Hospital Research Articles

Screening high-risk individuals for primary gastric adenocarcinoma: evaluating progression-free survival probability score in the presence and absence of Rictor expression after gastrectomy

ObjectiveDeveloping nomogram-based risk stratification model to determine 3-year and 5-year progression-free survival (PFS) and to identify high-risk patients with gastric adenocarcinoma based on different Rictor statuses.Methods1366 individuals who underwent radical gastric surgery to treat gastric adenocarcinoma at Shanxi Cancer Hospital from May 2002 to December 2020 were analyzed. Cox regression analysis was employed to create the nomograms. The nomograms’ performance was assessed using C-index, time receiver operating characteristic (t-ROC) curves, calibration curves, and decision curve analysis (DCA) curves in training and validation cohorts. Subsequently, patients were categorized into high-risk and low-risk groups based on the nomogram’s risk scores.ResultsThe Rictor (-) nomogram for predicting PFS included variables such as age, number of positive lymph nodes, vascular invasion, maximum diameter of the tumor, omentum metastasis, and expression of MSH2. In the internal validation, the C-index of the Rictor (-) nomogram was 0.760 (95%CI: 0.720-0.799), which was superior to the C-index of the American Joint Committee on Cancer (AJCC) 8th edition TNM staging (0.683, 95%CI: 0.646-0.721). Similarly, the Rictor (+) nomogram for predicting PFS included variables such as gender, age, pT stage, number of positive lymph nodes, neural invasion, maximum diameter of the tumor, omentum metastasis, Clavien-Dindo classification for complications, and CGA expression. The C-index of the Rictor (+) nomogram was 0.795 (95%CI: 0.764-0.825), which outperformed the C-index of the AJCC 8th edition TNM staging (0.693, 95%CI: 0.662-0.723). The calibration curves, t-ROC curves, and decision curve analysis for both nomogram models demonstrated their excellent prediction ability.ConclusionThis study presents the first risk stratification for Rictor status in gastric adenocarcinoma. Our model identifies low-risk patients who may not require additional postoperative treatment, while high-risk patients should consider targeted therapies that specifically target Rictor-positive indicators.

Exploration of the pattern of lymph node metastasis in esophageal cancer based on membrane anatomy theory

AbstractObjectiveTo analyze the pattern of lymph node metastasis in esophageal cancer based on the theory of membrane anatomy.MethodsA retrospective analysis was conducted on 143 patients who underwent esophageal surgery at the Cancer Hospital of the Chinese Academy of Medical Sciences from March 2021 to March 2022. Lymph node metastasis was observed and categorized according to postoperative T staging. The characteristics and patterns of lymph node metastasis in different regions were observed, and the lymph node metastasis patterns in patients with clinical T3 esophageal cancer were analyzed using membrane anatomy theory.ResultsAmong the 143 patients with esophageal squamous cell carcinoma, 21 were treated with surgery alone, while the rest received preoperative adjuvant therapy. A total of 5456 lymph nodes were cleared from the 143 patients, with 204 positive lymph nodes, resulting in a positive rate of 3.74%. In the thoracic lymph node dissection, the metastatic rates exceeded 5% for the following regions: 106recR (17.36%), 106recL (12.5%), 107 (10.42%), and 108 (5.56%) station. When analyzing the abdominal lymph node metastasis, the metastatic rates exceeded 5% for regions 7 (13.19%), 3a (7.64%), 2 (6.94%), and 1 (6.25%) station. Group analysis of patients with esophageal squamous cell carcinoma before postoperative pathological T3 stage revealed an increasing trend in tumor lymph node metastasis rate with later T staging. Lymph node metastasis in region 106recR can occur early, with a metastasis rate of 18.37% in T1 tumors. Analysis of lymph node metastasis characteristics in 103 patients clinically staged as T3 showed that 3966 lymph nodes were cleared, with 186 positive nodes, resulting in a positive rate of 4.69%. Lymph node metastasis rates were higher in regions 106recL, 106recR, 107, 108, 110, 1, 2, 3a, and 7, all exceeding 5%.ConclusionThe theory of membrane anatomy can effectively explain the pattern of lymph node metastasis in esophageal cancer.

