Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit ...Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit resection(SUICR) for patients with distal upper urinary tract recurrence of bladder cancer following radical cystectomy.Four patients with high-grade distal upper urinary tract recurrence underwent SUICR 15-108 months after radical cystectomy.The surgical technique details of SUICR,operative results,and follow-up outcomes are reported.The median operation time was 280 min,and estimated blood loss was less than 100 ml One patient suffered from ileus 5 days after surgery and was managed conservatively.Histopathologic evaluation showed high-grade stages pTa-pT1 diseases for these patients,and ureteral margins were all negative.No patient suffered from tumor recurrence,with a median follow-up of 39 months.SUICR preserved the ipsilateral renal unit and conformed to oncological principles during surgery.The oncological outcome was satisfactory for these properly selected patients.This technique provides a valid alternative to nephroureterectomy for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.展开更多
Objective Recurrence of local segmental glomerulosderosis(FSGS) in 2 patients with renal allograft was reported. Methods A male child aged 15 years and a male adult aged 25 years with primary FSGS, who were June 2003 ...Objective Recurrence of local segmental glomerulosderosis(FSGS) in 2 patients with renal allograft was reported. Methods A male child aged 15 years and a male adult aged 25 years with primary FSGS, who were June 2003 Vol12 No2 subjected to cadaveric kidney transplantation, had a recurrent nephritic syndrome showing massive proteinuria, hyperlipidemia and hypertension respectively in 2 weeks and 18 months postoperatively, that was suspected a recurrent FSGS. The child immediately was treated with Benazepril hydrochlocide,30 mg/day plus high dosage of Prednisolone(1 mg/kg every day) for 6 weeks, but proteinuria was not ameliorated The adult was treated with high dosage of Prednisolone(1 mg/kg every) and Tripterygium wifordii for 12 weeks, but the syndrome was not improved. Results Two patients had recurrent FSGS according to renal biopsy revealing characterized by similar features: diffuse effacement of foot processes on electron microscope, segmental or focal sclerosis under light microscope and IgM,展开更多
We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for d...We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for differentiating ER from late recurrence,with implications for postrecurrence survival and overall survival.This offers not only a valuable timeframe for enhancing surveillance strategies in patients at higher risk,especially those who have undergone neoadjuvant chemoradiotherapy(CRT),but also raises questions about its applicability across different populations.Furthermore,the article suggests that while CRT is very effective in reducing locoregional recurrence,this treatment alone may not fully address the overall risk of ER.The authors advocate for personalized risk assessment and intensive surveillance during the postoperative period to improve outcomes,particularly in the first year.Future research should focus on larger,multicenter studies and incorporate advanced diagnostic techniques with genetic and molecular biomarkers to enhance prediction and management of ER.The ultimate goal is to refine treatment and surveillance strategies to improve survival and quality of life for patients with RC.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases pos...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.展开更多
Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarte...Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.展开更多
BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the cor...BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.展开更多
Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamm...Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamma-carboxy prothrombin(DCP),lack specificity,limiting their utility in risk strati-fication.YKL-40,a glycoprotein involved in extracellular matrix remodeling,hepatic stellate cell activation,and immune modulation,has emerged as a promising biomarker for post-LT surveillance.Elevated serum levels of YKL-40 are associated with advanced liver disease,tumor progression,and poorer post-LT outcomes,highlighting its potential to address gaps in early detection and personalized management of HCC recurrence.This manuscript synthesizes clinical and mechanistic evidence to evaluate YKL-40’s predictive utility in post-LT care.While preliminary findings demonstrate its specificity for liver-related pathologies,challenges remain,including assay standardization,lack of pro-spective validation,and the need to distinguish between malignant and non-malignant causes of elevated levels.Integrating YKL-40 into multi-biomarker panels with AFP and DCP could enhance predictive accuracy and enable tailored therapeutic strategies.Future research should focus on multicenter studies to validate YKL-40’s clinical utility,address confounding factors like graft rejection and systemic inflammation,and explore its role in predictive models driven by emerging technologies such as artificial intelligence.YKL-40 holds transformative potential in reshaping post-LT care through precision medicine,providing a pathway for better outcomes and improved management of high-risk LT recipients.展开更多
Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction mode...Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction model for postoperative recurrence in pancreatic cancer patients, incorporating multiple preoperative, intraoperative, and postoperative factors to assist clinical decision-making. Methods: A retrospective study was conducted on 216 patients who underwent surgical treatment for pancreatic malignancy at the First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2023. An independent external validation cohort of 76 patients from the Second Affiliated Hospital of Chongqing Medical University was used to validate the model. Seven independent risk factors for postoperative recurrence were identified through univariate and multivariate Cox regression analyses. The model’s performance was evaluated using the concordance index (C-index) and ROC curves, and its accuracy and clinical value were assessed using calibration curves and decision curve analysis (DCA). Results: The predictive model demonstrated good discriminatory power, with a C-index of 0.72 in the training cohort and 0.66 in the validation cohort. The ROC curves for predicting recurrence at 3, 6, and 12 months postoperatively showed AUC values ranging from 0.72 to 0.83, indicating strong predictive value. Calibration curves and DCA confirmed the model’s accuracy and clinical utility. Conclusion: This study successfully developed and validated a clinical prediction model that incorporates seven independent risk factors for postoperative recurrence in pancreatic cancer. The model provides a useful tool for predicting recurrence risk, aiding in the identification of high-risk patients, and informing clinical decision-making.展开更多
Background:Hepatocellular carcinoma(HCC)is a common malignancy with high mortality.Liver resection(LR)is a curative treatment for early-stage HCC,but the prognosis of HCC patients after LR is unsatisfactory because of...Background:Hepatocellular carcinoma(HCC)is a common malignancy with high mortality.Liver resection(LR)is a curative treatment for early-stage HCC,but the prognosis of HCC patients after LR is unsatisfactory because of tumor recurrence.Prognostic prediction models with great performance are urgently needed.The present study aimed to establish a novel prognostic nomogram to predict tumor recurrence in HCC patients after LR.Methods:We retrospectively analyzed 726 HCC patients who underwent LR between October 2011 and December 2016.Patients were randomly divided into the training cohort(n=508)and the testing cohort(n=218).The protein expression of 14 biomarkers in tumor tissues was assessed by immunohistochemistry.The nomogram predicting recurrence-free survival(RFS)was established by a multivariate Cox regression analysis model and was evaluated by calibration curves,Kaplan-Meier survival curves,time-dependent areas under the receiver operating characteristic(ROC)curves(AUCs),and decision curve analyses in both the training and testing cohorts.Results:Alpha-fetoprotein[hazard ratio(HR)=1.013,P=0.002],portal vein tumor thrombosis(HR=1.833,P<0.001),ascites(HR=2.024,P=0.014),tumor diameter(HR=1.075,P<0.001),Ecadherin(HR=0.859,P=0.011),EMA(HR=1.196,P=0.022),and PCNA(HR=1.174,P=0.031)immunohistochemistry scores were found to be independent factors for RFS.The 1-year and 3-year AUCs of the nomogram for RFS were 0.813 and 0.739,respectively.The patients were divided into the high-risk group and the low-risk group by median value which was generated from the nomogram,and Kaplan-Meier analysis revealed that the high-risk group had a shorter RFS than the low-risk group in both the training(P<0.001)and testing cohorts(P<0.001).Conclusions:Our newly developed nomogram integrated clinicopathological data and key gene expression data,and was verified to have high accuracy in predicting the RFS of HCC patients after LR.This model could be used for early identification of patients at high-risk of postoperative recurrence.展开更多
BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicat...BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.展开更多
