Overall Disease-free Survival Research Articles

Updated Comparison of Outcomes in Hispanic and Non-Hispanic Patients with Ph-Negative Acute Lymphoblastic Leukemia Using the Modified Pediatric-Based University of Southern California Acute Lymphoblastic Leukemia (USC ALL) Regimen in the Era of Novel Agents

INTRODUCTION: Hispanic patients with acute lymphoblastic leukemia (ALL) are historically known to have poor outcomes compared to non-Hispanic patients which may be associated with healthcare disparities, although further elucidation is needed. Since we take care of a large population of Hispanic patients, we now report further updated outcomes in Hispanic compared to Non-Hispanic ALL patients using the modified USC ALL regimen in the era of novel agents like blinatumomab and inotuzumab. METHODS: This retrospective chart review included adults 18 years old with newly diagnosed Ph-negative ALL (2016-2020). Primary objectives were 3-year over-all survival (OS), event-free survival (EFS) and disease-free survival (DFS) stratified by MRD flow status and blinatumomab use. Secondary objectives were complete remission/complete remission with incomplete recovery (CR/CRi), MRD by flow, descriptive statistics of patients stratified into Hispanic and non-Hispanic cohorts evaluated using Fisher's exact test. OS, DFS, EFS reported through Kaplan Meier curves and Log-rank tests. Two-sided p-value ≤0.05 was significant. RESULTS: 121 Ph-negative ALL patients were reviewed. 87 Hispanic patients (HP) and 34 non-Hispanic patients (NHP). Median ages in HP and NHP were 39 and 35 years; median BMI 29 and 26.9 kg/ m2 (p=0.42-0.51), respectively. About equal males and females in HP while NHP had 70.6% males compared to 29.4% females (p=0.08). Both HP and NHP were mainly Ph-negative ALL, 50.6% vs 47.1%, 25.4% vs 20.6% were Ph-like, respectively (p=0.884). Most of our population had unfavorable risk by NCCN, 86.8% in HP and 90.5% in NHP (p=0.99). 71.1% HP and 62.5% NHP received PEG during induction 1 (p=0.37), and 69.6% of HP and 63% of NHP received PEG during induction 2 (p=0.52). After induction 1: 91.1% of HP and 80% in NHP achieved CR/Cri (p=0.18). 55.7% of HP and 40.9% of NHP achieved MRD negativity by flow (p=0.23). After induction 2: 92.7% of HP and 79% of NHP achieved CR/CRi, with 7.3% in HP being refractory compared to 21.1% of NHP (p=0.19). 73.3% of HP and 64.7% of NHP achieved MRD negativity by flow (p=0.54). 26.4% of HP and 35.3% of NHP had relapse (p=0.33), 4.6% of HP and 20.6% of NHP had refractory disease (p=0.01), while 4.6% of HP compared to 20.6% of NHP died (p=0.27). Blinatumomab was given in 35.6% of HP and 32.3% of NHP (p=0.73). Meanwhile only 6.9% of HP and 2.9% of NHP received inotuzumab (p=0.67). 39.1% of HP underwent allogenic hematopoietic stem cell transplant (allo-HSCT) versus 26.5% in NHP (p=0.19). 26.4% HP and NHP who received blinatumomab did not undergo allo-HSCT. 3.4% of HP and 11.8% of NHP underwent CAR-T (p=0.096). 3y OS was 82.4% in HP vs 75.8% in NHP (p=0.18). 3y EFS was 58.6% in HP vs 43.7% in NHP (p=0.008). 3y DFS was 62.4% in HP vs 57.1% in NHP (p=0.08). In HP when stratified by MRD flow negativity post induction, there was no statistically significant difference in 3y OS (79.1% vs 90%) (p=0.4), 3y DFS 65.9% vs 60.4% (p=0.8) and 3y EFS 65.9% vs 52.9% (p=0.66). In NHP when stratified by MRD flow negativity post induction, there was also no statistically significant difference in 3y OS (100% vs 88.9%) (p=0.56), 3y DFS (75% vs 67.5%) (p=0.84) and 3y EFS (75% vs 67.5%) (p=0.8). Of note, when survival is stratified by blinatumomab use, in HP: 3y OS 71.6% vs 88.3% (p=0.14), 3y EFS was 27.8% vs 76.6% (p=0.001), 3y DFS was 37.2% vs 76.6% (p=0.001) (Fig 1-2). In NHP: 3y OS 72.7% vs 77.7% (p=0.56), 3y EFS was 36.4% vs 44.4% (p=0.2), 3y DFS was 42.4% vs 64% (p=0.02). No clear difference in grade 3/4 PEG toxicities were found in HP compared to NHP except grade 4 hypertriglyceridemia which was noted more in HP 31.3% compared to 9.7% in NHP (p=0.019). CONCLUSIONS: Our updated data shows a trend to better outcomes in HP compared to NHP in terms of OS and DFS, and a statistically significantly better EFS in the Hispanic population. Having MRD negativity by flow showed no statistically significant difference in both groups. Of note, 3y EFS and 3y DFS were significantly lower in HP who received blinatumomab since these patients were MRD flow positive and lacked deeper remissions, but 3y OS (71.6%) remained high regardless, even though 26.4% who received blinatumomab were not able to go for allo-HSCT. In NHP, the trend is like that of HP but less pronounced. This suggests the beneficial effect of blinatumomab especially in Hispanic patients. Further follow-up is necessary to provide a more robust and mature survival data. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Diagnostic and prognostic significance of long noncoding RNA SSTR5-AS1 in patients with gastric cancer.

