Objective:To develop and validate a radiomics prognostic scoring system(RPSS)for prediction of progressionfree survival(PFS)in patients with stageⅣnon-small cell lung cancer(NSCLC)treated with platinum-based chemothe...Objective:To develop and validate a radiomics prognostic scoring system(RPSS)for prediction of progressionfree survival(PFS)in patients with stageⅣnon-small cell lung cancer(NSCLC)treated with platinum-based chemotherapy.Methods:In this retrospective study,four independent cohorts of stageⅣNSCLC patients treated with platinum-based chemotherapy were included for model construction and validation(Discovery:n=159;Internal validation:n=156;External validation:n=81,Mutation validation:n=64).First,a total of 1,182 three-dimensional radiomics features were extracted from pre-treatment computed tomography(CT)images of each patient.Then,a radiomics signature was constructed using the least absolute shrinkage and selection operator method(LASSO)penalized Cox regression analysis.Finally,an individualized prognostic scoring system incorporating radiomics signature and clinicopathologic risk factors was proposed for PFS prediction.Results:The established radiomics signature consisting of 16 features showed good discrimination for classifying patients with high-risk and low-risk progression to chemotherapy in all cohorts(All P<0.05).On the multivariable analysis,independent factors for PFS were radiomics signature,performance status(PS),and N stage,which were all selected into construction of RPSS.The RPSS showed significant prognostic performance for predicting PFS in discovery[C-index:0.772,95%confidence interval(95%CI):0.765-0.779],internal validation(C-index:0.738,95%CI:0.730-0.746),external validation(C-index:0.750,95%CI:0.734-0.765),and mutation validation(Cindex:0.739,95%CI:0.720-0.758).Decision curve analysis revealed that RPSS significantly outperformed the clinicopathologic-based model in terms of clinical usefulness(All P<0.05).Conclusions:This study established a radiomics prognostic scoring system as RPSS that can be conveniently used to achieve individualized prediction of PFS probability for stageⅣNSCLC patients treated with platinumbased chemotherapy,which holds promise for guiding personalized pre-therapy of stageⅣNSCLC.展开更多
Objective:Lung cancer is the most common cause of cancer-related deaths worldwide.Somatic copy number alterations(SCNAs)have been used to predict responses to therapies in many cancers,including lung cancer.However,li...Objective:Lung cancer is the most common cause of cancer-related deaths worldwide.Somatic copy number alterations(SCNAs)have been used to predict responses to therapies in many cancers,including lung cancer.However,little is known about whether they are predictive of radiotherapy outcomes.We aimed to understand the prognostic value and biological functions of SCNAs.Methods:We analyzed the correlation between SCNAs and clinical outcomes in The Cancer Genome Atlas data for 486 patients with non-small cell lung cancer who received radiotherapy.Gene set enrichment analyses were performed to investigate the potential mechanisms underlying the roles of SCNAs in the radiotherapy response.Our results were validated in 20 patients with lung adenocarcinoma(LUAD)receiving radiotherapy.Results:SCNAs were a better predictor of progression-free survival(PFS)in LUAD(P=0.024)than in lung squamous carcinoma(P=0.18)in patients treated with radiotherapy.Univariate and multivariate regression analyses revealed the superiority of SCNAs in predicting PFS in patients with LUAD.Patients with stage I cancer and low SCNA levels had longer PFS than those with high SCNA levels(P=0.022).Our prognostic nomogram also showed that combining SCNAs and tumor/node/metastasis provided a better model for predicting long-term PFS.Additionally,high SCNA may activate the cell cycle pathway and induce tumorigenesis.Conclusions:SCNAs may be used to predict PFS in patients with early-stage LUAD with radiotherapy,in combination with TNM,with the aim of predicting long-term PFS.Therefore,SCNAs are a novel predictive biomarker for radiotherapy in patients with LUAD.展开更多
BACKGROUND After the failure of second-line standard therapy,effective treatment options for metastatic colorectal cancer are limited,and the duration of remission cannot meet clinical needs.In addition,associated dru...BACKGROUND After the failure of second-line standard therapy,effective treatment options for metastatic colorectal cancer are limited,and the duration of remission cannot meet clinical needs.In addition,associated drug toxicity may lead to treatment interruption that may affect patient outcomes.Therefore,more safe,effective and convenient treatments are urgently needed.CASE SUMMARY Here,we describe a patient with advanced colorectal cancer with multiple metastases in both lungs.Oxaliplatin combined with 5-fluorouracil or capecitabine was given as the first-line treatment,and bevacizumab combined with irinotecan was given as the second-line treatment after disease progression.However,treatment was interrupted due to recurrent grade 2 nausea and grade 1 diarrhea.He received targeted therapy with fruquintinib starting on August 26,2020 and responded well for 12 mo.After slow progression of the lung metastases,progression-free survival was again achieved over 13.5 mo by continued treatment of fruquintinib in combination with tegafur-gimeracil-oteracil potassium chemotherapy.Overall treatment duration was more than 25.5 mo.The treatments delayed tumor progression,reduced drug side effects,maintained a good quality of life,and further extended overall survival.CONCLUSION This case report detailed preliminary evidence showing that the combination of fruquintinib with tegafur-gimeracil-oteracil potassium chemotherapy double oral therapy may result in longer progression-free survival in patients with advanced colorectal cancer.展开更多
BACKGROUND Enhanced magnetic resonance imaging(MRI)is widely used in the diagnosis,treatment and prognosis of hepatocellular carcinoma(HCC),but it can not effectively reflect the heterogeneity within the tumor and eva...BACKGROUND Enhanced magnetic resonance imaging(MRI)is widely used in the diagnosis,treatment and prognosis of hepatocellular carcinoma(HCC),but it can not effectively reflect the heterogeneity within the tumor and evaluate the effect after treatment.Preoperative imaging analysis of voxel changes can effectively reflect the internal heterogeneity of the tumor and evaluate the progression-free survival(PFS).AIM To predict the PFS of patients with HCC before operation by building a model with enhanced MRI images.METHODS Delineate the regions of interest(ROI)in arterial phase,portal venous phase and delayed phase of enhanced MRI.After extracting the combinatorial features of ROI,the features are fused to obtain deep learning radiomics(DLR)_Sig.DeLong's test was used to evaluate the diagnostic performance of different typological features.K-M analysis was applied to assess PFS in different risk groups,and the discriminative ability of the model was evaluated using the Cindex.RESULTS Tumor diameter and diolame were independent factors influencing the prognosis of PFS.Delong's test revealed multi-phase combined radiomic features had significantly greater area under the curve values than did those of the individual phases(P<0.05).In deep transfer learning(DTL)and DLR,significant differences were observed between the multi-phase and individual phases feature sets(P<0.05).K-M survival analysis revealed a median survival time of high risk group and low risk group was 12.8 and 14.2 months,respectively,and the predicted probabilities of 6 months,1 year and 2 years were 92%,60%,40%and 98%,90%,73%,respectively.The C-index was 0.764,indicating relatively good consistency between the predicted and observed results.DTL and DLR have higher predictive value for 2-year PFS in nomogram.CONCLUSION Based on the multi-temporal characteristics of enhanced MRI and the constructed Nomograph,it provides a new strategy for predicting the PFS of transarterial chemoembolization treatment of HCC.展开更多
BACKGROUND：Progression-free survival（PFS）has not been extensively investigated as a surrogate for survival in the firstline treatments of pancreatic cancer.The aim of this review was to evaluate PFS as a potential ...BACKGROUND：Progression-free survival（PFS）has not been extensively investigated as a surrogate for survival in the firstline treatments of pancreatic cancer.The aim of this review was to evaluate PFS as a potential surrogate endpoint for overall survival（OS）in advanced pancreatic cancer in trials comparing poly-chemotherapy to gemcitabine alone.DATA SOURCES： A systematic literature search in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted. The key words included randomized trial, first-line chemotherapy, pancreatic cancer, gemcitabine and poly-chemotherapy. Adjusted weighted linear regression was used to calculate Rs （Spearman＇s rank-order correlation coefficient） between PFS and post-progression survival （PPS） with OS （Rs） and between treatment effects on PFS and OS （RHR）. RESUEFS： A total of 30 trials including 8467 patients met the inclusion criteria. Correlation between the treatment effects on PFS and OS （RHR=0.78） and between the endpoint PFS and OS was high across all studies （Rs=0.75）. The slope of the re- gression line was 0.76±0.26, indicating that an agent produc- ing a 10% risk reduction for PFS will provide a 7.6%±2.6% risk reduction for OS. Correlation between PPS and OS was very strong （Rs=0.71） and accounted for more than 50% of the whole OS variability （R2=0.57）. CONCLUSION： Because of the robust correlation with OS and the potential influence of PPS caused by the second line therapies, it may be justified to consider PFS as a surrogate endpoint in trials evaluating new cytotoxic agents when gemcitabine is the control arm.展开更多
