Independent Risk Factors For Prognosis Research Articles

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.

Prognostic factor analysis of elderly patients with small-cell lung cancer

Objective To retrospectively analyze clinical data of elderly patients with small-cell lung cancer(SCLC)in order to investigate their prognostic factors. Methods Clinical data of SCLC patients aged 65 years and over in our hospital from January 2006 to February 2017 were analyzed.Survival data were analyzed by Kaplan-Meier method.Univariate analysis of prognosis was conducted by Log rank test.Multivariate analysis was performed by Cox regression. Results A total of 143 patients were enrolled, the median overall survival(OS)was 17.9 months, with 21.3 months for limit stage(LD)and 9.6 months for extensive stage(ED). For LD patients, age(HR=18.688, 95%CI: 3.237-107.889), smoking index(HR=2.783, 95%CI: 1.196-6.475), thoracic irradiation(HR=0.305, 95%CI: 0.120-0.779), chemotherapy efficacy(HR=0.210, 95%CI: 0.065-0.685)were the independent risk factors for the prognosis.For ED patients, chemotherapy cycles(HR=0.461, 95%CI: 0.229-0.927)and performance status(HR=0.422, 95%CI: 0.218-0.818)were the independent risk factors for prognosis. Conclusions Smoking index, tumor stage and treatment mode can influence the survival of SCLC patients.The LD patients, who were aged less than 75 years, with smoking index less than 1000, receiving thoracic irradiation and achieving remission with chemotherapy, show a longer OS.For ED patients, a good performance status and sufficient chemotherapy can predict an improved OS. Key words: Smallcell lung carcinoma; Prognosis

The expression of miR-155 and miR-181 in gastric cancer and their effects on clinical parameters and prognostic value*

Abstract Objective The aim of this study was to investigate the expression and clinical significance of miR-155 and miR-181 in gastric cancer. Methods Sixty-eight patients with gastric cancer and 80 healthy volunteers were selected as subjects. Serum samples of patients and volunteers were collected to detect miR-155 and miR-181 expression levels in serum and tumor tissues. Results miR-155 and miR-181 serum levels were significantly higher in patients with gastric cancer than those in the control group (P &lt; 0.05). miR-155 and miR-181 expression levels in gastric cancer tissues were 16.74 ± 4.29 and 12.17 ± 3.26, respectively and 3.42 ± 0.39) and 3.06 ± 0.69 in paracancerous tissues, respectively, and they were 1.22 ± 0.21 and 1.08 ± 0.35 in normal tissues, respectively. miR-155 and miR-181 expression levels in cancer tissues were significantly higher than adjacent tissues, and they were lowest in normal tissues (P &lt; 0.05). High miR-155 and miR-181 expression had significant effects on differentiation, T stage, lymph node metastasis, and clinical stage (P &lt; 0.05). Cox multivariate analysis showed that onset, T stage, clinical stage, differentiation degree, lymph node metastasis, miR-155, and miR-181 were independent risk factors for prognosis of patients with gastric cancer. Conclusion Serum miR-155 and miR-181 have a diagnostic value in gastric cancer, and they are strong signals of poor prognosis.

The impact of intraoperative pancreatic resection margin status on prognosis of patients with pancreatic head cancer

Objective To study the impact of intraoperative pancreatic resection margin status on prognosis in patients with pancreatic head cancer. Methods The clinical and follow-up data of 109 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili Hospital from March 2012 to October 2018 were analyzed retrospectively. The association of intraoperative resection margin status and other clinicopathological factors on prognosis was analyzed by the Kaplan-Meier method and the Cox proportional hazard model. Logistic multivariate analysis was used to study factors influencing the margin status. Results Of 109 patients, 20 had a positive intraoperative resection margin, and 89 had a negative margin. Postoperative pathological examination showed that all the patients had a negative surgical margin. Univariate analysis suggested that CA19-9 before operation, preoperative adjuvant chemotherapy, intraoperative pancreatic resection margin status, maximum diameter of tumor, perineural invasion, lymphovascular invasion, tumor differentiation, and N staging were significantly related to survival in the entire cohort (all P 0.05). Analysis of the clinicopathological factors between the two groups showed that in the positive pancreatic neck margin group, the distribution of adverse pathologic factors like low tumor differentiation, tumor diameter ≥4 cm, perineural invasion and lymphovascular invasion were significantly different compared with the negative group (P<0.05). Tumor diameter ≥4 cm (OR=5.72, 95%CI: 1.60~20.49) and low tumor differentiation (OR=3.79, 95%CI: 1.20~11.95) were independent influencing factors of positive margin on logistic multivariate analysis. Conclusions Intraoperative pancreatic positive margin was not an independent risk factor of prognosis, but it was meaningful in predicting survival. Presence of positive margins was often combined with existence of some adverse pathological features, such as large tumor diameter and low tumor differentiation. Prognosis of patients with a positive margin was often poor. A positive pancreatic margin was an intraoperative marker of poor tumor biology in patients with pancreatic ductal adenocarcinoma. Key words: Pancreatic neoplasms; Positive margin; Pancreaticoduodenectomy; Prognosis

