Purpose:Regard preoperative chemotherapy as a holistic sequential treatment modality to identify predictive factors associated with recurrence and survival in pancreatic ductal adenocarcinoma(PDAC)and construct models...Purpose:Regard preoperative chemotherapy as a holistic sequential treatment modality to identify predictive factors associated with recurrence and survival in pancreatic ductal adenocarcinoma(PDAC)and construct models to provide decision support and treatment selection for the candidate patients.Methods:Retrospect PDAC patients who received preoperative chemotherapy from January 2016 to June 2023 at the Second Affiliated Hospital of Zhejiang University School of Medicine.Run a univariate and multivariate analysis of factors associated with recurrence-free survival(RFS)and overall survival(OS).Scoring systems were developed based on the hazard ratios(HR)of all significant predictors.Kaplan-Meier analyses and log-rank tests were used to calculate RFS and OS.Results:A total of 72 PDAC patients with preoperative chemotherapy were analyzed.After preoperative chemotherapy,21(29.17%)patients achieved any radiologic downstaging with 68(94.44%)patients achieving negative resection margin status(R0 margins).For carbohydrate antigen 19-9(CA19-9)non-secreting patients,shrinkage rate of length diameter of tumor≥20%(P=.027),resection margin status(P=.011)were independent predictors of OS.For CA19-9-secreting patients,CA19-9 serum level at the end of chemotherapy≥1000(P=.027)and resection margin status(P=.012)were independent predictors of OS.Points according to HR were allocated to these factors in the proposed scoring system,respectively.Recurrence curves and survival curves with statistically significant differences were also presented for patients grouped according to the scoring systems.For CA19-9-non-secreting patients,the OS of patients with a score from 2 to 2.97 was significantly shorter than that of patients with a score from 4.94 to 5.91(P=.009).For CA19-9-secreting patients,the OS of patients with a score of 2 was significantly shorter than that of patients with a score from 3.75 to 4.99(P<.001).Conclusion:Simple scoring models for RFS and OS incorporating CA19-9 serum levels or the tumor shrinkage rate and post-operative pathology may assist clinicians in evaluating the prognosis of PDAC patients with preoperative chemotherapy.展开更多
A DRNN (diagonal recurrent neural network) and its RPE (recurrent prediction error) learning algorithm are proposed in this paper .Using of the simple structure of DRNN can reduce the capacity of calculation. The prin...A DRNN (diagonal recurrent neural network) and its RPE (recurrent prediction error) learning algorithm are proposed in this paper .Using of the simple structure of DRNN can reduce the capacity of calculation. The principle of RPE learning algorithm is to adjust weights along the direction of Gauss-Newton. Meanwhile, it is unnecessary to calculate the second local derivative and the inverse matrixes, whose unbiasedness is proved. With application to the extremely short time prediction of large ship pitch, satisfactory results are obtained. Prediction effect of this algorithm is compared with that of auto-regression and periodical diagram method, and comparison results show that the proposed algorithm is feasible.展开更多
<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Hepatocellular carcinoma is the third leading cause of tumor </span&...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Hepatocellular carcinoma is the third leading cause of tumor </span><span style="font-family:Verdana;">related mortality and develops mostly in patients with chronic liver disease and</span><span style="font-family:;" "=""> <span style="font-family:Verdana;">liver cirrhosis. Human hepatocyte growth factor (HGF) is produced in various</span> <span style="font-family:Verdana;">organs of the body and is characterized as a multifunctional factor with vari</span><span style="font-family:Verdana;">ous biologic activities. </span><b><span style="font-family:Verdana;">Aim:</span></b><span style="font-family:Verdana;"> Our aim was to investigate the predictive factors of </span><span style="font-family:Verdana;">recurrence specially the role of HGF in patients with HCC treated with TACE. </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> one hundred HCC patients treated by TACE who </span><span style="font-family:Verdana;">achieved complete response were included and divided into two groups a</span><span style="font-family:Verdana;">ccording to disease free survival (DFS) status at 1 year: the non</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">early recurrence</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> (NER) group (1) and the early recurrence (ER) group (2). Univariate binary logistic regression analysis for the possible risk factors of recurrence showed that AFP, multinodularity and HGF level were significant. