Independent Risk Factors For Prognosis Research Articles

Plasma cell-free DNA methylation combined with tumor mutation detection in prognostic prediction of patients with non-small cell lung cancer (NSCLC).

Background:Lung Cancer is one of the most common cancers with high degree of malignancy, is a devastating disease with a poor prognosis worldwide. prognostic prediction for patients with non small-cell lung cancer (NSCLC) is still challenge.Material and methods:The cohort consisted of 64 consecutive patients with NSCLC identified from June1, 2014, to June 30, 2018. Liquid biopsy samples were collected. Genomic mutation DNA was calculated by including all substitutions and indels over the entire somatic, coding, sequencing length. statistical evaluations were carried out using SPSS software.Results:Quantity of total ctDNA was successfully determined in all 64 patients from whom baseline circulating DNA was available. ctDNA concentration ranged from 4000 to 3,562,000 genome equivalents per milliliter. Treatments induced a significant decrease in cancer specific markers in most patients with response to treatments, while the methylated DNA demonstrated favorable prediction efficiency regardless of the response status. Patients with ctDNA mutation and methylated DNA decreasing have favorable overall survival (P < .05). combination of genetic and methylated DNA decreasing had high reliability in predicting overall survival of patients with NSCLC.Conclusions:We have detected both tumor mutations and methylated DNA in plasma of patients with NSCLC. Combined genetic and methylated DNA decreasing after treatment was an independent risk factor for prognosis of patients with NSCLC. Meanwhile, it had favorable predict value and had potential to be defined as a novel biomarker for patients with NSCLC.

Expression and clinical significance of LRFN4 in colorectal cancer tissue

Objective: To investigate the expression and clinical significance of LRFN4 in colorectal cancer. Methods: A total of 210 cases of colorectal cancer tissues and 228 cases of corresponding surgical margin tissues were collected. Immunohistochemistry was employed to evaluate the expression of LRFN4 in colorectal cancer.The correlation between LRFN4 expression and clinicopathological features of colorectal cancer as well as patient outcome were analyzed. Results: The positive rate of LRFN4 in colorectal cancer and in non-cancer was 55.24%(116/210), and 37.28% (85/228) , respectively.The expression of LRFN4 in colorectal cancer tissues was higher than that in non-cancer tissues(χ(2)=14.196, P<0.001). High expression of LRFN4 was significantly correlated with tumor location(χ(2)=4.133,P=0.042), T staging(χ(2)=6.494,P=0.039), N staging(χ(2)=11.715,P=0.008), TNM staging(χ(2)=13.398,P=0.004), CEA (χ(2)=6.017, P=0.049), but without gender, age, degree of differentiation, M staging(P>0.05).The Kaplan-Meier survival curves indicated that high LRFN4 expression was associated with good survival (P<0.05). In addition, Cox proportional hazards model showed that the high expression of LRFN4(HR=0.585, P=0.018)was an independent risk factor for prognosis in patients with colorectal cancer. Conclusions: The expression of LRFN4 is up-regulated in colorectal cancer, which is significantly correlated with the clinicopathological features and prognosis. High expression of LRFN4 reduced the risk of death in patients with colorectal cancer.

An analysis of clinicopathological characteristics and prognosis on hepatoid adenocarcinoma of stomach.

e16558 Background: Hepatoid adenocarcinoma of the stomach(HAS) is a rare type of gastric adenocarcinoma(GAC). At present, histopathology is the gold standard for the diagnosis of HAS, however, HAS is easy to be missed diagnosis, and lack of a perfect diagnosis system and effective treatment strategy. In this research, clinical pathological features will be analyzed to improve the diagnostic system, judge prognosis and provide clues for exploration of pathogenesis and targeted therapy of HAS. Methods: 576 cases including 5 confirmed patients with HAS were enrolled onto this study from 1320 patients with GAC. 10 cases of HAS were diagnosed by the second histopathological examination from the other 571 enrolled cases. 30 cases from the remaining 561 enrolled patients were randomly selected as the control group. The information of the two group cases were completed by collecting the existing case data, detecting the missed immunohistochemical indicators and telephone follow-up. The clinicopathological features of the two group cases were compared, and the treatment and prognosis of 15 HAS cases were analyzed. Results: In this study, 15 cases of HAS were found in 576 patients with GAC, including 5 cases from the 1st pathological diagnosis and 10 cases from the 2nd pathological diagnosis. There was no significant difference in age, gender, HP positive rate, serum CEA or CA19-9 level, tumor size, TNM stage, tumor invasion depth, lymph node invasion, distant metastasis rate, differentiation degree, nerve/vascular invasion, and Ki-67 expression level between the two groups( P&gt; 0.05). Compared with the control group, the serum AFP level, and the expression level of GPC3, AFP, EGFR and VEGF protein of patients in HAS group were significantly high, as well as the patients in the HAS group were more likely to develop liver metastasis( P&lt; 0.05). The mOS was 12 mo vs 42 mo for HAS group vs control group( P&lt; 0.05). Multivariate analysis showed immunohistochemical AFP staining intensity was an independent risk factor for prognosis of HAS. Conclusions: As a special type of GAC, HAS is prone to developing liver metastasis with poor prognosis. Based on the higher missed diagnosis rate of HAS, it is suggested to make 2nd cancer histopathological diagnosis including immunohistochemical detection of AFP and GPC3 for GAC patients with significantly increased serum AFP level. The intensity of immunohistochemical AFP staining is an independent risk factor for the prognosis of patients with HAS. VEGF, EGFR and PD-1 / PDL-1 may be potential therapeutic targets of HAS, which is worth further study.

