BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM T...BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.展开更多
BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2...AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.展开更多
This study aims to evaluate the potential value of patient characteristics in predicting overall survival （OS） in patients with metastatic castration-resistant prostate cancer （mCRPC） treated with docetaxel-based ...This study aims to evaluate the potential value of patient characteristics in predicting overall survival （OS） in patients with metastatic castration-resistant prostate cancer （mCRPC） treated with docetaxel-based thermotherapy. A total of 115 patients with mCRPC undergoing a docetaxel q3w regimen were enrolled in this study. A survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards models were used to evaluate the prognostic value of all covariates for OS. OS was also analysed after stratifying patients according to the results of multivariate analysis. The median OS for the entire cohort was 17.0 months. The multivariate analysis showed that the prostate-specific antigen doubling time （PSADT）, baseline haemoglobin （Hb） concentration, alkaline phosphatase （ALP） concentration, cycles of chemotherapy and time to castration resistance were independent prognostic factors of OS. According to the presence of PSADT 〈46.3 days and baseline ALP/〉 110 IU 1-1, all patients were divided into three risk groups： low-risk group （no risk factors）, intermediate-risk group （one risk factor） and high-risk group （two risk factors）. Median OSs for patients in low-, intermediate- and high-risk groups were 28.0 months （95% Ch 23.8-32.2）, 21.0 months （95% Ch 18.9-23.1） and 11.0 months （95% Ch 7.6-14.4）, respectively （P〈O.O01）. In conclusion, PSADT, baseline Hb concentration, ALP concentration, cycles of chemotherapy and time to castration resistance were independent prognostic factors of OS in Chinese patients with mCRPC treated with docetaxel. PSADT combined with the baseline ALP concentration could be a useful risk stratification parameter for evaluating survival outcomes.展开更多
AIM:To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases(CLM) and to describe the effects of time-related changes on su...AIM:To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases(CLM) and to describe the effects of time-related changes on survival and recurrence in these patients.METHODS:From January 1994 to January 2006,236 patients with CLM underwent surgery with the aim of performing curative resection of neoplastic disease at our institution and 189(80%) of these patients underwent resection of CLM with curative intention.Preoperative,intraoperative and postoperative data,including primary tumor and CLM pathology results,were retrospectively reviewed.Patients were divided into two time periods:a first period from January 1994 to January 2000(n = 93),and a second period from February 2000 to January 2006(n = 143).RESULTS:Global survival at 1,3 and 5 years in patients undergoing hepatic resection was 91%,54% and 47%,respectively.Patients with preoperative extrahepatic disease,carcinoembryonic antigen(CEA) levels over 20 ng/dL,more than four nodules or extrahepatic invasion at pathological analysis had worse survival.Tumor recurrence rate at 1 year was 48.3%,being more frequent in patients with preoperative and pathological extrahepatic disease and CEA levels over 20 ng/dL.Although patients in the second time period had more adverse prognostic factors,no differences in overall survival and recurrence were observed between the two periods.CONCLUSION:Despite advances in surgical technique and better adjuvant treatments and preoperative imaging,careful patient staging and selection is crucial to continue offering a chance of cure to patients with CLM.展开更多
BACKGROUND： Hilar cholangiocarcinoma （HCCA） is a devastating malignancy arising from the bifurcation of the hepatic duct, whether combined vascular resection benefits HCCA patients is controversial. This study was ...BACKGROUND： Hilar cholangiocarcinoma （HCCA） is a devastating malignancy arising from the bifurcation of the hepatic duct, whether combined vascular resection benefits HCCA patients is controversial. This study was undertaken to assess the effect of combined vascular resection in HCCA patients and to analyze the prognostic factors.展开更多
AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecut...AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions.The clinicopathological factors that could be associated with overall survival were evaluated.The cumulative survival was determined by the Kaplan-Meier method,and univariate comparisons between the groups were performed using the log-rank test.Multivariate analysis was performed using the Cox proportional hazard model and a step-wise procedure. RESULTS:The study patients comprised 53 men (74.6%)and 18 women(25.4%)aged 39-89 years (mean,68.9 years).Nineteen patients(26.8%)had postoperative morbidity:pancreatic fistula developed in 6 patients(8.5%)and was the most frequent complication,followed by anastomosis stricture in 5 patients (7.0%).During the follow-up period,28 patients(39.4%)died because of gastric cancer recurrence,and 3(4.2%) died because of another disease or accident.For all patients,the estimated overall survival was 34.1%at 5 years.Univariate analyses identified the following statistically significant prognostic factors in T4 gastric cancer