Survival Outcomes In Patients Research Articles

Comprehensive analysis of the impact of primary percutaneous coronary intervention on patients with ST-segment elevation myocardial infarction

This comprehensive analysis by Saeed and Faeq investigates the impact of primary percutaneous coronary intervention (pPCI) on mortality among patients with ST-segment elevation myocardial infarction (STEMI) at the Erbil Cardiac Center. Analyzing data from 96 consecutive STEMI patients, the study identified significant predictors of in-hospital mortality, emphasizing the critical impact of time of hospital arrival post-symptom onset on overall prognosis. Findings indicate that factors such as atypical presentation, cardiogenic shock, chronic kidney disease, and specific coronary complications are associated with higher mortality rates. The study underscores the necessity of prompt medical intervention for improving survival outcomes in STEMI patients, especially in the high-risk subgroup. This research offers valuable insights into optimizing STEMI management and enhancing patient survival rates through effective and timely pPCI.

Prognostic significance of hemoglobin, albumin, lymphocyte and platelet score in solid tumors: a pooled study

ObjectiveThe high hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been reported to be a good prognostic indicator for several malignancies. However, more evidence is needed before it can be introduced into clinical practice. Here, we systematically evaluated the predictive value of HALP for survival outcomes in patients with solid tumors.MethodsThis study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) Guidelines. In March 2024, an electronic literature search was performed for articles regarding the prognostic role of HALP in solid tumors. Data from studies with reported risk ratios (HRs) and 95% confidence intervals (CIs) were pooled in a meta-analysis. Study bias was assessed using the QUIPS tool.ResultsOf the 729 articles reviewed, 45 cohorts including data from 17,049 patients with cancer were included in the pooled analysis. The pooled results demonstrated that elevated HALP score was significantly associated with favorable overall survival (HR = 0.60, 95% CI 0.54-0.67, p < 0.01), cancer-specific survival (HR = 0.53, 95% CI 0.44- 0.64, p < 0.01), progression-free survival (HR = 0.62, 95% CI 0.54-0.72, p < 0.01), recurrence-free survival (HR = 0.48, 95% CI 0.30-0.77, p < 0.01), and disease-free survival (HR = 0.72, 95% CI 0.57-0.82, p < 0.01). Subgroup analyses based on various confounding factors further revealed the consistent prognostic impact of HALP on overall survival in patients with solid tumors.ConclusionsOur findings suggest that high HALP is associated with better survival outcomes in patients. The HALP score is a potential prognostic biomarker in solid tumors, but it needs to be further studied whether it can improve the established prognostic model.

Expression of mTOR, CD163, α-SMA, FOXp3 as survival predictors and its significance in patients with oral squamous cell carcinoma

BackgroundOral cancer; categorised under head and neck cancers (HNC) predominantly originates from squamous cells and is referred as oral squamous cell carcinoma (OSCC). Various factors (internal and external) causes OSCC. PI3K/AKT/mTOR pathways are known to be primarily mutated in HNC. mTOR remains as a key regulator for various physiological and developmental processes in normal and cancer cells. Cancer cells are surrounded by tumor microenvironment, majorly composed of immune cells. Cancer associated fibroblasts, macrophages and regulatory T cells controlled by mTOR, plays an important role in the progression of cancer.MethodsTwo hundred sixty retrospective patient samples were collected along with their demographical and clinic-pathological data. Here, we have analysed expression of mTOR, α-SMA, CD163 and FOXp3 using immunohistochemistry and their survival outcomes were calculated using Kaplan-Meier statistical method.ResultsOverexpression of CD163 and α-SMA was detected in samples of patients compared to mTOR and FOXp3. Their expression was compared with clinico-oncological parameters. We also observed two and three combinations of markers and its association with the prognosis of the cancer. The results suggest, higher the expression of all the four markers in combination correlated to poor prognosis of patients and vice-versa.ConclusionThe study reveals that over expression of CD163 and α-SMA is strongly associated with disease outcome. The combinations of all the four marker expression profile will be emerging strategy towards prognosis and also to determine survival outcomes in patients. This is a pioneering observation of these combinations of markers in OSCC despite certain limitations.