The Value of ABO Blood Group and Complete Blood Count for the Prognosis Analysis of Gastric Cancer Patients.

ObjectiveTo investigate the value of ABO blood group and complete blood count results in predicting the survival rate of patients with gastric cancer.Patients and MethodsA retrospective study was conducted to collect 488 gastric cancer patients diagnosed in the Tumor Hospital Affiliated to Xinjiang Medical University from January 2010 to December 2011. Relevant clinical data were collected by the medical record system, and the patients were followed up by the medical record follow-up system of the hospital. The follow-up was ended until the death of the patients, and the survival time of all patients was obtained. Survival curve and Cox regression analysis model were used to study the role of various indicators in the prognosis of gastric cancer patients.ResultsNeutrophil lymphocyte ratio (NLR), neutrophil monocyte ratio (NMR), lymphocyte monocyte ratio (LMR) and platelet distribution width (PDW) in blood routine test could predict the death outcome of gastric cancer patients, with the predicted thresholds of 1.95, 13.49, 5.22 and 11.25, respectively. Survival curve analysis showed that female patients, type O blood patients, LMR >5.22 patients, NMR >13.49 patients and NLR ≤1.95 patients had longer survival. Multivariate Cox regression analysis model showed that gender and NLR were independent prognosis risk factors for gastric cancer, with HR values of 2.964 (95% CI of 2.258–3.891) and 1.103 (95% CI of 1.028–1.183), respectively. PLT and PDW were independent prognosis protective factors for gastric cancer, with HR values of 0.998 (95% CI of 0.997–1.000) and 0.891 (95% CI of 0.797–0.996), respectively. Compared with type O blood patients, patients with type A blood, type B blood and type AB blood had 3.472 times (95% CI 2.562–4.706), 3.368 times (95% CI 2.454–4.624) and 4.407 times (95% CI 2.871–6.766) increased risk of death.ConclusionThe results of NLR, PLT, PDW and ABO blood group can help to predict the survival of gastric cancer patients.

Lactic acid, lactate clearance and procalcitonin in assessing the severity and predicting prognosis in sepsis

To explore the value of lactic acid (Lac), lactate clearance (LCR) and procalcitonin (PCT) in assessing the severity and predicting the prognosis in sepsis. 18-80-year-old patients with sepsis admitted to the department of critical care medicine of Beijing Friendship Hospital, Capital Medical University from April 2009 to December 2019 were enrolled. The gender, age, basic illness, infection site, organ function, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), Lac and PCT were collected on admission to intensive care unit (ICU), as well as Lac after 24 hours, 24-hour LCR, and 28-day prognosis. The patients were divided into sepsis group and septic shock group according to Sepsis-3 criteria. According to the 28-day prognosis, the septic shock patients were divided into survival group and death group, and the differences of each index between the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of death in septic shock patients. The receiver operating characteristic (ROC) curve was used to analyze the role of Lac, LCR, PCT, SOFA score and APACHE II score in predicting prognosis of the patients with septic shock. A total of 998 patients with sepsis were enrolled, including 642 males and 356 females; with (59.56±13.22) years old. There were 478 patients with septic shock, among which 180 died and 298 survived during the 28-day observation. (1) Compared with the sepsis group, the age of the sepsis shock group was significantly higher (years old: 60.49±12.31 vs. 58.72±13.97), APACHE II score, SOFA score, Lac, PCT and 24 h Lac increased [APACHE II: 24.57±7.04 vs. 19.37±6.93, SOFA: 7.78±3.31 vs. 4.38±3.42, Lac (mmol/L): 3.00 (1.70, 5.00) vs. 1.40 (1.00, 2.30), PCT (μg/L): 0.05 (0.00, 4.00) vs. 0.00 (0.00, 1.10), 24-hour Lac (mmol/L): 2.60 (1.60, 4.40) vs. 1.40 (1.00, 2.20)], and the 28-day mortality was significantly higher [41.63% (199/478) vs. 19.42% (101/520)], with significant statistic differences (all P < 0.05). (2) Compared with the survival group, APACHE II score, SOFA score, Lac, 24-hour Lac significantly increased in the septic shock death group, and 24-hour LCR decreased [APACHE II: 26.19±6.52 vs. 22.25±6.07, SOFA: 9.07±2.90 vs. 7.50±3.10, Lac (mmol/L): 3.80 (2.50, 5.10) vs. 2.80 (2.00, 3.90), 24-hour Lac (mmol/L): 3.20 (2.20, 5.60) vs. 2.10 (1.60, 3.30), 24-hour LCR: 1.43 (-37.50, 30.77)% vs. 16.67 (0.00, 33.98)%, all P < 0.05]. In assessment of organ function, central venous pressure (CVP) and oxygenation index (PaO2/FiO2) were lower in death group [CVP (mmHg; 1 mmHg = 0.133 kPa): 5.00 (2.00, 8.00) vs. 6.00 (2.00, 9.00), PaO2/FiO2 (mmHg): 184.21±84.57 vs. 199.20±86.98], alanine aminotransferase (ALT) and serum creatinine (SCr) increased [ALT (U/L): 376.56±41.43 vs. 104.17±14.10, SCr (μmol/L): 213.53±8.06 vs. 181.91±5.03], with significant statistic differences (all P < 0.05). (3) Multivariate Logistic regression analysis showed that PaO2/FiO2, SCr, Lac and SOFA were independent risk factors of prognosis in septic shock [PaO2/FiO2: odds ratio (OR) = 0.997, 95% confidence interval (95%CI) was 0.996-0.999, P = 0.001; SCr: OR = 1.001, 95%CI was 1.000-1.002, P = 0.041; Lac: OR = 0.925, 95%CI was 0.871-0.982, P = 0.011; SOFA: OR = 1.178, 95%CI was 1.110-1.251, P = 0.000]. ROC curve analysis showed that SOFA, SOFA+APACHE II, Lac+24-hour LCR+PCT+SOFA+APACHE II could predict mortality in septic shock patients, and the area under the ROC curve (AUC) was 0.769 (95%CI was 0.740-0.798), 0.787 (95%CI was 0.759-0.815), 0.800 (95%CI was 0.773-0.827), respectively. The joint of the five indicators, Lac, 24-hour LCR, PCT, SOFA and APACHE II has the largest AUC. Lac is an independent risk factor for death in patients with septic shock, however, the prognosis cannot be predicted. Comprehensive analysis of LCR, PCT, SOFA, APACHE II and the clinical organ functions are required for analysis.