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> high </span><span style="font-family:Verdana;">AFP, multinodularity and high HGF were inter-related possible risk factor</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> for</span><span style="font-family:Verdana;"> 1-year recurrence of HCC in patients with initial remission following TACE</span><span style="font-family:Verdana;">.</span>展开更多
Gastrointestinal stromal tumors(GISTs),the most prevalent mesenchymal tumors,often have poor outcomes due to high recurrence rates.However,the specific risk factors for GISTs,particularly those concerning the innate i...Gastrointestinal stromal tumors(GISTs),the most prevalent mesenchymal tumors,often have poor outcomes due to high recurrence rates.However,the specific risk factors for GISTs,particularly those concerning the innate immune-inflammatory response,remain poorly understood.This editorial highlights key prognostic factors that impact GIST progression and prognosis,while discussing the findings of a recent study that investigated the prognostic value of systemic inflammatory markers:systemic immune-inflammation index,neutrophil/lym-phocyte ratio,platelet/lymphocyte ratio,and monocyte/lymphocyte ratio,on recurrence-free survival in GIST patients.This editorial examines strategies to enhance the clinical applicability of the nomogram developed in the study,ensuring its effectiveness for robust implementation.Future directions outlined in the editorial stress the importance of integrating molecular insights,including KIT and PDGFRA mutations,tumor staging,and mitotic rates to refine predictive models.The editorial also underscores the value of multi-center studies to enhance the generalizability and clinical relevance of these approaches.By bridging inflammatory biomarkers with genetic and clinicopathologic factors,a more comprehensive understanding of GIST pathophysiology can be developed,paving the way for improved management strategies and patient outcomes.This perspective serves as a call to action for continued research into the interplay between genetic mutations,inflammatory marker modulation,and GIST progression,aiming to expand the scope of personalized oncology through a deeper understanding of GIST progression.展开更多
Background:Breast cancer with low-positive human epidermal growth factor receptor 2(HER2)expression has triggered further refinement of evaluation criteria for HER2 expression.We studied the clinicopathological featur...Background:Breast cancer with low-positive human epidermal growth factor receptor 2(HER2)expression has triggered further refinement of evaluation criteria for HER2 expression.We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors.Methods:Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association,from January 2015 to December 2016 were collected.The prognostic factors of these patients were analyzed.Results:Twenty-nine hospitals provided valid cases.From 2015 to 2016,a total of 25,096 cases of early-stage breast cancer were treated,7642(30.5%)of which had low-positive HER2 expression and were included in the study.After ineligible cases were excluded,6486 patients were included in the study.The median follow-up time was 57 months(4-76 months).The disease-free survival rate was 92.1%at 5 years,and the overall survival rate was 97.4%at 5 years.At the follow-up,506(7.8%)cases of metastasis and 167(2.6%)deaths were noted.Multivariate Cox regression analysis showed that tumor stage,lymphvascular invasion,and the Ki67 index were related to recurrence and metastasis(P<0.05).The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815(95%confidence interval:0.750-0.880).Conclusions:Early-stage breast cancer patients with low-positive HER2 expression account for 30.5%of all patients.Tumor stage,lymphvascular invasion,and the Ki67 index are factors affecting prognosis.The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years.Trial registration:ChiCTR.org.cn,ChiCTR2100046766.展开更多