Survival Differences in Asian and Hispanic Patients With In-Hospital Cardiac Arrest.

Although they are fast-growing populations in the United States, little is known about survival outcomes of Hispanic and Asian patients after in-hospital cardiac arrest. In Get With The Guidelines-Resuscitation, we identified Asian, Hispanic, and White adults with in-hospital cardiac arrest during 2005 to 2023. Using multivariable models, we compared rates of survival to discharge separately for Asian and Hispanic patients versus White patients, as well as rates of sustained return of spontaneous circulation for ≥20 minutes and favorable neurologic survival as secondary outcomes. Of 189 557 in-hospital cardiac arrests, 167 640 (88.4%), 16 800 (8.9%), and 5117 (2.7%) patients were White, Hispanic, and Asian, respectively. Compared with the survival rate to discharge for White patients (22.0%), rates were lower for Hispanic (19.4%; adjusted odds ratio [OR], 0.93 [95% CI, 0.89-0.97]; P<0.001) and Asian patients (17.8%; adjusted OR, 0.90 [95% CI, 0.83-0.97]; P=0.008), and these differences were attenuated after accounting for the hospital at which patients received care (adjusted OR: Hispanic patients, 0.95 [95% CI, 0.91-1.00]; Asian patients, 0.91 [95% CI, 0.84-0.99]). Although there were no differences in rates of return of spontaneous circulation between White (68.7%), Hispanic (69.0%), and Asian patients (69.7%), both Asian and Hispanic patients were less likely to have favorable neurologic survival (White: 18.3%; Hispanic: 15.4%; adjusted OR, 0.88 [95% CI, 0.84-0.93]; Asian: 13.2%; adjusted OR, 0.80 [95% CI, 0.73-0.87]). These differences were also attenuated after accounting for hospital site. Compared with White patients, Hispanic and Asian patients with in-hospital cardiac arrest had lower rates of overall survival and favorable neurologic survival. Some of these differences were associated with the hospital at which patients received care.

The impact of high-risk cytogenetic abnormalities in extramedullary multiple myeloma in the era of novel agents: insights from a multicenter study

PurposeThis study aimed to examine the impact of high-risk cytogenetic abnormalities (HRA) on the survival outcomes of multiple myeloma patients with extramedullary disease (EMD) in the era of novel agents, utilizing the largest dataset of extramedullary multiple myeloma patients in China.MethodsThis study included a total of 371 patients with EMD, comprising 113 patients with de novo EME and 258 patients with EMB.ResultsPatients with one HRA and those with ≥ 2 HRA demonstrated significantly worse overall survival (OS) (P < 0.01) and progression-free survival (PFS) (P < 0.01) compared to patients without HRA. Additionally, 1q21 gain/amplification (1q21 +) remained a predictor of poor prognosis in EMD. CD38 monoclonal antibody-based therapy and single transplantation were less effective in improving survival outcomes for EMD with ≥ 2 HRA. Multivariable analysis identified LDH levels > 250 U/L, creatinine levels > 177 μmol/L, extramedullary extraosseous (EME), 1 HRA, and ≥ 2 HRA as independent adverse prognostic factors in patients with EMD.ConclusionPatients with EMD who had ≥ 2 HRA experienced an extremely poor prognosis, which could not be improved by single transplantation or CD38 monoclonal antibody-based treatment. The number of HRA could serve as an important factor in guiding treatment choices and predicting prognosis in patients with EMD. Furthermore, 1q21 + remained a significant factor associated with worse survival outcomes in EMD.

Double mutant DNMT3A AML: a unique subtype experiencing increased DNA damage and poor prognosis.

