic factors for early esophageal cancer. The nomogram developed with these factors could provide good prognosis prediction.

The Function of SUMOylation and Its Role in the Development of Cancer Cells under Stress Conditions: A Systematic Review.

Malignant tumors still pose serious threats to human health due to their high morbidity and mortality. Recurrence and metastasis are the most important factors affecting patient prognosis. Chemotherapeutic drugs and radiation used to treat these tumors mainly interfere with tumor metabolism, destroy DNA integrity, and inhibit protein synthesis. The upregulation of small ubiquitin-like modifier (SUMO) is a prevalent posttranslational modification (PTM) in various cancers and plays a critical role in tumor development. The dysregulation of SUMOylation can protect cancer cells from stresses exerted by external or internal stimuli. SUMOylation is a dynamic process finely regulated by SUMOylation enzymes and proteases to maintain a balance between SUMOylation and deSUMOylation. An increasing number of studies have reported that SUMOylation imbalance may contribute to cancer development, including metastasis, angiogenesis, invasion, and proliferation. High level of SUMOylation is required for cancer cells to survive internal or external stresses. Downregulation of SUMOylation may inhibit the development of cancer, making it an important potential clinical therapeutic target. Some studies have already begun to treat tumors by inhibiting the expression of SUMOylation family members, including SUMO E1 or E2. The tumor cells become more aggressive under internal and external stresses. The prevention of tumor development, metastasis, recurrence, and radiochemotherapy resistance by attenuating SUMOylation requires further exploration. This review focused on SUMOylation in tumor cells to discuss its effects on tumor suppressor proteins and oncoproteins as well as classical tumor pathways to identify new insights for cancer clinical therapy.

Effect of Xuebijing on inflammatory response and prognosis in patients with septic shock

To study the effect of Xuebijing on inflammatory response and prognosis in patients with septic shock. A prospective randomized controlled study was conducted. Eighty septic shock patients admitted to department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from January to December in 2019 were enrolled. The enrolled patients were divided into Xuebijing group and control group by randomized number table method, with 40 cases in each group. Both groups were strictly followed the guidelines for the diagnosis and treatment of septic shock to take comprehensive treatment measures against sepsis. On this basis, Xuebijing group received intravenous 100 mL Xuebijing injection twice a day for 7 days. Baseline data of enrolled patients were recorded. The levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and heparin binding protein (HBP) were measured before treatment and 3, 7 and 10 days after treatment. Mechanical ventilation time, the length of intensive care unit (ICU) stay, total hospitalization time and 28-day mortality were recorded. The differences of every indicator between the two groups were compared. Independent risk factors affecting patient prognosis were analyzed by binary Logistic regression. (1) There was no significant difference in baseline data such as gender, age, infection site, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure score (SOFA) between the two groups. (2) The levels of serum inflammatory factors in both groups showed a decreasing trend after treatment. Compared with the control group, IL-6 and HBP in the Xuebijing group significantly decreased on day 7 [IL-6 (ng/L): 66.20 (16.34, 163.71) vs. 79.81 (23.95, 178.64), HBP (ng/L): 95.59 (45.23, 157.37) vs. 132.98 (73.90, 162.05), both P < 0.05]; on day 10, PCT, CRP, IL-6 and HBP significantly decreased [PCT (μg/L): 1.14 (0.20, 3.39) vs. 1.31 (0.68, 4.21), CRP (mg/L): 66.32 (19.46, 115.81) vs. 89.16 (20.52, 143.76), IL-6 (ng/L): 31.90 (13.23, 138.74) vs. 166.30 (42.75, 288.10), HBP (ng/L): 62.45 (29.17, 96.51) vs. 112.33 (58.70, 143.96), all P < 0.05]. (3) Compared with the control group, mechanical ventilation time and the length of ICU stay were significantly shortened and the total hospitalization expenses were significantly reduced in Xuebijing group [mechanical ventilation time (hours): 57.0 (0, 163.5) vs. 168.0 (24.0, 282.0), the length of ICU stay (days): 8.80±4.15 vs. 17.13±7.05, the total hospitalization expenses (ten thousand yuan): 14.55±7.31 vs. 20.01±9.86, all P < 0.05]. There was no significant difference in 28-day mortality and the total hospitalization time [28-day mortality: 37.5% vs. 35.0%, the total hospitalization time (days): 13.05±8.44 vs. 18.30±9.59, both P > 0.05]. (4) Patients were divided into death and survival groups according to the prognosis, and univariate analysis showed that white blood cell (WBC), neutrophil percentage (NEU%), CRP, lactic acid (Lac), APACHE II score, IL-6, HBP were the factors influencing the prognosis of patients. The above indicators were further analyzed by Logistic regression, which showed that CRP, IL-6, and APACHE II score were independent risk factors for prognosis [odds ratio (OR) was 1.007, 1.828, 1.229, all P < 0.05]. Combined with Xuebijing to treat septic shock can reduce the body's inflammatory response to a certain extent, thereby reducing the time of mechanical ventilation, shortening the stay of ICU and reducing the total cost of hospitalization. But it cannot reduce the 28-day mortality of patients with septic shock.

