Influencing Factors Of Survival Research Articles

Silva Classification System for HPV-Related EAC of Stage I ∼ IIIc1p Cervical Adenocarcinoma and Its Effect on Prognosis and Survival

The proportion of adenocarcinoma in cervical cancer gradually increased and presented a younger trend. The previous pathological classification of cervical adenocarcinoma is difficult to provide reference for clinical treatment. In recent years, Silva classification, a new pathologic system for cervical adenocarcinoma, has been confirmed to be suitable for HPV-associated adenocarcinoma (HPVA), and has shown certain clinical application value in subsequent studies. Therefore, this study will retrospectively analyze the distribution of Silva typing system in patients with HPVA under standard treatment mode and its relationship with prognosis and survival. From January 2010 to September 2021, 124 cervical adenocarcinoma patients with HPVA were retrospectively included, who underwent radical resection of cervical cancer. The HE staining sections of the patients were divided into SilvaA, SilvaB, and SilvaC types according to the Silva typing system. Kaplan-Meier calculation was used for single-factor analysis, and COX stepwise regression model was used for multi-factor analysis. Of the 124 patients with HPVA who could be graded according to the Silva system, 16 (12.9%, 16/124) were SilvaA, 27 (21.7%, 27/124) SilvaB, and 81 (65.4%, 81/124) SilvaC. In Silva classification, FIGO staging of Silva A and B was stage I. And FIGO staging of Silva C was more significantly later than the staging of Silva A and B. All lymph node metastases and paruterine infiltrates were found only in Silva C. In addition, the patients with Silva C large mass accounted for a higher proportion (41.7%). SilvaA type cervical adenocarcinoma patients were in a survival state by the end of follow-up. Among Silva B, 3 patients died due to tumor, and the 5-year OS rate were 91.3%. Among SilvaC, 15 patients died due to tumor, and the 5-year OS rate were 76.5%. FIGO stage and lymph node invasion were the influencing factors for survival and prognosis of Silva classification (P <0.05). FIGO stage, tumor size, lymph node invasion, and paralegal invasion were the influencing factors for survival and prognosis of SilvaC patients (P <0.05). Silva model classification system combined with clinicopathological features has certain clinical value for the prognostic guidance of HPVA patients. Among Silva classification, SilvaC had the worst prognosis. Late FIGO stage, lymph node metastasis, and paralegal infiltration are the influencing factors for survival and prognosis of SilvaC type.

Risk Factors and Prognosis of Cardiovascular Damage in Hypereosinophilia

To investigate the risk factors and prognosis of cardiovascular damage in hypereosinophilia (HE). The clinical data of 62 patients with HE in Gansu Provincial Hospital from January 2015 to December 2020 were retrospectively analyzed, including clinical characteristics and laboratory indicators, and the influencing factors of survival and prognosis were also analyzed. In this study, there were 34 males and 28 females, with a median age of 53.5 (20-79) years, 35 patients without cardiovascular damage, 27 patients with cardiovascular damage, including 22 patients with abnormal electrocardiogram (ECG) (81.5%), 18 patients with abnormal echocardiography (ECHO) (66.7%), 9 patients with single ECG abnormality, 5 patients with single ECHO abnormality, and other 13 patients with multiple abnormalities. In cardiovascular damage group, peripheral white blood cell count, absolute value of eosinophils, troponin T (TNT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), interleukin (IL)-4 and IL-5 levels at initial diagnosis were significantly higher than those in the non-cardiovascular damage group (P <0.01), while hemoglobin, IL-2 and interferon-γ levels were significantly lower (P <0.01). There were no significant differences in age, sex, course of disease, etiological classification, platelet count, serum creatine kinase, serum creatine kinase isoenzyme and lactate dehydrogenase between the two groups (P >0.05). The 5-year overal survival rate of patients with cardiovascular damage was 88.9%, and that of patients without cardiovascular damage was 100%, the difference was statistically significant (P =0.012). The 5-year event-free survival (EFS) rate of patients with cardiovascular damage was 59.3%, and the median time was 37 (21-52) months, while that of patients without cardiovascular damage was 80%, and the median time was 63 (51-74) months (P =0.002). Age (>60 years old), course of disease (>24 months), NT-proBNP (>3 000 pg/ml), TNT (>100 ng/L), elevated IL-4 and IL-5 were associated with EFS shortening in patients with cardiovascular damage, which were independent risk factors for EFS. The EFS rate in HE patients without cardiovascular damage is significantly higher than patients with cardiovascular damage. Age, course of disease, NT-proBNP, TNT, IL-4 and IL-5 are independent risk factors affecting EFS of patients with cardiovascular damage.