BACKGROUND： Four tumor markers for hepatocellular carcinoma（HCC）, alpha-fetoprotein（AFP）, glypican-3（GPC3）, vascular endothelial growth factor（VEGF） and des-gammacarboxy prothrombin（DCP）, are closely associ...BACKGROUND： Four tumor markers for hepatocellular carcinoma（HCC）, alpha-fetoprotein（AFP）, glypican-3（GPC3）, vascular endothelial growth factor（VEGF） and des-gammacarboxy prothrombin（DCP）, are closely associated with tumor invasion and patient＇s survival. This study estimated the predictability of preoperative tumor marker levels along with pathological parameters on HCC recurrence after hepatectomy.METHODS： A total of 140 patients with HCC who underwent hepatectomy between January 2012 and August 2012 were enrolled. The demographics, clinical and follow-up data were collected and analyzed. The patients were divided into two groups： patients with macroscopic vascular invasion（Ma VI ＋） and those without Ma VI（Ma VI-）. The predictive value of tumor markers and clinical parameters were evaluated by univariate and multivariate analysis.RESULTS： In all patients, tumor size（〉8 cm） and Ma VI were closely related to HCC recurrence after hepatectomy. For Ma VI＋ patients, VEGF（〉900 pg/m L） was a significant predictor for recurrence（RR=2.421; 95% CI： 1.272-4.606; P=0.007）. The 1- and 2-year tumor-free survival rates for Ma VI＋ patients with VEGF ≤900 pg/m L versus for those with VEGF 〉900 pg/m L were 51.5% and 17.6% versus 19.0% and 4.8%（P〈0.001）. For Ma VI- patients, DCP 〉445 m Au/m L and tumor size 〉8 cm were two independent risk factors for tumor recurrence（RR=2.307, 95% CI： 1.132-4.703, P=0.021; RR=3.150, 95% CI： 1.392-7.127, P=0.006; respectively）. The 1- and 2-year tumor-free survival rates for the patients with DCP ≤445 m Au/m L and those with DCP 〉445 m Au/m L were 90.4% and 70.7% versus 73.2% and 50.5% respectively（P=0.048）. The 1-and 2-year tumor-free survival rates for the patients with tumor size ≤8 cm and 〉8 cm were 83.2% and 62.1% versus 50.0% and 30.0%, respectively（P=0.003）.CONCLUSIONS： The Ma VI＋ patients with VEGF ≤900 pg/m L had a relatively high tumor-free survival than those with VEGF 〉900 pg/m L. In the Ma VI- patients, DCP 〉445 m Au/m L and tumor size 〉8 cm were predictive factors for postoperative recurrence.展开更多
Catheter ablation has been recommended as a treatment option for paroxysmal atrial fibrillation（PAF） patients complicated with type 2 diabetes mellitus（T2DM）. PAF patients with T2 DM have a higher recurrence rate ...Catheter ablation has been recommended as a treatment option for paroxysmal atrial fibrillation（PAF） patients complicated with type 2 diabetes mellitus（T2DM）. PAF patients with T2 DM have a higher recurrence rate after catheter ablation. Prolongation of corrected QT（QTc） interval has been linked to poor outcomes in T2 DM patients. Whether the abnormal QTc interval is associated with the ablation outcome in the PAF patients with T2 DM remains unknown. In this study, 134 PAF patients with T2 DM undergoing primary catheter ablation were retrospectively enrolled. Pre-procedural QTc interval was corrected by using the Bazett＇s formula. Cox proportional hazards models were constructed to assess the relationship between QTc interval and the recurrence of AF. After a 29.1-month follow-up period, 61 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had a longer QTc interval than non-recurrent patients（425.2±21.5 ms vs. 414.1±13.4 ms, P=0.002）. Multivariate Cox regression analysis revealed that QTc interval [hazard ratio（HR）=1.026, 95% confidence interval（CI） 1.012–1.040, P=0.005] and left atrial diameter（LAD）（HR=1.125, 95% CI 1.062–1.192, P=0.003） were independent predictors of recurrent atrial tachyarrhythmia. Receiver operating characteristic analysis demonstrated that the cut-off value of QTc（418 ms） predicted arrhythmia recurrence with a sensitivity of 55.7% and a specificity of 69.9%. A combination of LAD and QTc was more effective than LAD alone（P〈0.001） in predicting arrhythmia recurrence after the procedure. QTc interval could be used as an independent predictor of arrhythmia recurrence in T2 DM patients undergoing AF ablation, thus providing a simple method to identify those patients who likely have a better outcome following the procedure.展开更多
