Univariate Analysis Of Factors Research Articles

ДИАГНОСТИЧЕСКИЕ ВОЗМОЖНОСТИ ПЭТ/КТ С 18F-PSMA-1007 В ОБНАРУЖЕНИИ МЕТАСТАТИЧЕСКОГО ПОРАЖЕНИЯ У ПАЦИЕНТОВ С ВПЕРВЫЕ ВЫЯВЛЕННЫМ РАКОМ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Introduction. The initial detection of regional and/or distant metastases in patients with newly diagnosed prostate cancer (PCa) is important for the management and disease prognosis. Conventional diagnostic imaging methods have certain limitations and do not allow a comprehensive assessment of the tumor spread. In recent years the use of positron emission tomography combined with computed tomography (PET/CT) with ligands of the prostate-specific membrane antigen (PSMA) has been rapidly expanding in oncological practice. The aim of the study was to analyze the diagnostic performance of 18F-PSMA-1007 PET/CT for the detection of metastases in patients with newly diagnosed prostate cancer. Material and methods. The study included 52 patients with newly diagnosed high-risk PCa, who underwent 18F-PSMA-1007 PET/CT. In all patients, there were no regional and/or distant metastases according to results of conventional imaging methods (bone scan, computed (or magnetic resonance) tomography of the pelvis). The conclusion about the presence or absence of metastases was made based on pathomorphological verification (in 27 patients) or using all available imaging and clinical follow-up as a reference. Results. Of the 52 patients included in the analysis, 26 (50.0%) had PCa metastases. Of these, 25 (48.1% of total cases) patients had true positive 18F-PSMA-1007 PET/CT. False-positive findings occurred in 2 cases. The positive predictive value of the method was 96.1%. In a univariate analysis of factors associated with true-positive PET/CT results, only the T-stage and Gleason score demonstrated statistically significant predictive value (p<0.05). According to multivariate analysis, only the Gleason score was statistically significantly associated with true positive findings on 18F-PSMA-1007 PET/CT (p=0.03). The most unfavorable in terms of the risk of detecting metastases was the group of patients with a Gleason score 7 (4+3) -10 (metastasis rate was 62.2%). Conclusion. 18F-PSMA-1007 PET/CT is an informative method for the detection of metastases in patients with newly diagnosed high risk PCa. 18F-PSMA-1007 PET/CT may be recommended in patients with Gleason score 4+3 or higher due to the high probability of regional and/or distant metastases, which were not detected by conventional methods.

Percutaneous Thermal Ablation for Managing Small Renal Metastatic Tumors.

To retrospectively evaluate the treatment outcomes of thermal ablation for renal metastatic tumors. Thirteen consecutive patients with small renal metastatic tumors (≤3 cm), who underwent thermal ablation between 2009 and 2020, were included in this study. Eight patients had extra-renal tumors during renal ablation. The primary tumors were adenoid cystic carcinoma in four patients, lung cancer in three, hemangiopericytoma in three, leiomyosarcoma in two, and thyroid cancer in one. The therapeutic effects, safety, survival rate, prognostic factor, and renal function were evaluated. We performed 18 ablation sessions (cryoablation, n = 13; radiofrequency ablation, n = 5) on 19 renal metastases with a mean diameter of 1.7 cm, which resulted in a primary technique efficacy rate of 100% without procedure-related deaths or major complications. Renal function significantly declined 6 months after ablation (P = 0.0039). During the mean follow-up period of 31.2 ± 22.4 months (range, 2.7-71.4 months), one patient had local tumor progression at 11.9 months following radiofrequency ablation. The overall survival rates at 1 and 3 years after ablation were 76.9% (95% confidence interval [CI], 54.0%-99.8%) and 59.3% (95% CI, 31.3%-87.3%), respectively. Tumor size ≥ 2 cm (P = 0.02) and metastasis from non-small cell lung cancer (P = 0.001) were significant worse prognostic factors in univariate analysis, and metastasis from non-small cell lung cancer (P = 0.01) was significant in multivariate analysis. Percutaneous thermal ablation for small renal metastases is safe and feasible and can control local tumors.

Foreboding lncRNA markers of low-grade gliomas dependent on metabolism.