Early assessment value of brain function prognosis in patients with traumatic brain injury by regional saturation of cerebral oxygenation combined with percentage of α variability

To explore the usability of regional saturation of cerebral oxygenation (rScO2) combined with percentage of α variability (PAV) in predicting brain function prognosis in patients with traumatic brain injury (TBI). A retrospective analysis was conducted. The clinical data of patients with TBI who were monitored rScO2 and bedside quantitative electroencephalogram (qEEG) admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from August 2018 to July 2019 were collected. The rScO2, PAV, and Glasgow coma scale (GCS) score were recorded within 72 hours after the TBI. The primary prognostic indicator was the 3-month Glasgow outcome score (GOS) score. The differences between the two groups of poor prognosis of brain function (GOS score 1-3) and good prognosis (GOS score 4-5) were compared. Binary multivariate Logistic regression analysis was used to analyze the correlation between rScO2, PAV, GCS score and the prognosis of brain function in patients with TBI. In addition, receiver operating characteristic (ROC) curve was plotted to analyze the predicting value of rScO2 and PAV only or combination for prognosis of brain function. A total of 42 patients with TBI were enrolled in the study, with rScO2 ≥ 0.60 (grade I) in 14 patients, 0.50 ≤ rScO2 < 0.60 (grade II) in 16 patients, and rScO2 < 0.50 (grade III) in 12 patients. PAV 3-4 scores (grade I) were detected in 16 patients, 2 scores (grade II) in 17 patients, and 1 score (grade III) in 9 patients. GCS score 9-14 (grade I) were observed in 13 patients, 4-8 (grade II) in 23 patients, and 3 (grade III) in 6 patients; 18 patients had poor prognosis and 24 had good one. The rScO2, PAV and GCS scores of the poor-prognosis group were significantly higher than those in the good-prognosis group [rScO2 with grade III: 55.6% (10/18) vs. 8.3% (2/24), PAV with grade III: 38.9% (7/18) vs. 8.4% (2/24), GCS score with grade III: 27.7% (5/18) vs. 4.1% (1/24)] with significant differences (all P < 0.05). There was no significant difference in other general data including gender, age, total length of hospital stay or acute physiology and chronic health evaluation II (APACHE II) score between the two groups. Binary multivariate Logistic regression analysis showed that rScO2 and PAV were independent risk factors for prognosis of brain in patients with TBI [rScO2: odds ratio (OR) = 4.656, 95% confidence interval (95%CI) was 1.071-20.233, P = 0.040; PAV: OR = 3.525, 95%CI was 1.044-11.906, P = 0.042]. ROC curve analysis showed that both of rScO2 and PAV had predictive value for the prognosis of brain function in patients with TBI (AUC was 0.796 and 0.780, respectively, both P < 0.01), and rScO2 combined with PAV had higher predictive value with the AUC of 0.851 (P < 0.01) than rScO2 or PAV alone, the sensitivity was 94.4% and the specificity was 62.5%. rScO2 and PAV were associated with early brain function prognosis in patients with TBI. The combination of two monitoring indicators can reliably assess the prognosis of brain function in patients with TBI.