Mutation of DNMT3A, encoding a de novo methyltransferase essential for cytosine methylation, is a common early event in clonal hematopoiesis (CH) and adult acute myeloid leukemia (AML). Spontaneous deamination of methylated cytosines damages DNA, which is repaired by the base excision repair (BER) enzymes MBD4 and TDG. Congenital MBD4-deficiency has been linked to early-onset CH and AML, and is marked by exceedingly high levels of DNA damage and mutation of DNMT3A. Strikingly, wildtype (WT) DNMT3A binds TDG, thereby potentiating its repair activity. Since TDG is the only remaining BER enzyme in MBD4-deficient AML patients capable of repairing methylation damage, we investigated whether mutant DNMT3A negatively affects the repair function of TDG. We found that, whereas WT DNMT3A stimulates TDG function, mutant DNMT3A impairs TDG-mediated repair of DNA damage in vitro. In light of this finding and to extrapolate our observations to the broader AML patient population, we investigate here the genetic profiles and survival outcomes of AML patients with single (SM) versus double mutant (DM) DNMT3A. DM DNMT3A AML patients show a characteristic driver mutation landscape and reduced overall survival when compared to SM DNMT3A AML patients. Importantly, whole-genome sequencing showed a trend for increased DNA damage in primary DM DNMT3A AML samples, especially when DNMT3A mutations are located at the DNMT3A-TDG interaction interface.

Clinical and splenectomy-based treatment outcomes in 40 cases of hepatosplenic T-cell lymphoma: a comprehensive analysis

Background/aimThis research study was conducted to examine the clinical characteristics and post-splenectomy survival outcomes of patients diagnosed with hepatosplenic T-cell lymphoma (HSTCL).Materials and methodsA total of 10 cases of HSTCL patients admitted to the Hematology Department of Fudan University Affiliated Huadong Hospital between January 2012 and December 2021 were included. In addition, we also included 30 other cases reported from domestic and international sources. All pathological specimens were stained with hematoxylin and eosin (H&E) and immunohistochemistry, with color development using DAB staining. Survival analysis was conducted using Kaplan-Meier curves and log-rank tests.ResultsIn the 10 HSTCL patients, Epstein-Barr virus (EBV) infection was confirmed. Six patients had died, with 5 of them within 1 year of disease onset. Survival analysis showed poorer prognosis in patients with hemophagocytic syndrome and thrombocytopenia. Patients who underwent splenectomy followed by chemotherapy had a higher median and average survival time compared to those who only received chemotherapy. The study included a total of 40 HSTCL patients, with 29 males and 11 females, and an average age of onset at 42.3 years. All patients presented with fever, with some exhibiting emaciation and/or hemophagocytic syndrome. Splenomegaly, hepatomegaly, lymphadenopathy, and bone marrow involvement were found in the patients. Common laboratory findings included leukopenia, anemia, and thrombocytopenia. All patients exhibited elevated ferritin levels and decreased blood calcium levels.ConclusionThose patients suffering from hemophagocytic syndrome at the onset of this disease face greater treatment-related difficulties and a higher risk of mortality. Combined chemotherapy after splenectomy may improve HSTCL patient survival.

Circulating tumor DNA as a predictive biomarker for treatment response and survival in metastatic colorectal cancer

PurposeTo explore the potential of circulating tumor DNA (ctDNA) as a prognostic biomarker to predict treatment response and survival outcomes in patients with metastatic colorectal cancer (mCRC).MethodsA retrospective analysis was conducted on 134 patients with mCRC who were treated between January 2020 and December 2021. The patients were classified into ctDNA-negative and ctDNA-positive groups based on plasma ctDNA detection. Demographic, clinical, and laboratory parameters, treatment response, survival outcomes, and adverse events were recorded and analyzed.ResultsNo significant differences were observed in baseline characteristics between the two groups. Compared to the ctDNA-positive patients, ctDNA-negative patients exhibited superior outcomes, including a higher objective response rate (65.22% vs. 46.15%), disease control rate (81.16% vs. 63.08%), progression-free survival (8.24 ± 1.02 vs. 7.86 ± 0.91 months), overall survival (24.58 ± 3.58 vs. 23.27 ± 3.46 months), and 1-year survival rate (73.91% vs. 55.38%). The ctDNA-positive group had a significantly higher incidence of adverse events. Correlation analyses revealed significant associations between ctDNA status, tumor markers, treatment response, and survival outcomes.ConclusionsctDNA is a promising noninvasive biomarker for predicting treatment response, survival, and adverse events in mCRC, potentially guiding personalized therapeutic strategies.