BACKGROUND Cervical cancer,a prevalent gynecological malignancy,exhibits recurrence rates of 30%-50%post-treatment,with recurrent cases facing a dire 10%-20%long-term survival rate,severely impacting patients’mental ...BACKGROUND Cervical cancer,a prevalent gynecological malignancy,exhibits recurrence rates of 30%-50%post-treatment,with recurrent cases facing a dire 10%-20%long-term survival rate,severely impacting patients’mental health and quality of life.Fear of cancer recurrence(FCR)emerges as a critical psychological challenge,often leading to anxiety,social avoidance,and even suicidal tendencies.Despite its high prevalence,structured,evidence-based interventions for FCR in cervical cancer remain scarce,with most studies focusing on general psychological support rather than targeted strategies.The fear of progression theory provides a theoretical framework,highlighting cognitive-emotional conflicts arising from perceived threats of disease recurrence.Addressing this gap,this study developed a specialized,phased psychological intervention program grounded in fear of progression theory,aiming to reduce FCR and enhance resilience in cervical cancer survivors through multi-disciplinary strategies.AIM To establish a psychological intervention program to support the fear of cervical cancer recurrence and to alleviate the psychological pressure of patients after cervical cancer surgery.METHODS Thirteen experts were selected to conduct two rounds of correspondence through literature review and group discussions to amend the psychological intervention draft and form the basis for the psychological intervention.The selected experts also performed two rounds of correspondence to revise the psychological intervention draft and outline the first draft,and pre-experiments were conducted for further improvement of the psychological intervention program.Experiments were performed in 80 patients with cervical cancer to further improve the psychological intervention program of relapse fear support.RESULTS The expert authority coefficient of the first and second rounds was higher than 0.8,indicating high authority.The coordination coefficient>0.8 indicated high consistency with high significance(all P<0.05).The FCR Inventory,Kessler Psychological Distress Scale,Psychological Distress Thermometer,and General Hospital Anxiety and Depression Scale scores at 3 and 6 months in the study group were lower than those of the control group,and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Perceived Social Support Scale scores were higher than those of the control group(P<0.05).CONCLUSION The psychological intervention program of relapse fear support which considers the individual differences between patients and expert opinions,has a good scientific and practical basis,and can be used to enhance the quality of life of patients.展开更多
Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and p...Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.展开更多
Background:The high recurrence rate of hepatocellular carcinoma(HCC)following curative resection affects patient survival.The present study combined critical clinicopathological features and molecular markers to devel...Background:The high recurrence rate of hepatocellular carcinoma(HCC)following curative resection affects patient survival.The present study combined critical clinicopathological features and molecular markers to develop machine learning models to predict the risk of recurrence and mortality.We aimed to individualize risk stratification,post-surgical management strategies,and ultimately improve long-term prognosis for HCC patients with curative resections.Methods:A total of 815 HCC patients undergoing surgical resection were divided randomly into a training cohort(n=652)and a validation cohort(n=163).To build a high-accuracy recurrent/death classifier using clinicopathological characteristics and molecular biomarkers,four different machine learning models,including the Cox proportional risk model,generalized linear model,extreme gradient boosting(XGBoost)model,and random survival forest(RSF)model,were developed and comprehensively compared.The outcomes were recurrence-free survival(RFS)and overall survival(OS).Results:Factors including diabetes,albumin,tumor numbers,HCC diameter,portal vein tumor thrombus,blood loss,mismatch repair protein 2(MSH2),and epithelial membrane antigen were significantly associated with RFS,while albumin,HCC diameter,MSH2,and Barcelona Clinic Liver Cancer(BCLC)stage were significantly associated with OS.The RSF model not only grouped HCC patients into high-and lowprobability recurrence groups with significant differences in 5-year recurrence probability rate(training cohort:87.3%vs.51.5%,P<0.0001;validation cohort:75.9%vs.64.8%,P<0.0001),but also grouped HCC patients into high-and low-probability death groups with significant differences in 5-year death probability rate(training cohort:56.0%vs.15.3%,P<0.0001;validation cohort:50.0%vs.23.1%,P<0.0001).Conclusions:The RSF model accurately stratified HCC patient into high-and low-risk recurrence or death groups,which guides the surgeons to plan adjuvant therapy after surgery.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making pr...BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making precise treatment plans and improving patient prognosis.AIM To establish an intratumoral and peritumoral model for predicting ER in HCC patients following curative ablation.METHODS This study included a total of 288 patients from three Centers.The patients were divided into a primary cohort(n=222)and an external cohort(n=66).Radiomics and deep learning methods were combined for feature extraction,and models were constructed following a three-step feature selection process.