Expression and clinical significance of serine-threonine kinase receptor-related protein in hepatocellular carcinoma

Objective To detect the expression of serine-threonine kinase receptor-related protein (STRAP) in hepatocellular carcinoma (HCC) tissue microarray, and to investigate the relationship between STRAP expression level and the clinical characteristics of HCC. Methods Immunohistochemistry was used to detect the expression of STRAP in 93 cases of hepatocellular carcinoma and the corresponding adjacent normal tissues. The relationship between the expression of STRAP and the clinicopathological features and prognosis was analyzed statistically. Results The expression level of STRAP in HCC was significantly higher than that in adjacent tissues. In 9 cases of HCC with vascular invasion, the positive rate of STRAP expression was 66.7%, and all of them were strongly positive. The expression of STRAP in liver cancer tissues was negatively correlated with pathological grade (R=-0.205, P 0.05). Postoperative survival time was related with tumor size (P 0.05). Cox regression analysis indicated that clinical stage was independent risk factors of prognosis. Conclusion STRAP is highly expressed in HCC, and the positive rate of cancer tissue with vascular invasion is very high, indicating that STRAP may be related to the invasion ability of liver cancer. STRAP is negatively correlated with pathological grade, but it has no effect on the prognosis of liver cancer. Clinical stage is an independent risk factor influencing the prognosis of liver cancer. Key words: Carcinoma, hepatocellular; Serine-threonine kinase receptor-related protein; Prognosis; Immunohistochemistry

Early clinical management of acute CNS infections: a prospective cohort study.

Aim: To explore early management and clinical predictors of patients with suspected CNS infections. Methods: In a prospective cohort study of 125 adult patients with suspected CNS infections, clinical features and early management time points were compared between groups with and without confirmed CNS infections. Results: The door-to-lumbar puncture time was associated with the initial Glasgow Coma Scale score, the confirmed diagnosis and the time to change empirical treatment. Multivariate analysis indicated that the initial Glasgow Coma Scale score was an independent risk factor for prognosis. Conclusion: Lumbar puncture plays a crucial role in early management of CNS infections. Patients with CNS infection who have disturbances of consciousness should receive particular attention.

1156P - The clinical significance and biological mechanisms of miR-499a in high-tobacco exposed head and neck squamous cell carcinoma

BackgroundFew studies have directly investigated the differential expression of miRNA between low-tobacco and high-tobacco exposed HNSCC. The purpose of this study is to screen the differentially expressed miRNA and to investigate the clinical significance and potential biological mechanisms in above two groups of HNSCC. MethodsThe HNSCC datasets were obtained from TCGA database. Meanwhile, we collected 22 HNSCC patients in our hospital. The differentially expressed miRNAs between low-tobacco and high-tobacco exposed HNSCC were identified based on log2FC>1 and FDR < 0.05. KM survival analysis, Cox regression, chi-square test were used to evaluate the clinical significance of miRNA. The correlation between gene and clinical characteristic was analyzed by WGCNA. TargetScan, miRDB, DIANA databases were used to predict the target genes of miRNA. RT-qPCR was used to identify miRNA expression in HNSCC tissues. p<0.05 was considered statistically significant. Results30 differentially expressed miRNAs were identified between low-tobacco and high-tobacco exposed HNSCC. The patients with high expression of miR-499a had lower overall survival than those with low expression of miR-499a in high-tobacco exposed HNSCC (p=0.02). Multivariate Cox regression showed that high expression of miR-499a was an independent risk factor for prognosis of high-tobacco exposed HNSCC (HR=3.26, p=0.03). Chi-square test showed that miR-499a was related to N stage in high-tobacco exposed HNSCC (p<0.01). The clinical significance of miR-499a was not found in low-tobacco exposed HNSCC. WGCNA identified genes associated with N stage in high-tobacco exposed HNSCC. The three databases predicted the target genes of miR-499a, which intersected the genes associated with N stage. ZNRF1, AEBP2, NUS1 were obtained. RT-qPCR showed that miR-499a was differentially expressed between low-tobacco and high-tobacco exposed HNSCC in our own patients. Conclusions30 differentially expressed miRNAs are identified between low-tobacco and high-tobacco exposed HNSCC. In high-tobacco exposed HNSCC, highly expressed miR-499a may promote lymph node metastasis by down-regulating one or more of ZNRF1, AEBP2, NUS1, resulting in shortened patient survival. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Profiles of tumor‑infiltrating immune cells in renal cell carcinoma and their clinical implications