Objective To compare the value of contrast-enhanced ultrasound(CEUS)and conventional ultrasound(US)during radiofrequency ablation(RFA)for the treatment of hepatocellular carcinoma(HCC)≥3.0 cm in diameter.Methods A to...Objective To compare the value of contrast-enhanced ultrasound(CEUS)and conventional ultrasound(US)during radiofrequency ablation(RFA)for the treatment of hepatocellular carcinoma(HCC)≥3.0 cm in diameter.Methods A total of 149 HCC patients treated with RFA guided by either CEUS or conventional US between January 2012 and June 2013 were retrospectively analyzed.Patients were divided into different groups based on the type of ultrasound guidance(CEUS or conventional US)and tumor volume(diameter<3.0 or≥3.0 cm).The progressionfree survival(PFS)and complete ablation rates were compared between groups,and risk factors for the PFS were investigated.Results Seventy four patients received CEUS-guided RFA,and conventional US was performed in 75 patients.Among patients with a tumor<3.0 cm,the PFS and complete ablation rates were similar.However,for patients with a tumor≥3.0 cm,those treated with CEUS had a significantly longer PFS(17.3 vs.3.1 months,HR=2.73;95%CI,1.28~5.81;P=0.007)and higher complete ablation rates at 6-and 12-month post-treatment(87.5%vs.57.7%,P=0.042;75.0%vs.38.5%,P=0.009,respectively)than those treated with conventional US-guided RFA.The type of treatment(P=0.024)and maximum tumour size(P=0.011)were both found to be independent factors associated with the PFS.Conclusion Compared with conventional US,CEUS is more effective for guiding RFA in patients with HCC≥3.0 cm.CEUS-guided RFA could target HCC more accurately,and its ability to immediately detect any residual tumor during RFA might contribute to an increase in complete ablation rates and reduced progression.展开更多
Background:Previous studies have provided conflicting evidence about the increased overall survival(OS)in lung cancer patients with diabetes mellitus(DM)compared with those without DM.This study assessed progression-f...Background:Previous studies have provided conflicting evidence about the increased overall survival(OS)in lung cancer patients with diabetes mellitus(DM)compared with those without DM.This study assessed progression-free survival(PFS)/OS in lung cancer patients with or without DM and tentatively analyzed the impact of blood glucose levels on PFS/OS in lung cancer patients.Methods:Data were collected from lung cancer patients based upon admission records from January 2010 to January 2012 and follow-up records from January 2010 to January 2015 in the Department of Pulmonary Medicine,Zhongshan Hospital,Fudan University,Shanghai.The data included patient sex,age,body mass index(BMI),smoking status,history of DM,level of blood glucose,pathological type,clinical stage of cancer,chemotherapy regimen,and history of anti-DM drugs.The Cox regression model and Kaplan-Meier method were used for the analysis of hazard factors and PFS/OS.For comparison of PFS/OS in lung cancer with or without DM,patients were divided into three groups:lung cancer with DM,lung cancer without DM but with elevated level of blood glucose,lung cancer without DM or elevated level of blood glucose.Results:In total,the data from 200 lung cancer patients(138 males/62 females,aged 29.0 to 78.0 years,mean 60.0±8.6 years)were collected.For the comparison of PFS/OS in lung cancer patients with or without DM,patients were divided into three groups:lung cancer with DM(n=31);lung cancer without DM but with elevated levels of blood glucose(n=40);and lung cancer without both DM and elevated levels of blood glucose(n=128),whereas 1 patient dropped out of the study.All the patients underwent complete chemotherapy and were followed up for 36.0 to 60.0 months.Kaplan-Meier survival analysis showed that lung cancer patients with DM had increased PFS and OS compared with those without DM(log-rank,P<0.05,P<0.01);the median PFS in lung cancer with DM was 12.0 months(95%confidence interval[CI],4.0-16.0)vs.6.0 months in those without DM(95%CI,5.8-6.3);and the median OS in lung cancer patients with DM was 37.0 months(95%CI,29.0-46.6)vs.12.0 months in those without DM(95%CI,10.9-13.1).For the other two groups of patients without DM,there was a trend toward a shorter PFS and OS in patients with elevated blood glucose compared with those without elevated blood glucose.Cox regression showed that PFS in lung cancer patients was favorably associated with the usage of anti-DM drugs,BMI,clinical stage of cancer,and chemotherapy regimen(all P<0.05)but was inversely associated with the level of blood glucose(P<0.05).Conclusions:Lung cancer patients with DM have prolonged PFS and OS compared with those without DM,and the level of blood glucose was inversely associated with PFS.The current results indicate that PFS may be a meaningful intermediate endpoint for OS and that the levels of blood glucose hopefully represent a prognostic factor in lung cancer patients.展开更多
Background Significant efforts have been made to identify factors that differentiate patients treated with novel therapies,such as bortezomib in multiple myeloma （MM）.The exact expression pattern and prognostic valu...Background Significant efforts have been made to identify factors that differentiate patients treated with novel therapies,such as bortezomib in multiple myeloma （MM）.The exact expression pattern and prognostic value of the cancer/testis antigen preferentially expressed antigen of melanoma （PRAME） in MM are unknown and were explored in this study.Methods The transcript level of PRAME was detected in bone marrow specimens from 100 newly diagnosed MM patients using real-time quantitative polymerase chain reaction,and the prognostic value of PRAME was determined through retrospective survival analysis.PRAME expression higher than the upper limit of normal bone marrow was defined as PRAME overexpression or PRAME （＋）.Results Sixty-two patients （62.0％） overexpressed PRAME.PRAME overexpression showed no prognostic significance to either overall survival （n=100） or progression-free survival （PFS,n=96,all P ＞0.05） of patients.The patients were also categorized according to regimens with or without bortezomib.PRAME overexpression tended to be associated with a lower two-year PFS rate in patients treated with non-bortezomib-containing regimens （53.5％ vs.76.9％,P=0.071）.By contrast,it was not associated with the two-year PFS rate in patients with bortezomib-containing regimens （77.5％ vs.63.9％,P ＞0.05）.When the patients were categorized into PRAME （＋） and PRAME （-） groups,treatment with bortezomib-containing regimens predicted a higher two-year PFS rate in PRAME （＋） patients （77.5％ vs.53.5％,P=0.027） but showed no significant effect on two-year PFS rate in PRAME （-） patients （63.9％ vs.76.9％,P ＞0.05）.Conclusion PRAME overexpression might be an adverse prognostic factor of PFS in MM patients treated with non-bortezomib-containing regimens.Bortezomib improves PFS in patients overexpressing PRAME.展开更多
Objective： To examine the effect of a Chinese medicinal herbal formula （Feitai Capsule, 肺泰胶囊） on the quality of life （QOL） and progression-free survival （PFS） of patients with unresectable non-small cell lu...Objective： To examine the effect of a Chinese medicinal herbal formula （Feitai Capsule, 肺泰胶囊） on the quality of life （QOL） and progression-free survival （PFS） of patients with unresectable non-small cell lung cancer （NSCLC）. Methods： Sixty-two patients were randomly divided into the treatment group （31 cases） and the control group （31 cases）. For the treatment group, 4 capsules （1.2 g/capsule） of Feitai Capsule were administered 3 times a day after meals for 3 weeks; then no drug was administered for 1 week. This schedule was continued for at least 3 more cycles （12 weeks totally）. If there were no obvious toxic reactions, the treatment was extended. The patients were evaluated at least once every 8 weeks until progressive dJsease （PD）. For the control group, the regular follow-up and evaluation were performed at least once every 8 weeks until PD. Clinical symptoms, objective response, physical constitution and energy, QOL, and PFS were evaluated regularly. Analysis of variance （ANOVA）, a non-parametric test, and analysis of covariance were used to compare clinical features, amelioration of clinical symptoms, physical constitution and energy, and QOL. Kaplan- Meier analysis was used to compare the two-group PFS. Results： Sixty patients finished the final evaluation, with 30 patients in each group. Baseline characters between groups were not significantly different （P〉0.05）. The control group had a 36.7% improvement in clinical symptoms, while the treatment group had a 73.3% improvement. This difference was statistically significant （Z=-2.632, P=0.008）. The control group had a 26.7% improvement in the Karnofsky performance status （KPS）, while the treatment group had a 53.4% improvement. This was also significantly different （Z=-2.182, P=0.029）. A comparative analysis indicated a positive correlation （r=0.917, P〈0.001）. Compared with the control group, QOL in the treatment group was significantly improved, except in the social/family condition and doctor-patient relationship indicators. The PFS of the treatment group and control group were 6.23 months and 4.67 months, respectively （P=0.048）. Conclusion： Feitai Capsule, a Chinese medicinal herbal treatment could improve the QOL and extend the PFS of the unresectable NSCLC patients.展开更多