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 for laryngeal sarcoma and nomogram development for prediction: a retrospective study based on SEER database.

BackgroundLaryngeal sarcoma is an extremely rare malignant tumor of larynx and usually reported as case reports or small series. At present, there is no research based on big data about the prognostic factors affecting laryngeal sarcoma. Our study aimed to investigate the prognostic survival factors of laryngeal sarcoma and develop a comprehensive nomogram for predicting the survival of laryngeal sarcoma.MethodsData were obtained from the Surveillance, Epidemiology, and End Results (SEER) database to find patients diagnosed with laryngeal sarcoma from 1998 to 2016. The data were obtained using SEER Stat 8.3.5 software, collated, and analyzed by Excel 2016 software and SPSS (v25.0). Kaplan-Meier curves were used for survival analysis. The variables obtained by univariate analysis were introduced into the Cox proportional hazard model for multivariate analysis. The risk factors affecting the prognosis of laryngeal sarcoma were obtained (P<0.05 indicated statistical significance). The independent prognostic factors of laryngeal sarcoma were integrated and used to construct a nomogram.ResultsA total of 381 patients with laryngeal sarcoma were included. The median age of diagnosis was 67 years. The proportion of patients who had received surgical treatment was 62.73%, while 22.31% of patients had received no surgery. The 1-, 3-, 5-, and 10-year survival rates were 87%, 76%, 61%, and 45%, respectively. The median survival time was 102.35 months. Univariate analysis showed that increased age, primary site, pathology, pathological grade, and surgical treatment were significantly correlated with patient survival time and were risk factors for the patients' prognosis. Race, gender, and even lymph node metastasis were not significantly correlated with patient prognosis. The risk factors obtained from the univariate analysis were incorporated into the Cox risk model for multivariate analysis, the independent risk factors for prognosis of patients were: age (HR 1.569, 95% CI: 1.358–1.813, P<0.005), pathology (HR 0.834, 95% CI: 0.734–0.948, P<0.005), pathological grade (HR 1.433, 95% CI: 1.164–1.764, P<0.001), surgical treatment (HR 0.778, 95% CI: 0.696–0.870, P<0.000), primary site was excluded (P=0.092). We included all the risk factors from the multi-factor analysis to construct a nomogram, and the C-index value was 0.73, indicating that it was well-calibrated in the medium and long term.ConclusionsLaryngeal sarcoma is a rare malignant tumor of the larynx, which most often affects people between the ages of 50 and 79 and males. Our study shows that age, pathology, pathological grade, surgical treatment may be the risk factors for patients’ prognosis. Based on this, we constructed a nomogram model with a prediction accuracy of 73% that could help clinicians make decisions on an individual basis.