patients who underwent potentially curative resection: peritoneal washing cytology(P<0.01),number of metastatic lymph nodes(P<0.05),and venous invasion(P <0.05).In multivariate analyses,only peritoneal washing cytology was identified as an independent prognostic factor(HR=3.62,95%CI=1.37-9.57)for longterm survival. CONCLUSION:Positive peritoneal washing cytology was the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors in China,and the liver is the most common metastatic site in patients with advanced CRC.Hepatectomy is the gold standard treatment for colore...BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors in China,and the liver is the most common metastatic site in patients with advanced CRC.Hepatectomy is the gold standard treatment for colorectal liver metastases.For patients who cannot undergo radical resection of liver metastases for various reasons,ablation therapy,interventional therapy,and systemic chemotherapy can be used to improve their quality of life and prolong their survival time.AIM To explore the prognostic factors and treatments of liver metastases of CRC.METHODS A retrospective analysis was conducted on 87 patients with liver metastases from CRC treated at the Liaoning Cancer Hospital and Institute between January 2005 and March 2011.According to different treatments,the patients were divided into the following four groups:Surgical resection group(36 patients);ablation group(23 patients);intervention group(15 patients);and drug group(13 patients).The clinicopathological data and postoperative survival of the four groups were analyzed.The Kaplan-Meier method was used for survival analysis,and the Cox proportional hazards regression model was used for multivariate analysis.RESULTS The median survival time of the 87 patients was 38.747±3.062 mo,and the 1-and 3-year survival rates were 87.5%and 53.1%,respectively.The Cox proportional hazards model showed that the following factors were independent factors affecting prognosis:The degree of tumor differentiation,the number of metastases,the size of metastases,and whether the metastases are close to great vessels.The results of treatment factor analysis showed that the effect of surgical treatment was better than that of drugs,intervention,or ablation alone,and the median survival time was 48.83±4.36 mo.The drug group had the worst prognosis,with a median survival time of only 13.5±0.7 mo(P<0.05).For patients with liver metastases of CRC near the great vessels,the median survival time(27.3 mo)of patients undergoing surgical resection was better than that of patients using other treatments(20.6 mo)(P<0.05).CONCLUSION Patients with a low degree of primary tumor differentiation,multiple liver metastases(number of tumors>4),and maximum diameter of liver metastases>5 cm have a poor prognosis.Among drug therapy,intervention,ablation,and surgical treatment options,surgical treatment is the first choice for liver metastases.When liver metastases are close to great vessels,surgical treatment is significantly better than drug therapy,intervention,and ablation alone.展开更多
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical recor...This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.展开更多
BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among ...BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among patients with different treatments for HCC. METHODS: Forty-three consecutive patients who were diagnosed with BMs from HCC between January 2010 and December 2014 were retrospectively enrolled. The clinical features were identified, the impacts of prognostic factors on survival were statistically analyzed, and clinical data were compared. RESULTS: The median patient age was 54 years; 38 patients were male and 5 female. The most common site for BMs was the trunk (69.3%). BMs with extension to the soft tissue were found in 14 patients (32.5%). Most (90.7%) of the lesions were mixed osteolytic and osteoblastic, and most (69.8%) patients presented with multiple BMs. The median survival after BMs diagnosis was 11 months. In multivariate analyses, survival after BM diagnosis was correlated with Karnofsky performance status (P=0.008) and the Child-Pugh classification (P<0.001); BM-free survival was correlated with progression beyond the University of California San Francisco criteria (P<0.001) and treatment of primary tumors (P<0.001). BMs with extension to soft tissue were less common in liver transplantation patients. During metastasis, the control of intrahepatic tumors was improved in liver transplantation and hepatectomy patients, compared to conservatively treated patients. CONCLUSIONS: The independent prognostic factors of survival after diagnosis of BMs were the Karnofsky performance status and Child-Pugh classification. HCC patients developed BMs may also benefit from liver transplantation or hepatectomy.展开更多