BACKGROUND The combination of sorafenib with transarterial chemoembolization(TACE)is being investigated for its potential to improve outcomes in advanced hepatocellular carcinoma(HCC).AIM To evaluate the efficacy of t...BACKGROUND The combination of sorafenib with transarterial chemoembolization(TACE)is being investigated for its potential to improve outcomes in advanced hepatocellular carcinoma(HCC).AIM To evaluate the efficacy of this combined treatment strategy in enhancing overall survival(OS)and progression-free survival(PFS)compared to monotherapies.METHODS A systematic review was conducted following the PRISMA guidelines.A comprehensive search was performed across PubMed,EMBASE,Web of Science,and the Cochrane Library up to May 8,2024.Studies were included if they compared sorafenib plus TACE to sorafenib alone or TACE alone in adults with advanced HCC.Primary outcomes were OS,PFS,response rates,and safety profiles.Data extraction and quality assessment were independently performed by two reviewers.Heterogeneity was assessed using the I^(2)statistic,and a random-effects model was applied for pooling data.Sensitivity analysis and publication bias assessment were also conducted.RESULTS A total of twelve studies involving 1174 patients met the inclusion criteria.Significant heterogeneity was observed for both OS(I^(2)=72.6%,P<0.001)and PFS(I^(2)=83.7%,P<0.001).The combined treatment of sorafenib with TACE significantly improved OS[hazard ratio(HR)=0.60,95%confidence interval(CI):0.44-0.76]and PFS(HR=0.54,95%CI:0.38-0.69).Sensitivity analysis confirmed the robustness of these findings.Funnel plots and Egger's test indicated no significant publication bias.CONCLUSION Sorafenib combined with TACE significantly enhances both OS and PFS in patients with advanced HCC compared to monotherapy.This combination therapy represents a promising approach to improving clinical outcomes in advanced liver cancer.展开更多
Gastric cancer(GC)remains one of the leading causes of cancer-related mortality worldwide.Accurate prognostic assessment,which is essential for enhancing overall survival(OS),currently depends on pathologic and clinic...Gastric cancer(GC)remains one of the leading causes of cancer-related mortality worldwide.Accurate prognostic assessment,which is essential for enhancing overall survival(OS),currently depends on pathologic and clinical staging.This underscores the urgent need for reliable and real-time prognostic biomarkers.The triglyceride-glucose(TyG)index,a readily available marker of insulin resistance,has recently emerged as a potential prognostic tool in GC.Numerous studies have consistently shown a significant association between elevated TyG levels and inferior OS as well as progression-free survival.Despite these promising findings,several challenges must be addressed before the TyG index can be widely adopted in clinical practice.Firstly,the TyG index lacks cancer-specificity,reflecting broader metabolic disturbances commonly observed in conditions such as obesity,diabetes,and cardiovascular disease.This lack of specificity complicates its interpretation in oncological settings.Additionally,the cutoff values for TyG index vary across studies,hindering the establishment of a standardized threshold for clinical application.While the TyG index provides valuable insights into a patient's metabolic health,its limited cancer specificity necessitates cautious use when evaluating the prognosis of GC treatment.展开更多
BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surg...BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.展开更多
Objective:A conventional endpoint for locally advanced cervical cancer(LACC)clinical trials is overall survival(OS)with five years of follow-up.The primary hypothesis was that progression-free survival(PFS)with three ...Objective:A conventional endpoint for locally advanced cervical cancer(LACC)clinical trials is overall survival(OS)with five years of follow-up.The primary hypothesis was that progression-free survival(PFS)with three years of follow-up(PFS36)would be an appropriate primary surrogate endpoint.Materials and methods:The primary hypothesis,which was developed from our data,was further investigated using phase III randomized controlled trials and then externally validated using retrospective studies up to 2023.Correlation analysis at the treatment-arm level was performed between 2-,3-,4-,and 5-year PFS rates and 5-year OS.Results:A total of 613 patients with histologically confirmed cervical cancer who underwent radiotherapy or chemoradiation at our institute between January 2010 and December 2013 were eligible.The recurrence rates for years 1 through 5 were 12.9%,7.3%,3%,2.3%,and 1.8%,respectively.Patients who did not achieve PFS36 had a 5-year OS rate of 30.3%.However,patients who achieved PFS36 had a 5-year OS rate of 98.2%.Further data were extracted from 26 randomized phase III trials on LACC.The trials included 55 arms,with a pooled sample size of 7,281 patients.Trial-level surrogacy results revealed that PFS36(r2,0.732)was associated with 5-year OS.The correlation between PFS36 and OS was externally validated using independent retrospective data.Conclusion:A significant positive correlation was found between PFS36 and OS at 5 years of follow-up both within patients and across trials.These results suggest that PFS36 is an appropriate endpoint for LACC clinical trials of radiotherapy-based regimens.展开更多
BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling lo...BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling local tumor growth.We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.AIM To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.METHODS We conducted a randomized study involving eighty patients diagnosed with unresectable HCC,classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A.Participants were divided into two treatment arms:A control group receiving TACE alone(Group A)and an experimental group receiving sequential TACE and SBRT(Group B).The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week.Primary endpoints included local control,progression-free survival(PFS),and overall survival(OS),with secondary endpoints focusing on toxicity profiles.Additional analyses explored the impact of different SBRT dose levels.RESULTS The study enrolled 88 patients from April 2021 to January 2023,with 48 assigned to Group A and 40 to Group B.Over a median follow-up period of 20 months,the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics.Complete response rates reached 75%in Group B compared to 54.5%in Group A.The combination therapy extended median PFS to 16 months,significantly longer than the 11 months observed with TACE alone(P=0.003).Neither group had reached median OS by study conclusion.Importantly,both treatment approaches showed comparable safety profiles.CONCLUSION Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients.This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy,while maintaining an acceptable safety profile.展开更多
BACKGROUND Colorectal cancer(CRC)is among the most prevalent and deadly cancers globally,particularly in China.Treatment challenges remain in advanced and metastatic cases,especially in third-and fourth-line settings....BACKGROUND Colorectal cancer(CRC)is among the most prevalent and deadly cancers globally,particularly in China.Treatment challenges remain in advanced and metastatic cases,especially in third-and fourth-line settings.The combination of targeted therapies with immune checkpoint inhibitors(ICIs)has shown potential in addressing the limitations of single-agent treatments.AIM To evaluate the efficacy and safety of targeted therapy(TT)alone and in combination with ICIs for metastatic CRC(mCRC).METHODS A multicenter retrospective observational study was conducted to evaluate the efficacy and safety of TT alone and in combination with ICIs for mCRC.A total of 99 patients treated with regorafenib or fruquintinib,with or without ICIs,were enrolled.Propensity score matching(PSM)and inverse probability weighting(IPW)were employed to balance baseline characteristics.The primary endpoint was progression-free survival(PFS),while overall survival(OS)and safety were secondary.RESULTS Patients who received combined therapy showed significantly longer median PFS rates compared to those who underwent TT in all analyses(original:6.0 vs 3.4 months,P<0.01;PSM:6.15 vs 4.25 months,P<0.05;IPW:5.6 vs 3.3 months,P<0.01).Although the median OS showed a trend toward improvement in the combination group,the difference was insignificant.Cox regression analysis revealed that combining TT with ICIs significantly reduced the risk of disease progression(hazard ratio=0.38,P<0.001).Adverse events(AEs)were generally manageable with both regimens,while serious AEs(grade 3-4)were primarily hypertension,fatigue,and reduced platelet counts.All AEs were controlled effectively by symptomatic treatment or discontinuation of the drug,and no treatment-related deaths were observed.CONCLUSION The combination of TT with ICIs offers a significant advantage in terms of PFS for patients with advanced mCRC,accompanied by a favorable safety profile.These findings underscore the benefits of combination therapy in this setting,warranting further investigation in larger prospective clinical trials.展开更多