Background and Aims:Hepatocellular carcinoma(HCC)cases with small nodules are commonly treated with radi-ofrequency ablation(RFA),but the recurrence rate remains high.This study aimed to establish a blood signature fo...Background and Aims:Hepatocellular carcinoma(HCC)cases with small nodules are commonly treated with radi-ofrequency ablation(RFA),but the recurrence rate remains high.This study aimed to establish a blood signature for identifying HCC with metastatic traits pre-RFA.Methods:Data from HCC patients treated between 2010 and 2017 were retrospectively collected.A blood signature for meta-static HCC was established based on blood levels of alpha-fetoprotein and des-γ-carboxy-prothrombin,cell-free DNA(cfDNA)mutations,and methylation changes in target genes in frozen-stored plasma samples that were collected before RFA performance.The HCC blood signature was validated in patients prospectively enrolled in2021.Results:Of 251 HCC patients in the retrospective study,33.9% experienced recurrence within 1 year post-RFA.The HCC blood signature identified from these patients included des-γ-carboxy-prothrombin≥40mAU/mL with cfDNA mutation score,where cfDNA mutations occurred in the genes of TP53,CTNNB1,and TERT promoter.This signature effectively predicted 1-year post-RFArecurrence of HCC with 92% specificity and 91% sensitivity in the retrospective dataset,and with 87% specificity and 76% sensitivity in the prospective dataset(n=32 patients).Among 14 cases in the prospective study with biopsy tissues available,positivity for the HCC blood signature was associated with a higher HCC tissue score and shorter distance between HCC cells and microvasculature.Conclusions:This study established an HCC blood signature in pre-RFA blood that potentially reflects HCC with metastatic traits and may be valuable for predicting the disease’s early recurrence post-RFA.展开更多
基金the financial support by Key Project of Traditional Chinese Medicine Science and Technology Plan of Zhejiang Province(No.GZY-ZJ-KJ-24077)National Natural Science Foundation of China(Nos.82001673 and 82272860)+2 种基金Fundamental Research Funds for the Central Universities(No.226-2023-00038)Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province(No.CXPJJH12000009-07)Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province(No.2020E10004).
文摘Purpose:Regard preoperative chemotherapy as a holistic sequential treatment modality to identify predictive factors associated with recurrence and survival in pancreatic ductal adenocarcinoma(PDAC)and construct models to provide decision support and treatment selection for the candidate patients.Methods:Retrospect PDAC patients who received preoperative chemotherapy from January 2016 to June 2023 at the Second Affiliated Hospital of Zhejiang University School of Medicine.Run a univariate and multivariate analysis of factors associated with recurrence-free survival(RFS)and overall survival(OS).Scoring systems were developed based on the hazard ratios(HR)of all significant predictors.Kaplan-Meier analyses and log-rank tests were used to calculate RFS and OS.Results:A total of 72 PDAC patients with preoperative chemotherapy were analyzed.After preoperative chemotherapy,21(29.17%)patients achieved any radiologic downstaging with 68(94.44%)patients achieving negative resection margin status(R0 margins).For carbohydrate antigen 19-9(CA19-9)non-secreting patients,shrinkage rate of length diameter of tumor≥20%(P=.027),resection margin status(P=.011)were independent predictors of OS.For CA19-9-secreting patients,CA19-9 serum level at the end of chemotherapy≥1000(P=.027)and resection margin status(P=.012)were independent predictors of OS.Points according to HR were allocated to these factors in the proposed scoring system,respectively.Recurrence curves and survival curves with statistically significant differences were also presented for patients grouped according to the scoring systems.For CA19-9-non-secreting patients,the OS of patients with a score from 2 to 2.97 was significantly shorter than that of patients with a score from 4.94 to 5.91(P=.009).For CA19-9-secreting patients,the OS of patients with a score of 2 was significantly shorter than that of patients with a score from 3.75 to 4.99(P<.001).Conclusion:Simple scoring models for RFS and OS incorporating CA19-9 serum levels or the tumor shrinkage rate and post-operative pathology may assist clinicians in evaluating the prognosis of PDAC patients with preoperative chemotherapy.