A bioinformatics analysis of gene expression in endometrial cancer, endometriosis and obesity

ABSTRACT Endometrial cancer (EC), endometriosis (ENDO), and obesity (OBY) are interconnected conditions in women that may share underlying genetic pathways. This study aimed to identify shared genetic pathways and differential gene expressions across these conditions to uncover potential therapeutic targets. A bioinformatics pipeline was applied using gene expression datasets from the GEO database, incorporating differential expression analysis, functional and pathway enrichment, PPI network construction, survival analysis, and mutational profiling across 198 samples. The analysis revealed 26 shared differentially expressed genes (DEGs), with IGF-1, CREBBP, EP300, and PIAS1 identified as key hub genes. Elevated IGF-1 expression was significantly linked to poorer survival outcomes in EC patients (p < .05). Frequent mutations were observed in these hub genes, suggesting their critical role in disease mechanisms. This study highlights genetic links among EC, ENDO, and OBY, emphasizing high IGF-1 expression as a potential prognostic marker in EC and recurrent alterations in hub genes as promising therapeutic targets. These findings provide insights into the shared genetic underpinnings of these conditions and present new avenues for targeted therapies.

3-Year Survival Outcomes of Patients with Enhanced Recovery After Surgery vs. Conventional Care in Laparoscopic Distal Gastrectomy: The GISSG1901 Randomized Clinical Trial.

The efficacy of enhanced recovery after surgery (ERAS) to improve the prognosis of patients who undergo laparoscopic distal gastrectomy (LDG) for gastric cancer is uncertain. This randomized study compared oncological outcomes in LDG after ERAS or conventional care. At present, randomized controlled trials have confirmed that ERAS can improve the short-term clinical outcomes of patients undergoing LDG, but whether it improves survival has not been reported yet. A multicenter, randomized, controlled trial was performed to compare oncological outcomes of ERAS versus conventional care in LDG. Between April 4, 2019, and March 18, 2020, 527 patients with locally advanced lower gastric adenocarcinoma were recruited from 13 centers in China. The primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS). The secondary endpoints were complications, mortality, recovery, time of receiving adjuvant chemotherapy and medical expenses. The full analysis set included 186 cases in the ERAS group and 184 in conventional group, well balanced with respect to patient demographics and baseline characteristics (published before). Postoperative hospital stay and the interval before adjuvant chemotherapy were obviously shorter in the ERAS group compared to conventional group as reported previously and with lower medical expenses. Compared with the conventional group, ERAS group had fewer overall complications (21.0% vs. 30.4%, respectively; P=0.037). The median (IQR) follow-up for all cases was 42.17 (range, 3.12-48.50) months. The 3-year OS and DFS in the ERAS group and conventional group were 86.56% and 80.11% (log-rank P=0.025), 79.57% and 69.57% (log-rank P=0.027), respectively. In a subgroup analysis of stage I and II disease patients, 3-year OS and DFS were similar between the groups (P=0.901; P=0.859 for stage I and P=0.421; P=0.459 for stage II). However, in the stage III disease, the ERAS group exhibited longer 3-year OS and DFS than the conventional group (79.41% vs. 64.47% for OS, log-rank P=0.046; 70.59% vs. 53.95% for DFS, log-rank P=0.046). Patients undergoing ERAS LDG had fewer overall complications, shorter hospital stay, decreased medical expenses, and improved 3-year OS and DFS rates, particularly in cases with stage III gastric cancer.

Survival of Patients with Resected Microsatellite Instability-High, Mismatch Repair Deficient, and Lynch Syndrome-Associated Pancreatic Ductal Adenocarcinomas.