Clinicopathological features and prognosis of mucinous breast carcinoma with a micropapillary structure

AbstractObjectiveTo conduct a comparative analysis of clinicopathological data between mucinous micropapillary breast carcinoma (MUMPC) and pure mucinous carcinoma (PMC) without a micropapillary structure to elucidate the distinctive clinicopathological characteristics of MUMPC and their impact on prognosis.MethodsThis retrospective analysis included 325 patients diagnosed with mammary mucinous carcinoma admitted to Tianjin Cancer Hospital between July 2014 and December 2019, including 197 patients with MUMPC and 128 patients with PMC without a micropapillary structure. Clinicopathological features were compared, and factors influencing the prognosis of MUMPC were analyzed. Survival analysis was conducted using the Kaplan–Meier method, and univariate and multivariate prognostic analyses for MUMPC were performed using the Cox proportional hazard regression model.ResultsThe median follow‐up period was 76 months. In the MUMPC and PMC groups, the disease‐free survival (DFS) rates at 3, 5, and 7 years were 95.4%, 90.4%, 89.8%, and 100%, 98.4%, and 96.9%, respectively, with a statistically significant difference between the two groups (p = 0.009). Tumor, node, and metastasis (TNM) stage, lymph node metastasis, and endocrine treatment were significant factors influencing the prognosis of the MUMPC group (p < 0.001). Multivariate analysis revealed that lymph node metastasis and endocrine therapy were independent prognostic factors in patients with MUMPC (p < 0.001). Compared with PMC, the MUMPC group exhibited a higher prevalence of HER2 (11.2% vs. 3.1%, p = 0.009) and Ki‐67 overexpression (79.7% vs. 60.2%, p < 0.001).ConclusionThe lymph node stage is the most crucial clinicopathological feature of MUMPC. Endocrine treatment strategy is an independent risk factor affecting the prognosis of MUMPC.

Impact of Physician Specialty on Treatment Costs of Invasive Melanoma

Introduction: Melanoma is a deadly type of skin cancer that develops from melanocytes and can manifest on the skin or other regions of the body. Its incidence is increasing rapidly, with approximately 100,000 diagnoses and 7000 deaths per year in the US alone. We conducted a cross-sectional study with the aim of determining an association between the cost of care for invasive melanoma and the specialty involved in the treatment to adequately guide future treatment. Methods: We analyzed data from 3817 patients (2013–2018) using the Florida inpatient/outpatient dataset, CMS cost reports, and the National Plan and Provider Enumeration System. Covariates included age, sex, race/ethnicity, insurance type, region, county rurality, the number of procedures, the comorbidity index, obesity, metastatic cancer presence, hospital size, and physician volume. Multivariable mixed linear regression was used to analyze the data, and the cost was adjusted to the 2019 USD. Results: Dermatology had the largest decrease in the overall and outpatient costs compared to general surgery, followed by plastic surgery. The inpatient costs for dermatology and plastic surgery were lower than those for general surgery, but not significantly so. Conclusions: The costs associated with surgical procedures may vary depending on the specialty of the physician treating the patient. Dermatology was associated with lower treatment costs for invasive melanoma compared to other specialties, indicating that physician specialty influences the cost of care.

Machine learning for epithelial ovarian cancer platinum resistance recurrence identification using routine clinical data

BackgroundMost epithelial ovarian cancer (EOC) eventually develops recurrence. Identification of high-risk patients can prompt earlier intervention and improve long-term outcomes. We used laboratory and clinical data to create models based on machine learning for EOC platinum resistance recurrence identification.MethodsThis study was designed as a retrospective cohort analysis. Initially, we identified 1,392 patients diagnosed with epithelial ovarian cancer who underwent platinum-based chemotherapy at Yunnan Cancer Hospital between January 1, 2012, and June 30, 2022. We collected data on the patients’ clinicopathologic characteristics, routine laboratory results, surgical information, details of chemotherapy regimens, and survival outcomes. Subsequently, to identify relevant variables influencing the recurrence of platinum resistance, we screened thirty potential factors using two distinct variable selection methods: Lasso regression and multiple logistic regression analysis. Following this screening process, five machine learning algorithms were employed to develop predictive models based on the selected variables. These included decision tree analysis (DTA), K-Nearest neighbor (KNN), support vector machine (SVM), random forest (RF), and eXtreme gradient boosting (XGBoost). The performance of these models was compared against that of traditional logistic regression. To ensure robust internal validation and facilitate comparison among model performance metrics, a five-fold cross-validation method was implemented. Key performance indicators for the models included the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and average accuracy. Finally, we will visualize these models through nomograms, decision tree diagrams, variable importance plots, etc., to assist clinicians in their practice.ResultsMultiple logistic regression analysis identified eight variables associated with platinum resistance recurrence. In the lasso regression, seven variables were selected. Based on the findings from both Lasso regression and multiple logistic regression analysis, models were developed using these 7 and 8 factors. Among these, the XGBoost model derived from multiple logistic regression exhibited superior performance and demonstrated good discrimination during internal validation, achieving an AUC of 0.784, a sensitivity of 0.735, a specificity of 0.713, an average accuracy of 80.4%, with a cut-off value set at 0.240. Conversely, the LR model based on lasso regression yielded commendable results as well; it achieved an AUC of 0.738, a sensitivity of 0.541, a specificity of 0.836, with a cut-off value established at 0.154 and an accuracy rate of 79.6%. Finally, we visualized both models through nomograms to illustrate the significance of each variable involved in their development.ConclusionsWe have successfully developed predictive models for platinum-resistant recurrence of epithelial ovarian cancer, utilizing routine clinical and laboratory data. Among these models, the XGBoost model—derived from variables selected through multiple logistic regression—demonstrated the best performance. It exhibited high AUC values and average accuracy during internal validation, making it a recommended tool for clinical use. However, due to variations in time and context, influencing factors may change over time; thus, continuous evolution of the model is necessary. We propose a framework for this ongoing model adaptation.