At present, there is no systematic study on the signature of long-chain noncoding RNAs (lncRNAs) involved in metabolism that can fully predict the prognosis in patients with low-grade gliomas (LGGs). Therefore, consistent metabolic-related lncRNA signatures need to be established. The Cancer Genome Atlas (TCGA) was used to identify the expression profile of lncRNAs containing 529 LGGs samples. LncRNAs and genes related to metabolism are used to establish a network in the form of coexpression to screen lncRNAs related to metabolism. LncRNA was more clearly described by univariate Cox regression. Moreover, lncRNA signatures were explored by multivariate Cox regression and lasso regression. The risk score was established according to the signature and it was an unattached prognostic marker according to Cox regression analysis. Functional enrichment of lncRNAs was shown by employing Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Univariate Cox retrospective analysis showed that 543 metabolism-related lncRNAs were independent prognostic factors of LGG, and multivariate Cox regression analysis confirmed that 19 metabolism-related lncRNAs were prognostic genes of LGG. In the risk model, the low-risk group had a higher Overall survival (OS) than the high-risk group (P < .001). Univariate Cox regression analysis of risk score and clinical factors showed that risk score was an independent prognostic factor (P < .001, HR = 1.047, 95% CI: 1.038-1.056). Multivariate Cox results showed that risk score could predict the prognosis of LGG (P < .001, HR = 1.036, 95% CI: 1.026-1.045). ROC curve analysis showed that risk score could predict the prognosis of LGG. The areas of 1-year, 3-years, and 5 years are 0.891, 0.904 and 0.832. GO and KEGG analysis showed that metabolism-related lncRNAs was mainly concentrated in the pathways related to tumor metabolism. In order to find a more stable and reliable target for the treatment of LGG, we established 19 metabolic-related lncRNAs prognostic model, and determined that it can predict the prognosis of LGG patients. This provides a new solution approach to the poor prognosis of patients with LGG and may reverse the trend of LGG's transformation to high-grade gliomas.

Complications during Induction Chemotherapy in Acute Promyelocytic Leukemia: An Institutional Experience.

Stalin Chowdary BalaIntroduction Acute promyelocytic leukemia (APL) has transformed from a highly fatal disease to a highly curable one. Induction deaths continue to represent one of the major impediments in modern therapy of APL. Sepsis, hemorrhage, and differentiation syndrome are the major complications during induction therapy in APL. The present study reports the incidence and prognostic factors of major complications during induction chemotherapy in patients with newly diagnosed APL. Materials and Methods The present study was a single institutional, observational, retrospective study. All cases of APL diagnosed by morphology and confirmed by RT PCR (PML RARα) were included in this study. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Results A total of 73 patients were analyzed. The median age at presentation was 30 years (range, 3-60 years) with a female to male ratio of 1.02:1. The most common symptom at presentation was fever (80%), followed by fatigue (56%) and gum bleeding (37%). The majority of the patients at presentation were high risk (42.4%), followed by intermediate risk (38.4%) and low risk (19.2%). Fifty-seven (78%) patients achieved complete hematological remission and 16 (22%) succumbed during induction chemotherapy. Infection was the most common cause of induction death (50%), followed by hemorrhage (37.5%) and differentiation syndrome (12.5%). On univariate analysis of prognostic factors, bcr3 variant, grade 3/4 bleeding during induction, and low levels of albumin at presentation were significant for induction mortality ( p = 0.034, 0.041, and 0.008 respectively). On multivariate analysis, only serum albumin < 3.5 g/dL was an independent predictor for induction mortality ( p = 0.043). Conclusion The majority of patients were high risk at presentation. Sepsis was the most common complication during induction and also the leading cause of induction death. Identifying induction complications at the earliest and providing aggressive supportive measures can further improve outcomes in APL.

Analysis of influencing factors of early neurological improvement after intravenous rt-PA thrombolysis in acute anterior circulation ischemic stroke.

It has been widely reported that Early neurological improvement (ENI) after rt-PA intravenous thrombolysis contributes to a good long-term prognosis in patients experiencing acute ischemic stroke (AIS). However, which clinical factors influence after intravenous administration of recombinant tissue-type plasminogen activator (IV-rt PA) in AIS patients ENI is still unclear. This study aimed to evaluate the impact of influencing factors on the benefit of ENI after intravenous thrombolysis neurological improvement after IV-rt PA. The data of 73 patients with acute anterior circulation ischemic stroke who received intravenous thrombolysis with rt-PA in Chongqing University Jiangjin Hospital from January 2021 to July 2022 were retrospectively studied. According to the change rate of 24 h NISHH score, the research subjects were divided into the recovery group, the significant curative effect group, the curative effect group and the no curative effect group, the ENI after intravenous thrombolysis with rt-PA was defined as the improvement rate of National Institutes of Health Stroke Scale (NIHSS)score >46% at 24 h after IV-rt PA, and univariate factor analysis was used Clinical factors associated with ENI after intravenous thrombolysis. According to the 24-h NIHSS improvement rate of rt-PA intravenous thrombolysis in patients with acute anterior circulation ischemic stroke, 35 cases (47.95%) of the study population had ENI. There was no statistical difference between the improvement and non-improvement group in general demographic data, stroke TOAST classification, stroke risk factors (history of stroke, heart disease, hyperlipidemia, hypertension), and laboratory test data. There was a statistically significant difference in the random blood glucose levels between the two groups (p < 0.001, t = 3.511). The effect of rt-PA intravenous thrombolysis within the time window of patients with acute anterior circulation ischemic stroke is significant, but the ENI after thrombolysis is easily affected by the level of blood glucose; diabetes is the most important factor affecting the acute anterior circulation ischemic stroke patients Clinical factors of ENI after intravenous thrombolysis with rt-PA.