BACKGROUND Liver cancer has a high mortality and morbidity rate throughout the world.In clinical practice,the prognosis of liver cancer patients is poor,and the complex reasons contribute to treatment failures,includi...BACKGROUND Liver cancer has a high mortality and morbidity rate throughout the world.In clinical practice,the prognosis of liver cancer patients is poor,and the complex reasons contribute to treatment failures,including fibrosis,hepatitis viral infection,drug resistance and metastasis.Thus,screening novel prognostic biomarkers is of great importance for guiding liver cancer therapy.Orosomucoid genes(ORMs)encode acute phase plasma proteins,including orosomucoid 1(ORM1)and ORM2.Previous studies showed their upregulation upon inflammation,but the specific function of ORMs has not yet been determined,especially in the development of liver cancer.AIM To determine the expression of ORMs and their potential function in liver cancer.METHODS Analysis of the expression of ORMs in different human tissues was performed on data from the HPA RNA-seq normal tissues project.The expression ratio of ORMs was determined using the HCCDB database,including the ratio between liver cancer and other cancers,normal liver and other normal tissues,liver cancer and adjacent normal liver tissues.Analysis of ORM expression in different cancer types was performed using The Cancer Genome Atlas and TIMER database.The expression of ORMs in liver tumor tissues and adjacent normal tissues were further confirmed using Gene Expression Omnibus data,including GSE36376 and GSE14520.The 10-year overall survival(OS),progression-free survival(PFS)and relapse-free survival(RFS)rates between high and low ORM expression groups in liver cancer patients were determined using the Kaplan-Meier plotter tool.Gene Set Enrichment Analysis(GSEA)was employed to explore the ORM2-associated signaling network.Correlations between ORM2 expression and tumor purity or the infiltration level of macrophages in liver tumor tissues were determined using the TIMER database.The correlation between ORM2 gene levels,tumor-associated macrophage(TAM)markers(including CD68 and TGFβ1)and T cell immunosuppression(including CTLA4 and PD-1)in liver tumor tissues and liver GTEx was determined using the GEPIA database.RESULTS ORM1 and ORM2 were highly expressed in normal liver and liver tumor tissues.ORM1 and ORM2 expression was significantly decreased in liver tumor tissues compared with adjacent normal tissues,and similar results were also noted in cholangiocarcinoma,esophageal carcinoma,and lung squamous cell carcinoma.Further analysis of the Gene Expression Omnibus Database also confirmed the downregulation of ORM1 and ORM2 in liver tumors.Survival analysis showed that the high ORM2 group had better survival rates in OS,PFS and RFS.ORM1 only represented better performance in PFS,but not in OS or RFS.GSEA analysis of ORM2 from The Cancer Genome Atlas liver cancer data identified that ORM2 positively associated with the G2/M checkpoint,E2F target signaling,as well as Wnt/β-catenin and Hedgehog signaling.Moreover,apoptosis,IFN-αresponses,IFN-γresponses and humoral immune responses were upregulated in the ORM2 high group.ORM2 expression was negatively correlated with the macrophage infiltration level,CD68,TGFβ1,CTLA4 and PD-1 levels.CONCLUSION The results showed that ORM1 and ORM2 were highly expressed specifically in liver tissues,whereas ORM1 and ORM2 were downregulated in liver tumor tissues.ORM2 is a better prognostic factor for liver cancer.Furthermore,ORM2 is closely associated with cancer-promoting pathways.展开更多
Objective： To assess the clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma （DLBCL）. Methods： A retrospective study of 37 patients with primary testicular DLBCL ...Objective： To assess the clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma （DLBCL）. Methods： A retrospective study of 37 patients with primary testicular DLBCL was carried out from November 2003 to May 2012. Their clinical features, survival and prognostic factors were analyzed. Results： During a median follow-up period of 39.8 months （5.4-93.0 months）, the median progression-free survival （PFS） was 26.2 months （95% CI：0-65 months） and the 3-year overall survival （OS） rate was 78.4%. Within the whole cohort, the factors significantly associated with a superior PFS were limited stage （stage Ⅰ/Ⅱ）, lactate dehydrogenase （LDH） ≤245 U/L, international prognostic index （IPI） ≤1, primary tumor diameter 〈7.5 cm, and patients who had complete response （CR） and received doxoruhicin-contained chemotherapy （P〈0.05）. There was a trend toward superior outcome for patients who received combined therapy （surgery/ chemotherapy/radiotherapy） （P=0.055）. Patients who had CR, primary tumor diameter 〈7.5 cm and IPI score ≤1 were significantly associated with longer PFS at multivariate analysis. Conclusions： Primary testicular DLBCL had poorer survival. CR, primary tumor diameter and IPI were independent prognostic factors. The combined therapy of orchectomy, doxorubicin-contained chemotherapy and contralateral testicular radiotherapy （RT） seemed to improve survival.展开更多
To elucidate the effect of expression of doublecortin and CaM kinase-like-1 (DCLK1) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODSTumor specimens were obtained from 136 patients with pancreatic canc...To elucidate the effect of expression of doublecortin and CaM kinase-like-1 (DCLK1) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODSTumor specimens were obtained from 136 patients with pancreatic cancer who had undergone resection without preoperative therapy between January 2000 and December 2013 at the Department of Surgical Oncology, Osaka City University. The resected specimens were analyzed for associations with clinicopathological data, including DCLK1 expression, epithelial mesenchymal transition (EMT) marker expression, and cancer stem cell (CSC) marker expression. Univariate and multivariate survival analyses were performed and we assessed the association between DCLK1 