Tumor-infiltrating immune cells (TIICs) are crucial for the clinical outcome of renal cell carcinoma (RCC), as they regulate cancer progression. TIICs have therefore the potential to become novel targets of immunotherapies. The present study used CIBERSORT analytical tool, which is a deconvolution algorithm, to comprehensively analyze the composition of immune cells in RCC and normal tissues from The Cancer Genome Atlas (TCGA) cohort, and to determine the prognostic value of TIICs in RCC. A landscape of infiltrating immune cells was determined as containing 13 subpopulations of immune cells, with significant differences between normal and tumor tissues. Subsequently, Kaplan-Meier analysis and log-rank test were used to estimate the prognostic value of TIICs in RCC. The results demonstrated that a higher proportion of regulatory T cells (Tregs) [hazard ratio (HR)=1.596; 95% confidence interval (CI), 1.147–2.222; P=0.006] and follicular helper T cells (HR=1.516; 95% CI, 1.089–2.111; P=0.014) were associated with poor outcome in patients with RCC. Conversely, resting mast cells (HR=0.678; 95% CI, 0.487–0.943; P=0.021) and monocytes (HR=0.701; 95% CI, 0.503–0.977; P=0.036) were associated with a favorable prognosis in patients with RCC. Furthermore, the results from multivariate Cox regression analysis indicated that Tregs and monocytes represented independent risk factors for prognosis in patients with RCC. These findings demonstrated that gene profiling deconvolution by CIBERSORT served to determine the composition of immune cells infiltrated in RCC and may provide some crucial information for the development of immunotherapies.

Poor expression of long-chain noncoding RNA GAPLINC inhibits epithelial–mesenchymal transition, and invasion and migration of hepatocellular carcinoma cells

Our study aims to investigate the relationship between lncRNA GAPLINC and survival and prognosis of hepatocellular carcinoma (HCC) and its influence on epithelial-mesenchymal transition (EMT), proliferation, invasion and migration of HCC cells. HCC tissues and cells were obtained for detecting the expression of GAPLINC, and the relationship between GAPLINC and prognosis of patients with HCC was also explored. HCC cells were transfected with siRNA-NC or GAPLINC siRNA to figure out the role of GAPLINC in cell migration, invasion, proliferation and EMT in HCC cells. The upregulated expression of GAPLINC was found both in HCC tissues and cells. The expression of GAPLINC was correlated with tumor stage, distant metastasis and pathological grade of HCC. Moreover, GAPLINC was confirmed as an independent risk factor for prognosis of patients with HCC. In HCC-LM3 and MHCC-97H cells, cells transfected with GAPLINC siRNA inhibited cell migration, invasion, proliferation and EMT in HCC cells. This study suggests that the high expression of GAPLINC in HCC is an independent risk factor for the prognosis of HCC. Additionally, downregulation of GAPLINC can inhibit the EMT, proliferation, invasion and migration of HCC cells.

Health care professionals' views on psychological factors affecting nutritional behaviour in people with motor neuron disease: A thematic analysis.

Five qualitative focus groups were carried out across the United Kingdom in June 2018 with 51 participants, including 47 HCPs involved with MND care and four service user representatives. Data were analysed through thematic analysis. Four overarching themes were identified: psychological adjustment and patient engagement; nutrition and the need for control; knowledge of nutrition and the complexity of MND; and the psychosocial nature of eating. The findings suggest that the nutritional management of pwMND should be mindful of factors such as the impact of distress at the time of diagnosis, the availability of clear information on nutrition and MND, as well as the importance of illness perceptions and coping strategies. Moreover, tailored psychological interventions should be considered to mitigate the impact on MND on the experience of eating. Statement of contribution What is already known on this subject? Since weight loss and reduced body mass index (BMI) have been identified as independent risk factors for prognosis and survival in motor neuron disease (MND), nutritional management represents an important component of the symptomatic care of people with MND (pwMND) aimed at prolonging survival and maintaining or improving quality of life. However, the current guidelines and quantitative and qualitative literature on the topic are mainly focused on issues around enteral feeding and gastrostomy insertion, and very little is currently known about potential psychological enablers or barriers to earlier nutritional management, especially from the perspectives of health care professionals (HCPs) involved in the delivery of nutritional care in pwMND. What does this study add? First qualitative investigation of enablers or barriers to nutritional care in pwMND from the perspective of HCPs. New insight into psychological factors (e.g., adjustment, avoidance, loss of control) in nutritional care for pwMND. Practical implications and novel clinical suggestions for HCPs involved in nutritional care of pwMND.