The Role of FLT3-ITD Mutation, PI3K/AKT Pathway, and Leukemia Stem Cells in D3A7 Induction therapy – the Outcomes of Adult Indonesian Patients with Acute Myeloid Leukemia

Objective. This cohort study aimed to examine the impact of the FLT3-ITD mutation on the downstream signaling pathway of PI3K/AKT pathway, the percentage of leukemia stem cells, and the survival of patients receiving D3A7 induction therapy. Method. Bone marrow mononuclear cells were collected from 20 adult AML patients who had completed D3A7 induction therapy at Cipto Mangunkusumo National General Hospital and Dharmais Cancer Hospital. FLT3-ITD gene mutation was examined by the PCR-sequencing method. Expression of phosphorylated PI3K and AKT was detected using the sandwich ELISA method. Flow cytometry was used for detecting the number of apoptosis and proliferation cells, and biomarkers of leukemia stem cells. Result. The expression levels of PI3K and AKT proteins were higher in FLT3-ITD, both in the mutant group compared to the non-mutation group, and in the patient group with treatment failure outcomes compared to the patient group with treatment response. The percentage of the leukemia stem cell population did not differ significantly between the FLT3-ITD mutation group and the wild type group, and between the treatment failure outcome group and the response outcome group. Conclusion. This study presents the important role of FLT3-ITD mutation via its downstream signaling (PI3K/AKT) in the outcome of D3A7 induction therapy. The FLT3-ITD mutation plays an important role in the 12-month survival of AML patients after D3A7 therapy. However, the outcome of D3A7 therapy and FLT3-ITD mutation were not associated with leukemia stem cells.

Mean platelet volume/platelet count ratio can predict the recurrence-free survival rate of patients after complete resection of gastrointestinal stromal tumors

PurposeThe aim of this study is to compare mean platelet volume/platelet count ratio (PVPR) and other indicators’ predictive abilities. Simultaneously, a new nomogram for predicting recurrence-free survival (RFS) after gastrointestinal stromal tumors (GISTs) R0 resection was developed.MethodsFrom January 2010 to July 2019, 295 patients with GIST who were operated on at Harbin Medical University Cancer Hospital were retrospectively reviewed. With a 4-year RFS as the end point, using the Kaplan–Meier methods and log rank test, and then conducting Cox regression analysis, we compared and identified meaningful indicators for predicting prognosis. Finally, a nomogram was developed and validated using calibration curves.ResultsThe receiver operating characteristic curve indicated that a cutoff point of 0.044 was the ideal threshold for PVPR, and patients were divided into a high-PVPR group (≤0.044) and a low-PVPR group (>0.044). Kaplan–Meier curves suggested that PVPR>0.044 had obvious associations with better RFS (p < 0.001). In accordance with multivariate analysis, PVPR (>0.044 vs. ≤0.044) (p = 0.005), National Institutes of Health (NIH) risk category (p < 0.001), and Ki-67 (p = 0.005) were the independent prognostic indicators of RFS. Tumor size, gastrointestinal bleeding, mitotic index, NIH risk category, CD34, and Ki-67 all exhibited an obvious correlation with PVPR (all p < 0.05). The nomogram’s probability of concordance was 0.823, indicating that the nomogram predictions were well calibrated.ConclusionIn GISTs, RFS can be independently predicted by PVPR. Patients with higher PVPR have better RFS. The nomogram including PVPR could be used to assist clinical treatment decision-making.