expression and clinicopathological factors, including the EMT marker and CSC marker. RESULTSIn total, 48.5% (66/136) of the pancreatic cancer samples were positive for DCLK1. Patients with DCLK1-positive tumors had significantly shorter survival times than those with DCLK1-negative tumors (median, 18.7 mo vs 49.5 mo, respectively; P < 0.0001). Positive DCLK1 expression correlated with histological grade (P = 0.0290), preoperative CA19-9 level (P = 0.0060), epithelial cell adhesion molecule (EpCAM) expression (P = 0.0235), and the triple-positive expression of CD44/CD24/EpCAM (P = 0.0139). On univariate survival analysis, five factors were significantly associated with worse overall survival: histological grade of G2 to G4 (P = 0.0091), high preoperative serum SPan-1 level (P = 0.0034), R1/2 (P < 0.0001), positive expression of DCLK1 (P < 0.0001) or CD44 (P = 0.0245). On multivariate survival analysis, R1/2 [odds ratio (OR) = 2.019, 95% confidence interval (CI): 1.380-2.933; P = 0.0004] and positive DCLK1 expression (OR = 1.848, 95%CI: 1.2854-2.661; P = 0.0009) were independent prognostic factors. CONCLUSIONDCLK1 expression was found to be an independent prognostic factor and it may play a crucial prognostic role by promoting acquisition of stemness.展开更多
BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopi...BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.展开更多
Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized ch...Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized children. Pediatric patients （〈18 years old） admitted during 2003 to 2013 were enrolled in this study. AKI was defined and staged using Kidney Disease Improving Global Outcomes （KDIGO） crite- ria. Logistic regression analysis was performed to determine the risk factors and prognostic factors. The morbidity of pediatric AKI was 0.31% （205/65 237）. There were 45 （22.0%） cases in stage I, 30 （14.6%） cases in stage II and 130 （63.4%） cases in stage Ill. The majority of etiologies were intrinsic renal defects （85.4%）. Age, weight, vomit, etiology, blood urea nitrogen （BUN） at admission and sev- eral blood gas measurements were associated with AKI stage III. Age （OR=0.894; 95% CI, 0.832- 0.962; P=0.003）, vomit （OR=2.375; 95% CI, 1.058-5.333; P=0.036） and BUN at admission （OR=1.135;95% CI, 1.085-1.187; P〈0.001） were identified as independent risk factors for AKI stage Ill. After treatment, 172 （83.9%） patients achieved complete or partial recovery. The mortality was 3.9%. Variables were found as prognostic factors for renal recovery, such as age, stage, hospital stay, BUN at discharge, white blood cells, red blood cells, platelets （PLTs）, blood pH and urine blood. Among them, AKI stage（stage III vs. stage I ; OR, 6.506; 95% CI, 1.640-25.816; P=0.008）, BUN at discharge （OR, 0.918; 95% CI, 0.856-0.984; P=0.016） and PLTs （OR, 1.007; 95% CI, 1.001- 1.013; P=0.027） were identified as independent prognostic factors. AKI is still common in Chinese hos- pitalized children. Identified risk factors and prognostic factors provide guiding information for clinical management of AKI.展开更多
BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors rem...BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.展开更多
AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer an...AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer and compared it with the Cox model.Three thousand and eighteen gastric cancer patients who received a gastrectomy between 1980 and 2004 were retrospectively evaluated.Clinic-pathological factors were included in a log-normal model as well as Cox model.The akaike information criterion (AIC) was employed to compare the efficiency of both models.Univariate analysis indicated that age at diagnosis,past history,cancer location,distant metastasis status,surgical curative degree,combined other organ resection,Borrmann type,Lauren's classification,pT stage,total dissected nodes and pN stage were prognostic factors in both log-normal and Cox models.RESULTS:In the final multivariate model,age at diagnosis,past history,surgical curative degree,Borrmann type,Lauren's classification,pT stage,and pN stage were significant prognostic factors in both log-normal and Cox models.However,cancer location,distant metastasis status,and histology types were found to be significant prognostic factors in log-normal results alone.According to AIC,the log-normal model performed better than the Cox proportional hazard model (AIC value:2534.72 vs 1693.56).CONCLUSION:It is suggested that the log-normal regression model can be a useful statistical model to evaluate prognostic factors instead of the Cox proportional hazard model.展开更多
AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up.METHODS We enrolled 41 patients treated with curative gastrecto...AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up.METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1).We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2).We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis)of 41 cases matched with Group 1 according to demographic and pathological characteristics.RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients.In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns:lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.展开更多
AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) unde...AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.展开更多
文摘BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.