Background:Small cell lung cancer(SCLC)is characterized by its aggressive nature and high propensity for brain metastases.This study investigates the clinical efficacy and safety profile of Anlotinib in combination wi...Background:Small cell lung cancer(SCLC)is characterized by its aggressive nature and high propensity for brain metastases.This study investigates the clinical efficacy and safety profile of Anlotinib in combination with Stereotactic Radiotherapy(SRT)for treating brain metastases in patients with small cell lung cancer(SCLC).Methods:This research included 98 SCLC brain metastasis patients treated at Chengde Central Hospital from October 2020 to January 2024.The patients were categorized into a combined treatment group(CTG)(n=45)and a Simple SRT group(SSG)(n=53).The CTG(58 lesions)received Anlotinib with brain SRS,while the SSG(67 lesions)underwent only brain SRS.We compared the rates of intracranial hypertension relief,intracranial lesion treatment efficacy,radiation-induced brain necrosis,intracranial progression-free survival,and overall survival between the groups.Additionally,Anlotinib usage and adverse reactions in the CTG were documented.Results:Intracranial hypertension relief was significantly higher in the CTG at 80.0%(36/45)compared to 11.3%(6/53)in the SSG(p<0.001).Radiation-induced brain necrosis occurred in 3.4%(2/58)of the CTG,markedly less than the 20.9%(14/67)in the SSG,indicating a significant difference(χ^(2)=8.479,p=0.004).Effective intracranial lesion treatment rates were 86.7%(39/45)in the CTG and 62.3%(33/53)in the SSG,with a notable difference(χ^(2)=7.951,p=0.047).The median intracranial progression-free survival was 7.8 months in the CTG vs.4.8 months in the SSG(p<0.0001).Median overall survival times were 11.3 months for the CTG and 7.8 months for the SSG(p=0.3506).The duration of Anlotinib treatment in the CTG was 6(6,18)weeks.Adverse reactions included Grade I hypertension in three patients and Grade I hand-foot skin reactions in two patients,with a drug-related adverse reaction rate of 11.1%(5/45).Conclusion:Anlotinib combined with SRT significantly alleviates brain edema,reduces the incidence of radiation-induced brain necrosis,enhances intracranial progression-free survival,and demonstrates a low adverse reaction rate.展开更多
BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quali...BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quality multicenter data remain limited,and the prognostic impact of site-specific extrapulmonary metastases is not well defined.AIM To assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.METHODS This multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022.Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC,tumor diameter<50 mm,fewer than 5 metastatic lesions,and≤2 organs involved.Kaplan-Meier and Cox regression methods assessed survival outcomes,including local tumor progression-free survival,progression-free survival(PFS),and overall survival(OS).RESULTS The 3-year cumulative local tumor progression rate was 14.0%.Median PFS and OS were 15.6 and 51 months,respectively,with 3-and 5-year OS rates of 59.5%and 41.0%.Poor survival outcomes were associated with a higher tumor burden(larger size and greater number),carcinoembryonic antigen>20 ng/mL,carbohydrate antigen 19-9>37 U/mL,and extrapulmonary metastases.Patients without extrapulmonary metastasis had 1-,3-,and 5-year PFS rates of 65.4%,31.0%,and 27.3%,respectively,which were longer than those of CRLM patients with liver metastasis[hazard ratio(HR)=1.449,P=0.019]and abdominal cavity metastasis(HR=1.864,P=0.010).The 1-,3-,and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%,71.0%,and 53.0%,respectively,which were significantly longer than those for patients with bone metastasis(HR=4.538,P<0.001),abdominal cavity metastasis(HR=4.813,P<0.001),and pelvic cavity metastasis(HR=3.105,P<0.001).CONCLUSION Metastatic patterns significantly influence PFS and OS,emphasizing the need for careful patient selection.Notably,patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes,suggesting a distinct biological behavior and better prognosis within this subgroup.展开更多
AIM:To investigate tumor response and survival in patients with postembolization fever(PEF) and to determine the risk factors for PEF.METHODS:Four hundred forty-three hepatocellular carcinoma(HCC) patients who underwe...AIM:To investigate tumor response and survival in patients with postembolization fever(PEF) and to determine the risk factors for PEF.METHODS:Four hundred forty-three hepatocellular carcinoma(HCC) patients who underwent the first session of transcatheter arterial chemoembolization(TACE) between January 2005 and December 2009 were analyzed retrospectively.PEF was defined as a body temperature greater than 38.0 ℃ that developed within 3 d of TACE without evidence of infection.The tumor progression-free interval was defined as the interval from the first TACE to the second TACE based on mRECIST criteria.Clinical staging was based on the American Joint Committee on Cancer tumor,node,metastases(TNM) classification of malignant tumors.All patients were admitted before their 1 st TACE treatment,and blood samples were obtained from all patients before and after treatment.Clinicoradiological variables and host-related variables were compared between two groups:patients with PEF vs patients without PEF.Additionally,variables related to 20-mo mortality and tumor progression-free survival were analyzed.RESULTS:The study population comprised 370(85.4%) men and 73(14.6%) women with a mean age of 62.29 ± 10.35 years.A total of 1836 TACE sessions were conducted in 443 patients,and each patient received between 1 and 27(mean:4.14 ± 3.57) TACE sessions.The mean follow-up duration was 22.23 ± 19.6 mo(range:0-81 mo).PEF developed in 117 patients(26.41%) at the time of the first TACE session.PEF was not associated with 20-mo survival(P = 0.524) or computed tomography(CT) response(P = 0.413) in a univariate analysis.A univariate analysis further indicated that diffuse-type HCC(P = 0.021),large tumor size(≥ 5 cm)(P = 0.046),lipiodol dose(≥ 7 mL,P = 0.001),poor blood glucose control(P = 0.034),alanine aminotransferase(ALT) value after TACE(P = 0.004) and C-reactive protein(CRP) value after TACE(P = 0.036) served as possible risk factors correlated with PEF.The ALT value after TACE(P = 0.021) and lipiodol dose over 7 mL(P = 0.011) were independent risk factors for PEF in the multivariate analysis.For the 20-mo survival,poor blood sugar control(P < 0.001),portal vein thrombosis(P = 0.001),favorable CT response after TACE(P < 0.001),initial aspartate aminotransferase(P = 0.02),initial CRP(P = 0.042),tumor size(P < 0.001),TNM stage(P < 0.001) and lipiodol dose(P < 0.001) were possible risk factors in the univariate analysis.Tumor size(P = 0.03),poor blood sugar control(P = 0.043),and portal vein thrombosis(P = 0.031) were significant predictors of survival in the multivariate analysis.Furthermore,the tumor progression-free interval was closely associated with CRP > 1 mg/dL(P = 0.003),tumor size > 5 cm(P < 0.001),tumor type(poorly defined)(P < 0.001),and lipiodol dose(> 7 mL,P < 0.001).CONCLUSION:PEF has no impact on survival at 20 mo or radiologic response.However,the ALT level after TACE and the lipiodol dose represent significant risk factors for PEF.展开更多
BACKGROUND： Traditional Chinese medicine （TCM） is considered an important complementary therapy with beneficial effects for cancer patients. Elderly patients with non-small-cell lung cancer （NSCLC） are a complex ...BACKGROUND： Traditional Chinese medicine （TCM） is considered an important complementary therapy with beneficial effects for cancer patients. Elderly patients with non-small-cell lung cancer （NSCLC） are a complex patient group with increasing co-morbidity and shrinking physiological reserve, and may derive substantial benefit from the supportive aspects of TCM Researchers from Shanghai Longhua Hospital found that qi and yin deficiency is a common syndrome in patients with stage III or IV lung cancer. This project was designed to study the combination of single-agent chemotherapy with TCM methods of benefiting qi and yin in elderly patients with advanced NSCLC. METHODS AND DESIGN： This is a double-blind controlled, multi-center, and prospective study with randomly selected participants from elderly NSCLC patients in China. Seventy-six patients who meet the inclusion criteria will be allocated into two groups, which will receive treatments of 3-week single-agent chemotherapy with TCM or placebo for four cycles Progression-free survival （PFS） is the primary end point, and the secondary end points are overall survival, objective response rate, time-to-progression, and quality of life （EORTC QLQ-LC43, and TCM syndrome score） Meanwhile, other end points such as toxicity, side effects and safety of the treatments will be assessed. DISCUSSION： Results from this study may provide evidence on the effectiveness, and parameters for the usage of single-agent chemotherapy combined with or without TCM on PFS of elderly patients with NSCLC.展开更多