Trends in hospitalization for female breast and gynecological cancer in China from 2004 to 2020

Breast and gynecological cancers are common cancers with high mortality and have profound effects on the various physical functions of women. This study assessed trends in the number of hospitalizations, in-hospital mortality, length of stay (LOS), and hospital charges for female breast and gynecological cancer from 2004 to 2020. The data for this study come from the China Health Statistics Yearbook. Time trends of categorical variables were assessed with the Cochran-Armitage Test. The linear model was used to test for the trend of continuous variables. The hospitalizations for breast cancer increased from 15,204 to 276,387 (P for trend < 0.001) and gynecological cancer increased from 12,418 to 214,956 (P for trend < 0.001). The in-hospital mortality rate due to breast cancer decreased from 1.70 to 1.07% (P for trend < 0.001). Hospitalizations for both breast and gynecological cancer increased clearly, whether in urban or rural. The gap between urban and rural has narrowed. The average cost per hospitalization for breast cancer significantly increased. However, the average LOS for breast cancer gradually decreased (from 17.0 to 10.7 days, P for trend < 0.001). The average cost per hospitalization for gynecological cancer increased significantly. However, this steady downward trend was observed in the average LOS for gynecological cancer (from 10.34 to 6.69 days, P for trend = 0.003). The increase in hospitalizations and medical expenses for breast and gynecological cancer should encourage healthcare policymakers and healthcare system stakeholders to develop more cost-effective approaches to women’s cancer management.

Association of commission on cancer accreditation with receipt of guideline‐concordant care and survival among patients with colon cancer

AbstractBackgroundGuideline‐concordant care (GCC) is associated with improved survival for patients with cancer; however, variations in receipt of GCC remain a concern. The objective of this study was to evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of GCC and survival among patients with colon cancer.MethodsThis retrospective observational study identified patients diagnosed with stage I–IV colon cancer from 2018 to 2020 from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program Database. Guideline concordance was defined as receipt of stage‐appropriate lymphadenectomy or chemotherapy. Multivariable logistic regression models investigated associations with receipt of GCC. Cox proportional hazards regression models assessed 3‐year cancer‐specific mortality risk.ResultsOf 222,583 patients with colon cancer, 146,629 (91.2%) of eligible patients received guideline‐concordant lymphadenectomy and 70,586 (81.9%) of the eligible patients received guideline‐concordant chemotherapy. Treatment at CoC‐accredited hospitals was the strongest modifiable predictor for receipt of guideline‐concordant lymphadenectomy (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.75–1.88) and chemotherapy (OR 2.14; 95% CI 2.06–2.23). Among patients treated at CoC‐accredited hospitals, risk adjusted mortality was decreased for patients with stage I–II disease (hazard ratio [HR] 0.94; 95% CI 0.80–0.99), stage III disease (HR 0.93; 95% CI 0.88–0.98), and stage IV disease (HR 0.88; 95% CI 0.84–0.92).ConclusionsFor patients with colon cancer, treatment at CoC‐accredited hospitals was associated with increased receipt of GCC and decreased mortality risk. Benchmarking data may serve as a valuable accountability tool for quality assessment to improve cancer treatment and outcomes.

Survival outcomes of lymph node dissection in early-stage epithelial ovarian cancer: identifying suitable candidates

ObjectiveThe study aimed to assess the effect of lymph node dissection on survival outcomes in patients presenting with early-stage epithelial ovarian cancer and to delineate patient characteristics that may indicate a greater benefit from pelvic lymph node dissection.MethodsA retrospective analysis was performed on individuals diagnosed with clinical stage I-II epithelial ovarian cancer who received primary cytoreductive surgery at the Cancer Hospital Affiliated with Harbin Medical University from January 1, 2010, to January 1, 2018. The investigation encompassed an examination of demographic data, clinicopathological profiles, perioperative complications, and survival outcomes.ResultsA total of 315 patients diagnosed with ovarian cancer were incorporated into the study and were segregated into two distinct cohorts: 217 patients who underwent lymphadenectomy (Group A) and 98 patients who did not undergo the procedure (Group B). The disparities in progression-free survival and overall survival between the two cohorts did not attain statistical significance (p > 0.05). Upon conducting a subgroup analysis, it was discerned that patients characterized by clear cell carcinoma as the pathological subtype demonstrated a significantly extended progression-free survival post-lymphadenectomy (p = 0.02). Additionally, the operative duration for the patients in Group A was significantly protracted in comparison to Group B (146.15 ± 39.132 min vs. 133.49 ± 35.308 min, P = 0.043).ConclusionFor patients with early-stage ovarian cancer, lymph node dissection does not significantly improve progression-free or overall survival rates. Our findings suggest that individuals with clear cell carcinoma pathology have a higher probability of benefiting in terms of survival following lymph node dissection.