Impact of Silva classification system on the survival of HPV-related cervical adenocarcinoma patients with stage I ̃ IIIc1p.

e17505 Background: The incidence of cervical adenocarcinoma is increasing progressively in recent years and shows a younger trend that seriously threatens human health. However, the conventional pathological type of cervical adenocarcinoma is insufficient to predict the prognosis and therapeutic effect. Recently,the Silva classification system, a new pathological classification system was introduced and considered to have a better potential impact on the survival of HPV-related cervical adenocarcinoma patients. Methods: The clinical data of 102 patients with cervical adenocarcinoma from January 2010 to September 2021 were retrospectively included. All patients underwent radical resection of cervical cancer and were diagnosed as cervical adenocarci.noma by pathology.The HE staining sections of the patients were divided into SilvaA, SilvaB, and SilvaC types according to the Silva typing system. SPSS26.0 software was used for statistical analysis, Kaplan-Meier calculation was used for single-factor analysis, and COX stepwise regression model was used for multi-factor analysis. Results: Of the 102 patients with cervical adenocarcinoma who could be graded according to the Silva system, 14 (13.7%, 14/102) were SilvaA, 23 (22.5%, 23/102) SilvaB, and 65 (63.8%, 65/102) SilvaC. SilvaA type cervical adenocarcinoma patients were all stage I (IB1-IB3), no lymphatic or vascular invasion, and all patients were in a survival state by the end of follow-up. All patients with SilvaB cervical adenocarcinoma were stage I (IA2-IB3), without lymphatic or vascular invasion. Among 23 patients with Silva B, 2 patients died due to tumor, and the 5-year PFS and OS were 91.3%. Sixty-five patients with SilvaC type cervical adenocarcinoma (IB1-IIIC1P) and 15 patients died of tumor-related causes. FIGO stage, tumor size, lymph node invasion, and paralegal invasion were the influencing factors for survival and prognosis of SilvaC patients (P &lt;0.05). Conclusions: In the Silva typing system, SilvaC type has the worst prognosis, SilvaA type and SilvaB type are both stages I, without lymph node invasion, and the prognosis is better. Patients with SilvaC type are at the Ib1-IIIC1P stage and may have a lymphatic and vascular invasion. Late FIGO stage, lymph node metastasis, and paralegal infiltration are the influencing factors for survival and prognosis of SilvaC type.

Correlation between microRNA-766 expression in patients with advanced gastric cancer and the efficacy of platinum-containing chemotherapy.

We aimed at observing the correlation between microRNA-766 expression and the efficacy of platinum-containing chemotherapy in patients with stage IV gastric cancer (GCa). Tissue specimens were obtained from 100 patients with stage IV GCa who received platinum-based chemotherapy, and microRNA-766 expression in these samples was examined by quantitative real-time polymerase chain reaction (qPCR) analysis. Survival analysis was carried out through Kaplan-Meier test. The influencing factors of survival were assessed through COX univariate and multivariate regression. GCa tissues contained significant lower expression of microRNA-766 than adjacent tissues. The degree of tumor differentiation and peritoneal metastasis were confirmed to have great relevance to microRNA-766 level. Patients with high microRNA-766 expression have better chemotherapy efficacy and longer progression-free survival. Our study shows for the first time that the highly expressed microRNA-766 in tumor tissues of patients with stage Ⅳ GCa predicts better platinum-containing chemotherapy efficacy and prognosis.