基金supported by the National Key Research and Development Plan of China(No.2017YFC1309100)the National Science Fund for Distinguished Young Scholars(No.81925023)the National Natural Scientific Foundation of China(No.81771912,81901910,82072090,and 82001986)。
文摘Objective:To develop and validate a radiomics prognostic scoring system(RPSS)for prediction of progressionfree survival(PFS)in patients with stageⅣnon-small cell lung cancer(NSCLC)treated with platinum-based chemotherapy.Methods:In this retrospective study,four independent cohorts of stageⅣNSCLC patients treated with platinum-based chemotherapy were included for model construction and validation(Discovery:n=159;Internal validation:n=156;External validation:n=81,Mutation validation:n=64).First,a total of 1,182 three-dimensional radiomics features were extracted from pre-treatment computed tomography(CT)images of each patient.Then,a radiomics signature was constructed using the least absolute shrinkage and selection operator method(LASSO)penalized Cox regression analysis.Finally,an individualized prognostic scoring system incorporating radiomics signature and clinicopathologic risk factors was proposed for PFS prediction.Results:The established radiomics signature consisting of 16 features showed good discrimination for classifying patients with high-risk and low-risk progression to chemotherapy in all cohorts(All P<0.05).On the multivariable analysis,independent factors for PFS were radiomics signature,performance status(PS),and N stage,which were all selected into construction of RPSS.The RPSS showed significant prognostic performance for predicting PFS in discovery[C-index:0.772,95%confidence interval(95%CI):0.765-0.779],internal validation(C-index:0.738,95%CI:0.730-0.746),external validation(C-index:0.750,95%CI:0.734-0.765),and mutation validation(Cindex:0.739,95%CI:0.720-0.758).Decision curve analysis revealed that RPSS significantly outperformed the clinicopathologic-based model in terms of clinical usefulness(All P<0.05).Conclusions:This study established a radiomics prognostic scoring system as RPSS that can be conveniently used to achieve individualized prediction of PFS probability for stageⅣNSCLC patients treated with platinumbased chemotherapy,which holds promise for guiding personalized pre-therapy of stageⅣNSCLC.
基金This work was supported by grants from the National Key Technology R&D Program(Grant No.2018YFC1313400)National Natural Science Foundation of China(Grant No.81974246)+1 种基金Scientific Research Program of Tianjin Education Commission(Grant No.2019KJ185)Tianjin Research Innovation Project(Grant No.2020YJSB164)for postgraduate students.
文摘Objective:Lung cancer is the most common cause of cancer-related deaths worldwide.Somatic copy number alterations(SCNAs)have been used to predict responses to therapies in many cancers,including lung cancer.However,little is known about whether they are predictive of radiotherapy outcomes.We aimed to understand the prognostic value and biological functions of SCNAs.Methods:We analyzed the correlation between SCNAs and clinical outcomes in The Cancer Genome Atlas data for 486 patients with non-small cell lung cancer who received radiotherapy.Gene set enrichment analyses were performed to investigate the potential mechanisms underlying the roles of SCNAs in the radiotherapy response.Our results were validated in 20 patients with lung adenocarcinoma(LUAD)receiving radiotherapy.Results:SCNAs were a better predictor of progression-free survival(PFS)in LUAD(P=0.024)than in lung squamous carcinoma(P=0.18)in patients treated with radiotherapy.Univariate and multivariate regression analyses revealed the superiority of SCNAs in predicting PFS in patients with LUAD.Patients with stage I cancer and low SCNA levels had longer PFS than those with high SCNA levels(P=0.022).Our prognostic nomogram also showed that combining SCNAs and tumor/node/metastasis provided a better model for predicting long-term PFS.Additionally,high SCNA may activate the cell cycle pathway and induce tumorigenesis.Conclusions:SCNAs may be used to predict PFS in patients with early-stage LUAD with radiotherapy,in combination with TNM,with the aim of predicting long-term PFS.Therefore,SCNAs are a novel predictive biomarker for radiotherapy in patients with LUAD.
文摘BACKGROUND After the failure of second-line standard therapy,effective treatment options for metastatic colorectal cancer are limited,and the duration of remission cannot meet clinical needs.In addition,associated drug toxicity may lead to treatment interruption that may affect patient outcomes.Therefore,more safe,effective and convenient treatments are urgently needed.CASE SUMMARY Here,we describe a patient with advanced colorectal cancer with multiple metastases in both lungs.Oxaliplatin combined with 5-fluorouracil or capecitabine was given as the first-line treatment,and bevacizumab combined with irinotecan was given as the second-line treatment after disease progression.However,treatment was interrupted due to recurrent grade 2 nausea and grade 1 diarrhea.He received targeted therapy with fruquintinib starting on August 26,2020 and responded well for 12 mo.After slow progression of the lung metastases,progression-free survival was again achieved over 13.5 mo by continued treatment of fruquintinib in combination with tegafur-gimeracil-oteracil potassium chemotherapy.Overall treatment duration was more than 25.5 mo.The treatments delayed tumor progression,reduced drug side effects,maintained a good quality of life,and further extended overall survival.CONCLUSION This case report detailed preliminary evidence showing that the combination of fruquintinib with tegafur-gimeracil-oteracil potassium chemotherapy double oral therapy may result in longer progression-free survival in patients with advanced colorectal cancer.
文摘BACKGROUND Enhanced magnetic resonance imaging(MRI)is widely used in the diagnosis,treatment and prognosis of hepatocellular carcinoma(HCC),but it can not effectively reflect the heterogeneity within the tumor and evaluate the effect after treatment.Preoperative imaging analysis of voxel changes can effectively reflect the internal heterogeneity of the tumor and evaluate the progression-free survival(PFS).AIM To predict the PFS of patients with HCC before operation by building a model with enhanced MRI images.METHODS Delineate the regions of interest(ROI)in arterial phase,portal venous phase and delayed phase of enhanced MRI.After extracting the combinatorial features of ROI,the features are fused to obtain deep learning radiomics(DLR)_Sig.DeLong's test was used to evaluate the diagnostic performance of different typological features.K-M analysis was applied to assess PFS in different risk groups,and the discriminative ability of the model was evaluated using the Cindex.RESULTS Tumor diameter and diolame were independent factors influencing the prognosis of PFS.Delong's test revealed multi-phase combined radiomic features had significantly greater area under the curve values than did those of the individual phases(P<0.05).In deep transfer learning(DTL)and DLR,significant differences were observed between the multi-phase and individual phases feature sets(P<0.05).K-M survival analysis revealed a median survival time of high risk group and low risk group was 12.8 and 14.2 months,respectively,and the predicted probabilities of 6 months,1 year and 2 years were 92%,60%,40%and 98%,90%,73%,respectively.The C-index was 0.764,indicating relatively good consistency between the predicted and observed results.DTL and DLR have higher predictive value for 2-year PFS in nomogram.CONCLUSION Based on the multi-temporal characteristics of enhanced MRI and the constructed Nomograph,it provides a new strategy for predicting the PFS of transarterial chemoembolization treatment of HCC.
文摘BACKGROUND：Progression-free survival（PFS）has not been extensively investigated as a surrogate for survival in the firstline treatments of pancreatic cancer.The aim of this review was to evaluate PFS as a potential surrogate endpoint for overall survival（OS）in advanced pancreatic cancer in trials comparing poly-chemotherapy to gemcitabine alone.DATA SOURCES： A systematic literature search in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted. The key words included randomized trial, first-line chemotherapy, pancreatic cancer, gemcitabine and poly-chemotherapy. Adjusted weighted linear regression was used to calculate Rs （Spearman＇s rank-order correlation coefficient） between PFS and post-progression survival （PPS） with OS （Rs） and between treatment effects on PFS and OS （RHR）. RESUEFS： A total of 30 trials including 8467 patients met the inclusion criteria. Correlation between the treatment effects on PFS and OS （RHR=0.78） and between the endpoint PFS and OS was high across all studies （Rs=0.75）. The slope of the re- gression line was 0.76±0.26, indicating that an agent produc- ing a 10% risk reduction for PFS will provide a 7.6%±2.6% risk reduction for OS. Correlation between PPS and OS was very strong （Rs=0.71） and accounted for more than 50% of the whole OS variability （R2=0.57）. CONCLUSION： Because of the robust correlation with OS and the potential influence of PPS caused by the second line therapies, it may be justified to consider PFS as a surrogate endpoint in trials evaluating new cytotoxic agents when gemcitabine is the control arm.