文摘This study aims to evaluate the potential value of patient characteristics in predicting overall survival （OS） in patients with metastatic castration-resistant prostate cancer （mCRPC） treated with docetaxel-based thermotherapy. A total of 115 patients with mCRPC undergoing a docetaxel q3w regimen were enrolled in this study. A survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards models were used to evaluate the prognostic value of all covariates for OS. OS was also analysed after stratifying patients according to the results of multivariate analysis. The median OS for the entire cohort was 17.0 months. The multivariate analysis showed that the prostate-specific antigen doubling time （PSADT）, baseline haemoglobin （Hb） concentration, alkaline phosphatase （ALP） concentration, cycles of chemotherapy and time to castration resistance were independent prognostic factors of OS. According to the presence of PSADT 〈46.3 days and baseline ALP/〉 110 IU 1-1, all patients were divided into three risk groups： low-risk group （no risk factors）, intermediate-risk group （one risk factor） and high-risk group （two risk factors）. Median OSs for patients in low-, intermediate- and high-risk groups were 28.0 months （95% Ch 23.8-32.2）, 21.0 months （95% Ch 18.9-23.1） and 11.0 months （95% Ch 7.6-14.4）, respectively （P〈O.O01）. In conclusion, PSADT, baseline Hb concentration, ALP concentration, cycles of chemotherapy and time to castration resistance were independent prognostic factors of OS in Chinese patients with mCRPC treated with docetaxel. PSADT combined with the baseline ALP concentration could be a useful risk stratification parameter for evaluating survival outcomes.
基金Supported by An investigation grant from Abertis Infraestructuras S.A
文摘AIM:To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases(CLM) and to describe the effects of time-related changes on survival and recurrence in these patients.METHODS:From January 1994 to January 2006,236 patients with CLM underwent surgery with the aim of performing curative resection of neoplastic disease at our institution and 189(80%) of these patients underwent resection of CLM with curative intention.Preoperative,intraoperative and postoperative data,including primary tumor and CLM pathology results,were retrospectively reviewed.Patients were divided into two time periods:a first period from January 1994 to January 2000(n = 93),and a second period from February 2000 to January 2006(n = 143).RESULTS:Global survival at 1,3 and 5 years in patients undergoing hepatic resection was 91%,54% and 47%,respectively.Patients with preoperative extrahepatic disease,carcinoembryonic antigen(CEA) levels over 20 ng/dL,more than four nodules or extrahepatic invasion at pathological analysis had worse survival.Tumor recurrence rate at 1 year was 48.3%,being more frequent in patients with preoperative and pathological extrahepatic disease and CEA levels over 20 ng/dL.Although patients in the second time period had more adverse prognostic factors,no differences in overall survival and recurrence were observed between the two periods.CONCLUSION:Despite advances in surgical technique and better adjuvant treatments and preoperative imaging,careful patient staging and selection is crucial to continue offering a chance of cure to patients with CLM.
基金supported by a grant from the National Natural Science Foundation of China(81172039)
文摘BACKGROUND： Hilar cholangiocarcinoma （HCCA） is a devastating malignancy arising from the bifurcation of the hepatic duct, whether combined vascular resection benefits HCCA patients is controversial. This study was undertaken to assess the effect of combined vascular resection in HCCA patients and to analyze the prognostic factors.