Expression and clinical significance of miR-4516 and miR-21-5p in serum of patients with colorectal cancer

BackgroundThis study sought to detect the expression and clinical significance of miR-4516 and miR-21-5p in serum of patients with colorectal cancer.MethodsBioinformatics methods were used to analyze the expression patterns of miR-4516 and miR-21-5p in colorectal cancer. A total of 80 patients with colorectal cancer, 65 patients with benign colorectal tumors and 50 healthy persons were selected. qRT-PCR was performed to detect the expression levels of serum miR-4516 and miR-21-5p before and after operation or postoperative recurrence. The correlation of miR-4516 and miR-21-5p expression levels with the clinical characteristics and prognosis of colorectal cancer was analyzed, and that with the patient’s survival was further examined by Kaplan-Meier analysis.ResultsMiR-4516 was poorly expressed in colorectal cancer in the preoperative group, and miR-21-5p was highly expressed. While in the postoperative group, miR-4516 was up-regulated, and miR-21-5p was down-regulated. The low expression of miR-4516 was shown to be related to TNM staging, invasion degree, lymph node metastasis and distant metastasis of the patients. Whereas the high expression of miR-21-5p was proved to be correlated with TNM staging and lymph node metastasis. Kaplan-Meier survival analysis showed that high expression of miR-4516 or low expression of miR-21-5p could contribute to better overall survival.ConclusionLow miR-4516 or high miR-21-5p could be used as an independent risk factor for prognosis of colorectal cancer.

Analysis on plausible factors related to the prognosis of stage IV esophageal cancer.

To investigate factors related to poor prognosis of patients with stage IV esophageal cancer and to provide some bases on which proper therapeutic schemes could be formulated for stage IV esophageal cancer patients with performance status (PS) score between 0 and 2.Clinical data of 60 patients with stage IV esophageal cancer were retrospectively analyzed, and the relationships of clinical characteristics and therapeutic methods with patients’ prognosis were explored. Univariate analysis on factors possibly affecting the prognosis of patients with stage IV esophageal cancer was performed using Log-rank test, and independent risk factors for the prognosis were estimated in multivariate Cox regression analysis through embracing variables which showed statistical significance in univariate analyses.According to univariate analysis results, nutritional status, anemia, therapeutic method, esophageal stent, and visceral metastasis were main influencing factors for the prognosis of stage IV esophageal cancer (P < .05). While in multivariate Cox regression analysis, visceral metastasis was revealed to be an independent risk factor for poor prognosis in patients with stage IV esophageal cancer.Visceral metastasis is an independent risk factor for poor prognosis in patients with stage IV esophageal cancer. Optimizing therapeutic modes according to with or without combined visceral metastasis possesses certain clinical significance in prolonging survival time and in improving the quality of life among patients with stage IV esophageal cancer.

Analysis of clinical efficacy and prognosis of childhood T-cell acute lymphoblastic leukemia

Objective To evaluate the treatment efficacy of children with T-cell acute lymphoblastic leukemia (T-ALL) and to explore the prognostic risk factors. Methods The clinical and laboratory data of children with newly diagnosed T-ALL in Children's Hospital of Fudan University and Children's Hospital of Shanghai from January 2002 to December 2014 were retrospectively analyzed and compared with children with newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL) in the same period. The treatment protocols were based on the combination of the Berlin-Frankfurt-Munster (BFM)-ALL regimen with chemotherapy. The treatment response and infection of the children were observed. Cox proportional hazard regression model single-factor and multifactor analysis were used to evaluate the prognostic factors. Results Seventy-one children with T-ALL and 333 children with B-ALL were enrolled. The clinical features including gender, age, central nervous system leukemia as well as the white blood cell count at first diagnosis were significantly different between the two groups (all P 0.05). The difference of EFS curves between children with early T-precursor (ETP)-ALL and non-ETP ALL was statistically significant (P= 0.044). The most common infection site was respiratory tract [63.9% (186/291)], and the gram-negative bacteria accounted for 43.5% (20/46). Cox univariate analysis showed that prednisone poor response, bone marrow non-remission on day 33 of induction-therapy, relapse and sepsis were prognostic risk factors for children with T-ALL (all P < 0.05), and Cox multivariate analysis showed that the latter three were independent prognostic risk factors (all P < 0.05). Conclusions The prognosis of children with T-ALL is worse than children with B-ALL, and T-ALL patients are prone to early relapse. The EFS of children with ETP-ALL is poor. Non-remission at the end of induction-therapy, relapse and sepsis are independent risk factors for prognosis. Key words: Leukemia, T-cell; Child; Prognosis; Clinical feature

Serum prealbumin predicts prognosis of hepatectomy in patients with hepatocellular carcinoma