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

IntroductionTotal neoadjuvant therapy (TNT) is a new therapeutic strategy in patients with rectal cancer. We examined the role of TNT, in addition to other pre-operative factors, as a predictor for pathologic complete response (pCR). MethodsA retrospective analysis of all rectal cancer patients who underwent surgery between 2016 and 2021 was conducted. Patients were classified into two groups—pCR group and residual tumor group. Patient data were reviewed and entered into univariate and multivariate analyses to determine predictors of pCR. ResultsA total of 172 patients were treated with neoadjuvant therapy and underwent surgery during the study period. Sixty patients (34.9%) were treated with TNT while 112 (65.1%) were treated with traditional neoadjuvant chemoradiation. The overall pCR rate was 25.6% (44 patients), with 31.6% (19 patients) in patients who received TNT compared to 22.3% (25 patients) in patients who received neoadjuvant chemoradiation (NCRT). Univariate analysis of clinical and radiological factors correlated with pCR demonstrated no significant differences between the two groups in cT stage (p = 0.46), cN stage (p = 0.52), positive circumferential resection margin (CRM) (p = 0.72), tumor location (p = 0.35), symptomatic presentation (p = 0.09), and anal sphincter involvement (p = 0.68). Multivariate logistic analysis demonstrated that only pre-operative TNT (OR:2.35; 95% CI 1.06–5.25; p = 0.03) was predictive of pCR, while extramural vascular invasion (EMVI) was a predictor for lower rates of pCR (OR: 0.28; 95% CI 0.09–0.9; p = 0.03). ConclusionRectal cancer patients undergoing TNT prior to surgery have a higher chance of developing a complete pathologic response. Evaluation of this therapy should be continued and extended to larger numbers of patients to see if the differences we observed are real.

The Utility of Immature Granulocyte Count and Percentage on the Prediction of Acute Appendicitis in the Suspected Acute Appendicitis According to the Alvarado Scoring System: A Retrospective Cohort Study.

This study aimed to investigate the utility of immature granulocyte count and percentage on the prediction of suspected acute appendicitis according to the Alvarado scoring system and its effect on the need for computed tomography scanning. Adult patients who had an Alvarado scoring system between 4 and 7 with the first imaging technique computed tomography were included and retrospectively analyzed. The immature granulocyte count and granulocyte percentage were obtained from the blood samples taken at the time of the patient's first admission to the hospital. A total of 652 patients were evaluated and 186 patients were included in the study. Acute appendicitis was not detected in computed tomography imaging of 121 (65%) patients (group N) and detected in 65 (35%) patients (group P). The mean immature granulocyte percentage in group N and group P were 0.314 ± 0.188 (0.00-1.40) and 0.364 ± 0.205 (0.05-1.00), respectively. The mean immature granulocyte percentage was similar between groups (P = .095). The mean immature granulocyte count was 33 ± 46/μL (0-50) in group N and 60 ± 85/μL (10-690) in group P. Immature granulocyte count was significantly higher in group P (P = .005). Univariate analysis results revealed that age and immature granulocyte percentage were not predictive factors for the presence of acute appen- dicitis in suspected cases (P &gt; .05). On the other hand white blood cell, neutrophil-lymphocyte ratio, C-reactive protein, and immature granulocyte count were determined as predictive factors in univariate analysis and multivariate analysis. Receiver operating character- istic curve analysis of preoperative immature granulocyte percentage and immature granulocyte count values in the diagnosis of acute appendicitis: the cut-off value of immature granulocyte percentage was ≥0.35 and its sensitivity, specificity, positive predictive value, and negative predictive value were 44.1%, 72.1%, 71.1%, and 41.5%, respectively (area under the curve: 0.588; CI: 0.484-0.682). The cut-off value of immature granulocyte count was ≥35/μL and its sensitivity, specificity, positive predictive value, and negative predictive value were 66.1%, 73.6%, 71.9%, and 67.7%, respectively (area under the curve: 0.743; CI: 0.659-0.827) Conclusion: Immature granulocyte count is a predictive factor for acute appendicitis in patients with the middle-risk group according to the Alvarado score and may be useful for the selective use of tomography.