Therapeutic effects of intracranial ependymoma in children

Objective To investigate the treatment and prognosis of intracranial ependymoma in children. Methods The clinical data of 48 children with intracranial ependymoma who were first diagnosed and treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from September 2012 to September 2016 were retrospectively analyzed. The tumors were solitary in 48 patients, including under-tentorial tumors in 34 cases and supratentorial tumors in 14 cases. All patients underwent surgical resection, adjuvant radiotherapy and/or chemotherapy, and regular outpatient and telephone follow-up. Kaplan-Meier method was used to analyze the survival rate of patients, and Cox regression analysis was used to explore the influencing factors of survival. Results Of the 48 patients, 31 achieved gross total resection at the first operation and 17 received subtotal resection. Postoperative pathological results showed that classical ependymomas (WHO grade Ⅱ) was in 4 cases, anaplastic ependymomas (WHO grade Ⅲ) in 26 cases, and partial anaplastic ependymomas (between WHO grade Ⅱ and Ⅲ) in 18 cases. Postoperative local recurrence occurred in 21 cases, of which 20 cases underwent reoperation. 7 cases developed local recurrence with distant dissemination, of which 4 cases underwent reoperation. Of 48 patients, radiotherapy were performed in 46 cases/times and chemotherapy in 42 patients/times after operation. 2 cases died of hydrocephalus and 14 cases died of recurrence of tumors. The follow-up time of 48 patients ranged from 5 to 68 months, with a median of 34 months. The 3-year progression-free survival rate and overall survival rate were 29.3% and 70.8% respectively. The 3-year overall survival rate of 28 patients with recurrence was 62.1%. Univariate analysis showed that for children with ependymoma, the degree of first surgical excision was a factor affecting progression free survival(P=0.027). The age of diagnosis, the location of the tumors and the degree of last surgical excision might be the influencing factors of overall survival in patients with ependymoma (all P<0.05). Multivariate analysis showed that the degree of resection (RR=3.568, 95%CI: 1.638-7.775, P=0.001) was an independent factor affecting the survival time of patients. Conclusions Surgical resection is still the most important treatment for children with ependymoma. The degree of tumor resection is related to survival outcomes. Key words: Ependymoma; Child; Neurosurgical procedures; Chemotherapy, adjuvant; Radiotherapy, adjuvant; Prognosis

Comparison of clinicopathological features and prognosis between left-sided colon cancer and right-sided colon cancer

To compare the clinicopathological features and prognosis between left-sided colon cancer (LC) and right-sided colon cancer (RC). Clinicopathological and follow-up data of 2 174 colon carcinoma cases undergoing resection at Shanghai Changhai Hospital of The Second Military Medical University from January 2000 to December 2010 were retrospectively analyzed. Patients with transverse colon cancer, overlapping position, unknown location, recurrent cancer, multiple primary cancer, concomitant malignant tumors, preoperative chemotherapy, local resection, incomplete clinical data and missed follow up were excluded. Finally, a total of 1 036 patients, whose primary tumors were radically removed, were enrolled, with 563 patients in LC group (including carcinoma in cecum, ascending colon and hepatic flexure) and 473 in RC group (including carcinoma in splenic flexure, descending colon and sigmoid colon). The clinicopathological features and survival, including median overall survival, 5-year overall survival rate, tumor specific median overall survival, cancer specific 5-year overall survival rate, were compared between LC and RC groups. Tumor specific overall survival was defined as the period between operation date to the date of death caused by cancer progression. Multivariate Cox regression analysis was used to analyze the influencing factors of survival. Propensity score matching was carried out to balance the clinicopathological factors between the two groups with the SAS 9.3, taking the following parameters into consideration (age, gender, gross appearance, tumor diameter, invasion depth, lymph node metastasis, distant metastasis, TNM stages, differentiation, CEA and CA199-9). Patients in RC group and LC group were matched according to the propensity scores and the clinicopathological characteristics and prognosis of two groups were compared again. No significant differences were identified between the two groups in age, distant metastasis and serum CEA level. Compared with RC group, LC group had more male patients [60.9%(343/563) vs. 51.0%(241/473), P=0.001], more ulcerative tumors [71.9% (405/563) vs. 65.3%(309/473), P=0.006], better differentiation [well/moderately differentiated: 87.5%(493/563) vs. 73.8%(349/473), P=0.000], lower infiltration depth [T1-2: 17.1%(96/563) vs. 10.1%(48/473), P=0.001], higher lymph node metastasis rate [N0: 53.3%(300/563) vs. 62.4%(295/473), P=0.013], lower TNM stage [stage I(: 13.3%(75/563) vs. 7.8%(37/473), P=0.000], lower serum CA199 level [<37 kU/L: 68.4% (385/563) vs. 62.6% (296/473), P=0.022] and smaller tumor diameter [<5.0 cm: 55.1%(310/563) vs. 38.3%(181/473), P=0.000]. The median overall survival was 82 months and 76 months in LC and RC groups, respectively, and the 5-year overall survival rate was 58.3% and 50.9%(P=0.038). The median tumor specific survival was 84 months and 78 months in LC and RC groups, respectively, and the 5-year tumor specific overall survival rate was 60.6% and 52.9% (P=0.031). Multivariate Cox regression analysis showed that tumor location (LC vs. RC) was not associated with overall survival (P=0.106) and tumor specific survival (P=0.091). After propensity score matching, no significant difference was found in clinicopathological factors and propensity score (0.458±0.129 vs. 0.459±0.129, P=0.622) between LC and RC group. After matching, there was no significant difference in overall survival rate (54.0% vs. 51.7%, P=0.982) and tumor specific overall survival rate(56.4% vs. 53.1%, P=0.819) between two groups. Significant difference exists between RC and LC in clinicopathological factors, but not in survival.