Long noncoding RNAs (lncRNAs) display a functional effect on the pathogenesis of several diseases, including various tumors. Herein, we aimed to reveal the role of lncRNA somatostatin receptor 5 antisense RNA 1 (SSTR5-AS1) in gastric cancer (GC). qRT-PCR was utilized for testing the SSTR5-AS1 expression in 158 paired primary GC tissues and corresponding normal gastric specimens. Receiver operating characteristic (ROC) curves were established to determine the diagnostic values of overexpression of SSTR5-AS1 in GC. A chi-square test was performed to analyze the correlation between SSTR5-AS1 expressions and several clinicopathological features in GC patients. Kaplan-Meier survival curve was constructed to estimate the overall survival (OS) and disease-free survival (DFS). Multivariate analyses were conducted to examine the prognostic value of SSTR5-AS1. We observed that SSTR5-AS1 expression was highly expressed in GC specimens compared with adjacent non-tumor specimens (p < 0.01). High SSTR5-AS1 expression was correlated with an advanced pathologic stage. The ROC curves showed that areas under the ROC curve (AUC) for SSTR5-AS1 is 0.8419. Moreover, high expression of SSTR5-AS1 was observed to be associated with distant metastasis (p = 0.021) and TNM stage (p = 0.042). Besides, survival analysis showed that GC patients with high SSTR5-AS1 expression suffered poorer OS (p = 0.020) and DFS (p = 0.0007). Multivariate assays demonstrated that increased expressions of SSTR5-AS1 could be an independent prognostic marker of OS and DFS of GC patients. Our findings indicate that SSTR5-AS1 served as a promising novel prognostic biomarker for GC.

Combined postoperative adjuvant transarterial chemoembolization and portal vein chemotherapy to treat patients with hepatocellular carcinoma and portal vein tumor thrombosis: a meta-analysis

Objective To systematically review the clinical effectiveness of combined postoperative adjuvant transcatheter arterial chemoembolization (TACE) with portal vein chemotherapy (PVC) versus TACE alone in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). Methods Databases including PubMed, Embase, Cochrane Library, Medline, Web of Science, CNKI, China Biology Medicine, Wan Fang and VIP were searched from Jan 1st 2000 to Jun 30th 2019 for eligible studies on clinical effectiveness of combined postoperative adjuvant TACE with PVC versus TACE alone in patients with HCC and PVTT. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoint was adverse events. These endpoints were evaluated by odds ratio (OR) and 95% confidence interval (CI) using Review Manager 5.3 software. Results Nine studies with 642 patients were enrolled in this meta-analysis. There were 323 patients in the TACE group and 319 patients in the TACE plus PVC group. The pooled OR for the 1-, 2-, and 3-year OS were all significantly better in the TACE plus PVC group than the TACE group (1-year OS, OR=2.20, 95% CI: 1.53-3.17; 2-year OS, OR=2.44, 95% CI: 1.69-3.53; 3-year OS, OR=2.30, 95% CI: 1.52-3.46) (all P 0.05). Conclusion Postoperative adjuvant TACE combined with PVC for patients with HCC and PVTT was safe and effective, and was significantly better than TACE alone in long-term prognosis. Large-scale, multi-center, prospective studies are needed to support the conclusion. Key words: Carcinoma, hepatocellular; Portal vein tumor thrombosis; Transarterial chemoembolization; Portal vein chemotherapy; Meta-analysis

Prognostic factors in patients with occult ruptured hepatocellular carcinoma after hepatectomy