Analysis of risk factors and establishment of early warning model for recent postoperative complications of colorectal cancer

ObjectiveThis study aimed to analyze factors associated with recent complications after colorectal cancer surgery, constructing a nomogram to aid gastrointestinal surgeons in preoperative decision-making for patients at risk of such complications.MethodsIn this retrospective study, clinical data were collected from patients undergoing radical colorectal cancer surgery at the Department of Gastrointestinal Surgery of the Affiliated Cancer Hospital of Guizhou Medical University and the Second People’s Hospital of Chengdu from November 1, 2021, to January 26, 2024. Univariable and multivariable logistic regression analyses were conducted to assess risk factors for recent postoperative complications and develop a prediction model. External validation was performed using data from 48 postoperative colorectal cancer patients in the Second People’s Hospital of Chengdu City from January 1, 2023, to May 30, 2023. Evaluation included receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis using R4.2.2 statistical software.ResultsA total of 324 patients who underwent radical colorectal cancer surgery were enrolled. The training cohort (n=176) identified four independent risk factors for recent complications: PNI ≥45 (OR=4.17, P&amp;lt;0.001), Albumin &amp;lt;40 g/L (OR=3.9, P&amp;lt;0.001), ASA score III-IV (OR=6.29, P&amp;lt;0.001), and Tumor diameter ≥5 cm (OR=4.24, P&amp;lt;0.001). A nomogram was constructed incorporating these factors. The AUC of the nomogram model in the training cohort was 0.835, with subsequent internal and external validation cohort AUCs of 0.815 and 0.819, respectively, indicating strong discriminatory ability. The calibration curve demonstrated good consistency, and decision curve analysis indicated high clinical utility.ConclusionPNI ≥45, Albumin &amp;lt;40 g/L, ASA score III-IV, and Tumor diameter ≥5 cm emerged as independent risk factors for recent complications following colorectal cancer surgery. We developed a nomogram model for these complications, potentially aiding gastrointestinal surgeons in preoperative patient evaluation and treatment planning for colorectal cancer surgery.

Photobiomodulation Therapy in the Prevention of Chemotherapy Induced Oral Mucositis in Children with Acute Myeloid Leukemia: A Randomized, Double-blind, Clinical trial.

Many preventive modalities have been advocated to reduce the incidence and severity of chemotherapy-induced Oral Mucositis (OM). Photobiomodulation, also known as Low-Level laser. Therapy, has shown promising results. This clinical trial was performed to evaluate the effectiveness of Photobiomodulation (PBM) for the prevention of chemotherapy-induced oral mucositis (OM) in children with Acute Myeloid Leukemia (AML). A double-blinded randomized clinical trial was performed, including forty-two children diagnosed with Acute Myeloid Leukemia (AML) admitted to receiving chemotherapy (CT) at Children's Cancer Hospital 57357, Cairo, Egypt. Patients were randomly assigned to either the control or test group. Both groups followed the standard preventive protocol for oral mucositis. In the control group I sham therapy, while in the Laser group I had Photobiomodulation sessions for five consecutive days once a day performed by Diode laser (Sirrolaser Blue ™, USA) 660nm, 15watt, 10 s. Laser sessions began on day 1 of chemotherapy and were repeated on days 2,3, 4, and 5. The response to both groups was evaluated according to the development of oral mucositis; graded using the classification criteria of the World Health Organization (WHO) and the National Cancer Institute scale (NCI - Common Terminology Criteria for Adverse Events, version 4.0). Incidence of oral mucositis was evaluated from baseline to 5, 12, 19, and 30 days after treatment. A clinical significant difference between the laser and control group was observed. The laser group showed a higher prevalence of no oral mucositis with decreased incidence of OM, while on day 12, the control group showed a higher prevalence of grades I and II (P-value <0.001, effect size = 0.796). However, the laser group showed higher prevalence of mucosa free of OM; on day 19, the control group showed higher rates of grades II and III, (P-value <0.001, effect size = 0.670). while on day 30 there was higher rates of grades I and II (P-value <0.001, effect size = 0.576) with higher rates of healthy oral mucosa in the laser group. Photobiomodulation effectively reduces the incidence and severity of chemotherapy-induced oral mucositis in pediatric patients diagnosed with AML.