CML-155 Prognostic Markers of the Effectiveness of Tyrosine Kinase Inhibitors in Third-Line Therapy of Chronic Phase Chronic Myeloid Leukemia Patients: Data From a Multicenter Study

Despite success in chronic myeloid leukemia (CML) treatment there are unmet needs third-line therapy. To determine the efficacy and factors influencing the long-term outcomes of third-line therapy with tyrosine kinase inhibitors (TKIs). Multicenter retrospective study was conducted in 2019. All adult 73 pts, including 26(35%), CML chronic phase (CP) pts treated with TKIs in third line (TKI-3L) without complete cytogenetic response (CCyR) at baseline were included in the study. The me duration of CML from diagnosis to baseline was 63(10-314) mos. The rate of CCyR (equal to BCR::ABL transcript level <1%) and overall survival (OS) were assessed. Univariate and multivariate logistic regression analyses assessed risk factors for CCyR achievement. For a scoring system, selection of predictors was performed using L2-regularization after standardization of quantitative variables. The me duration of TKI-3L therapy was 14(1-120) mos, the me time of follow-up from initiation of TKI-3L was 25(3-136) mos. CCyR was achieved in 22/73(30%) pts. Both in univariate and multivariate regression analysis factors influenced on CCyR achievement were absence of CCyR at baseline (OR 0.26[95% CI, 0.08-0.85]; p=0.0252), no CCyR on TKI-1L and TKI-2L (OR 0.21[95% CI, 0.04-0.99]; p=0.0502), as well as pt's age at baseline per every 10 years (OR 1.52[95% CI, 0.61-3.8]; p=0.369). Score system was set up based on these factors with scores 7, 8, 1 score per 10 years respectively. ROC analysis divided pts into three groups: low risk (score ≤9, n=22), intermediate-risk (score 10-15, n=27) and high risk (score ≥16, n=24). The low-risk group had a significantly higher rate of CCyR on TKI-3L compared to intermediate or high-risk groups (14/22[64%] vs 7/27[26%] vs 1/24[4%], p<0.05). There were 19(26%) deaths. Estimated 1-year and 5-year OS was 95% and 65% respectively. All CML-related deaths(n=14), as well as transformation to BC (n=13), occurred in intermediate- and high-risk groups. Nearly a third of pts obtained CCyR on TKI-3L in our study. Most pts were alive at 5 years. Younger pts with any CyR on previous TKIs and at baseline had favorable prognosis. The use of TKI-3L is justified in low-risk groups and may be used in transplant-eligible pts.

Serum hepcidin levels and cardiovascular outcomes in patients on maintenance hemodialysis

Background Cardiovascular mortality is high in patients on maintenance hemodialysis. Different factors and plausible mechanisms have been explained for the increased risk. A recent concept of iron dysregulation and the related biomarker serum hepcidin was thought to be one of the novel markers of cardiovascular disease. We undertook this study to study the fatal and nonfatal cardiovascular events in dialysis population. Patients and methods All the patients who satisfied inclusion criteria were included in the study. All the patients have been on either twice-/thrice-weekly dialysis with polysulfone membrane of 1.3-m2 surface area. Serum hepcidin levels were estimated in blood samples using the appropriate techniques. All the patients were followed up for 18 months to assess the fatal and nonfatal cardiovascular outcomes. Results A total of 80 patients satisfied the criteria and were followed up. Mean serum hepcidin levels were 116.3 ± 32 ng/ml. On univariate analysis of factors influencing mortality, age, sex, and presence of comorbidities did not show significant association, but the levels of serum bicarbonate, albumin, creatinine, cholesterol, triglycerides, and the high-sensitivity C-reactive protein, hepcidin, showed a significant association with mortality. Serum hepcidin level of 120 ng/ml predicted mortality with a sensitivity of 100% and specificity of 85%. Conclusions Serum hepcidin is associated with all-cause mortality and cardiovascular mortality in patients on hemodialysis. Hepcidin levels may serve a good predictor of cardiovascular outcomes in patients on hemodialysis.

Risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumonia infection in intensive care unit: A retrospective observational study in a tertiary care hospital in Eastern India.

Carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumonia, have become a severe global problem with a significant threat to public health, but few studies have investigated the risk factors and epidemiology of carbapenem-resistant K. pneumonia (CRKP) infections in India. We performed a retrospective observational study of 224 participants with K. pneumoniae who were admitted to the medical intensive care unit (ICU) of Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India, between January 1 and December 30, 2020. Antibiotic susceptibility testing was done by automated broth microdilution VITEK® 2 (BioMerieux, Inc., Hazelwood, USA). The Clinical and Laboratory Standards Institute document M100-S22 (January 2020) was used to interpret antimicrobial susceptibility testing. Data were obtained from paper medical records. Two hundred and twenty-four subjects with culture-positive for K. pneumonia were retrieved during the study period, out of which 108 had CRKP. The risk factors for univariate analysis were Acute Physiology and Chronic Health Evaluation II, ICU length of stay (LOS), invasive mechanical ventilator days, central venous catheter days, and arterial line days. The multivariate analysis showed invasive mechanical ventilation and ICU LOS were independent risk factors for CRKP infection. Mortality in the CRKP group was 48 (44%) compared to 27 (23%) in the carbapenem-sensitive K. pneumonia (CSKP) group, which was statistically significant (P < 0.01). Infection due to CRKP in the ICU was associated with 1.9 times higher mortality as compared to CSKP. Invasive mechanical ventilation and ICU LOS were found to be independent risk factors for CRKP infection.