Objective To study the prognostic factors in patients with occult ruptured hepatocellular carcinoma (HCC) after hepatectomy. Methods The clinical data of 31 patients with occult ruptured HCC who underwent hepatectomy at the Heze Multiple Hospital from January 2001 to December 2014 were retrospectively analyzed. There were 27 males and 4 females, with ages ranging from 29 to 73 years. Kaplan-Meier survival analysis was carried out for survival analysis, and compared by the log-rank test. Multivariate analysis was conducted using the Cox proportional hazards regression model. Results Of 31 patients in this study, 27(87.1%) had died, and 25(80.6%) had developed tumor recurrence and metastasis. The median overall survival was 8 months and the median tumor-free survival was 4 months. On Cox regression analysis, non-R0 resection was an independent risk factor of overall survival (RR=2.816, 95%CI: 1.006-7.887) and disease-free survival (RR=3.295, 95%CI: 1.215-8.940). Poor tumor differentiation was an independent risk factor of overall survival (RR=3.120, 95%CI: 1.193-8.160). Conclusions The prognosis of patients with occult rupture HCC who underwent no R0 resection was poor. However, the prognosis of patients who underwent non-R0 resection was even poorer. Key words: Carcinoma, hepatocellular; Hepatectomy; Rupture; Prognosis; Influencing factor

Analysis of efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation in treatment of relapsed/refractory acute myeloid leukemia

Objective To explore the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of relapsed/refractory acute myeloid leukemia (AML). Methods The clinical data of 35 patients with relapsed/refractory AML treated with allo-HSCT in the Affiliated Cancer Hospital of Zhengzhou University from June 2011 to October 2018 was retrospectively analyzed. The overall survival (OS), disease-free survival (DFS), graft versus host disease (GVHD) incidence, transplantation related mortality and recurrence rate were calculated, and the risk factors affecting prognosis were analyzed. Results Hematopoietic reconstitution was obtained in all patients after transplantation. The 100 d incidence of grade Ⅱ-Ⅳ acute GVHD was (22.9±7.7)%, and the 3-year incidence of chronic GVHD was (49.5±10.60)%. The median follow-up time after transplantation was 14.1 months (4.2-89.4 months). In all cases, 18 cases survived (including 16 cases of DFS), and 17 cases died. Fourteen cases relapsed, and the median recurrence time was 4.7 months (2.9-32.4 months). The 3-year OS rate and DFS rate were (44.4±9.3)% and (43.0±9.5)%, respectively. Univariate analysis showed that the non-remission disease before transplantation, poor genetic risk grade before transplantation and recurrence after transplantation were the risk factors for OS (all P < 0.05). The 3-year OS rates in complete remission before transplantation group and non-remission before transplantation group were (63.2±12.0)% and (15.7±12.8)% (P = 0.025), the 3-year DFS rates were (62.2±12.3)% and (15.3±12.7)% (P = 0.028), and the 3-year recurrence rates were (28.2±10.7)% and (80.6±15.7)% (P = 0.057). The 3-year recurrence rate in genetic high-risk group was higher than that in middle-risk group and low-risk group [100.0%, (45.0±12.1)% and (14.3±13.2)%, P = 0.045]. The 3-year tansplantation related mortality was (18.7±7.7)%. Conclusions Allo-HSCT is an effective method for salvage treatment of relapsed/refractory AML, and recurrence is the main factor affecting survival. Reducing tumor load before transplantation is very important for reducing recurrence and improving curative effect. Key words: Leukemia, myeloid, acute; Hematopoietic stem cell transplantation; Refractory; Recurrence; Prognosis

Correlation of CXCR4 expression with clinicopathological characteristics and prognosis of patients with non-small cell lung cancer: a Meta-analysis