Prognostic factors of radical resection on patients with intrahepatic cholangiocarcinoma and impact of abdominal lymph node dissection on prognosis

Objective To study factors affecting prognosis of patients with intrahepatic cholangiocarcinoma (ICC), focusing on the correlation between extent of lymph node dissection and prognosis of patients with ICC. Methods The clinical data of ICC patients who underwent radical resection at the Hepatobiliary and Pancreatic Surgery of Affiliated Cancer Hospital of Zhengzhou University from October 2013 to October 2017 were retrospectively analyzed. According to the extent of lymph node dissection, the patients were divided into the non-dissected lymph node group, the routine dissection lymph node group and the extended lymph node dissection group. The prognoses of the three groups were compared. The Cox stepwise regression model was used to analyze the independent risk factors for prognosis of patients with ICC. Results The 178 patients included 109 males and 69 females. Their ages ranged from 30 to 81 years (average 59 years). There were 80 patients in the non-dissected group, 34 patients in the routine lymph node dissection group, and 64 patients in the extended lymph node dissection group. The overall survival rates of the 178 patients at 3 years after liver resection was 29.2%(52/178), overall median survival 25.8 months. The 3-year survival rates of the non-dissected group, routine dissection group, and extended dissection group were 10.0%(8/80), 52.9%(18/34), 40.6%(26/64), respectively. The differences among the three groups were significant (P 0.05). There was a significant difference in survival rates between the non-dissected group and the extended lymph node dissection group (P<0.05). Univariate analysis showed that CA19-9, tumor diameter, portal tumor thrombus, and lymph node dissection were related to prognosis of patients with ICC (P<0.05). Multivariate analysis showed CA19-9, tumor diameter, and extent of lymph nodes clearance were related to patient survival (P<0.05). Conclusions CA19-9, tumor diameter, and extent of lymph node dissection were independent risk factors of survival in patients with ICC. For patients with ICC who undergo surgical resection, conventional laparoscopic lymph node dissection can achieve good results, and there is no need to extend lymph node dissection. Key words: Cholangiocarcinoma; Lymph node excision; Prognosis analysis

Analysis of impact factors on prognosis of patients with gallbladder adenocarcinoma after surgery

Objective To study the impact factors on prognosis of patients with gallbladder adenocarcinoma after surgery. Methods The clinicopathological data of 1 285 patients who underwent surgery and were histologically confirmed to have gallbladder adenocarcinoma from 2004 to 2014 was extracted from the SEER database of US National Cancer Institute. Life table was used to calculate the survival rate. Kaplan-Meier was used to construct the survival curves. Univariate and Cox multivariate regression analysis were applied to evaluate the prognostic factors. The univariate analysis was evaluated by the log-rank χ2 test. Results The median survival of 1 285 patients with gallbladder adenocarcinoma was 32 months. The 1-, 3- and 5-year survival rates were 77.5%, 46.8% and 36.5%, respectively. The 5-year survival rates of stage Ⅰ, Ⅱ, ⅢA, ⅢB, ⅣA, ⅣB were 72.7%, 63.2%, 24.6%, 20.5%, 0 and 5.1%, respectively. The median survival of stage ⅢA, ⅢB, ⅣA and ⅣB were 22 months, 19 months, 12 months and 16 months, respectively. The differences were statistically significant (P 0.05). Multivariate Cox regression analysis showed that sex (male), age (≥65 years), degree of differentiation, T staging, number of lymph nodes detected (<4) and AJCC staging were independent risk factors affecting prognosis of patients with gallbladder adenocarcinoma (P<0.05). Conclusions With increase in AJCC staging, the survival rates in patients with gallbladder adenocarcinoma after surgery decreased gradually. Parameters including sex, age, T staging, number of lymph nodes detected and AJCC staging were independent factors affecting prognosis of patients with gallbladder adenocarcinoma after surgery. Key words: Gallbladder neoplasms; Neoplasm staging; Gallbladder adenocarcinoma; Prognosis; Survival