Influencing factors for postoperative survival of patients with stage III silicosis treated by lung transplantation

Objective: To investigate the clinical effect, postoperative complications, and causes of death in the treatment of stage III silicosis with lung transplantation and the influencing factors for survival. Methods: A retrospective analysis was performed for the clinical data of 32 patients with stage III silicosis who underwent lung transplantation in our hospital from September 2002 to September 2015. The survival, causes of death, and postoperative complications were analyzed. The Kaplan-Meier method was used to plot survival curves, the log-rank test was used to compare the influence of each factor on survival rates, and the multivariate Cox proportional hazards regression model was used to evaluate the influence of each factor on survival. Results: All the patients underwent successful lung transplantation. The 3-month and 1-, 3-, and 5-year postoperative cumulative survival rates were 90.6%, 80.8%, 76.7%, and 76.7%, respectively. Eight patients died during the postoperative follow-up, among whom 1 died of multiple organ failure, 3 died of severe infection, 2 died of sudden cardiac death, 1 died of renal failure, and 1 died of bronchiolitis obliterans. The major postoperative complications included primary graft dysfunction (PGD) in 10 patients, severe infection in 7 patients, acute rejection reaction in 3 patients, bronchiolitis obliterans in 5 patients, bleeding in 5 patients, anastomotic complication in 2 patients, and renal dysfunction in 3 patients. The Kaplan-Meier survival analysis showed that sex, postoperative PGD, postoperative infection, massive intraoperative blood loss, preoperative pulmonary arterial hypertension were influencing factors for postoperative survival rates (P<0.05). The multivariate Cox regression model showed that male sex was the protective factor (P<0.05) and postoperative PGD and massive intraoperative blood loss were independent risk factors for death after transplantation (P<0.05). Conclusion: Lung transplantation is a method for the treatment of silicosis. Postoperative PGD and massive intraoperative blood loss are independent risk factors for death after transplantation. Survival rates are affected by postoperative PGD, infection, massive intraoperative blood loss, and preoperative pulmonary arterial hypertension.

Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of esophageal carcinoma: an analysis of 349 patients