Objective To systematically evaluate the relationship between CXCR4 and the clinicopathological characteristics and prognosis of patients with non-small cell lung cancer (NSCLC). Methods The PubMed, EMbase, Cochrane Library, CNKI, Wanfang and China Biology Medicine databases were searched by the computer to collect the publicly published cohort studies on the correlation between CXCR4 expression and prognosis of NSCLC. The retrieval time was from the establishment of the database to May 31, 2018. Literature screening, data extraction and risk of bias were performed independently by two reviewers, and Meta-analysis was performed by using Stata 12.0 software. Results Finally, 20 studies were included, with a total of 2 124 NSCLC patients. The positive expression rate of CXCR4 in patients with adenocarcinoma was 51.8% (337/650) and it was 50.3% (224/445) in patients with squamous cell carcinoma, the difference was statistically significant (RR=1.22, 95% CI 1.09-1.38, P=0.001). The positive expression rate of CXCR4 in patients with stageⅠ-Ⅱ was 41.1% (317/772), and the rate was 57.0% (348/610) in patients with stage Ⅲ-Ⅳ, the difference was statistically significant (RR=0.62, 95% CI 0.55-0.69, P < 0.01). The positive expression rate of CXCR4 in patients with distant metastasis was 55.3% (268/485), and the positive rate of CXCR4 in those without distant metastasis was 39.2% (256/653), the difference was statistically significant (RR=1.78, 95% CI 1.54-2.06, P < 0.01). The expression of CXCR4 was not related to the size and invasion of the primary tumor, the positive expression rates of CXCR4 in T1-T2 and T3-T4 patients were 41.0%(215/524) and 53.8%(84/156) (RR=0.71, 95% CI 0.60-0.84, P=0.053). The overall survival rate of patients with CXCR4-positive was lower than that of patients with CXCR4-negative, and the difference was statistically significant (30.1% vs. 66.9%, RR=0.45, 95% CI 0.30-0.61, P < 0.01). The disease-free survival rate of patients with CXCR4-positive was lower than that of patients with CXCR4-negative (38.0% vs. 20.1%, RR=1.89, 95% CI 1.45-2.47, P=0.002). Conclusions The pathological type, tumor staging and distant metastasis of NSCLC patients are correlated with CXCR4 expression level. The expression level of CXCR4 in tumor tissues has a predictive value for the prognosis of NSCLC patients; and the higher the expression level of CXCR4 is, the lower the overall survival and disease-free survival rates are. Key words: Carcinoma, non-small-cell lung; CXCR4; Prognosis; Meta-analysis

Relationship between prognosis of Lumina B breast cancer and tumor infiltration of forxhead box protein 3+ regulatory T lymphocytes and CD8+ cytotoxic T lymphocytes

Objective To detect the expression level of forxhead box Protein 3 (FoxP3) and CD8 in invasive ductal carcinoma of breast Lumina B, investigate the relevance between FoxP3+ regulatory T lymphocyte (Treg) and CD8+ cytotoxic T lymphocyte (CTL) as well as prognosis of breast cancer patients. Methods Immunohistochemistry was used to detect the expression level of FoxP3 and CD8 in the paraffin-embedded breast cancer samples. One-sample t test was applied to analyze the relationship among the expression levels of FoxP3 and CD8 of patient’s age, tumor size, nodal status, and histophathologic grade. Kaplan meier Log-rank was used to analyze the correlation between the expression level of CD8 and FoxP3 and the overall survival and disease-free survival of breast cancer patients. Results The expression of CD8 is associated with tumor diameter ≤2 cm, lymph node negative metastasis, and with lower histopathologic grade (gradeⅠ/Ⅱ) (P 2 cm, lymph node metastasis (P<0.01). High expression level of FoxP3 infiltrating in tumor was could reduce the desease-free survival of breast cancer patients (P<0.05), while low expression of CD8 prolonged desease-free survival (P<0.01). Conclusion Tumor-infiltrating CD8+ CTLs are associated with good prognosis, whereas tumor-infiltrating FoxP3+ Tregs are associated with adverse outcomes. Key words: Invasive ductal carcinoma of breast; Tumor-infiltrating T lymphocyte; Regulatory T lymphocyte; Cytotoxic T lymphocytes; Forxhead box protein 3; CD8

Advances in the study of ASXL1 mutations in myeloid neoplasms

In recent years, many studies on myeloid neoplasms have reported the occurrence of ASXL1 mutations, including myeloproliferative neoplasms (5%-35%), myelodysplastic syndrome (15%-50%), acute myelogenous leukemia (5%-15%), and so on. ASXL1 mutations include three types: frame-shift mutation, nonsense mutation, and missense mutation; among which, the first two have a great impact on the overall survival rate and disease-free survival rate of patients with myeloid neoplasms. At the same time, myeloid neoplasms patients with ASXL1 mutations have obvious clinical characteristics, and have significant differences in response to treatment and in prognosis compared with wild-type patients. The universality of ASXL1 mutation indicates that it is closely related to the occurrence and progress of myeloid neoplasms. In this paper, based on the current research data, the molecular structure and mutation characteristics of ASXL1 and its relationship with various myeloid tumors are reviewed. Key words: ASXL1 mutations; Myeloid neoplasms; Research progress

Clinical significance of SPRY4-IT1 in efficacy and survival prediction in breast cancer patients undergoing neoadjuvant chemotherapy.