The pattern of lymph node metastasis and prognostic factors analysis of Siewert type II adenocarcinoma of esophagogastric junction

Objective To investigate the pattern of lymph node metastasis and analyze prognostic factors of Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). Methods The retrospective case-control study was conducted. The clinicopathological data of 368 patients with Siewert type Ⅱ AEG who were admitted to Tianjin Medical University Cancer Institute and Hospital from June 2010 and November 2015 were collected. There were 323 males and 45 females, aged from 35 to 80 years, with an average age of 64 years. Of 368 patients, 209 underwent left transthoracic surgery, 112 underwent thoracoabdominal surgery, and 47 underwent Ivor-Lewis surgery. Observation indicators: (1) total lymph node metastasis and metastasis of various lymph node stations; (2)follow-up and survival; (3)prognostic factors analysis; (4) influencing factors affecting thoracic lymph node metastasis. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients up to November 2018. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute number or percentage. The survival time and rate were calculated using the Kaplan-Meier method. The univariate and multivariate analyses were done by the COX proportional hazard model. Results (1) Total lymph node metastasis and metastasis of various lymph node stations: the total lymph node metastasis rate was 66.58%(245/368) in 368 patients. The metastasis rates of abdominal lymph nodes, thoracic lymph nodes, lower mediastinal lymph nodes, and upper mediastinal lymph nodes were 65.49%(241/368), 12.77%(47/368), 12.23%(45/368), and 1.09%(4/368), respectively. The order of metastasis rate of various lymph node stations from high to low was 51.99%(170/237) of No.7 left gastric artery, 34.23%(89/260) of No.1 right paracardial region, 33.88%(83/245) of No.2 left paracardial region, 28.91%(85/294) of No.3 lesser curvature, 27.10%(29/107) of No.11 splenic artery, 19.75%(16/81) of No.9 celiac trunk, 15.25%(36/236) of No.E8Lo lower paraesophageal region, 11.94%(16/134) of No.4 greater curvature, 11.76%(6/51) of No.E8M middle paraesophageal region, 11.11%(10/90) of No.8 common hepatic artery, 4.65%(4/86) of No.E9L left inferior pulmonary ligament and 3.39%(2/59) of No.E7 subcarinal region. (2) Follow-up and survival: of the 368 patients, 309 were followed up for 1-103 months, with a median follow-up time of 38 months. The survival time of 309 patients was 0.7-101.9 months, and the median survival time was 35.9 months. During the follow-up, the postoperative 1-, 2-, 3-year overall survival rates were 85.9%, 68.6%, and 58.7%, respectively. (3) Prognostic factors analysis. Results of univariate analysis showed that tumor differentiation degree, presence of thoracic lymph node metastasis, number of metastatic lymph nodes, T staging, tumor diameter, and length of esophageal invasion were associated factors affecting prognosis of patients (χ2=8.776, 26.582, 46.057, 18.679, 22.460, 9.158, P<0.05). Results of multivariate analysis showed that presence of thoracic lymph node metastasis, number of metastatic lymph nodes, T staging, and tumor diameter were independent influencing factors for prognosis of patients [odds ratio (OR)=1.699, 1.271, 1.422, 1.238, 95% confidence interval: 1.102-2.621, 1.019-1.481, 1.090-1.856, 0.971-1.481, P<0.05]. (4) Influencing factors affecting thoracic lymph node metastasis: results of univariate analysis showed that tumor diameter, length of esophageal invasion, number of lymph lodes harvested in thorax were related factors for thoracic lymph node metastasis (χ2=5.129, 43.140, 10.605, P<0.05). Results of multivariate analysis showed that length of esophageal invasion ≥2 cm, number of lymph lodes harvested in thorax ≥4 were independent risk factors for thoracic lymph node metastasis (OR=6.321, 1.097, 95% confidence interval: 2.982-13.398, 1.026-1.173, P<0.05). Conclusion Lymph node metastasis of Siewert type Ⅱ AEG spreads two regions, mainly at abdominal lymph nodes, followed by the thoracic lymph nodes. Presence of thoracic lymph node metastasis, number of metastatic lymph nodes, T staging, and tumor diameter are independent influencing factors for prognosis of patients. Presence of thoracic lymph node metastasis indicates poor prognosis of patients. Length of esophageal invasion ≥2 cm and number of lymph lodes harvested in thorax ≥4 are independent risk factors for thoracic lymph node metastasis. Key words: Esophagogastric junction neoplasms; Adenocarcinoma of esophagogastric junction; Siewert Ⅱ type; Thoracic lymph node metastasis; Esophageal invasion; Prognosis