基金the Training Plan for Outstanding Young Teachers of Jilin University(No.419080500356).
文摘Objective To compare the value of contrast-enhanced ultrasound(CEUS)and conventional ultrasound(US)during radiofrequency ablation(RFA)for the treatment of hepatocellular carcinoma(HCC)≥3.0 cm in diameter.Methods A total of 149 HCC patients treated with RFA guided by either CEUS or conventional US between January 2012 and June 2013 were retrospectively analyzed.Patients were divided into different groups based on the type of ultrasound guidance(CEUS or conventional US)and tumor volume(diameter<3.0 or≥3.0 cm).The progressionfree survival(PFS)and complete ablation rates were compared between groups,and risk factors for the PFS were investigated.Results Seventy four patients received CEUS-guided RFA,and conventional US was performed in 75 patients.Among patients with a tumor<3.0 cm,the PFS and complete ablation rates were similar.However,for patients with a tumor≥3.0 cm,those treated with CEUS had a significantly longer PFS(17.3 vs.3.1 months,HR=2.73;95%CI,1.28~5.81;P=0.007)and higher complete ablation rates at 6-and 12-month post-treatment(87.5%vs.57.7%,P=0.042;75.0%vs.38.5%,P=0.009,respectively)than those treated with conventional US-guided RFA.The type of treatment(P=0.024)and maximum tumour size(P=0.011)were both found to be independent factors associated with the PFS.Conclusion Compared with conventional US,CEUS is more effective for guiding RFA in patients with HCC≥3.0 cm.CEUS-guided RFA could target HCC more accurately,and its ability to immediately detect any residual tumor during RFA might contribute to an increase in complete ablation rates and reduced progression.
基金supported by a grant from the National Natural Science Foundation of China(No.81172219).
文摘Background:Previous studies have provided conflicting evidence about the increased overall survival(OS)in lung cancer patients with diabetes mellitus(DM)compared with those without DM.This study assessed progression-free survival(PFS)/OS in lung cancer patients with or without DM and tentatively analyzed the impact of blood glucose levels on PFS/OS in lung cancer patients.Methods:Data were collected from lung cancer patients based upon admission records from January 2010 to January 2012 and follow-up records from January 2010 to January 2015 in the Department of Pulmonary Medicine,Zhongshan Hospital,Fudan University,Shanghai.The data included patient sex,age,body mass index(BMI),smoking status,history of DM,level of blood glucose,pathological type,clinical stage of cancer,chemotherapy regimen,and history of anti-DM drugs.The Cox regression model and Kaplan-Meier method were used for the analysis of hazard factors and PFS/OS.For comparison of PFS/OS in lung cancer with or without DM,patients were divided into three groups:lung cancer with DM,lung cancer without DM but with elevated level of blood glucose,lung cancer without DM or elevated level of blood glucose.Results:In total,the data from 200 lung cancer patients(138 males/62 females,aged 29.0 to 78.0 years,mean 60.0±8.6 years)were collected.For the comparison of PFS/OS in lung cancer patients with or without DM,patients were divided into three groups:lung cancer with DM(n=31);lung cancer without DM but with elevated levels of blood glucose(n=40);and lung cancer without both DM and elevated levels of blood glucose(n=128),whereas 1 patient dropped out of the study.All the patients underwent complete chemotherapy and were followed up for 36.0 to 60.0 months.Kaplan-Meier survival analysis showed that lung cancer patients with DM had increased PFS and OS compared with those without DM(log-rank,P<0.05,P<0.01);the median PFS in lung cancer with DM was 12.0 months(95%confidence interval[CI],4.0-16.0)vs.6.0 months in those without DM(95%CI,5.8-6.3);and the median OS in lung cancer patients with DM was 37.0 months(95%CI,29.0-46.6)vs.12.0 months in those without DM(95%CI,10.9-13.1).For the other two groups of patients without DM,there was a trend toward a shorter PFS and OS in patients with elevated blood glucose compared with those without elevated blood glucose.Cox regression showed that PFS in lung cancer patients was favorably associated with the usage of anti-DM drugs,BMI,clinical stage of cancer,and chemotherapy regimen(all P<0.05)but was inversely associated with the level of blood glucose(P<0.05).Conclusions:Lung cancer patients with DM have prolonged PFS and OS compared with those without DM,and the level of blood glucose was inversely associated with PFS.The current results indicate that PFS may be a meaningful intermediate endpoint for OS and that the levels of blood glucose hopefully represent a prognostic factor in lung cancer patients.
文摘Background Significant efforts have been made to identify factors that differentiate patients treated with novel therapies,such as bortezomib in multiple myeloma （MM）.The exact expression pattern and prognostic value of the cancer/testis antigen preferentially expressed antigen of melanoma （PRAME） in MM are unknown and were explored in this study.Methods The transcript level of PRAME was detected in bone marrow specimens from 100 newly diagnosed MM patients using real-time quantitative polymerase chain reaction,and the prognostic value of PRAME was determined through retrospective survival analysis.PRAME expression higher than the upper limit of normal bone marrow was defined as PRAME overexpression or PRAME （＋）.Results Sixty-two patients （62.0％） overexpressed PRAME.PRAME overexpression showed no prognostic significance to either overall survival （n=100） or progression-free survival （PFS,n=96,all P ＞0.05） of patients.The patients were also categorized according to regimens with or without bortezomib.PRAME overexpression tended to be associated with a lower two-year PFS rate in patients treated with non-bortezomib-containing regimens （53.5％ vs.76.9％,P=0.071）.By contrast,it was not associated with the two-year PFS rate in patients with bortezomib-containing regimens （77.5％ vs.63.9％,P ＞0.05）.When the patients were categorized into PRAME （＋） and PRAME （-） groups,treatment with bortezomib-containing regimens predicted a higher two-year PFS rate in PRAME （＋） patients （77.5％ vs.53.5％,P=0.027） but showed no significant effect on two-year PFS rate in PRAME （-） patients （63.9％ vs.76.9％,P ＞0.05）.Conclusion PRAME overexpression might be an adverse prognostic factor of PFS in MM patients treated with non-bortezomib-containing regimens.Bortezomib improves PFS in patients overexpressing PRAME.
基金Supported by the Key Subject of People's Liberation Army Eleventh-Five-Year Traditional Chinese Medicine Clinical Research Program(No.2006051002)
文摘Objective： To examine the effect of a Chinese medicinal herbal formula （Feitai Capsule, 肺泰胶囊） on the quality of life （QOL） and progression-free survival （PFS） of patients with unresectable non-small cell lung cancer （NSCLC）. Methods： Sixty-two patients were randomly divided into the treatment group （31 cases） and the control group （31 cases）. For the treatment group, 4 capsules （1.2 g/capsule） of Feitai Capsule were administered 3 times a day after meals for 3 weeks; then no drug was administered for 1 week. This schedule was continued for at least 3 more cycles （12 weeks totally）. If there were no obvious toxic reactions, the treatment was extended. The patients were evaluated at least once every 8 weeks until progressive dJsease （PD）. For the control group, the regular follow-up and evaluation were performed at least once every 8 weeks until PD. Clinical symptoms, objective response, physical constitution and energy, QOL, and PFS were evaluated regularly. Analysis of variance （ANOVA）, a non-parametric test, and analysis of covariance were used to compare clinical features, amelioration of clinical symptoms, physical constitution and energy, and QOL. Kaplan- Meier analysis was used to compare the two-group PFS. Results： Sixty patients finished the final evaluation, with 30 patients in each group. Baseline characters between groups were not significantly different （P〉0.05）. The control group had a 36.7% improvement in clinical symptoms, while the treatment group had a 73.3% improvement. This difference was statistically significant （Z=-2.632, P=0.008）. The control group had a 26.7% improvement in the Karnofsky performance status （KPS）, while the treatment group had a 53.4% improvement. This was also significantly different （Z=-2.182, P=0.029）. A comparative analysis indicated a positive correlation （r=0.917, P〈0.001）. Compared with the control group, QOL in the treatment group was significantly improved, except in the social/family condition and doctor-patient relationship indicators. The PFS of the treatment group and control group were 6.23 months and 4.67 months, respectively （P=0.048）. Conclusion： Feitai Capsule, a Chinese medicinal herbal treatment could improve the QOL and extend the PFS of the unresectable NSCLC patients.