Breast cancer is the most frequent malignancy and the leading cause of cancer death among females. Long noncoding RNAs (lncRNAs) are under investigation as novel prognostic biomarkers in cancer. The aim of the study was to investigate the expression, clinical implications and prognostic significance of lncRNA SPRY4-IT1, and to identify the predictive value of SPRY4-IT1 on the outcome of chemotherapy in breast cancer patients undergoing neoadjuvant chemotherapy (NACT). Bioinformatics indicated SPRY4-IT1 was related to chemo-resistance in breast cancer. SPRY4-IT1 expression was assessed by qRT-PCR in breast cancer tissues and matched normal breast tissues (n=26 pairs). SPRY4-IT1 expression was also detected by In situ hybridization (ISH) in 60 paraffin slices with complete clinical datum. In this study, SPRY4-IT1 was significantly more expressed in cancer tissues than in normal tissues (P<0.05). Increased SPRY4-IT1 expression was significantly corre¬lated with increased rates of lymph node metastasis (P=0.002) and recurrence (P=0.017). Both were independent factors of SPRY4-IT1 expression (P<0.05). High-SPRY4-IT1 patients had significantly lower overall survival and disease-free survival. High SPRY4-IT1 expression indicated poor clinical response in the whole group, luminal A subgroup and luminal B subgroup (P<0.05) and pathological complete response in the whole group. Overexpression of SPRY4-IT1 promoted chemo-resistance of MCF-7 and MDA-MB-231 cells to epirubicin. SPRY4-IT1 has the potential to be a biomarker to predict NACT efficacy and prognosis in breast cancer patients.

Clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic analysis

Clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic analysis

Reduced serum miR-98 predicts unfavorable clinical outcome of colorectal cancer.

Circulating microRNAs (miRNAs) are considered to be promising biomarkers for the diagnosis and prognosis prediction of cancers. However, the potential clinical significance of the serum miR-98 in colorectal cancer (CRC) remained unclear. This study aimed to examine the serum miR-98 levels in CRC patients and explore its potential value for CRC. A total of 115 CRC cases and 50 healthy volunteers were enrolled in this study. Quantitative reverse-transcription PCR (qRT-PCR) was performed to detect serum miR-98 expression in all the participants. The results revealed that serum miR-98 levels were frequently downregulated in CRC patients compared with controls. In addition, low serum miR-98 levels were closely associated with aggressive clinical features and shorter survival. Receiver operating characteristic (ROC) curve analysis demonstrated that serum miR-98 could well differentiate CRC patients from healthy controls with relatively high accuracy. Multivariate analysis further demonstrated that serum miR-98 was an independent prognostic factor for both overall survival and disease-free survival. Mechanistically, MYC, IL-6, and HIST1H2BH were identified as direct downstream targets of miR-98 in CRC cells. Collectively, serum miR-98 might be useful as an indicator for predicting the clinical outcome of CRC patients.

Invasion and migration regulation of human glioma cells by long non-coding RNA linc00996

Objective To investigate the expression of long non-coding RNA linc00996 in glioma, its function in migration, invasion and its relationship with prognosis. Methods The differential expression of linc00996 in glioma patients and normal brain tissues was compared in TCGA database. 21 patients with glioma treated in our hospital were recruited. Tumor tissues and normal brain tissues were collected in the operation. The expression level of linc00996 in the above tissues was detected by real-time fluorescent quantitative polymerase chain reaction (FQ-PCR). Small interfering RNA targeting linc00996 sequence was synthesized and transfected into human glioma cell line U251. Wound healing and Transwell assay were used to detect the effect of down-regulation of linc00996 on migration and invasion of U251 cells respectively. In TCGA database, according to the median expression of linc00996 in glioma tissues, the patients were divided into two groups to compare the overall survival and disease-free survival of the linc00996 high and low expression groups. Statistical Analysis with STATA 12.0 Software. Results TCGA database showed that the expression level of linc00996 in glioma tissues was higher than that in normal brain tissues. In 21 cases of glioma, the expression level of linc00996 in tumor tissues was higher than that in normal tissues in 15 cases (71.4%). Small interfering RNA (si00996) could significantly down-regulate the expression of linc00996 in U251 cells (t=8.870, P<0.05). Wound healing assay showed that the cell migration ability decreased significantly after down-regulation of linc00996 expression. Transwell assay showed that the ability of U251 cells to penetrate membranes decreased after small interfering RNA silenced linc00996. Conclusion Linc00996 is highly expressed in glioma tissues and is associated with poor prognosis. Down-regulation of linc00996 expression can inhibit the migration and invasion of glioma cells. Key words: Glioma; Long non-coding RNA; Migration; Prognosis

Predictive value of preoperative albumin-to-fibrinogen ratio for postoperative survival of esophageal squamous cell carcinoma after radical esophagectomy