361. EARLY RECURRENCE PATTERNS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER IN PATIENTS UNDERGOING CROSS NEOADJUVANT THERAPY

Abstract Chemoradiotherapy (CROSS regimen) has been regarded as standard preoperative treatment for patients with locally advanced esophageal cancer, but some patients still developed early recurrence after such intensive therapy. The present study aimed to determine the factors associated with early recurrence for patients with ESCC treated by CROSS therapy within 6 months. Patients were identified from single institution from 2019 to 2021. All patients with locally advanced ESCC who underwent CROSS regimen NCRT and following R0 esophagectomy were reviewed. Total 115 patients were included. 19 patients (16.52%) recurred within 6 months post-surgery. 8 patients (6.96%) had local-regional recurrence with most common location was cervical lymphnodes; 11 patients (9.56%) had distant recurrence and most often occured in lung. In univariate analysis: BMI before CROSS (p = 0.03), tumor size regression (p = 0.03), ypN≧1 (p = 0.002) and neck metastases (p = 0.01) were significantly associated with local-regional recurrence. In multivariate analysis: ypN≧1 (HR = 9.08, p = 0.05) was only independent covariate. For distant recurrence, tumor size regression (p = 0.02), ypN≧1 (p &amp;lt; 0.0001) and TRG3/4 (p = 0.01) were risk factors in univariate analysis, ypN≧1 (HR = 15.60, p = 0.01) was also independent covariate in multivariate analysis. For patients after CROSS neoadjuvant therapy, if there are still positive lymph nodes in clinical evaluation, M staging should be performed more carefully to avoid ineffective surgery with early postoperative distant recurrence.

Natural history of acute unruptured vertebral basilar artery dissection: Temporal changes in imaging findings and contributory factors

ObjectivesTo investigate temporal changes in imaging findings of conservatively treated acute unruptured vertebral basilar artery dissection (VBAD) and its contributing factors. MethodsFifty-three patients who underwent conservative treatment for 64 cases of acute VBAD diagnosed between January 2006 and March 2019 with follow-up of at least 12 months after onset were retrospectively investigated. Statistical analyses of age, sex, medical history, pattern of onset, lesion site, imaging findings and changes over time, regular medication, and outcomes were performed. ResultsChanges in the vascular morphology of the lesion site during the follow-up period were observed in only 23 (43 %) patients (median time until change: 19 days). Univariate analysis of factors contributing to morphological changes at the dissection site showed that changes were significantly more likely in younger patients (p = 0.011). Patients taking antiplatelet drugs had a significantly greater rate of deterioration at the dissection site (p = 0.028) than others. On multivariate analysis, age was an independent factor contributing to changes at the dissection site, and taking antiplatelet drugs, particularly clopidogrel, was an independent factor contributing to deterioration. No patient developed intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during follow-up. ConclusionsMorphological changes at the dissection site are more likely in younger patients with acute unruptured VBAD and those taking antiplatelet drugs. However, chances of intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during conservative therapy are low; therefore, acute unruptured VBAD may be considered a benign condition.

Development and validation of a prognostic nomogram for early stage non-small cell lung cancer: a study based on the SEER database and a Chinese cohort

ObjectiveThis study aimed to construct a nomogram to effectively predict the overall survival (OS) of patients with early-stage non-small-cell lung cancer (NSCLC).MethodsFor the training and internal validation cohorts, a total of 26,941 patients with stage I and II NSCLC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. A nomogram was constructed based on the risk factors affecting prognosis using a Cox proportional hazards regression model. And 505 patients were recruited from Jiaxing First Hospital for external validation. The discrimination and calibration of the nomogram were evaluated by C-index and calibration curves.ResultsA Nomogram was created after identifying independent prognostic factors using univariate and multifactorial factor analysis. The C-index of this nomogram was 0.726 (95% CI, 0.718–0.735) and 0.721 (95% CI, 0.709–0.734) in the training cohort and the internal validation cohort, respectively, and 0.758 (95% CI, 0.691–0.825) in the external validation cohort, which indicates that the model has good discrimination. Calibration curves for 1-, 3-, and 5-year OS probabilities showed good agreement between predicted and actual survival. In addition, DCA analysis showed that the net benefit of the new model was significantly higher than that of the TNM staging system.ConclusionWe developed and validated a survival prediction model for patients with non-small cell lung cancer in the early stages. This new nomogram is superior to the traditional TNM staging system and can guide clinicians to make the best clinical decisions.