基金Supported by Sichuan Science and Technology Program,No.2022YFS0625。
文摘BACKGROUND The combination of sorafenib with transarterial chemoembolization(TACE)is being investigated for its potential to improve outcomes in advanced hepatocellular carcinoma(HCC).AIM To evaluate the efficacy of this combined treatment strategy in enhancing overall survival(OS)and progression-free survival(PFS)compared to monotherapies.METHODS A systematic review was conducted following the PRISMA guidelines.A comprehensive search was performed across PubMed,EMBASE,Web of Science,and the Cochrane Library up to May 8,2024.Studies were included if they compared sorafenib plus TACE to sorafenib alone or TACE alone in adults with advanced HCC.Primary outcomes were OS,PFS,response rates,and safety profiles.Data extraction and quality assessment were independently performed by two reviewers.Heterogeneity was assessed using the I^(2)statistic,and a random-effects model was applied for pooling data.Sensitivity analysis and publication bias assessment were also conducted.RESULTS A total of twelve studies involving 1174 patients met the inclusion criteria.Significant heterogeneity was observed for both OS(I^(2)=72.6%,P<0.001)and PFS(I^(2)=83.7%,P<0.001).The combined treatment of sorafenib with TACE significantly improved OS[hazard ratio(HR)=0.60,95%confidence interval(CI):0.44-0.76]and PFS(HR=0.54,95%CI:0.38-0.69).Sensitivity analysis confirmed the robustness of these findings.Funnel plots and Egger's test indicated no significant publication bias.CONCLUSION Sorafenib combined with TACE significantly enhances both OS and PFS in patients with advanced HCC compared to monotherapy.This combination therapy represents a promising approach to improving clinical outcomes in advanced liver cancer.
基金Supported by National Natural Science Foundation of China,No.82301700(to Wang B)and No.82471464(to Li S)Liaoning Province Natural Science Foundation Project,No.2023-MS-266(to Teng Y)and No.2024-MS-157(to Wang B)+2 种基金Youth Talent Cultivation Fund Key Project of Dalian Medical University(to Wang B)Scientific Research Projects from Wuhan Municipal Health Commission,No.WX23Z26(to Xia M)Research Project Plan of the Qingpu Branch of Zhongshan Hospital,No.QYT2023-02(to Chen DF).
文摘Gastric cancer(GC)remains one of the leading causes of cancer-related mortality worldwide.Accurate prognostic assessment,which is essential for enhancing overall survival(OS),currently depends on pathologic and clinical staging.This underscores the urgent need for reliable and real-time prognostic biomarkers.The triglyceride-glucose(TyG)index,a readily available marker of insulin resistance,has recently emerged as a potential prognostic tool in GC.Numerous studies have consistently shown a significant association between elevated TyG levels and inferior OS as well as progression-free survival.Despite these promising findings,several challenges must be addressed before the TyG index can be widely adopted in clinical practice.Firstly,the TyG index lacks cancer-specificity,reflecting broader metabolic disturbances commonly observed in conditions such as obesity,diabetes,and cardiovascular disease.This lack of specificity complicates its interpretation in oncological settings.Additionally,the cutoff values for TyG index vary across studies,hindering the establishment of a standardized threshold for clinical application.While the TyG index provides valuable insights into a patient's metabolic health,its limited cancer specificity necessitates cautious use when evaluating the prognosis of GC treatment.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.
基金funded by the CAMS Innovation Fund for Medical Sciences(CIFMS)(grant number:2024-I2M-C&T-B-071)the Beijing Hope Run Special Fund of Cancer Foundation of China(grant number:LC2018B04).
文摘Objective:A conventional endpoint for locally advanced cervical cancer(LACC)clinical trials is overall survival(OS)with five years of follow-up.The primary hypothesis was that progression-free survival(PFS)with three years of follow-up(PFS36)would be an appropriate primary surrogate endpoint.Materials and methods:The primary hypothesis,which was developed from our data,was further investigated using phase III randomized controlled trials and then externally validated using retrospective studies up to 2023.Correlation analysis at the treatment-arm level was performed between 2-,3-,4-,and 5-year PFS rates and 5-year OS.Results:A total of 613 patients with histologically confirmed cervical cancer who underwent radiotherapy or chemoradiation at our institute between January 2010 and December 2013 were eligible.The recurrence rates for years 1 through 5 were 12.9%,7.3%,3%,2.3%,and 1.8%,respectively.Patients who did not achieve PFS36 had a 5-year OS rate of 30.3%.However,patients who achieved PFS36 had a 5-year OS rate of 98.2%.Further data were extracted from 26 randomized phase III trials on LACC.The trials included 55 arms,with a pooled sample size of 7,281 patients.Trial-level surrogacy results revealed that PFS36(r2,0.732)was associated with 5-year OS.The correlation between PFS36 and OS was externally validated using independent retrospective data.Conclusion:A significant positive correlation was found between PFS36 and OS at 5 years of follow-up both within patients and across trials.These results suggest that PFS36 is an appropriate endpoint for LACC clinical trials of radiotherapy-based regimens.
文摘BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling local tumor growth.We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.AIM To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.METHODS We conducted a randomized study involving eighty patients diagnosed with unresectable HCC,classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A.Participants were divided into two treatment arms:A control group receiving TACE alone(Group A)and an experimental group receiving sequential TACE and SBRT(Group B).The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week.Primary endpoints included local control,progression-free survival(PFS),and overall survival(OS),with secondary endpoints focusing on toxicity profiles.Additional analyses explored the impact of different SBRT dose levels.RESULTS The study enrolled 88 patients from April 2021 to January 2023,with 48 assigned to Group A and 40 to Group B.Over a median follow-up period of 20 months,the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics.Complete response rates reached 75%in Group B compared to 54.5%in Group A.The combination therapy extended median PFS to 16 months,significantly longer than the 11 months observed with TACE alone(P=0.003).Neither group had reached median OS by study conclusion.Importantly,both treatment approaches showed comparable safety profiles.CONCLUSION Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients.This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy,while maintaining an acceptable safety profile.
基金Supported by Hebei Provincial Medical Science Research Project Program,No.20240164.
文摘BACKGROUND Colorectal cancer(CRC)is among the most prevalent and deadly cancers globally,particularly in China.Treatment challenges remain in advanced and metastatic cases,especially in third-and fourth-line settings.The combination of targeted therapies with immune checkpoint inhibitors(ICIs)has shown potential in addressing the limitations of single-agent treatments.AIM To evaluate the efficacy and safety of targeted therapy(TT)alone and in combination with ICIs for metastatic CRC(mCRC).METHODS A multicenter retrospective observational study was conducted to evaluate the efficacy and safety of TT alone and in combination with ICIs for mCRC.A total of 99 patients treated with regorafenib or fruquintinib,with or without ICIs,were enrolled.Propensity score matching(PSM)and inverse probability weighting(IPW)were employed to balance baseline characteristics.The primary endpoint was progression-free survival(PFS),while overall survival(OS)and safety were secondary.RESULTS Patients who received combined therapy showed significantly longer median PFS rates compared to those who underwent TT in all analyses(original:6.0 vs 3.4 months,P<0.01;PSM:6.15 vs 4.25 months,P<0.05;IPW:5.6 vs 3.3 months,P<0.01).Although the median OS showed a trend toward improvement in the combination group,the difference was insignificant.Cox regression analysis revealed that combining TT with ICIs significantly reduced the risk of disease progression(hazard ratio=0.38,P<0.001).Adverse events(AEs)were generally manageable with both regimens,while serious AEs(grade 3-4)were primarily hypertension,fatigue,and reduced platelet counts.All AEs were controlled effectively by symptomatic treatment or discontinuation of the drug,and no treatment-related deaths were observed.CONCLUSION The combination of TT with ICIs offers a significant advantage in terms of PFS for patients with advanced mCRC,accompanied by a favorable safety profile.These findings underscore the benefits of combination therapy in this setting,warranting further investigation in larger prospective clinical trials.