Dynamics trajectory of patient-reported quality of life and its associated risk factors among hepatocellular carcinoma patients receiving immune checkpoint inhibitors: a prospective cohort study

ObjectiveWe aimed to characterize quality of life (QOL) trajectories among patients with intermediate and advanced hepatocellular carcinoma patients treated with immunotherapy.MethodsBarcelona Clinic Liver Cancer (BCLC) stage B-C HCC patients receiving immunotherapy at Guangxi Medical University Cancer Hospital were included. Trajectories of QOL, assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire, were identified through iterative estimations of group-based trajectory models. Associations with trajectory group membership were analyzed using multivariable multinomial logistic regression.ResultsThree trajectory groups were identified (n=156): excellent (35.3%), poor (43.6%), and deteriorating (21.1%) QOL. The deteriorating trajectory group reported a mean QOL score of 124.79 (95% CI, 116.58–133.00), but then declined significantly at month-2 (estimated QOL score 98.67 [95% CI, 84.33–113.00]), and the lowest mean score is reached at month-6 (estimated QOL score 16.58 [95% CI, 0–46.07]). Factors associated with membership to the deteriorating group included no drinking (odds ratio [OR] vs yes [95% CI], 3.70 [1.28–11.11]), no received radiotherapy (OR vs yes [95% CI], 8.33 [1.41–50.00]), diabetes (OR vs no [95% CI], 6.83 [1.57–29.73]), and extrahepatic metastasis (OR vs no [95% CI], 3.08 [1.07–8.87]). Factors associated with membership to the poor group also included body mass index ≤24.0 kg/m2 (OR vs no [95% CI], 4.49 [1.65–12.22]).ConclusionsThis latent-class analysis identified a high-risk cluster of patients with severe, persistent post-immunotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of immunotherapy and preserve QOL.

Efficacy of rechallenge after first-line immunotherapy for advanced gastric cancer: A retrospective real-world study

ABSTRACT We aimed to explore the efficacy of rechallenge after first-line immunotherapy in advanced gastric cancer (AGC) and to analyze the factors affecting prognosis based on clinical characteristics. Eighty-five AGC patients who underwent rechallenged after the failure of first-line treatment with immune checkpoint inhibitors (ICIs) were retrospectively collected from July 2019 to December 2022 in Jiangsu Cancer Hospital. Potential factors affecting prognosis were analyzed by univariate and multivariate Cox analysis. Survival analysis was performed by Kaplan–Meier method and Log rank test. Stratified factors included human epidermal growth factor receptor 2 (HER-2) and programmed cell death-ligand 1 combined positive score (PD-L1 CPS). The objective response rate (ORR) was 15.3%, and the disease control rate (DCR) was 74.1%. The median progression-free survival (PFS) was 4.8 months. Results showed that patients in the I + C group had the best response. The ORR was 20.0% VS 8.7% in the I + C group and I + C + AAD group. The DCR was 78.0% VS 65.2%, and the median PFS was 6.7 VS 4.7 months [hazard ratio (HR): 0.55, 95% confidence interval (CI): 0.30–1.00, p = .022]. The ORR was 20.0% VS 8.3% in the I + C group and I + C + ADC group. The DCR was 78.0% VS 75.0%, and the median PFS was 6.7 VS 4.4 months (HR: 0.59, 95%CI: 0.26–1.30, p = .112). The median PFS was 4.7 VS 4.4 months in the I + C + AAD group and I + C + ADC group (HR: 1.21, 95%CI: 0.60–2.47, p = .580). Adverse events (AEs) were found in 34 patients, mainly including leukopenia 9 (10.6%), and neutropenia 8 (9.4%). The incidence of grade 3–4 AEs was 8.2%. There were no drug-related deaths and all AEs were manageable. Rechallenge after first-line immunotherapy showed good survival benefit and acceptable safety in the therapy of AGC. Especially for patients with HER-2-positive and PD-L1 CPS ≥ 1%, rechallenge may be an effective treatment modality.