Pancreatic ductal adenocarcinoma (PDAC) remains a challenging disease due to its aggressiveness, late-stage diagnosis, and limited treatment options. Microsatellite instability-high (MSI-H) cancersare susceptible to immune checkpoint inhibitors. Survival outcomes for patients with MSI-H PDAC are unknown as the disease is rare. This study included patients with PDACs surgically resected from 1990 to 2023, and those with germline or sporadic pathogenic variants in DNA mismatch repair genes were identified. The study matched MSI-H, mismatch repair-deficient (MMRd), and Lynch syndrome (LS)-associated PDAC cases (on age, gender, and year of surgery) with microsatellite-stable (MSS), mismatch repair-proficient, or non-LS-associated PDAC cases in a 1:2 ratio. A generalized estimating equation Cox model with a robust sandwich estimator was used to compare overall survival (OS) in the matched cohorts. Of 936 cases, 18 were included. Eight cases were MSI-H/MMRd, two were MSI/IHC-indeterminate, seven were MSS, and one was not tested for MSI. Nine patients had LS (MLH1 [n = 1], MSH2 [n = 4], MSH6 [n = 1], PMS2 [n = 3]), and nine patients had sporadic pathogenic variants in DNA MMR genes (MLH1 [n = 4], MSH6 [n = 5]). After matching to 36 control patients, the MSI-H/MMRd/LS PDACs had a significantly better OS (hazard ratio [HR], 0.36 [95% confidence interval [CI], 0.18-0.73; p = 0.005]; 5-year OS: MSI-H 77% [95% CI 58-100%] vs. MSS 27% [95% CI 15-51%]). Before routine use of immune checkpoint inhibitors, the patients with MSI-H, MMRd, and LS-associated PDACs displayed significantly better survival than the patients with MSS, MMR-proficient, non-LS-associated PDACs. It is expected that survival for this cohort will further improve with increased availability of immunotherapy.

Lung cancer in patients with pulmonary fibrosis: characteristics features and prognosis.

Lung cancer is one of the significant comorbidities seen in patients with Idiopathic Pulmonary Fibrosis (IPF). However, there is limited data on non-IPF Pulmonary Fibrosis (PF) patients with lung cancer (LC). The present study aims to compare the characteristics and survival outcomes of patients diagnosed with LC in IPF and non-IPF PF. The multicenter data records of IPF and non-IPF PF patients diagnosed with lung cancer between 2010- 2022 were analyzed in this descriptive, cross-sectional, and retrospective study. Of the 251 patients involved in this study [164 IPF-LC, 87 non-IPF PF-LC], 89.6% were male, the mean age was 69±7.9 years and the smoking rate was 85.7%. Honeycomb pattern was more frequently observed in IPF-LC patients [62.8%,37.9%p<0.001], whereas ground-glass opacity [33.5%,59.8%p<0.001] and emphysema [37.8%,59.8%p<0.001] were more frequently seen in non-IPF PF-LC patients. The most commonly seen histological type was squamous cell carcinoma [42.7%,33.9%], followed by adenocarcinoma [28.2%; 32.2%]. [46.4%;47.2%] and their 5-year mortality rates were high [64.6%, 63.2%]. The median survival for both groups was 2±0.22 years [median 95% CI (1.55-2.44)]. The shortest survival time was observed in non-IPF PF-LC subgroup with unclassified PF [1±0.253 years median 95% CI (0.50-1.49) (p=0.030)]. The majority of IPF and non-IPF PF LC patients were male, elderly, and had a high smoking rate. Squamous cell carcinoma was the most frequently seen histological type and they had short survival periods and high mortality rates. The survival period of unclassified non-IPF PF-LC patients was found to be the shortest.

The Impact of Tumor Stage and Histopathology on Survival Outcomes in Esophageal Cancer Patients over the Past Decade