文摘A DRNN (diagonal recurrent neural network) and its RPE (recurrent prediction error) learning algorithm are proposed in this paper .Using of the simple structure of DRNN can reduce the capacity of calculation. The principle of RPE learning algorithm is to adjust weights along the direction of Gauss-Newton. Meanwhile, it is unnecessary to calculate the second local derivative and the inverse matrixes, whose unbiasedness is proved. With application to the extremely short time prediction of large ship pitch, satisfactory results are obtained. Prediction effect of this algorithm is compared with that of auto-regression and periodical diagram method, and comparison results show that the proposed algorithm is feasible.
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Hepatocellular carcinoma is the third leading cause of tumor </span><span style="font-family:Verdana;">related mortality and develops mostly in patients with chronic liver disease and</span><span style="font-family:;" "=""> <span style="font-family:Verdana;">liver cirrhosis. Human hepatocyte growth factor (HGF) is produced in various</span> <span style="font-family:Verdana;">organs of the body and is characterized as a multifunctional factor with vari</span><span style="font-family:Verdana;">ous biologic activities. </span><b><span style="font-family:Verdana;">Aim:</span></b><span style="font-family:Verdana;"> Our aim was to investigate the predictive factors of </span><span style="font-family:Verdana;">recurrence specially the role of HGF in patients with HCC treated with TACE. </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> one hundred HCC patients treated by TACE who </span><span style="font-family:Verdana;">achieved complete response were included and divided into two groups a</span><span style="font-family:Verdana;">ccording to disease free survival (DFS) status at 1 year: the non</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">early recurrence</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> (NER) group (1) and the early recurrence (ER) group (2). Univariate binary logistic regression analysis for the possible risk factors of recurrence showed that AFP, multinodularity and HGF level were significant. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> high </span><span style="font-family:Verdana;">AFP, multinodularity and high HGF were inter-related possible risk factor</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> for</span><span style="font-family:Verdana;"> 1-year recurrence of HCC in patients with initial remission following TACE</span><span style="font-family:Verdana;">.</span>
文摘Gastrointestinal stromal tumors(GISTs),the most prevalent mesenchymal tumors,often have poor outcomes due to high recurrence rates.However,the specific risk factors for GISTs,particularly those concerning the innate immune-inflammatory response,remain poorly understood.This editorial highlights key prognostic factors that impact GIST progression and prognosis,while discussing the findings of a recent study that investigated the prognostic value of systemic inflammatory markers:systemic immune-inflammation index,neutrophil/lym-phocyte ratio,platelet/lymphocyte ratio,and monocyte/lymphocyte ratio,on recurrence-free survival in GIST patients.This editorial examines strategies to enhance the clinical applicability of the nomogram developed in the study,ensuring its effectiveness for robust implementation.Future directions outlined in the editorial stress the importance of integrating molecular insights,including KIT and PDGFRA mutations,tumor staging,and mitotic rates to refine predictive models.The editorial also underscores the value of multi-center studies to enhance the generalizability and clinical relevance of these approaches.By bridging inflammatory biomarkers with genetic and clinicopathologic factors,a more comprehensive understanding of GIST pathophysiology can be developed,paving the way for improved management strategies and patient outcomes.This perspective serves as a call to action for continued research into the interplay between genetic mutations,inflammatory marker modulation,and GIST progression,aiming to expand the scope of personalized oncology through a deeper understanding of GIST progression.