Development and validation of a nomogram for predicting overall survival of head and neck adenoid cystic carcinoma

This study aimed to develop and validate a nomogram using clinical variables to guide personalized treatment strategies for adenoid cystic carcinoma of the head and neck (ACCHN). Data from 1069 patients with ACCHN diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were used to construct the nomogram. External validation was performed using an independent cohort of 70 patients from Fujian Cancer Hospital. Multivariate Cox regression analysis was conducted using IBM SPSS version 26.0 and R Software version 4.2.3. The concordance index (C-index) and receiver operating characteristic (ROC) curves were used to assess the predictive accuracy of the nomogram. Age, tumor site, surgery, N stage, M stage, and TNM stage were identified as independent prognostic factors through univariate and multivariate Cox analyses. The nomogram demonstrated superior predictive performance compared to the TNM staging system, effectively stratifying patients into high-risk and low-risk groups. This nomogram offers a valuable tool for predicting overall survival in patients with ACCHN and tailoring individualized treatment approaches.

Postoperative Outcome And Complications Among Peritoneal Carcinomatosis Patients

Introduction: Peritoneal carcinomatosis is a recurrence pattern in gastric cancer, commonly complicating the postoperative course, especially in high-risk individuals. These complications adversely affect quality of life, increase mortality, and have immediate postoperative clinical implications. Surgery is the best treatment for early-stage tumors, despite its associated risks, including mortality. Aim: To evaluate the impact of postoperative complications on the clinical outcomes of patients undergoing peritoneal cancer surgery. Methods: This cross-sectional observational study was conducted at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, over twenty-one months from July 2017 to March 2019. Forty-two patients were selected based on inclusion and exclusion criteria and diagnosed clinically, radiologically, and histopathologically. Data were collected using a structured case record form and analyzed using SPSS-22. Results: The mean age of participants was 66.19 ± 10.38 years, with 33.3% aged 56-65 years. The cohort included 64.3% males and 35.7% females, with 52.4%, 40.5%, and 7.1% having a BMI of 18.5-24.9 kg/m², 25- 30 kg/m², and &gt;30 kg/m², respectively. Smoking and betel leaf use were common (61.9% and 83.3%, respectively), with 69% from the middle class. Tumors primarily involved the proximal and distal stomach, with a mean size of 6.20 ± 1.86 cm, predominantly Type 3 and Type 4, and stages T4a and N2. No metastasis was observed. Total and lower radical gastrectomies were performed, with complications occurring in 9.5% (chest infection) and 14.3% (wound infection), while 76.2% had no complications. Conclusion: Complications can serve as indicators of postoperative clinical outcomes. The findings highlight the need for systemic changes in healthcare to reduce postoperative morbidity and mortality, thereby decreasing hospital stays.

Nurse‐Authored Patents and Their Influencing Factors Analysis Among Oncology Nurses Based on the Structural Equation Model

ABSTRACTAimsThis study analysed the status of nurse‐authored patents and their influencing factors. In particular, this study examined the effects of nurses' innovative behaviour and creative self‐efficacy on nurse‐authored patent output via structural equation modelling (SEM).DesignA descriptive cross‐sectional study.MethodsNurses were recruited from one tertiary cancer hospital in Beijing, China. Among them, 352 oncology nurses completed the online versions of the Nurse Innovative Behavior Scale and Creative Self‐Efficacy Scale in 2023.ResultsWe collected a total of 332 valid questionnaires. Fifty‐seven (17.2%) nurses had 1–3 patents, and only 6 (1.8%) had more than three patents. The final model revealed a chain reaction between creative self‐efficacy, innovation behaviour and nurse‐authored patent output (χ2 = 11.962, df = 7, p = 0.102). Significant differences were observed in the number of nurse‐authored patents and based on age, educational profile, professional title, length of service, position, participation in science and technology innovation training, and experience in project presentation (all p &lt; 0.05).ConclusionNurses still play a minor role in the field of medical technology innovation. It is necessary to promote innovative behaviour among nurses and improve their creative self‐efficacy in terms of innovation.ImpactDeveloping intervention strategies to encourage nurses to pursue clinical innovations is crucial for nursing managers and technological innovation promoters.

Clinicopathological Characteristics and Perioperative Treatment of Epstein-Barr Virus-Associated Gastric Cancer: A Retrospective Study.