Objective To investigate the predictive value of preoperative albumin-to-fibrinogen ratio (A/F) for postoperative survival of esophageal squamous cell carcinoma after radical esophagectomy. Methods The retrospective cohort study was conducted. The clinicopathological data of 559 patients with esophageal squamous cell carcinoma who underwent radical resection in the Sun Yat-sen University Cancer Center from January 2009 and January 2012 were collected. There were 443 males and 116 females, aged from 53 to 66 years, with an average age of 59 years. Of 559 patients, 394 with A/F > 11.14 were in high A/F group, and 165 with A/F ≤ 11.14 were in low A/F group. Levels of plasma albumin and fibrinogen were measured at two weeks before surgery, and patients underwent radical esophagectomy. Observation indicators: (1) clinicopathological characteristics of patients; (2) survival of patients; (3) risk factors analysis of prognosis of patients. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to November 2018. The overall survival time was from surgery date to date of endpoint events including death or the last follow-up, and the overall disease-free survival time was from surgery date to date of endpoint events including tumor recurrence, tumor-ralted death, or the last follow-up. Measurement data with skewed distribution were expressed by M (range). Count data were described as percentage, and comparison between groups was analyzed using chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed by Mann-Whitney U non-parametric test. The survival rate and curve were calculated and drawn by Kaplan-Meier method and the Log-rank test was used for survival analysis. The univariate and multivariate analyses were done using COX proportional hazard model. Results (1) Clinicopathological characteristics of patients: of 559 patients, cases with age ≤60 years and > 60 years, cases in T1 stage, T2 stage, T3 stage(depth of tumor invasion)were 246, 148, 60, 79, 255 in the high A/F group, and 79, 86, 5, 32, 128 in the low A/F group, there were statistically significant differences in the age and depth of tumor invasion between the two groups (χ2=10.127, Z=-3.468, P<0.05). (2) Survival of patients: 559 patients were followed up for 97 months (range, 91-103 months). The 5-year overall survival rate and 5-year disease-free survival rate were 55.8% and 48.7% in the high A/F group, and 38.8% and 35.8% in the low A/F group, respectively, with statistically significant differences between the two groups (χ2=16.501, 11.679, P<0.05). (3) Risk factors analysis of prognosis of patients: results of univariate analysis showed that sex, age, preoperative fibrinogen level, preoperative A/F level, surgical method, depth of tumor invasion, tumor pathological N staging, and postoperative adjuvant therapy were associated with 5-year overall survival rate of esophageal squamous cell carcinoma after radical esophagectomy [hazard ratio (HR) = 1.362, 1.358, 1.421, 0.617, 0.772, 1.490, 1.732, 1.436, 95% confidence interval (CI): 1.010-1.835, 1.084-1.700, 1.114-1.814, 0.487-0.781, 0.612-0.973, 1.239-1.792, 1.552-1.934, 1.128-1.829, P<0.05]; age, preoperative fibrinogen level, preoperative A/F level, surgical method, depth of tumor invasion, tumor pathological N staging, postoperative adjuvant therapy were associated with 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy (HR=1.248, 1.371, 0.675, 0.740, 1.427, 1.665, 1.606, 95%CI: 1.006-1.547, 1.086-1.732, 0.538-0.847, 0.592-0.924, 1.202-1.695, 1.498-1.851, 1.275-2.022, P<0.05). Results of multivariate analysis showed that age, preoperative A/F level, surgical method, depth of tumor invasion, and tumor pathological N staging were independent factors for 5-year overall survival rate and 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy (HR=1.491, 0.699, 0.741, 1.353, 1.761, 95%CI: 1.184-1.877, 0.550-0.888, 0.587-0.935, 1.120-1.634, 1.573-1.971, P<0.05; HR=1.372, 0.760, 0.703, 1.281, 1.692, 95%CI: 1.100-1.711, 0.603-0.957, 0.562-0.880, 1.074-1.527, 1.518-1.887, P<0.05). Conclusion Preoperative A/F level has a good predictive value for survival of esophageal squamous cell carcinoma after radical esophagectomy, and preoperative A/F level ≤ 11.14 is a independent risk factor for 5-year overall survival rate and 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy. Key words: Esophageal neoplasms; Esophageal cancer; Esophageal squamous cell carcinoma; Albumin; Fibrinogen; Albumin-to-fibrinogen ratio; Prognostic index; Prognosis

Long-term efficacy of laparoscope-assisted transanal total mesorectal excision for rectal cancer