Predictive value of ultrasonic features and microscopic extrathyroidal extension in the recurrence of PTC

PurposeTo determine the clinical value of ultrasonic features, especially extrathyroidal extension (ETE), in the prediction of PTC recurrence. MethodA total of 863 patients with PTC confirmed by pathological examinations from January 2012 to August 2018 were selected in this study, including 59 cases of recurrence. The Cox-proportional hazards regression analysis and Kaplan-Meier method were adopted to determine the relationship between the variables and recurrence free survival (RFS). ResultsThe recurrence rate of PTC is 6.8 %. Tumor maximum diameter, margin, multifocality, microcalcifications, ETE and preoperative lymph node metastasis were valuable predictive factors in univariate survival analysis. Tumor larger than 20 mm, multifocality and lateral cervical lymph node metastasis were independent risk factors for PTC recurrence, and lymph node metastasis has the highest hazard ratio (HR). Preoperative lateral cervical lymph node metastasis was more often found in the gross and extensive ETE groups. Microscopic ETE has little value in predicting PTC recurrence and has no correlation with preoperative cervical lymph node metastasis. ConclusionsTumor maximum diameter >20 mm, multifocality and lateral cervical lymph node metastasis were independent risk factors for PTC recurrence. Preoperative lateral cervical lymph nodes should be carefully examined when gross ETE and extensive ETE were detected. Microscopic ETE has no impact on preoperative cervical lymph node metastasis or tumor recurrence.

Lymph node ratio is a prospective prognostic indicator for locally advanced gastric cancer patients after neoadjuvant chemotherapy

BackgroundThe accuracy of lymph node ratio (LNR) as a prognostic index remains to be proven for gastric cancer patients after neoadjuvant chemotherapy (NACT). This study sought to investigate the prognostic value of LNR in locally advanced gastric cancer (LAGC) patients after NACT.MethodsLAGC patients with clinical TNM stages 2–3, Her2(−), and Eastern Cooperative Oncology Group, scores 0–2 are routinely scheduled with NACT. Patients with LAGC after NACT and surgical operation between January 2012 and October 2020 were retrospectively reviewed. The correlation between LNR and survival was investigated.ResultsOverall, 148 patients were enrolled: 103 with low-LNR (LNR ≤ 30%) and 45 with high-LNR (LNR > 30%). Approximately, 50.5% and 24.4% patients responded to NACT at the primary site in the low-LNR and high-LNR groups, respectively. The overall survival (OS) and progression-free survival (PFS) of low-LNR group were considerably better than those of high-LNR group (3-year OS: 81.9% vs 18.5%, P < 0.001; 3-year PFS: 72.6% vs 13.5%, P < 0.001). In the low-LNR group, OS and PFS were superior in patients with tumor regression grade (TRG) 0–2 than in those with TRG 3 (3-year OS: 89.2% vs 73.2%, P = 0.086; 3-year PFS: 80.3% vs 66.5%, P = 0.036). In association with OS and PFS, the degree of tumor differentiation, TRG, and LNR were identified as predictive factors, and LNR was identified as the independent prognostic factor in univariate and multivariate analyses, respectively.ConclusionsLNR is a prospective index of prognosis in patients with LAGC after NACT.

Associations of clinical and circulating metabolic biomarkers with low physical fitness and function in adults with chronic lymphocytic leukemia.

Many patients with chronic lymphocytic leukemia (CLL) experience physical dysfunction and low overall fitness. It remains unknown what factors drive CLL physical dysfunction. We assessed physical function and metabolic lipoprotein panels in 106 patients with CLL. In univariate analyses of clinical factors, a longer time since diagnosis was associated with a higher likelihood of dysfunctional aerobic fitness (OR = 3.56, 95% CI: 1.37–9.22; p = 0.002) and physical performance (SPPB: OR = 2.03, 95% CI: 1.20–3.44; p = 0.004). Having received treatment was associated with a higher likelihood of dysfunctional aerobic fitness (OR = 1.57, 95% CI: 1.02–2.40; p = 0.036), SPPB (OR = 1.85, 95% CI: 1.13–3.03; p = 0.011) and grip strength (OR = 1.67, 95% CI: 1.10–2.55; p = 0.015). We found that several small HDL particle parameters, higher levels of citrate (OR = 2.01, 95% CI: 1.22–3.31; p = 0.030), and lower levels of hemoglobin (OR = 0.50, 95% CI: 0.31–0.82; p = 0.030) were associated with a higher likelihood of dysfunctional aerobic fitness. Multivariable least absolute shrinkage and selection operator (LASSO)-penalized regression analyses using variable importance measures (VIM) showed that 7.8-nm HDL particles (VIM = 1.000) and total HDL particle levels (VIM = 1.000) were more informative than clinical measures for the odds of dysfunctional aerobic fitness and 6-min walk functional fitness, respectively, while 10.3-nm HDL particles (VIM = 0.383) were more informative for grip strength. Time since diagnosis (VIM = 0.680) and having received treatment (VIM = 0.490) were more informative than lipoprotein measures for the odds of having dysfunctional SPPB. Taken together, we establish significant relationships between clinical and metabolic factors and physical characteristics that might prompt early use of ancillary support services.