Background: Esophageal cancer (EC) is the sixth leading cause of cancer-related mortality worldwide, continuing to be a significant public health concern. The purpose of this study is to assess the impact of staging and histopathology of EC on associated mortality. The study also aims to further investigate clinical characteristics, prognostic factors, and survival outcomes in patients diagnosed with EC between 2010 and 2017. Furthermore, we analyzed the interaction between tumor histology and staging and the risk of mortality. Methods: A total of 24,011 patients diagnosed with EC between 2010 and 2017 in the United States were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic parameters, tumor stage, and histologic subtypes were analyzed and associated overall mortality (OM) and cancer-specific mortality (CSM) were measured across all subgroups. Covariates reaching the level of statistical significance, demonstrable by a p-value equal to or less than 0.01, were incorporated into a multivariate Cox proportional hazards model. A hazard ratio greater than 1 was indicative of an increased risk of mortality in the presence of the variable under discussion. Additionally, the study explores the interaction between histology and tumor stage on outcomes. Results: The majority of patients were male (80.13%) and non-Hispanic white (77.87%), with a predominant age at diagnosis of between 60 and 79 years (59.86%). Adenocarcinoma was the most common tumor subtype (68.17%), and most patients were diagnosed at a distant stage (41.29%). Multivariate analysis revealed higher mortality risks for males, older patients, unmarried individuals, and those with advanced-stage tumors. Higher income, receiving radiation or chemotherapy, and undergoing surgery were associated with lower mortality. Tumor subtype significantly influenced mortality, with squamous cell carcinoma and neuroendocrine tumors showing higher hazard ratios compared to adenocarcinoma. Adenocarcinoma is linked to a poorer prognosis at advanced stages, whereas the opposite trend is observed for SCC. Conclusions: The study identifies significant demographic and clinicopathologic factors influencing mortality in esophageal cancer patients, highlighting the importance of early diagnosis and treatment intervention. Future research should focus on tailored treatment strategies to improve survival outcomes in high-risk groups and to understand the interaction between tumor histology and tumor stage.

Oncologic Outcomes in Patients with Localized, Primary Head and Neck Synovial Sarcoma.

Background: this study aims to evaluate the survival outcomes of patients suffering from head and neck synovial sarcoma (HNSS), especially in relation to patients with a localized disease at diagnosis. Methods: this retrospective chart review includes 57 patients diagnosed with primary HNSS between 1981 and 2020 who presented with a localized disease at diagnosis. Overall survival (OS) from diagnosis, local recurrence-free survival (LRFS), and metastasis-free survival (MFS) from the end of the primary tumor treatment are estimated. The Kaplan-Meier method, the log-rank test, and the Cox proportional hazards regression are used. Results: the 5-year OS, LRFS, and MFS are estimated at 80.4% (95% CI: 66.6%, 88.9%), 67.7% (95% CI: 50.0%, 80.4%), and 50.6% (95% CI: 34.4%, 64.8), respectively. Compared to patients undergoing surgical resection alone, those receiving radiation therapy (RT) with surgery have better LRFS (HR: 0.03, 95% CI: 0.001, 0.57), and those undergoing neo/adjuvant chemotherapy with surgery and RT have better MFS (HR: 0.10, 95% CI: 0.01, 0.95). Moreover, among the patients with tumors ≥ 4 cm, those subject to neo/adjuvant chemotherapy have significantly better MFS (5-year MFS: 53.2%, 95% CI: 29.0%, 72.5%) than those treated with surgery and RT alone (5-year MFS: 20.0%, 95% CI: 0.8%, 58.2%) (LR-p = 0.003). Conclusions: overall, the prognosis of HNSS patients looks favorable. Perioperative RT significantly improves local control, and perioperative chemotherapy plays a vital role in delaying metastasis formation in patients with primary HNSS when diagnosed with a localized disease. Importantly, we recommend that systemic therapy should be considered for HNSS patients with tumors ≥ 4 cm.

Survival Impacts of Mitochondrial Status in Esophageal Squamous Cell Carcinoma Patients.

Little is known about the survival impacts of mitochondrial status in esophageal squamous cell carcinoma (ESCC) patients who undergo neoadjuvant chemotherapy (NAC) followed by surgery. In total, 260 pre-NAC samples from ESCC patients were analyzed. Mitochondrial status was estimated employing an objective, immunohistochemistry-based system (Mito-score). Mito-scores were dichotomized according to the median value of our cohort. We also evaluated the immune microenvironment (CD4, CD8, Foxp3, HLA class-1, Ki-67 and programmed death ligand-1) on pre-NAC specimens. Multivariate Cox hazards models were applied to determine independent predictors of poor overall survival (OS). Patients with cT3-4 tumors had higher Mito-scores than those with cT1-2 tumors (p=0.06), and good responders to NAC had significantly higher Mito-scores than poor responders to NAC (p=0.04). CD8 cells and Ki-67 expression were significantly higher in Mito-high than Mito-low tumors (p=0.017 and p<0.001, respectively). Patients with low Mito-scores had significantly poorer OS than those with high Mito-scores (3-year OS: 57.6% vs. 68.2%; p=0.03). A survival difference by Mito-score was evident in cStage III-IV patients (3-year OS: low 50.6% vs. high 66.1%; p=0.006). Multivariable analysis revealed that a low Mito-score (hazard ratio 1.59, 95% confidence interval 1.12-2.24; p=0.009) as well as pT3-4 disease (p<0.001) and pN2-3 disease (p<0.001) were independently associated with poor OS outcomes. A low Mito-score before NAC had a significant survival impact in ESCC patients, especially in those with advanced disease. Mitochondrial status might be associated with tumor aggressiveness and responsiveness to NAC, thereby possibly affecting the survival outcomes of ESCC patients.