Objective To observe the efficacy and adverse reactions of intensity-modulated radiotherapy (IMRT) with or without chemotherapy in the treatment of esophageal carcinoma, and to explore the influencing factors for prognosis. Methods The short-term outcomes and acute adverse reactions in 349 patients with esophageal carcinoma who received IMRT with or without chemotherapy from 2006 to 2012 were retrospectively analyzed. The 1-, 3-, and 5-year local control (LC) rates and overall survival (OS) rates were calculated with the Kaplan-Meier method. The influencing factors for survival were analyzed using the Cox regression model. Results The sample sizes at 3 and 5 years were 174 and 63, respectively. For all patients, the 1-, 3-, and 5-year LC rates were 72. 9%, 61. 2%, and 58. 4%, respectively, and the 1-, 3-, and 5-year OS rates were 66. 5%, 39.1%, and 24%, respectively. According to the results of subgroup analysis, the 1-, 3-, and 5-year LC and OS rates in patients with a tumor volume of < 54. 73 cm3 were significantly higher than those in patients with a tumor size of ≥54. 73 cm3 ( P=0. 001 and 0. 000). There were no significant differences in 1-, 3-, and 5-year LC rates between patients with and without lymph node metastasis (P= ?). However, the 1-, 3-, and 5-year OS rates were significantly lower in patients with lymph node metastasis than in patients without lymph node metastasis (62. 7% vs. 83.1%; 35. 9% vs. 53. 3%; 20. 4% vs. 38. 3%; P= 0.003). There were significant differences in the 1-, 3-, and 5-year LC and OS rates between patients with complete response, partial response, and no response (P= 0. 000 and 0. 000). The incidence rates of grade ≥ 2 acute radiation pneumonitis and grade ≥ 3 acute radiation esophagitis were 11. 3% and 9.0%, respectively. The tumor volume, short-term outcome, and lymph node metastasis were the influencing factors for OS (P= 0. 038, 0. 000, and 0. 008). Conclusions IMRT with or without chemotherapy is effective and safe in the treatment of esophageal carcinoma. The prognosis becomes poor along with increased tumor volume and regional lymph node metastasis. The evaluation of short-term outcomes is closely correlated with LC and OS. Key words: Esophageal neoplasms/radiotherapy; Radiotherapy, intensity-modulated; Prognosis

Prognostic analysis of esophageal carcinoma patients with stump carcinoma and atypical hyperplasia after esophagectomy

To analyze the prognostic factors for esophageal carcinoma patients with stump carcinoma and atypical hyperplasia after esophagectomy. From August 2006 to December 2010, 182 esophageal carcinoma patients with stump carcinoma and atypical hyperplasia after esophagectomy treated in our hospital were involved in this study, including 60 cases with grade I-II atypical hyperplasia, 23 cases with grade III atypical hyperplasia, 37 cases with carcinoma in situ, and 62 cases with invasive carcinoma. Prognostic factors for these patients were analyzed. The 1-, 2-, 3- and 4-year locoregional control rates of these 182 patients were 77.1%, 63.3%, 60.3% and 60.3%, respectively, and the over-all cumulative survival rates were 78.6%, 63.9%, 46.3% and 41.0%, respectively. A total of 56 cases suffered from locoregional recurrence (56/182, 30.8%), including anastomotic recurrence and lymph node metastasis. The number of locoregional recurrence patients of grade I-II of atypical hyperplasia was 13(13/60, 21.7%), grade III atypical hyperplasia and carcinoma in situ 21 (21/60, 35.0%), and invasive carcinoma 22 (22/62, 35.5%). There were no significant differences among the three groups(χ(2) = 3.485, P = 0.175). There were significant differences in locoregional control rate and survival rate among the four treatment groups (P < 0.05). For patients with stump grade I∼II atypical hyperplasia and different stage positive stump margin, the 1-, 2-, 3- and 4-year survival rates of the four treatment groups had significant differences (P < 0.05). As for locoregional control rates, there were no significant differences in the four groups (P > 0.05). Univariate analysis showed that tumor length, depth of invasion, number of metastatic lymph nodes, number of lymph node metastatic fields, pTNM stage, stump pathological grade and treatment modality were main influencing factors for survival rate (P < 0.05);invasion depth, stump pathological grade and treatment modality were important factors for locoregional control. Multivariate Cox regression analysis showed that tumor length, number of metastatic lymph nodes, stump pathological grade and treatment modality were independent influencing factors for survival (all P < 0.05);invasion depth, stump pathological grade and treatment modality were independent influencing factors for locoregional control (all P < 0.05). For the patients with stump carcinoma and atypical hyperplasia after esophagectomy, tumor length, number of metastatic lymph nodes, stump pathological grade and treatment modality are independent influencing factors for long-term survival, and invasion depth, stump pathological grade and treatment modality are independent influencing factors for locoregional control.