Significant Factors of High Performance Outcomes for Tibial Plafond Fractures.

Limited research exists about high performance postsurgical tibial plafond fractures. This study aimed to identify aspects of the plafond fracture injury and care associated with "high performance" based on Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) scores. Tibial plafond fracture patients with minimum 12-month follow-up treated at a level 1 trauma center from 2006 to 2019 were categorized into high (top 25%) vs average-low (AL) (bottom 75%) performers based on PROMIS PF scores. Demographics and fracture characteristics of high and AL performers were compared. Variables with a P value less than .1 were used in stepwise logistic regressions. The final cohort of 198 patients was divided into high (n=51) and AL (n=147) performers based on PF scores. The mean PF scores for the high and AL groups were 58 (SD=5.3) and 41.9 (SD=6.5), respectively. The mean PROMIS Pain Interference scores for the high performers and AL were 43.3 (SD=4.9) and 56.8 (SD=8.6) (P < .001), respectively. FAAM activities of daily living (high 95.4 [SD=5.5] vs AL 70.4 [SD=19.8], P < .001) and FAAM sports (high 76.8 [SD=21.3] vs AL 27.3 [SD=28.9], P < .001) subscale scores were significantly greater in the high-performing group. Sex, age, marital status, and diabetes were nonsignificant factors in univariate analysis. Significant demographic factors associated with high performance from univariate analysis were Caucasian race, private insurance, no tobacco use, lower body mass index (BMI), and mechanism of injury. Patients with fracture characteristics of OTA 43C (complete articular) fractures, bone loss, open fractures, or nonexcellent reduction were significantly less likely to be high performers. Additionally, less than excellent reductions were more common in more complex fracture patterns. Multivariable regression modeling showed that higher BMI, OTA/AO 43-C (complete articular) fracture classification, and open fracture were significant independent risk factors for reducing likelihood of high performance. Significant independent factors associated with high performance after tibial plafond fracture are lower BMI, closed fracture, and OTA/AO 43-B (partial articular) fracture.

Effects and Prognostic Values of Circadian Genes CSNK1E/GNA11/KLF9/THRAP3 in Kidney Renal Clear Cell Carcinoma via a Comprehensive Analysis.

Kidney renal clear cell carcinoma (KIRC) is one of the most prevalent and deadly types of renal cancer in adults. Recent research has identified circadian genes as being involved in the development and progression of KIRC by altering their expression. This study aimed to identify circadian genes that are differentially expressed in KIRC and assess their role in KIRC progression. In KIRC, there were 553 differentially expressed rhythm genes (DERGs), with 300 up-regulated and 253 down-regulated DERGs. Functional enrichment analyses showed that DERGs were greatly enriched in the circadian rhythm and immune response pathways. Survival analyses indicated that higher expression levels of CSNK1E were related to shorter overall survival of KIRC patients, whereas lower expression levels of GNA11, KLF9, and THRAP3 were associated with shorter overall survival of KIRC patients. Through cell assay verification, the mRNA level of CSNK1E was significantly up-regulated, whereas the mRNA levels of GNA11, KLF9, and THRAP3 were dramatically down-regulated in KIRC cells, which were consistent with the bioinformatics analysis of KIRC patient samples. Age, grade, stage, TM classification, and CSNK1E expression were all shown to be high-risk variables, whereas GNA11, KLF9, and THRAP3 expression were found to be low-risk factors in univariate Cox analyses. Multivariate Cox analyses showed that CSNK1E and KLF9 were also independently related to overall survival. Immune infiltration analysis indicated that the proportion of immune cells varied greatly between KIRC tissues and normal tissue, whereas CSNK1E, GNA11, KLF9, and THRAP3 expression levels were substantially linked with the infiltration abundance of immune cells and immunological biomarkers. Moreover, interaction networks between CSNK1E/GNA11/KLF9/THRAP3 and immune genes were constructed to explore the stream connections. The findings could help us better understand the molecular mechanisms of KIRC progression, and CSNK1E/GNA11/KLF9/THRAP3 might be used as molecular targets for chronotherapy in KIRC patients in the near future.

Clonal Myeloproliferative Disorders in Patients with Down Syndrome-Treatment and Outcome Results from an Institution in Argentina.