Objective To study the correlation between serum prealbumin level before liver resection and prognosis of patients with primary hepatocellular carcinoma (HCC). Methods The clinical data of patients with HCC who underwent liver resection at the Affiliated Tumor Hospital of Guangxi Medical University from August 2007 to October 2016 were retrospectively analyzed. The previous albumin of 200 mg/L and the pre-albumin as predicted by the maximum selection rank statistic method were used as the bounding group, and reduced groups and the correlation between pre-operative serum pre-albumin levels and clinicopathological characteristics were analyzed. The Kaplan-Meier method was used to calculate the overall survival rate of patients with the different cutoff levels. The Cox proportional regression model was used to analyze, and cirrhosis, alpha-fetoprotein levels and Barcelona Clinic Liver Cancer staging were used to adjust the relationship between serum prealbumin and prognosis of liver resection for HCC patients. Analysis of stratified variables was performed and their interactions with serum prealbumin were analyzed. Results Of the 2 022 patients included in this study, there were 1 739 males and 283 females. Their age was 49.5 ± 11.2 years. The median follow-up was 37.4 months. The optimal cutoff value of prealbumin predicted by the maximum selection rank statistic method was 166 mg/L. Regardless of the cutoff values of previous albumin 200 mg/L or prealbumin 166 mg/L, multivariate analysis showed that preoperative serum prealbumin level was an independent prognostic risk factor for patients (P 200 mg/L (>166 mg/L) serum prealbumin before surgery was significantly better than that of patients with ≤200 mg/L (≤166 mg/L) prealbumin, the differences were significant (all P<0.05). After adjusting for confounding factors, the prealbumin level correlated with prognosis of patients with HCC [cutoff value 200 mg/L: HR (95% CI) was 1.59 (1.35-1.86), cutoff value 166 mg/L: HR (95% CI) was 1.69 (1.44-1.98), all P<0.05]. The results of stratified analysis showed that the relationship between prealbumin levels and the prognosis of HCC patients became more robust. Conclusions Preoperative serum prealbumin was an independent risk factor for prognosis of HCC patients, and it had predictive value on prognosis of HCC patients. Key words: Carcinoma, hepatocellular; Prealbumin; Prognosis

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

Clinical characteristics and prognostic factors of primary hepatic neuroendocrine tumor: a study of 21 patients

Objective To analyze the clinical characteristics, diagnosis, treatment and prognostic factors of primary hepatic neuroendocrine tumor (PHNET). Methods To analyze the clinical data of 21 patients with PHNET who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2019. There were 11 males and 10 females, with ages which ranged from 36 to 75 years. Log-rank test was used for single-factor analysis of the relationship between clinical and pathological indicators and prognosis. Cox proportional risk model was used for multi-factor analysis. Results Among the 21 PHNET patients, 10 presented with central and upper abdominal pain, 3 abdominal pain accompanied by nausea and vomiting, 5 abdominal distension, and 3 were asymptomatic. Carbohydrate antigen (CA) 19-9 was elevated in 6 patients and CA125 in 7 patients. Abdominal enhanced CT showed solid liver space occupying lesions. Four patients had solitary and 17 had multiple lesions. The mean diameter was 58 mm. Fourteen patients had lymph node metastasis. Five patients underwent radical hepatectomy, 2 transcatheter hepatic arterial chemoembolization + chemotherapy, 12 chemotherapy, and 2 supportive treatment. Factors which were associated with prognosis of PHNET patients were surgery, tumor grading, cytokeratin positivity and lymph node metastasis. Multivariate Cox regression analysis showed that inoperability (HR=8.99, 95%CI: 1.13-71.80) was an independent risk factor of prognosis of PHNET patients. The prognosis in patients who underwent surgical resection was better. Conclusion Patients with PHNET had no specific clinical manifestations. Surgical resection gave the best results in treatment. As surgical resection affected prognosis, it should be carried out if technically feasible. Key words: Diagnosis; Primary liver neuroendocrine tumor; Clinical characteristics; Influencing factor

A multicenter retrospective study on clinical value of lymph node dissection in the radical resection of intrahepatic cholangiocarcinoma

Objective To investigate the clinical value of lymph node dissection (LND) in the radical resection of intrahepatic cholangiocarcinoma (ICC). Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 448 patients with ICC who were admitted to 12 medical centers from December 2011 to December 2017 were collected, including 279 in the Eastern Hepatobiliary Surgery Hospital of Navy Medical University, 32 in the Mengchao Hepatobiliary Hospital of Fujian Medical University, 21 in the First Hospital Affiliated to Army Medical University, 20 in the Cancer Hospital Chinese Academy of Medical Science and Peking Union Medical College, 19 in the West China Hospital of Sichuan University, 18 in the Second Hospital Affiliated to Zhejiang University School of Medicine, 18 in the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 16 in the Beijing Friendship Hospital Affiliated to Capital Medical University, 10 in the Xuanwu Hospital Affiliated to Capital Medical University, 7 in the Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, 5 in the Beijing Tiantan Hospital Affiliated to Capital Medical University, and 3 in the Affiliated Hospital of North Sichuan Medical College. There were 281 males and 167 females, aged from 22 to 80 years, with a median age of 57 years. Of the 448 patients, 143 with routinely intraoperative LND were divided into LND group and 305 without routinely intraoperative LND were divided into control group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after matching; (2) intraoperative and postoperative situations; (3) follow-up; (4) survival analysis. Patients were followed up by outpatient examination, telephone interview and email to detect survival of patients and tumor recurrence up to October 31, 2018 or death. Follow-up was conducted once every 3 months within postoperative 1-2 years, once every 6 months within postoperative 2-5 years, and once a year after 5 years. The propensity score matching was realized using the nearest neighbor method with 1∶1 ratio. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates and draw survival curve, and Log-rank test was used to perform survival analysis. Univariate analysis and multivaraiate analysis were conducted using the Log-rank test and COX regression model, respectively. Results (1) The propensity score matching conditions and comparison of general data between the two groups after matching: 286 of 448 patients had successful matching, including 143 in each group. The number of males and females, cases with hepatitis, cases with grade A and B of Child-Pugh classification, cases with distance from margin to tumor 0.05). (2) Intraoperative and postoperative situations: the operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, cases with postoperative complications, and duration of postoperative hospital stay were 265 minutes (range, 160-371 minutes), 300 mL (range, 200-500 mL), 37, 46, 12 days (range, 9-17 days) for the LND group, and 59 minutes (range, 46-250 minutes), 200 mL (range, 100-400 mL), 24, 25, 9 days (range, 7-11 days) for the control group, respectively. There was no significant difference in the volume of intraoperative blood loss or cases with intraoperative blood transfusion between the two groups (Z=1.700, χ2=3.520, P>0.05). There were significant differences in the operation time, cases with postoperative complications, and duration of postoperative hospital stay (Z=6.520, χ2=8.260, Z=4.270, P 0.05). (4) Survival analysis: results of univariate analysis showed that distance from margin to tumor, tumor diameter, the number of tumors, microvascular tumor thrombus, and lymph node metastasis by pathological examination were related factors for prognosis of patients undergoing radical resection of ICC (χ2=10.662, 9.477, 16.944, 6.520, 11.633, P 5 cm, multiple tumors, microvascular tumor thrombus, positive lymph node metastasis by pathological examination were independent risk factors for prognosis of patients undergoing radical resection of ICC (hazard ratio=0.600, 1.571, 1.601, 1.750, 1.723, 95% confidence interval: 0.430-0.837, 1.106-2.232, 1.115-2.299, 1.083-2.829, 1.207-2.460, P<0.05). Conclusion Lymph node metastasis is an independent risk factor affecting the prognosis of ICC patients, and it is necessary to perform LND in radical resection for patients with ICC and lymph node metastasis. Key words: Bile duct neoplasms; Intrahepatic cholangiocarcinoma; Radical resection; Lymph node dissection; Prognosis; Multicenter; Retrospective