The clinicopathological characteristics and perioperative treatment outcomes of patients with EBVaGC who underwent radical gastrectomy in Tianjin Medical University Cancer Hospital from September 2016 to May 2022 were retrospectively reviewed. Disease-free survival (DFS) was analyzed and Cox regression analysis was performed to identify risk factors. The study cohort included 128 patients with EBVaGC. Histologically, 126 (98.4%) patients had adenocarcinoma and only 2 (1.6%) had adenosquamous carcinoma. In addition, 18 (14.1%) had nerve invasion and 29 (22.7%) had vascular invasion. Notably, 41 (32.0%) patients had tumors in the proximal stomach and 69 (53.9%) had no lymph node metastasis. Proficient mismatch repair was confirmed in all 104 patients with available results. Overall, 16 (12.5%) patients received neoadjuvant therapy, 81 (63.3%) received adjuvant therapy, and 10 (7.8%) received perioperative immunotherapy combined with chemotherapy. In total, 22 patients experienced disease progression or had died. The 3-year DFS rate was 75.0%. DFS was relatively poorer for patients with advanced tumor (T) stage, lymph node (N) stage, disease stage, and vascular invasion. EBVaGC had unique clinicopathological characteristics and prognosis. Advanced T, N, and disease stages, in addition to vascular invasion, were predictive of poorer DFS. However, the efficacy of perioperative treatment of EBVaGC remains uncertain.

The negative impact of the COVID-19 pandemic on breast cancer tackle in Brazil’s public and private healthcare system: time series study between 2014 and 2022

BackgroundThe COVID-19 pandemic has overwhelmed the healthcare systems of many countries and negatively impacted the care of other diseases.ObjectiveTo evaluate the trend of screening mammograms, oncological breast surgeries, and breast cancer hospitalizations in Brazil’s public and private healthcare system between 2014 and 2022.MethodThis ecological time series study uses the inflection point regression model and semester percentage change (SPC). We use the open-access dataset of the different healthcare systems in Brazil. We analyzed the trend of the variables in the pre-pandemic and the effect of the pandemic on the total time series.ResultsIn 2020, compared to 2019, the decrease in screening mammograms, oncological breast surgeries, and breast cancer hospitalization was − 41.44%, -23.13%, and − 10.52% (public health system) and − 29.49%, -18.96%, and − 15.35% (private healthcare system). In the public healthcare system, the pandemic has enhanced the decreasing trend of mammograms (SPC − 1.6% before and − 3.4% after), has reverted the stationary trend of oncological breast surgeries to decreasing (SPC − 1.0%), has slowed the increasing trend of breast cancer hospitalization (SPC 1.8% before and 0.9% after). In the private healthcare system, the pandemic has reverted the stationary trend of mammograms to decreasing (SPC − 1.0%), has slowed the increasing trend of breast cancer surgeries (SPC 2.3% before and 0.8% after), has reverted the growing trend of breast cancer hospitalization (SPC 3.9%) to stationary.ConclusionDuring the COVID-19 pandemic, there was an increase in inequalities between healthcare systems, especially in breast cancer screening.

Predicting survival benefits of immune checkpoint inhibitor therapy in lung cancer patients: a machine learning approach using real-world data.

Due to the heterogeneity in the effectiveness of immunotherapy for lung cancer, identifying predictors is crucial. This study aimed to develop a machine learning model to identify predictors of overall survival in lung cancer patients treated with immune checkpoint inhibitors (ICIs). A retrospective analysis was performed on data from 1314 lung cancer patients at the Chongqing University Cancer Hospital from September 2018 to September 2022. We used the random survival forest (RSF) model to identify survival-influencing factors, using backward elimination for variable selection. A Cox proportional hazards (CPH) model was constructed using the most significant predictors. We assessed model performance and generalizability using time-dependent receiver operating characteristics (ROC) and predictive error curves. The RSF model demonstrated better predictive accuracy than the CPH (IBS 0.17 vs. 0.17; C-index 0.91 vs. 0.68), with better discrimination and prediction performance. The influential variables identified included D-dimer, Karnofsky performance status, albumin, surgery, TNM stage, platelet count, and age. The RSF model, which incorporated these variables, achieved area under the curve (AUC) scores of 0.95, 0.94, and 0.98 for 1-, 3-, and 5-year survival predictions, respectively, in the training set. The validation set showed AUCs of 0.94, 0.90, and 0.95, respectively, exceeding the performance of the CPH model. The study successfully developed a machine learning model that accurately predicted the survival benefits of ICI therapy in lung cancer patients, supporting clinical decision-making in lung cancer treatment.