文摘AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions.The clinicopathological factors that could be associated with overall survival were evaluated.The cumulative survival was determined by the Kaplan-Meier method,and univariate comparisons between the groups were performed using the log-rank test.Multivariate analysis was performed using the Cox proportional hazard model and a step-wise procedure. RESULTS:The study patients comprised 53 men (74.6%)and 18 women(25.4%)aged 39-89 years (mean,68.9 years).Nineteen patients(26.8%)had postoperative morbidity:pancreatic fistula developed in 6 patients(8.5%)and was the most frequent complication,followed by anastomosis stricture in 5 patients (7.0%).During the follow-up period,28 patients(39.4%)died because of gastric cancer recurrence,and 3(4.2%) died because of another disease or accident.For all patients,the estimated overall survival was 34.1%at 5 years.Univariate analyses identified the following statistically significant prognostic factors in T4 gastric cancer patients who underwent potentially curative resection: peritoneal washing cytology(P<0.01),number of metastatic lymph nodes(P<0.05),and venous invasion(P <0.05).In multivariate analyses,only peritoneal washing cytology was identified as an independent prognostic factor(HR=3.62,95%CI=1.37-9.57)for longterm survival. CONCLUSION:Positive peritoneal washing cytology was the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors in China,and the liver is the most common metastatic site in patients with advanced CRC.Hepatectomy is the gold standard treatment for colorectal liver metastases.For patients who cannot undergo radical resection of liver metastases for various reasons,ablation therapy,interventional therapy,and systemic chemotherapy can be used to improve their quality of life and prolong their survival time.AIM To explore the prognostic factors and treatments of liver metastases of CRC.METHODS A retrospective analysis was conducted on 87 patients with liver metastases from CRC treated at the Liaoning Cancer Hospital and Institute between January 2005 and March 2011.According to different treatments,the patients were divided into the following four groups:Surgical resection group(36 patients);ablation group(23 patients);intervention group(15 patients);and drug group(13 patients).The clinicopathological data and postoperative survival of the four groups were analyzed.The Kaplan-Meier method was used for survival analysis,and the Cox proportional hazards regression model was used for multivariate analysis.RESULTS The median survival time of the 87 patients was 38.747±3.062 mo,and the 1-and 3-year survival rates were 87.5%and 53.1%,respectively.The Cox proportional hazards model showed that the following factors were independent factors affecting prognosis:The degree of tumor differentiation,the number of metastases,the size of metastases,and whether the metastases are close to great vessels.The results of treatment factor analysis showed that the effect of surgical treatment was better than that of drugs,intervention,or ablation alone,and the median survival time was 48.83±4.36 mo.The drug group had the worst prognosis,with a median survival time of only 13.5±0.7 mo(P<0.05).For patients with liver metastases of CRC near the great vessels,the median survival time(27.3 mo)of patients undergoing surgical resection was better than that of patients using other treatments(20.6 mo)(P<0.05).CONCLUSION Patients with a low degree of primary tumor differentiation,multiple liver metastases(number of tumors>4),and maximum diameter of liver metastases>5 cm have a poor prognosis.Among drug therapy,intervention,ablation,and surgical treatment options,surgical treatment is the first choice for liver metastases.When liver metastases are close to great vessels,surgical treatment is significantly better than drug therapy,intervention,and ablation alone.
文摘This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
基金supported by grants from Zhejiang Provincial Clinical Scientific Research Foundation of China(2013ZYC-A17)Ministry of Health of China(WKJ-ZJ-12)Health Bureau of Zhejiang Province(2013KYB098)
文摘BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among patients with different treatments for HCC. METHODS: Forty-three consecutive patients who were diagnosed with BMs from HCC between January 2010 and December 2014 were retrospectively enrolled. The clinical features were identified, the impacts of prognostic factors on survival were statistically analyzed, and clinical data were compared. RESULTS: The median patient age was 54 years; 38 patients were male and 5 female. The most common site for BMs was the trunk (69.3%). BMs with extension to the soft tissue were found in 14 patients (32.5%). Most (90.7%) of the lesions were mixed osteolytic and osteoblastic, and most (69.8%) patients presented with multiple BMs. The median survival after BMs diagnosis was 11 months. In multivariate analyses, survival after BM diagnosis was correlated with Karnofsky performance status (P=0.008) and the Child-Pugh classification (P<0.001); BM-free survival was correlated with progression beyond the University of California San Francisco criteria (P<0.001) and treatment of primary tumors (P<0.001). BMs with extension to soft tissue were less common in liver transplantation patients. During metastasis, the control of intrahepatic tumors was improved in liver transplantation and hepatectomy patients, compared to conservatively treated patients. CONCLUSIONS: The independent prognostic factors of survival after diagnosis of BMs were the Karnofsky performance status and Child-Pugh classification. HCC patients developed BMs may also benefit from liver transplantation or hepatectomy.