Extracorporeal membrane oxygenation in patients with heart transplantation : A clinical prognosis analysis.

Extracorporeal membrane oxygenation (ECMO) is indicated for bridging to heart transplantation, graft failure, and right heart failure after heart transplantation. This study explored risk factors affecting the clinical prognosis of cardiac transplantation patients treated with ECMO during the perioperative period. Data on 28heart transplantation patients with ECMO obtained from January 2012 to January 2018 in the People's Hospital of Zhongshan City were retrospectively analyzed. Atotal of 25patients (20male and 5female) were finally included. Heart transplantation was performed mainly due to cardiomyopathy (77.8%). Of the treated patients, 18(72%) survived and were discharged, 4were treated with cardiopulmonary resuscitation (CPR) before ECMO, and 3died in hospital. There were no differences between the surviving and death group donors (N-terminal pro b‑type natriuretic peptide [NT-proBNP], creatine kinase-muscle/brain [CK-MB], warm ischemia time of donated heart, cold ischemia time of donated heart, total ischemia time of donated heart, and donor type). In univariate analysis, body mass index (BMI), length of stay in the intensive care unit (ICU), and CPR were relevant prognostic factors for heart transplantation patients with ECMO. Multi-factor logistic regression showed that CPR before ECMO (odds ratio, OR, 49.45; 95% confidence interval, CI, [1.37, 1781.6]; P = 0.033) is an independent risk factor influencing prognosis. ECMO is an important life support method for patients before and after heart transplantation surgery. Obesity, poor preoperative cardiac function, and considerable intraoperative red blood cell transfusion may influence prognosis. Extracardiac compression before ECMO is an independent risk factor for prognosis.

Vestigial like family member 3 is a novel prognostic biomarker for gastric cancer.

BACKGROUNDVestigial like family member 3 (VGLL3) is associated with the prognosis of epithelial ovarian cancer and soft tissue sarcoma, but its role in gastric cancer (GC) is unclear.AIMTo explore the expression pattern and clinical significance of VGLL3 in GC.METHODSIntegrative analysis was performed on the GC transcriptome profiles and survival information deposited in the ONCOMINE, GEPIA, and ONCOLNC databases. The expression levels of VGLL3 mRNA and protein were analyzed in the freshly resected tumor and normal gastric tissues from GC patients by quantitative RT-PCR and Western blot, respectively. In addition, the in situ expression of VGLL3 in the GC tissues was determined by immunohistochemistry (IHC), and the patients were accordingly classified into the high and low expression groups. The correlation of VGLL3 expression status with patient prognosis was then determined by univariate and multivariate Cox regression analyses.RESULTSAnalysis of the ONCOMINE and GEPIA databases showed that VGLL3 was significantly up-regulated in GC tissues (P = 0.003), and associated with the tumor TNM stage (P = 0.0163). The high VGLL3 expression group had a significantly worse prognosis compared to the low expression group, as per both GEPIA (P = 0.0057) and ONCOLNC (P = 0.01). The bioinformatics results were validated by the significantly higher VGLL3 mRNA and protein levels in the GC tissues compared to the adjacent normal tissues (P < 0.001) in a cohort of 30 GC patients. Furthermore, high in situ expression of VGLL3 protein was associated with more advanced N and TNM stages and HER2 mutation (P < 0.05) in a cohort of 172 patients. Kaplan-Meier analysis showed that the high VGLL3 expression group had a worse prognosis compared to the low expression group (P = 0.019). Multivariate analysis showed that VGLL3 expression status was an independent risk factor for prognosis. In addition, the prognostic risk model nomogram showed that VGLL3 was the most important indicator, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.613 for 3-year survival and 0.706 for 5-year survival. Finally, the protein interaction network analysis revealed that VGLL3 is likely involved in the Hippo signaling pathway.CONCLUSIONVGLL3 is overexpressed in GC tissues and associated with a poor prognosis, indicating its potential as a novel prognosis biomarker and therapeutic target for GC.