To investigate the long-term outcome of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer. Clinicopathological data of 29 patients with mid-low rectal cancer undergoing laparoscope-assisted taTME at Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou Medical University from May 2010 to December 2015 were collected for the retrospective case-series study. All the operations were performed with transabdominal and transanal procedure simultaneously or sequentially. Perioperative presentations, pathological examinations, and oncologic outcomes were retrospectively analyzed. Long-term recurrence, metastasis and survival were assessed during follow-up. Outpatient clinic and telephone survey were used for follow-up. The follow-up time ended in December 2018. The overall survival (OS) rate and disease-free survival (DFS) rate were calculated by the Kaplan-Meier method. The average intra-operative blood loss was (75.9±9.5) ml (range,20 to 200). The average operating time was (223.6±4.1) minutes (range, 165 to 280). The average number of harvested lymph node was 22.3±2.0. The average length of pathological specimen was (13.1±0.6) cm. The average distal resection margin was (2.9±0.2) cm. 89.7% (26/29) of specimens was complete and 10.3% (3/29) near complete. Two cases (6.9%) had positive cutting circumferential margin. Median follow-up was 56 (range, 22 to 91) months. Local recurrence rate, distant metastasis rate, 3-year OS rate, 3-year DFS rate, 5-year OS rate, 5-year DFS rate were 10.3% (3/29), 20.7%(6/29), 96.6%, 83.2%, 87.6% and 79.6%, respectively. No incisional hernia or adhesive intestinal obstruction was found. Long-term outcomes of mid-low rectal cancer patients undergoing laparoscope-assisted taTME are satisfactory.

Good response to neoadjuvant chemoradiotherapy predicts good oncological outcome in locally advanced rectal cancer

Background: After pre-operative concurrent long course chemoradiotherapy (CRT), pathologic complete response (pCR) has been reported with better oncologic outcomes in many articles, whether a moderate response (TRG1) can translate into good clinical outcome remains uncertain. Methods: A total of 132 locally advanced rectal cancer patients with neoadjuvant chemoradiotherapy followed by radical surgery were recruited. Their clinicopathologic characteristics and clinical records were retrospectively reviewed. The association between clinicopathologic parameters and pathological response was conducted, and the multivariable analysis of the association between pathologic response and survival was performed. Results: With a median follow-up of 21.5 months, gender was the only factor associated with pCR (TRG0), while dual-agent chemotherapy regimen was linked with a lower likelihood of good response (TRG0-1). Good response (TGR0-1) remained significant associated with overall survival (OS) and disease-free survival (DFS) after multivariate adjustment. TRG1 was linked with better DFS compared with TRG2-3. Conclusions: Patients with post-CRT good response (TRG0-1) demonstrate an excellent local and remote control, especially with those non-pCR patients (TRG1) getting better outcomes.

Patterns of Outcome in Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma Treated Primarily with Radical Radiotherapy

Introduction: The aims of this study were to determine patterns of outcome and prognostic factors in human papilloma virus positive oropharyngeal squamous cell carcinoma (OPSCC+) treated primarily with radical radiotherapy. Materials and methods: We identified 54 patients at a tertiary hospital in South Australia who received treatment with curative intent for OPSCC+ with radical radiotherapy ± chemotherapy or cetuximab from 1st January, 2010 to 31st March, 2017. We explored the effect of patient, tumour and radiotherapy factors on treatment outcomes. The primary endpoint was overall survival and the secondary endpoint was disease-free survival. Results: The median age was 59, with most patients being male (82%). The majority had advanced disease (89% stage IV). The median follow-up was 22.5 months. The one-year and two-year overall survival and disease-free survival rates were 89% and 79% and 77% and 68% respectively. Active smoking during radiotherapy was associated with trends to shortened overall survival (p=0.084) and reduced time to recurrence (p˃0.1). However, there was no statistically significant relationship between any other patient, tumour or treatment factors and disease-free or overall survival. Discussion: Despite advanced stage at presentation, radiotherapy ± concurrent systemic therapy results in favorable outcomes for OPSCC+. Active smoking during radiotherapy may compromise overall survival. We strongly recommend smoking cessation prior to commencing radiotherapy for OPSCC+. In addition, we note that smokers involved in de-intensification trials may be at increased risk of poor outcomes.

Update of diagnosis and treatment of plasma cell leukemia

Plasma cell leukemia (PCL) is a rare and aggressive malignant plasma cell tumor that is clinically susceptible to extramedullary lesions. It is classified into two types: primary PCL (pPCL) and secondary PCL (sPCL), of which 60 % are pPCL. The treatment of new drugs such as bortezomib and lenalidomide is important for improving the overall survival and disease-free survival of PCL, especially after induction of bortezomib-based chemotherapy, combined with autologous hematopoietic stem cell transplantation (auto-HSCT) can improve the survival of patients. Whether to adopt the next step of allogeneic hematopoietic stem cell transplantation (allo-HSCT) still needs further investigation. For young and suitable patients, early new drug-based regimen chemotherapy combined with auto-HSCT can be used, and if a suitable donor is available, the further allo-HSCT consolidation therapy is feasible. For elderly patients (≥65 years old), a new drug-based regimen can be used to induce chemotherapy, and further followed consolidation therapy plus maintenance therapy. Whether to take auto-HSCT after early induction chemotherapy depends on the individualized factors of the patient. The next generation anti-plasma cells drugs, monoclonal antibodies and other immunotherapies or new drugs in clinical trials are also worth exploring. Key words: Leukemia, plasma cell; Hematopoietic stem cell transplantation; Bortezomib; Lenalidomide