基金Supported by Medicine and Health Science and Technology Plan Projects of Zhejiang Province,No.2018KY569Zhejiang Provincial Natural Science Foundation of China,No.LY17H030002
文摘BACKGROUND Liver cancer has a high mortality and morbidity rate throughout the world.In clinical practice,the prognosis of liver cancer patients is poor,and the complex reasons contribute to treatment failures,including fibrosis,hepatitis viral infection,drug resistance and metastasis.Thus,screening novel prognostic biomarkers is of great importance for guiding liver cancer therapy.Orosomucoid genes(ORMs)encode acute phase plasma proteins,including orosomucoid 1(ORM1)and ORM2.Previous studies showed their upregulation upon inflammation,but the specific function of ORMs has not yet been determined,especially in the development of liver cancer.AIM To determine the expression of ORMs and their potential function in liver cancer.METHODS Analysis of the expression of ORMs in different human tissues was performed on data from the HPA RNA-seq normal tissues project.The expression ratio of ORMs was determined using the HCCDB database,including the ratio between liver cancer and other cancers,normal liver and other normal tissues,liver cancer and adjacent normal liver tissues.Analysis of ORM expression in different cancer types was performed using The Cancer Genome Atlas and TIMER database.The expression of ORMs in liver tumor tissues and adjacent normal tissues were further confirmed using Gene Expression Omnibus data,including GSE36376 and GSE14520.The 10-year overall survival(OS),progression-free survival(PFS)and relapse-free survival(RFS)rates between high and low ORM expression groups in liver cancer patients were determined using the Kaplan-Meier plotter tool.Gene Set Enrichment Analysis(GSEA)was employed to explore the ORM2-associated signaling network.Correlations between ORM2 expression and tumor purity or the infiltration level of macrophages in liver tumor tissues were determined using the TIMER database.The correlation between ORM2 gene levels,tumor-associated macrophage(TAM)markers(including CD68 and TGFβ1)and T cell immunosuppression(including CTLA4 and PD-1)in liver tumor tissues and liver GTEx was determined using the GEPIA database.RESULTS ORM1 and ORM2 were highly expressed in normal liver and liver tumor tissues.ORM1 and ORM2 expression was significantly decreased in liver tumor tissues compared with adjacent normal tissues,and similar results were also noted in cholangiocarcinoma,esophageal carcinoma,and lung squamous cell carcinoma.Further analysis of the Gene Expression Omnibus Database also confirmed the downregulation of ORM1 and ORM2 in liver tumors.Survival analysis showed that the high ORM2 group had better survival rates in OS,PFS and RFS.ORM1 only represented better performance in PFS,but not in OS or RFS.GSEA analysis of ORM2 from The Cancer Genome Atlas liver cancer data identified that ORM2 positively associated with the G2/M checkpoint,E2F target signaling,as well as Wnt/β-catenin and Hedgehog signaling.Moreover,apoptosis,IFN-αresponses,IFN-γresponses and humoral immune responses were upregulated in the ORM2 high group.ORM2 expression was negatively correlated with the macrophage infiltration level,CD68,TGFβ1,CTLA4 and PD-1 levels.CONCLUSION The results showed that ORM1 and ORM2 were highly expressed specifically in liver tissues,whereas ORM1 and ORM2 were downregulated in liver tumor tissues.ORM2 is a better prognostic factor for liver cancer.Furthermore,ORM2 is closely associated with cancer-promoting pathways.
文摘Objective： To assess the clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma （DLBCL）. Methods： A retrospective study of 37 patients with primary testicular DLBCL was carried out from November 2003 to May 2012. Their clinical features, survival and prognostic factors were analyzed. Results： During a median follow-up period of 39.8 months （5.4-93.0 months）, the median progression-free survival （PFS） was 26.2 months （95% CI：0-65 months） and the 3-year overall survival （OS） rate was 78.4%. Within the whole cohort, the factors significantly associated with a superior PFS were limited stage （stage Ⅰ/Ⅱ）, lactate dehydrogenase （LDH） ≤245 U/L, international prognostic index （IPI） ≤1, primary tumor diameter 〈7.5 cm, and patients who had complete response （CR） and received doxoruhicin-contained chemotherapy （P〈0.05）. There was a trend toward superior outcome for patients who received combined therapy （surgery/ chemotherapy/radiotherapy） （P=0.055）. Patients who had CR, primary tumor diameter 〈7.5 cm and IPI score ≤1 were significantly associated with longer PFS at multivariate analysis. Conclusions： Primary testicular DLBCL had poorer survival. CR, primary tumor diameter and IPI were independent prognostic factors. The combined therapy of orchectomy, doxorubicin-contained chemotherapy and contralateral testicular radiotherapy （RT） seemed to improve survival.