A signature of tumor immune microenvironment genes associated with the prognosis of non‑small cell lung cancer.

Establishing a prognostic genetic signature closely related to the tumor immune microenvironment (TIME) to predict clinical outcomes is necessary. Using the Gene Expression Omnibus (GEO) database of a non‑small cell lung cancer (NSCLC) cohort and the immune score derived from the Estimation of Stromal and Immune cells in Malignant Tumours using Expression data (ESTIMATE) algorithm, we applied the least absolute shrinkage and selection operator (LASSO) Cox regression model to screen a 10‑gene signature among the 448 differentially expressed genes and found that the risk prediction models constructed by 10 genes could be more sensitive to prognosis than TNM (Tumor, Lymph node and Metastasis) stage (P=0.006). The CIBERSORT method was applied to quantify the relative levels of different immune cell types. It was found that the ratio of eosinophils, mast cells (MCs) resting and CD4 T cells memory activated in the low‑risk group was higher than that in the high‑risk group, and the difference was statistically significant (P=0.003, P=0.014 and P=0.018, respectively). Inconsistently, the ratio of resting natural killer (NK) cells and activated plasma cells in the low‑risk group was significantly lower than that in the high‑risk group (P=0.05 and P=0.009, respectively). Kaplan‑Meier survival results showed that patients of the high‑risk group had significantly shorter overall survival (OS) than those of the low‑risk group in the training set (P<0.001). Furthermore, Kaplan‑Meier survival showed that patients of the high‑risk group had significantly shorter OS than those of the low‑risk group (P=0.0025 and P=0.0157, respectively) in the validation set [GSE31210 and TCGA (The Cancer Genome Atlas)]. The 10‑gene signature was found to be an independent risk factor for prognosis in univariate and multivariate Cox proportional hazard regression analyses (P<0.001). In addition, it was found that the risk model constructed by the 10‑gene signature was related to the clinical related factors in logistic regression analysis. The genetic signature closely related to the immune microenvironment was found to be able to predict differences in the proportion of immune cells (eosinophils, resting MCs, memory activated CD4 T cells, resting NK cells and plasma cells) in the risk model. Our findings suggest that the genetic signature closely related to TIME could predict the prognosis of NSCLC patients, and provide some reference for immunotherapy.

Relationships between serum procalcitonin level, severity and different stresses of non-septic critically ill patients

Abstract Background: To explore the relationships between serum procalcitonin (PCT) level, severity and different stresses of non-septic critically ill patients. Materials and Methods: Patients were divided into traumatic stress, stroke-induced stress and non-infectious inflammatory stress groups. According to 28-day prognosis, they were divided into survival and death groups. The factors affecting prognosis were studied by multivariate logistic regression analysis. Results: PCT level was significantly positively correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores (P=0.001). The PCT level and abnormality rate of the traumatic stress group significantly exceeded those of other groups (P---lt---0.05). The APACHE II score, SOFA score and 28-day mortality rate of traumatic stress and stroke-induced stress groups significantly exceeded those of the non-infectious inflammatory stress group (P---lt---0.05). The PCT level, APACHE II score and SOFA score of the death group significantly surpassed those of the survival group (P---lt---0.05). With rising PCT level, APACHE II score, SOFA score and 28-day mortality rate all increased, with significant intergroup differences (P---lt---0.01). Multivariate logistic analysis showed that serum PCT level, APACHE II score and SOFA score were independent risk factors for prognosis. The area under ROC curve for prognosis evaluated by PCT level was 0.797 (95%CI = 0.710~0.878, P=0.000). At a 4.3 μg/L cut-off, the sensitivity and specificity for predicting 28-day mortality were 87.4% and 78.1%, respectively. Conclusion: The serum PCT level of non-septic critically ill patient was positively correlated with severity, which was more likely elevated by traumatic stress than other stresses.