基金supported by the Science and Technology Program of Chengde(Project Number:202301A016).
文摘Background:Small cell lung cancer(SCLC)is characterized by its aggressive nature and high propensity for brain metastases.This study investigates the clinical efficacy and safety profile of Anlotinib in combination with Stereotactic Radiotherapy(SRT)for treating brain metastases in patients with small cell lung cancer(SCLC).Methods:This research included 98 SCLC brain metastasis patients treated at Chengde Central Hospital from October 2020 to January 2024.The patients were categorized into a combined treatment group(CTG)(n=45)and a Simple SRT group(SSG)(n=53).The CTG(58 lesions)received Anlotinib with brain SRS,while the SSG(67 lesions)underwent only brain SRS.We compared the rates of intracranial hypertension relief,intracranial lesion treatment efficacy,radiation-induced brain necrosis,intracranial progression-free survival,and overall survival between the groups.Additionally,Anlotinib usage and adverse reactions in the CTG were documented.Results:Intracranial hypertension relief was significantly higher in the CTG at 80.0%(36/45)compared to 11.3%(6/53)in the SSG(p<0.001).Radiation-induced brain necrosis occurred in 3.4%(2/58)of the CTG,markedly less than the 20.9%(14/67)in the SSG,indicating a significant difference(χ^(2)=8.479,p=0.004).Effective intracranial lesion treatment rates were 86.7%(39/45)in the CTG and 62.3%(33/53)in the SSG,with a notable difference(χ^(2)=7.951,p=0.047).The median intracranial progression-free survival was 7.8 months in the CTG vs.4.8 months in the SSG(p<0.0001).Median overall survival times were 11.3 months for the CTG and 7.8 months for the SSG(p=0.3506).The duration of Anlotinib treatment in the CTG was 6(6,18)weeks.Adverse reactions included Grade I hypertension in three patients and Grade I hand-foot skin reactions in two patients,with a drug-related adverse reaction rate of 11.1%(5/45).Conclusion:Anlotinib combined with SRT significantly alleviates brain edema,reduces the incidence of radiation-induced brain necrosis,enhances intracranial progression-free survival,and demonstrates a low adverse reaction rate.
基金Supported by the National Natural Science Foundation of China,No.82302332 and No.82272100Guiding Science and Technology Research Project of Quzhou,No.ZD2022020.
文摘BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quality multicenter data remain limited,and the prognostic impact of site-specific extrapulmonary metastases is not well defined.AIM To assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.METHODS This multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022.Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC,tumor diameter<50 mm,fewer than 5 metastatic lesions,and≤2 organs involved.Kaplan-Meier and Cox regression methods assessed survival outcomes,including local tumor progression-free survival,progression-free survival(PFS),and overall survival(OS).RESULTS The 3-year cumulative local tumor progression rate was 14.0%.Median PFS and OS were 15.6 and 51 months,respectively,with 3-and 5-year OS rates of 59.5%and 41.0%.Poor survival outcomes were associated with a higher tumor burden(larger size and greater number),carcinoembryonic antigen>20 ng/mL,carbohydrate antigen 19-9>37 U/mL,and extrapulmonary metastases.Patients without extrapulmonary metastasis had 1-,3-,and 5-year PFS rates of 65.4%,31.0%,and 27.3%,respectively,which were longer than those of CRLM patients with liver metastasis[hazard ratio(HR)=1.449,P=0.019]and abdominal cavity metastasis(HR=1.864,P=0.010).The 1-,3-,and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%,71.0%,and 53.0%,respectively,which were significantly longer than those for patients with bone metastasis(HR=4.538,P<0.001),abdominal cavity metastasis(HR=4.813,P<0.001),and pelvic cavity metastasis(HR=3.105,P<0.001).CONCLUSION Metastatic patterns significantly influence PFS and OS,emphasizing the need for careful patient selection.Notably,patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes,suggesting a distinct biological behavior and better prognosis within this subgroup.
文摘AIM:To investigate tumor response and survival in patients with postembolization fever(PEF) and to determine the risk factors for PEF.METHODS:Four hundred forty-three hepatocellular carcinoma(HCC) patients who underwent the first session of transcatheter arterial chemoembolization(TACE) between January 2005 and December 2009 were analyzed retrospectively.PEF was defined as a body temperature greater than 38.0 ℃ that developed within 3 d of TACE without evidence of infection.The tumor progression-free interval was defined as the interval from the first TACE to the second TACE based on mRECIST criteria.Clinical staging was based on the American Joint Committee on Cancer tumor,node,metastases(TNM) classification of malignant tumors.All patients were admitted before their 1 st TACE treatment,and blood samples were obtained from all patients before and after treatment.Clinicoradiological variables and host-related variables were compared between two groups:patients with PEF vs patients without PEF.Additionally,variables related to 20-mo mortality and tumor progression-free survival were analyzed.RESULTS:The study population comprised 370(85.4%) men and 73(14.6%) women with a mean age of 62.29 ± 10.35 years.A total of 1836 TACE sessions were conducted in 443 patients,and each patient received between 1 and 27(mean:4.14 ± 3.57) TACE sessions.The mean follow-up duration was 22.23 ± 19.6 mo(range:0-81 mo).PEF developed in 117 patients(26.41%) at the time of the first TACE session.PEF was not associated with 20-mo survival(P = 0.524) or computed tomography(CT) response(P = 0.413) in a univariate analysis.A univariate analysis further indicated that diffuse-type HCC(P = 0.021),large tumor size(≥ 5 cm)(P = 0.046),lipiodol dose(≥ 7 mL,P = 0.001),poor blood glucose control(P = 0.034),alanine aminotransferase(ALT) value after TACE(P = 0.004) and C-reactive protein(CRP) value after TACE(P = 0.036) served as possible risk factors correlated with PEF.The ALT value after TACE(P = 0.021) and lipiodol dose over 7 mL(P = 0.011) were independent risk factors for PEF in the multivariate analysis.For the 20-mo survival,poor blood sugar control(P < 0.001),portal vein thrombosis(P = 0.001),favorable CT response after TACE(P < 0.001),initial aspartate aminotransferase(P = 0.02),initial CRP(P = 0.042),tumor size(P < 0.001),TNM stage(P < 0.001) and lipiodol dose(P < 0.001) were possible risk factors in the univariate analysis.Tumor size(P = 0.03),poor blood sugar control(P = 0.043),and portal vein thrombosis(P = 0.031) were significant predictors of survival in the multivariate analysis.Furthermore,the tumor progression-free interval was closely associated with CRP > 1 mg/dL(P = 0.003),tumor size > 5 cm(P < 0.001),tumor type(poorly defined)(P < 0.001),and lipiodol dose(> 7 mL,P < 0.001).CONCLUSION:PEF has no impact on survival at 20 mo or radiologic response.However,the ALT level after TACE and the lipiodol dose represent significant risk factors for PEF.
基金supported by the Longhua Medicial Project (D-11)The Science and Technology Commission of Shanghai Municipality (No.12401905700)
文摘BACKGROUND： Traditional Chinese medicine （TCM） is considered an important complementary therapy with beneficial effects for cancer patients. Elderly patients with non-small-cell lung cancer （NSCLC） are a complex patient group with increasing co-morbidity and shrinking physiological reserve, and may derive substantial benefit from the supportive aspects of TCM Researchers from Shanghai Longhua Hospital found that qi and yin deficiency is a common syndrome in patients with stage III or IV lung cancer. This project was designed to study the combination of single-agent chemotherapy with TCM methods of benefiting qi and yin in elderly patients with advanced NSCLC. METHODS AND DESIGN： This is a double-blind controlled, multi-center, and prospective study with randomly selected participants from elderly NSCLC patients in China. Seventy-six patients who meet the inclusion criteria will be allocated into two groups, which will receive treatments of 3-week single-agent chemotherapy with TCM or placebo for four cycles Progression-free survival （PFS） is the primary end point, and the secondary end points are overall survival, objective response rate, time-to-progression, and quality of life （EORTC QLQ-LC43, and TCM syndrome score） Meanwhile, other end points such as toxicity, side effects and safety of the treatments will be assessed. DISCUSSION： Results from this study may provide evidence on the effectiveness, and parameters for the usage of single-agent chemotherapy combined with or without TCM on PFS of elderly patients with NSCLC.