文摘To elucidate the effect of expression of doublecortin and CaM kinase-like-1 (DCLK1) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODSTumor specimens were obtained from 136 patients with pancreatic cancer who had undergone resection without preoperative therapy between January 2000 and December 2013 at the Department of Surgical Oncology, Osaka City University. The resected specimens were analyzed for associations with clinicopathological data, including DCLK1 expression, epithelial mesenchymal transition (EMT) marker expression, and cancer stem cell (CSC) marker expression. Univariate and multivariate survival analyses were performed and we assessed the association between DCLK1 expression and clinicopathological factors, including the EMT marker and CSC marker. RESULTSIn total, 48.5% (66/136) of the pancreatic cancer samples were positive for DCLK1. Patients with DCLK1-positive tumors had significantly shorter survival times than those with DCLK1-negative tumors (median, 18.7 mo vs 49.5 mo, respectively; P < 0.0001). Positive DCLK1 expression correlated with histological grade (P = 0.0290), preoperative CA19-9 level (P = 0.0060), epithelial cell adhesion molecule (EpCAM) expression (P = 0.0235), and the triple-positive expression of CD44/CD24/EpCAM (P = 0.0139). On univariate survival analysis, five factors were significantly associated with worse overall survival: histological grade of G2 to G4 (P = 0.0091), high preoperative serum SPan-1 level (P = 0.0034), R1/2 (P < 0.0001), positive expression of DCLK1 (P < 0.0001) or CD44 (P = 0.0245). On multivariate survival analysis, R1/2 [odds ratio (OR) = 2.019, 95% confidence interval (CI): 1.380-2.933; P = 0.0004] and positive DCLK1 expression (OR = 1.848, 95%CI: 1.2854-2.661; P = 0.0009) were independent prognostic factors. CONCLUSIONDCLK1 expression was found to be an independent prognostic factor and it may play a crucial prognostic role by promoting acquisition of stemness.
文摘BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.
文摘Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized children. Pediatric patients （〈18 years old） admitted during 2003 to 2013 were enrolled in this study. AKI was defined and staged using Kidney Disease Improving Global Outcomes （KDIGO） crite- ria. Logistic regression analysis was performed to determine the risk factors and prognostic factors. The morbidity of pediatric AKI was 0.31% （205/65 237）. There were 45 （22.0%） cases in stage I, 30 （14.6%） cases in stage II and 130 （63.4%） cases in stage Ill. The majority of etiologies were intrinsic renal defects （85.4%）. Age, weight, vomit, etiology, blood urea nitrogen （BUN） at admission and sev- eral blood gas measurements were associated with AKI stage III. Age （OR=0.894; 95% CI, 0.832- 0.962; P=0.003）, vomit （OR=2.375; 95% CI, 1.058-5.333; P=0.036） and BUN at admission （OR=1.135;95% CI, 1.085-1.187; P〈0.001） were identified as independent risk factors for AKI stage Ill. After treatment, 172 （83.9%） patients achieved complete or partial recovery. The mortality was 3.9%. Variables were found as prognostic factors for renal recovery, such as age, stage, hospital stay, BUN at discharge, white blood cells, red blood cells, platelets （PLTs）, blood pH and urine blood. Among them, AKI stage（stage III vs. stage I ; OR, 6.506; 95% CI, 1.640-25.816; P=0.008）, BUN at discharge （OR, 0.918; 95% CI, 0.856-0.984; P=0.016） and PLTs （OR, 1.007; 95% CI, 1.001- 1.013; P=0.027） were identified as independent prognostic factors. AKI is still common in Chinese hos- pitalized children. Identified risk factors and prognostic factors provide guiding information for clinical management of AKI.
基金Supported by Opening Fund of Engineering Research Center of Cognitive Healthcare of Zhejiang Province,No.2018KFJJ09National Natural Science Foundation of China,No.81827804
文摘BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.
基金Supported by the Gastric Cancer Laboratory and Pathology Department of Chinese Medical University,Shenyang,Chinathe Science and Technology Program of Shenyang,No. 1081232-1-00
文摘AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer and compared it with the Cox model.Three thousand and eighteen gastric cancer patients who received a gastrectomy between 1980 and 2004 were retrospectively evaluated.Clinic-pathological factors were included in a log-normal model as well as Cox model.The akaike information criterion (AIC) was employed to compare the efficiency of both models.Univariate analysis indicated that age at diagnosis,past history,cancer location,distant metastasis status,surgical curative degree,combined other organ resection,Borrmann type,Lauren's classification,pT stage,total dissected nodes and pN stage were prognostic factors in both log-normal and Cox models.RESULTS:In the final multivariate model,age at diagnosis,past history,surgical curative degree,Borrmann type,Lauren's classification,pT stage,and pN stage were significant prognostic factors in both log-normal and Cox models.However,cancer location,distant metastasis status,and histology types were found to be significant prognostic factors in log-normal results alone.According to AIC,the log-normal model performed better than the Cox proportional hazard model (AIC value:2534.72 vs 1693.56).CONCLUSION:It is suggested that the log-normal regression model can be a useful statistical model to evaluate prognostic factors instead of the Cox proportional hazard model.
文摘AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up.METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1).We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2).We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis)of 41 cases matched with Group 1 according to demographic and pathological characteristics.RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients.In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns:lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.
文摘AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.