The Value of Serum Amyloid A on Early Diagnosing and Prognosis for Perioperative Patients with Extracorporeal Circulation

The present study was aimed to investigate the value of serum amyloid A in the early diagnosis of infection in patients with extracorporeal circulation and to evaluate the prognosis of patients. This was a prospective observational study. Patients admitted to the intensive care unit after cardiopulmonary bypass surgery between January 2017 and January 2019 were continuously collected. Daily blood serum amyloid A and traditional inflammatory markers (white blood cell, C-reactive protein and procalcitonin) were continuously monitored 1 day before surgery and 3 days after surgery. The efficacy of serum amyloid A and traditional inflammatory indicators in the early diagnosis of infection was assessed by receiving operating characteristic curve, and the efficacy of serum amyloid A in predicting the prognosis of patients was assessed by multivariate logistic regression analysis. A total of 150 patients admitted to ICU after extracorporeal circulation was included in the study period. There were 58 patients with perioperative infection and 92 patients in the non-infected group. There were 18 patients in the death group, accounting for 12 %. Serum amyloid A and traditional inflammatory indicators were increased in all patients on the first day after surgery compared with that before surgery, but in the non-infected group and the survival group, the decrease rate was significantly faster than that in the infected group and the death group within three days after surgery, p<0.05. According to ROC curve analysis, the diagnostic efficacy of perioperative infection was serum amyloid A, C-reactive protein, procalcitonin and white blood cell respectively, and the sensitivity and specificity were 84.48 and 86.96, 79.31 and 89.13, 65.52 and 98.91, 89.66, and 71.74 %, respectively. Multivariate logistic regression analysis indicated that the blood serum amyloid A level on the first day after surgery was an independent risk factor for hospitalization and death, OR was 1.49 (95 % CI was 1.27-2.96, p<0.01). Serum amyloid A could be used for early diagnosis of perioperative infection after extracorporeal circulation, and is an independent risk factor for prognosis of patients, and its value is better than traditional inflammatory indicators.

Four Low Expression LncRNAs are Associated with Prognosis of Human Lung Adenocarcinoma.

Lung cancer is the most prevalent and deadliest cancer worldwide. The present study aims to determine the prognosis value of low expression long non-coding RNAs (lncRNAs) in LUAD. RNA-seq data and clinical information were downloaded from The Cancer Genome Atlas (TCGA) data-base. Dysregulated genes between LUAD and paracancerous tissue were screened by GeneSpringGX. Prognostic lncRNAs which were low expressed in LUAD were filtrated by Ualcan, then further verified through the TCGA database. The association between clinicopathological features and the expression level of these lncRNAs was tested by chi-square test. Cox regression analysis was performed to test independent prognosis risk factors. Diagnostic efficiency was predicted by receiver operating characteristic (ROC) analysis. Gene Ontology (GO) functional and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to explore potential functions of these prognostic signatures. Nine prognostic lncRNAs (LINC00092, LINC00908, WWC2-AS2, RPL13AP17, CHIAP2, SFTA1P, SIGLEC17P, CYP2B7P1, CYP4Z2P) were screened out through Ualcan and further verified by TCGA. Among them, six lncRNAs (RPL13AP17, CHIAP2, SFTA1P, SIGLEC17P, CYP2B7P1, CYP4Z2P) were pseudogene transcripts. Multivariate Cox regression analysis showed that three lnRNAs (LINC00908, WWC2-AS2 CYP2B7P) were independent prognostic risk factors for OS and two lncRNAs (WWC2-AS2, SIGLEC17P) were independent prognostic risk factors for RFS in LUAD patients. Meanwhile, they showed powerful diagnostic value by ROC curve analysis. GO analysis revealed correlation genes of prognostic signatures were mainly enriched in plasma membrane, plasma membrane part, purine nucleotide binding, cytoskeleton and ribonucleotide binding and KEGG pathway analysis showed mainly enriched in cell adhesion molecules. The results illuminated that four lncRNAs (LINC00908, WWC2-AS2, CYP2B7P, SIGLEC17P) may be a powerful diagnostic and prognostic assessment tool for human LUAD.