Integral analyses of survival-related long non-coding RNA MIR210HG and its prognostic role in colon cancer.

Colon cancer is the third most common cancer worldwide, and lymphatic metastasis is one of the principal factors affecting patient prognosis. Recent studies have revealed that long non-coding RNAs (lncRNAs) serve as important regulators in the pathogenesis of colon cancer, therefore affecting patient survival rates. In the present study, colon cancer-associated lncRNAs were screened based on their influence on patient survival. A number of survival-associated lncRNAs (and their potential mechanisms of action) were identified, with the strongest candidate being MIR210HG. Gene expression correlation and protein-protein interaction (PPI) network analyses were performed to identify MIR210HG-associated genes. Various bioinformatics analyses (including gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses) were conducted to investigate the prognostic role of MIR210HG and its associated genes, in colon cancer. Higher expression levels of MIR210HG were associated with shorter overall survival in patients with colon cancer, which was significant in 373 candidates. Multiple findings indicated that MIR210HG may exert its effects in colon cancer through the modulation of energy metabolism and cell adhesion. Further predictions suggested that MIR210HG may affect colon cancer via transcription and post-transcriptional processing. Collectively, these results provided evidence of a transcriptional regulatory network of MIR210HG in colon cancer, and suggested its potential role as a novel biomarker and therapeutic target for colon cancer.

Clinical effects and prognostic analysis of radical surgery for primary gallbladder cancer

Clinical effects and prognostic analysis of radical surgery for primary gallbladder cancer

Analysis of prognostic factors in the surgical treatment of hilar cholangiocarcinoma