Prognostic significance of CD47 in human malignancies: a systematic review and meta-analysis

Background: High CD47 expression has been indicated to predict a poor prognosis in human malignancies. However, the prognostic significance remains inconsistent. Methods: Eligible studies were identified in PubMed, Embase, Web of Science, and the Cochrane Library prior to July, 2017. Relevant articles were screened for overall survival (OS), disease-free survival (DFS), event-free survival (EFS), progression-free survival (PFS), and clinicopathological data. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using Stata v.14.0 and Revman v.5.3 software, respectively. We also investigated heterogeneity, sensitivity, and publication bias for OS. Results: This meta-analysis investigated the prognostic value of CD47 expression in 38 cohorts reported in 17 articles with 7,229 cancer patients. We found that CD47 overexpression correlated with shorter OS in cancer patients (pooled HR =1.49; 95% CI: 1.36–1.62, P Conclusions: Our findings suggested CD47 could be a useful prognostic indicator in cancer patients and may be a useful therapeutic target. However, additional studies are still needed to verify the clinical value of CD47 in human malignancies.

Factors influencing long-term survival after hepatectomy in patients with a single large hepatocellular carcinoma

Objective To study the prognostic factors which affected the long-term survival in patients with a single large hepatocellular carcinoma (SLHCC) after hepatectomy. Methods The clinical data of 138 SLHCC patients who underwent hepatectomy in the Tianjin Hospital from January 2008 to December 2013 were retrospectively analyzed. There were 115 males and 23 females. Age ranged from 23 to 81 years (median 56.8 years). The impact of an array of clinicopathological factors was analyzed using a variety of statistical methods which included the Kaplan-Meier estimator and the Log-rank test. Results The 1, 3, 5 year overall survival rates for all the patients were 86.4%, 64.8% and 54.1%, respectively, and the 1, 3, 5 year disease free survival rates were 68.8%, 41.4% and 33.2%, respectively. Univariate analysis indicated that microvascular invasion, preoperative AFP≥400 μg/L, a maximum tumor diameter ≥10 cm, and preoperative AST ≥40 U/L were risk factors of overall survival (all P<0.05), and microvascular invasion, preoperative AFP≥400 μg/L, and preoperative AST ≥40 U/L were risk factors of disease free survival (all P<0.05). Multivariate analysis showed that microvascular invasion, preoperative AFP ≥400 μg/L and preoperative AST ≥40 U/L were independent prognostic factors of overall survival and disease free survival for these patients (all P<0.05). Conclusion Microvascular invasion, preoperative AFP ≥400 μg/L and AST ≥40 U/L were independent prognostic factors of long survival of SLHCC patients. Key words: Carcinoma, single large hepatocellular; Prognostic factors; Liver resection

Upregulated GP73 expression and downregulated NLRP3 expression in liver cancer tissues correlate with patient’s survival

Background: To investigate the correlation between Golgi protein 73 (GP73) and NLRP3 expression and the clinicopathologic features and prognosis in patients with hepatocellular carcinoma (HCC). Methods: A total of 54 HCC tumor tissues and matched paracarcinomatous liver (PCL) tissues from patients who received liver resection in our hospital were collected. The expression of GP73 and NLRP3 were tested by using Western blotting method. Eleven healthy liver (HL) tissues from patients with hepatic hemangioma were tested at the same time. Correlations between GP73/NLRP3 protein expression levels and clinicopathologic features were evaluated by Chi-square test. Survival analysis was conducted by Kaplan-Meier method, and overall survival (OS) and disease-free survival (DFS) were calculated, meanwhile the log-rank test was used to compare the survival differences between different groups. Results: The median GP73 protein level in HL, PCL and HCC tissues were 1.6 (1.4–1.9) RU, 2.7 (1.6–3.4) RU and 4.5 (2.8–5.5) RU, respectively. The median NLRP3 protein level in HL, PCL and HCC tissues were 1.1 (0.9–1.3) RU, 1.9 (1.4–2.6) RU and 1.2 (0.4–1.3) RU, respectively. They were both with significant difference (P Conclusions: GP73 and NLRP3 may play the role of different level in tumor development in patients with HCC. NLRP3 could have more effect on DFS.