Therapeutic effect of transcatheter arterial chemoembolization combined with iodine-125 seed strand implantation for treating hepatocellular carcinoma with portal vein tumor thrombus

Objective To study the efficacy of combined transcatheter arterial chemoembolization (TACE) with iodine-125 seed implantation in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods From January 2015 to January 2019, eighty patients with HCC and PVTT who were treated at Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. A total of 71 patients were male and 9 were female, aged (53.1±9.9) years. The patients included 48 patients (group A) who were treated with TACE alone and 32 patients (group B) with TACE combined with iodine-125 seed implantation. The survival time and disease control rate (DCR) of the intrahepatic lesions and PVTT in the two groups were compared. Results There were 32 patients who were successfully implanted with portal vein iodine-125 seed and stents. The DCR of PVTT in group B was significantly better than in group A (90.6% vs. 81.3%, P 0.05). The survival times of group A and group B were (8.0±0.6) and (16.0±2.1) months, respectively. The median survival times were (7.6±1.0) and (14.8±1.5) months respectively. Group B had significantly better survival time than Group A, (both P<0.05). Univariate and multivariate analysis showed that tumor size was an independent risk factor of prognosis (Regression coefficient: 0.960, HR: 0.383, 95% CI: 0.158-0.926, P<0.05). 125I treatment was a protective factor of prognosis (Regression coefficient: -1.525, HR: 0.218, 95% CI: 0.100-0.473, P<0.05). Conclusion For patients with HCC and PVTT, compared with TACE alone, TACE combined with iodine-125 seed implantation could safely and effectively control portal vein tumor thrombus, and prolonged patient survival. Key words: Carcinoma, hepatocellular; Portal vein tumor thrombus; Transcatheter arterial chemoembolization; Iodine radioisotopes

Prognostic value and initial exploratory research on TNM staging method of tumor deposits in stage III colon cancer

Objective: To investigate the effect of tumor deposits (TD) on the prognosis of patients with stage III colon cancer, and to explore whether TD number included into regional lymph node count can predict the prognosis more accurately. Methods: A retrospective cohort study was carried out. Case inclusion criteria: (1) primary colon cancer; (2) undergoing colon cancer radical operation; (3) definite pathological diagnosis; (4) colon cancer stage III according to AJCC 8th edition; (5) complete follow-up data; (6) without preoperative neoadjuvant treatment. Clinicopathological data of 296 patients undergoing colon cancer radical operation from January 2005 to December 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively collected. The effect of TD and its amount on the prognosis was evaluated. Colon cancer TNM staging method based on the 8th edition of AJCC was compared with the modified TNM staging (mTNM) adjusted by the number of TD. The differences of the disease-free survival (DFS) and overall survival (OS) between groups were also examined. The Kaplan-Meier curve was used to analyze the survival, and prognostic factors were analyzed by Cox univariate and multivariate analyses. Results: Among 296 patients with stage III colon cancer, 78 patients had TD. The median number of TD was 2 (1-10). Tumor T stage, N stage, vascular tumor thrombus and preoperative carcinoembryonic antigen (CEA) were associated with TD in patients with colon cancer (all P<0.05). The right hemicolon appears likely to have TD than left hemicolon, but the difference was not statistically significant (P=0.059). The median follow-up of the whole group was 71 (6-102) months. During the follow-up period, 129 patients (43.6%) had recurrence or metastasis, and 111 patients died (37.5%). The 5-year DFS in TD group was 44.9%, which was lower than that in the non-TD group (60.6%), with statistically significant difference (P=0.003). The 5-year OS in TD group was 50.0%, which was also lower than 67.0% in the non-TD group, and the difference was statistically significant (P=0.002). According to TD number, patients were divided into 3 groups: 1 TD (25 cases), 2-3 TD (32 cases), ≥4 TD (21 cases). The 5-year DFS in these 3 groups was 68%, 56.3%, and 0, respectively (P<0.001), and 5-year OS was 76%, 59.4%, and 4.8% respectively (P<0.001). Univariate analysis showed that TD presence (95% CI: 1.234-2.694, P=0.003) and TD number (95% CI: 3.531-14.138, P<0.001) were associated with the prognosis of patients with stage III colon cancer. At the same time, age, tumor N stage, tumor location, chemotherapy, and preoperative CEA elevation were also associated with the prognosis of stage III colon cancer patients (all P<0.05). Multivariate analysis revealed that TD presence (HR=1.957, 95%CI: 1.269-3.017, P=0.002) and TD number (HR=8.020, 95% CI: 3.414-18.842, P<0.001) were still independent risk factors for the prognosis of patients with stage III colon cancer.According to the TD number counted as metastatic lymph nodes, in 78 patients with TD, 24 patients were upstaged in N stage, and 16 patients upstaged from TNM stage IIIB to stage IIIC. For 16 stage IIIB cases with staging modification, 30 unadjusted stage IIIB cases with TD, and 148 stage IIIB cases without TD, the 5-year OS was 37.5%, 73.3% and 76.4%, respectively with significant difference (P<0.001). However, for 16 patients adjusted as stage IIIC (mTNM), 32 patients with unchanged stage IIIC with TD (TNM, AJCC 8th edition), and 63 stage IIIC cases without TD, the 5-year OS was 37.5%, 36.4%, and 41.3%, respectively without significant difference (P=0.707). Conclusions: TD presence and TD number are independent risk factors for prognosis of stage III colon cancerpatients. TNM staging evaluation with lymph node number including TD number can predict the prognosis of patients more accurately.