Conversion surgery for stage IV gastric cancer after third-line immunotherapy: a case report

The 5-year overall survival rate for stage IV gastric cancer is lower than 10%, despite the development of systemic therapy. Conversion surgery has shown to improve survival outcomes in patients with durable clinical response on chemotherapy. We report a clinical case of a patient, who underwent conversion surgery after pembrolizumab in the third-line setting for stage IV gastric cancer. The patient did not have recurrence for 22 months after conversion surgery.

Effects of Tobacco Smoking on Post-Liver-Transplant Outcomes

Background/Objectives: Our study examined 5-year patient and graft survival outcomes among non-smokers, former smokers, and active smokers at the time of liver transplantation (LT) and immediate post-operative complications and short-term outcomes following LT. Methods: This was a retrospective study that examined all liver transplants occurring at Cleveland Clinic Main Campus between January 2015–October 2022. Kaplan–Meier curves examined survival outcomes, and Cox’s multivariate regression analysis was performed. Results: Over the 5-year period, patient survival did not differ statistically between patient groups (all p-values &gt;0.05). However, graft survival was significantly lower in active smokers (p = 0.012). In the multivariate analysis, age (HR = 1.03, 95% CI 1.01–1.05, p = 0.002) and admission to the ICU (HR 1.68, 95% CI 1.13–2.50, p = 0.01) were positively associated with overall mortality. Immediate and short-term complications did not differ statistically between patient groups. Cardiovascular disease (22.5%) was the most common cause of death among all patients. Conclusions: Though our study did not show decreased patient survival outcomes, our findings are in line with previous studies that have shown that pre-transplant smoking is associated with overall reduced graft survival. Combined with the risk for de novo malignancy and cardiovascular events post transplant, smoking cessation before LT should be encouraged to ensure graft longevity.

An integrated machine learning framework for developing and validating a prognostic risk model of gastric cancer based on endoplasmic reticulum stress-associated genes

BackgroundGastric cancer (GC), a prevalent and deadly malignancy, demonstrates poor survival outcomes. Evidence has emerged indicating that disruptions in endoplasmic reticulum homeostasis are significantly implicated in the onset and progression of various oncological conditions. This study was designed to construct a prognostic model based on genes related to endoplasmic reticulum stress(ERS) to predict survival outcomes in patients with GC. MethodsExpression profiling data for GC samples were extracted and analyzed from TCGA-STAD, revealing 214 genes related to endoplasmic reticulum stress that show differential expression when compared with normal gastric tissue. Building on these insights, a prognostic model was formulated using data from TCGA-STAD and validated through subsequent analyses of GEO datasets. The tumor immune dysfunction and exclusion(TIDE) algorithm was applied to determine the susceptibility of individuals in high- and low-risk categories to immunotherapy. The presence of immune and stromal cells within the tumor microenvironment was assessed with the aid of the ESTIMATE algorithm. Sensitivity variations to prevalent anticancer drugs between the risk groups were evaluated using the Genomics of Drug Sensitivity in Cancer(GDSC) database, and prospective therapeutic agents were confirmed through molecular docking techniques. ResultsThirty-one endoplasmic reticulum stress (ERS)-related differentially expressed genes (DEGs) crucial for prognosis in GC were pinpointed. These DEGs were then used to construct a prognostic model and were considered as independent prognostic factors for GC patients. This risk model proved to have a good predictive performance for estimating the overall survival of these patients. The patients placed into the high-risk group showed worse results and lower sensitivity to immunotherapy. Moreover, five specific targeted therapy drugs, namely BMS-754807, Dasatinib, JQ1, AZD8055 and SB505124, produced better results in the treatment of the high-risk group of patients. ConclusionsA new molecular prognostic model associated with ERS was established and validated for GC and showed relatively good discriminative and predictive ability. This model greatly expands the collection of weapons in the armoury of prognostic analysis in GC.