Simple SummaryAround 30% of children with Down Syndrome (DS) will develop Transient Abnormal Myelopoiesis (TAM) and 20% of them will progress to Acute Myeloid Leukemia (AML), mostly Megakaryoblastic Leukemia (AMKL). The optimal balance between treatment intensity and treatment-related toxicity has not yet been defined; neither the prognostic factors that determine the risk of developing AML nor the outcome. The aims of our retrospective study were to analyze the demographic/biological features of this population, identify possible risk factors and the optimal treatment. We observed that early intervention in TAM is effective to prevent a dismal outcome. The strongest poor-prognostic factor of DS-AML was sporadic DS-AML (non-AMKL immunophenotype), as well as complex karyotype and young age. Classical Myeloid Leukemia associated with DS (ML-DS) good outcome is mainly related to their low relapse rate. Even though the augmented sensitivity to chemotherapy seen in DS patients must be kept in mind, our data do not support the omission of high doses of cytarabine in ML-DS.Children with Down syndrome (DS) are at an increased risk of developing clonal myeloproliferative disorders. The balance between treatment intensity and treatment-related toxicity has not yet been defined. We analyzed this population to identify risk factors and optimal treatment. This single-center retrospective study included 78 DS patients <16 years-old with Transient Abnormal Myelopoiesis (TAM, n = 25), Acute Myeloblastic Leukemia (DS-AML, n = 41) of which 35 had classical Myeloid Leukemia associated with DS (ML-DS) with megakaryoblastic immunophenotype (AMKL) and 6 sporadic DS-AML (non-AMKL). Patients with DS-AML were treated according to four BFM-based protocols. Classical ML-DS vs. non-DS-AMKL were compared and the outcome of ML-DS was analyzed according to treatment intensity. Only four patients with TAM required cytoreduction with a 5-year Event-Free Survival probability (EFSp) of 74.4 (±9.1)%. DS-AML treatment-related deaths were due to infections, with a 5-year EFSp of 60.6 (±8.2)%. Megakaryoblastic immunophenotype was the strongest good-prognostic factor in univariate and multivariate analysis (p = 0.000). When compared ML-DS with non-DS-AMKL, a better outcome was associated with a lower relapse rate (p = 0.0002). Analysis of administered treatment was done on 32/33 ML-DS patients who achieved CR according to receiving or not high-dose ARA-C block (HDARA-C), and no difference in 5-year EFSp was observed (p = 0.172). TAM rarely required treatment and when severe manifestations occurred, early intervention was effective. DS-AML good outcome was associated with AMKL with a low relapse-rate. Even if treatment-related mortality is still high, our data do not support the omission of HDARA-C in ML-DS since we observed a trend to detect a higher relapse rate in the arm without HDARA-C.

Prognostic factors in completely resected lymph-node-negative pulmonary adenocarcinoma.

BackgroundLymph node involvement is one of the important prognostic factors for early-stage lung cancer. However, in lymph node-negative (N0) lung cancer the recurrent rate may be as high as 30%. We aimed to study potential prognostic factors including clinicopathological factors and epidermal growth factor receptor (EGFR) mutation status in this lung cancer population.MethodsWe retrospectively reviewed the medical records and pathological examinations of patients with completely resected N0 pulmonary adenocarcinoma treated in our institute between 2009 and 2016. We used Cobas® test to determine EGFR mutation status. Recurrence-free survival (RFS) was analyzed by univariable and multivariable Cox regression analyses.ResultsWe recruited 220 patients with median duration of follow up 5 years. Majority of these patients were in stage I (80%) and did not receive adjuvant therapy (86%). There were 53% with EGFR mutations which comprised of exon 19 deletion 51% and L858R 43%. Recurrence occurred in 64 out of 220 patients (29%). The median time to recurrence was 2.1 years. Statistically significant prognostic factors in both univariate and multivariate analyses included tumor size ≥4 centimeter (cm) (HR: 1.94; 95% CI: 1.03–3.67), visceral pleural invasion (HR: 2.53; 95% CI: 1.34–4.79), tumor necrosis (HR: 2.45; 95% CI: 1.13–5.31) and bronchial resection margin <2 cm (HR: 1.96; 95% CI: 1.10–3.51). However, presence of sensitizing EGFR mutation was not found to be a significant prognostic factor (HR: 1.20; 95% CI: 0.66–2.18; P=0.56).ConclusionsIn N0 surgically resected lung adenocarcinoma, there were significant pathological prognostic factors including tumor 4 cm or more, visceral pleural invasion, tumor necrosis and bronchial resection margin less than 2 cm. Mutation of EGFR is not a significant prognostic factor to determine the risk of recurrence in this population and their risks shall be determined by the other poor prognostic factors.