基金supported by grants from the Youth Cultivation Fund of Beijing Medical Ward Foundation(No.20180502)Beijing Medical Ward Foundation(No.YXJL-2020-0941-0736)。
文摘Background:Breast cancer with low-positive human epidermal growth factor receptor 2(HER2)expression has triggered further refinement of evaluation criteria for HER2 expression.We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors.Methods:Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association,from January 2015 to December 2016 were collected.The prognostic factors of these patients were analyzed.Results:Twenty-nine hospitals provided valid cases.From 2015 to 2016,a total of 25,096 cases of early-stage breast cancer were treated,7642(30.5%)of which had low-positive HER2 expression and were included in the study.After ineligible cases were excluded,6486 patients were included in the study.The median follow-up time was 57 months(4-76 months).The disease-free survival rate was 92.1%at 5 years,and the overall survival rate was 97.4%at 5 years.At the follow-up,506(7.8%)cases of metastasis and 167(2.6%)deaths were noted.Multivariate Cox regression analysis showed that tumor stage,lymphvascular invasion,and the Ki67 index were related to recurrence and metastasis(P<0.05).The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815(95%confidence interval:0.750-0.880).Conclusions:Early-stage breast cancer patients with low-positive HER2 expression account for 30.5%of all patients.Tumor stage,lymphvascular invasion,and the Ki67 index are factors affecting prognosis.The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years.Trial registration:ChiCTR.org.cn,ChiCTR2100046766.
基金supported by grants from the National High Technology Research and Development Program of China(863 Program 2012AA020204)the"New-Century 151 Talent Program"of Zhejiang Province(the 1st level)+1 种基金Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health TalentsPublic Technology Research Projects of Science and Technology Department of Zhejiang,China(2014C37061)
文摘BACKGROUND： Four tumor markers for hepatocellular carcinoma（HCC）, alpha-fetoprotein（AFP）, glypican-3（GPC3）, vascular endothelial growth factor（VEGF） and des-gammacarboxy prothrombin（DCP）, are closely associated with tumor invasion and patient＇s survival. This study estimated the predictability of preoperative tumor marker levels along with pathological parameters on HCC recurrence after hepatectomy.METHODS： A total of 140 patients with HCC who underwent hepatectomy between January 2012 and August 2012 were enrolled. The demographics, clinical and follow-up data were collected and analyzed. The patients were divided into two groups： patients with macroscopic vascular invasion（Ma VI ＋） and those without Ma VI（Ma VI-）. The predictive value of tumor markers and clinical parameters were evaluated by univariate and multivariate analysis.RESULTS： In all patients, tumor size（〉8 cm） and Ma VI were closely related to HCC recurrence after hepatectomy. For Ma VI＋ patients, VEGF（〉900 pg/m L） was a significant predictor for recurrence（RR=2.421; 95% CI： 1.272-4.606; P=0.007）. The 1- and 2-year tumor-free survival rates for Ma VI＋ patients with VEGF ≤900 pg/m L versus for those with VEGF 〉900 pg/m L were 51.5% and 17.6% versus 19.0% and 4.8%（P〈0.001）. For Ma VI- patients, DCP 〉445 m Au/m L and tumor size 〉8 cm were two independent risk factors for tumor recurrence（RR=2.307, 95% CI： 1.132-4.703, P=0.021; RR=3.150, 95% CI： 1.392-7.127, P=0.006; respectively）. The 1- and 2-year tumor-free survival rates for the patients with DCP ≤445 m Au/m L and those with DCP 〉445 m Au/m L were 90.4% and 70.7% versus 73.2% and 50.5% respectively（P=0.048）. The 1-and 2-year tumor-free survival rates for the patients with tumor size ≤8 cm and 〉8 cm were 83.2% and 62.1% versus 50.0% and 30.0%, respectively（P=0.003）.CONCLUSIONS： The Ma VI＋ patients with VEGF ≤900 pg/m L had a relatively high tumor-free survival than those with VEGF 〉900 pg/m L. In the Ma VI- patients, DCP 〉445 m Au/m L and tumor size 〉8 cm were predictive factors for postoperative recurrence.