Total retroperitoneal lipectomy improves prognosis in patients with primary retroperitoneal liposarcoma: a comparative study.

Retroperitoneal liposarcoma (RPLS) is the most common soft tissue sarcoma originating in the retroperitoneal space. Although surgery is the standard treatment, recurrence remains frequent. In this study, we aimed to explore the safety and efficacy of total (ipsilateral) retroperitoneal lipectomy (TRL) compared to traditional complete resection (CR) for primary RPLS. We retrospectively analyzed patients with primary RPLS treated at our center between January 2014 and December 2020. Univariate and multivariable Cox regression analyses assessed the impact of demographic, operative, and clinicopathological variables on recurrence-free survival (RFS) and overall survival (OS). Kaplan-Meier plots illustrated RFS and OS, and the log-rank test compared time-to-event distributions. A total of 81 patients were included in the final analysis: 37 in the CR group and 44 in the TRL group. Demographic and clinicopathologic parameters were comparable between the two groups. Post-operative morbidity occurred in 30.9% of cases, with 15 (40.5%) in the CR group and 10 (22.7%) in the TRL group (P=0.086). There were 9 cases of severe complications at grade 3 or higher, with 5 cases in the CR group and 4 cases in the TRL group. There was no significant difference between the two groups (P=0.314). The TRL group demonstrated improved RFS and OS, particularly among dedifferentiated liposarcoma (DDLS) patients. Total retroperitoneal lipectomy (TRL) appears to be a safe procedure that enhances survival outcomes in patients with primary RPLS. Further studies are needed to validate these findings.

Survival Outcomes in Patients Undergoing Pelvic Exenteration for Pelvic Mucosal Melanomas: Retrospective Single Institution Australian Study.

Pelvic mucosal melanomas, including anorectal and urogenital melanomas, are rare and aggressive with a median overall survival of up to 20 months. Pelvic mucosal melanomas behave differently to its cutaneous counterparts and presents late with locoregional disease, making pelvic exenteration its only curative surgical option. This study aimed to evaluate the survival outcomes post pelvic exenteration in pelvic mucosal melanomas at Royal Prince Alfred Hospital. Retrospective case series from a prospectively collected pelvic exenteration database from October 1994 to November 2023. Royal Prince Alfred Hospital (quaternary institution), Camperdown, New South Wales, Australia. Seven patients undergoing pelvic exenteration for pelvic mucosal melanoma. Overall survival, disease-free survival, and complication rates. Of the seven patients, most were female (n = 5, 71.4%) and had a median age of 65 years (range, 36-79). Five patients (71.4%) underwent pelvic exenteration for primary pelvic mucosal melanoma; 3 of which were anorectal and 2 vaginal melanomas. Two patients (28.6%) had recurrent anorectal melanoma and received neoadjuvant radiotherapy following an initial wide local excision. Three patients (42.9%) required total pelvic exenteration, while 2 required a central pelvic exenteration (28.6%). The remaining procedures were a central and lateral pelvic exenteration; along with anterior, central and lateral pelvic exenteration. Median length of hospital stay was 19.7 days. Five patients had postoperative complications with one major complication (Clavien-Dindo IIIa). At the study's completion, there were 4 mortalities. Mean survival was 23.6 months (range, 2-100) with a recurrence rate of 83%. Median time to recurrence was 3 months, despite 6 patients (85.7%) having R0 resections. Distant recurrence, i.e. to bone, lung and liver was most common. Small study cohort due to rarity of disease, limiting generalizability. Pelvic exenteration for pelvic mucosal melanoma appears to help control local disease as recurrence is most commonly distant or regional. See Video Abstract.