Objective To analyze the prognostic factors in the surgical treatment of hilar cholangiocarcinoma. Methods The retrospective case-control study was conducted. The clinicopathological data of 93 patients [61 males and 32 females, age (64±8)years with the range of 43-84 years] with hilar cholangiocarcinoma who underwent surgical treatments in the General Hospital of the Northern Theater from January 2010 to December 2017 were collected. According to preoperative different staging and intraoperative exploration of hilar cholangiocarcinoma, corresponding operations were performed. Observation indicators: (1) surgical treatment situations; (2) tumor typing, staging and degree of differentiation: ① tumor typing and staging, ② degree of tumor differentiation; (3) follow-up situations; (4) analysis of prognostic factors: ①univariate analysis, ②multivariate analysis; (5) subgroup analysis. Follow-up using outpatient examination and telephone interview was performed to detect survival time and survival rate of patients up to December 31, 2017. Kaplan-Meier method was used to calculate survival time and survival rate and to draw survival curves. Survival situations were analyzed by Log-rank test. The univariate analysis and multivariate analysis were performed using the Log-rank test and COX proportional hazard model respectively. Results (1) Surgical treatment situations: 93 patients underwent surgical treatments, including 51 undergoing radical resection, 23 undergoing palliative resection, 16 undergoing internal biliary drainage or external drainage, 3 undergoing abdominal laparotomy and intraoperative biopsy. (2) Tumor typing, staging and degree of differentiation. ① Tumor typing and staging: of the 93 patients with hilar cholangiocarcinoma, Bismuth-Corlette type Ⅰ, Ⅱ, Ⅲa, Ⅲb and Ⅳ were detected in 26, 22 , 9, 18 and 18 patients. TNM stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were detected in 7, 34, 22 and 30 patients, Mayo Clinic stage 1, 2, 3, 4 were detected in 20, 19, 51 and 3 patients. ② Degree of tumor differentiation: results of pathological examination showed 16 of 93 patients with highly differentiated adenocarcinoma, 35 with moderately differentiated adenocarcinoma, 37 with poorly differentiated adenocarcinoma, 4 with mucinous adenocarcinoma and 1 with papillary adenocarcinoma. (3) Follow-up situations: 93 patients were followed up for 6-36 months, with a median time of 24 months. The survival time of 93 patients was (21.4±2.1)months and the 1-, 2-, 3-year overall survival rates were 62.2%, 34.9% and 17.1%, respectively. (4) Analysis of prognostic factors: ① results of univariate analysis showed that preoperative level of TBil, preoperative level of CA19-9, preoperative level of CA24-2, surgical methods, lymph node metastasis, vascular invasion, TNM staging, Mayo Clinic staging, degree of tumor differentiation were related factors affecting prognosis of patients with hilar cholangiocarcinoma (χ2=6.321, 7.357, 6.590, 22.088, 11.173, 22.914, 23.326, 25.966, 39.512, P 0.05). Of the 35 patients with vascular invasion, the overall survival time was (7.0±2.0)months and 1-, 2-, 3-year survival rates were 14.5%, 7.3%, 0 respectively in 18 with portal vein invasion only, (10.0±2.1)months and 37.5%, 18.8%, and 18.8% respectively in 8 with hepatic artery invasion, showing no statistically significant difference between the two groups (χ2=0.905, P>0.05). Conclusions Preoperative level of TBil, preoperative level of CA19-9, surgical procedures, vascular invasion and degree of tumor differentiation are independent prognostic factors for patients with hilar cholangiocarcinoma. Radical resection can prolong the survival time of patients compared with other surgical treatments. Key words: Hilar cholangiocarcinoma; Surgical procedures, operative; Tumor typing; Tumor staging; Degree of tumor differentiation; Prognosis analysis

Retrospective study on the effects of the prognosis of patients treated with extracorporeal membrane oxygenation combined with continuous renal replacement therapy.

Patients undergoing extracorporeal membrane oxygenation (ECMO) treatment often have severe fluid overload and electrolyte imbalances and may even suffer acute kidney injury (AKI). It is often necessary to use continuous renal replacement therapy (CRRT). In this study, we aimed to retrospectively analyze the prognosis of patients treated with ECMO combined with CRRT and to find the independent factors that affect the survival rate. There were 32 patients who were treated with ECMO combined with CRRT in our hospital from January 2007 to December 2017 who were analyzed. All of the patients were divided into a survival group and death group. The clinical indicators and biochemical indexes of the two groups were observed, and their differences were compared. Multivariate logistic regression analysis was carried out to determine the independent risk factors. The fluid balance at ECMO day 3, SOFA score and lactate at CRRT initiation, sequential organ failure assessment (SOFA) score at ECMO weaning, CRRT duration, ECMO to CRRT interval, mechanical ventilation (MV) duration, length of ICU, and overall hospital length of stay were statistically significant (P<0.05). The clinical biochemical indexes at CRRT initiation and ECMO weaning [serum creatinine, pH, white blood cell (WBC), hemoglobin (Hb), bilirubin]; patient's age, gender and BMI; and the fluid balance at ECMO days 1 and 7 were not statistically significance (P>0.05). The fluid balance at ECMO day 3 and lactate at CRRT initiation by multivariable logistic regression analysis were independent risk factors affecting patient prognosis. The fluid balance at ECMO day 3 and lactate at CRRT initiation are the prognosis independent risk factors for ECMO + CRRT patients.