基金supported by grants from the Ministry of Science and Technology of the People’s Republic of China(No.2013BAI09B02 and No.2013DFB30310)Beijing Municipal Commission of Science and Technology(No.D131100002-313001)the National Science Foundation Council of China(Nos.81170168,81370290,81370292 and 81470465)
文摘Catheter ablation has been recommended as a treatment option for paroxysmal atrial fibrillation（PAF） patients complicated with type 2 diabetes mellitus（T2DM）. PAF patients with T2 DM have a higher recurrence rate after catheter ablation. Prolongation of corrected QT（QTc） interval has been linked to poor outcomes in T2 DM patients. Whether the abnormal QTc interval is associated with the ablation outcome in the PAF patients with T2 DM remains unknown. In this study, 134 PAF patients with T2 DM undergoing primary catheter ablation were retrospectively enrolled. Pre-procedural QTc interval was corrected by using the Bazett＇s formula. Cox proportional hazards models were constructed to assess the relationship between QTc interval and the recurrence of AF. After a 29.1-month follow-up period, 61 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had a longer QTc interval than non-recurrent patients（425.2±21.5 ms vs. 414.1±13.4 ms, P=0.002）. Multivariate Cox regression analysis revealed that QTc interval [hazard ratio（HR）=1.026, 95% confidence interval（CI） 1.012–1.040, P=0.005] and left atrial diameter（LAD）（HR=1.125, 95% CI 1.062–1.192, P=0.003） were independent predictors of recurrent atrial tachyarrhythmia. Receiver operating characteristic analysis demonstrated that the cut-off value of QTc（418 ms） predicted arrhythmia recurrence with a sensitivity of 55.7% and a specificity of 69.9%. A combination of LAD and QTc was more effective than LAD alone（P〈0.001） in predicting arrhythmia recurrence after the procedure. QTc interval could be used as an independent predictor of arrhythmia recurrence in T2 DM patients undergoing AF ablation, thus providing a simple method to identify those patients who likely have a better outcome following the procedure.
基金funded by CAMS Innovation Fund for Medical Sciences(CIFMS,2021-I2M-1-066 to CQ)Open Funding of the State Key Lab of Molecular Oncology(SKLMOKF2021-06 to HX).
文摘Background and Aims:Hepatocellular carcinoma(HCC)cases with small nodules are commonly treated with radi-ofrequency ablation(RFA),but the recurrence rate remains high.This study aimed to establish a blood signature for identifying HCC with metastatic traits pre-RFA.Methods:Data from HCC patients treated between 2010 and 2017 were retrospectively collected.A blood signature for meta-static HCC was established based on blood levels of alpha-fetoprotein and des-γ-carboxy-prothrombin,cell-free DNA(cfDNA)mutations,and methylation changes in target genes in frozen-stored plasma samples that were collected before RFA performance.The HCC blood signature was validated in patients prospectively enrolled in2021.Results:Of 251 HCC patients in the retrospective study,33.9% experienced recurrence within 1 year post-RFA.The HCC blood signature identified from these patients included des-γ-carboxy-prothrombin≥40mAU/mL with cfDNA mutation score,where cfDNA mutations occurred in the genes of TP53,CTNNB1,and TERT promoter.This signature effectively predicted 1-year post-RFArecurrence of HCC with 92% specificity and 91% sensitivity in the retrospective dataset,and with 87% specificity and 76% sensitivity in the prospective dataset(n=32 patients).Among 14 cases in the prospective study with biopsy tissues available,positivity for the HCC blood signature was associated with a higher HCC tissue score and shorter distance between HCC cells and microvasculature.Conclusions:This study established an HCC blood signature in pre-RFA blood that potentially reflects HCC with metastatic traits and may be valuable for predicting the disease’s early recurrence post-RFA.