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),while calibration curves and decision curve analysis(DCA)were used to assess calibration and clinical utility.Finally,Kaplan-Meier(K-M)analysis was used to stratify patients according to progression-free survival(PFS)and overall survival(OS).RESULTS The combined model,which utilizes the light gradient boosting machine learning algorithm and incorporates both intratumoral and peritumoral regions(5 mm and 10 mm),demonstrated the best predictive performance for ER following HCC ablation,achieving AUCs of 0.924 in the training set,0.899 in the internal validation set,and 0.839 in the external validation set.Calibration and DCA curves confirmed strong calibration and clinical utility,whereas K-M curves provided risk stratification for PFS and OS in HCC patients.CONCLUSION The most efficient model integrated the tumor region with the peritumoral 5 mm and 10 mm regions.This model provides a noninvasive,effective,and reliable method for predicting ER after curative ablation of HCC.展开更多
BACKGROUND Colorectal cancer(CRC)recurrence within a year post-surgery poses significant challenges for stage II/III patients.Few models currently predict this early recu-rrence with multi-dimensional considerations f...BACKGROUND Colorectal cancer(CRC)recurrence within a year post-surgery poses significant challenges for stage II/III patients.Few models currently predict this early recu-rrence with multi-dimensional considerations for risk stratification.AIM To develop a model for predicting the risk of recurrence within one year after sur-gery in patients with stage II/III CRC.METHODS We conducted a retrospective cohort study at Zhejiang Provincial Hospital of Chinese Medicine,including 349 stage II/III CRC patients.Clinical data were collected,and the dataset was randomly divided into training(n=244)and testing(n=105)sets.Univariate and multivariate logistic regression analyses identified risk factors for postoperative recurrence.Then a nomogram model was constructed and evaluated via receiver operating characteristic curves,calibration curves and decision curve analysis.RESULTS During the one-year follow-up,10.9%(38/349)of patients experienced recurrence.Univariate analysis identified tumor size,lymph node metastasis(N2 stage),neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,fatigue,and appetite loss as significant correlates of recurrence.Multivariate logistic regression con-firmed N2 stage,appetite loss,tumor size,and neutrophil-to-lymphocyte ratio as independent risk factors.The nomogram model showed excellent performance.The area under the receiver operating characteristic was 0.98(95%confidence interval:0.97-1.00)in training set and 0.91(95%confidence interval:0.84-0.97)in testing set.The decision curve analysis curves showed strong concordance between predicted and observed recurrence probabilities.CONCLUSION The model effectively predicts early postoperative recurrence in stage II/III CRC,integrating clinical,inflam-matory,and symptomatic factors.展开更多
BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influen...BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.展开更多
BACKGROUND In cases of colorectal cancer(CRC)with obstruction,patients experience local tissue edema due to intestinal obstruction.This condition stimulates the accumulation of inflammatory factors,activates cancer ce...BACKGROUND In cases of colorectal cancer(CRC)with obstruction,patients experience local tissue edema due to intestinal obstruction.This condition stimulates the accumulation of inflammatory factors,activates cancer cells,and increases the risk of tumor recurrence.At present,analyses and evaluation tools for factors influencing early postoperative recurrence in patients with CRC and obstruction are limited.AIM To explore the influencing factors and construct a predictive model of the early postoperative recurrence of CRC with obstruction.METHODS Data from 181 patients with CRC and obstruction who underwent surgery in the Department of Gastrointestinal Surgery,Suzhou Ninth Hospital Affiliated to Soochow University,between January 2017 and May 2023 were retrospectively collected.Patients with CRC and obstruction were divided into a recurrence group and a non-recurrence group based on whether recurrence occurred during the 2-year follow-up after surgery.Datasets from the two groups were compared.Subsequently,multiple logistic regression was employed to analyze the influencing factors of the early postoperative recurrence of CRC with obstruction.The nomogram prediction model was drawn using R software,and its performance was evaluated by the goodness of fit test and receiver operating characteristic(ROC)curve analysis.The clinical benefit rate of the model was evaluated by decision curves.RESULTS Among the 181 patients with CRC and obstruction,52(28.73%)experienced tumor recurrence within 2 years after surgery.Significant differences were observed in preoperative carcinoembryonic antigen(CEA),preoperative systemic immuneinflammation index(SII),tumor,node,and metastasis(TNM)stage,differentiation degree,nerve infiltration,and Ki-67 expression between the recurrence and non-recurrence groups(P<0.05).Multivariate logistic regression analysis showed that high preoperative CEA(OR=2.094,P=0.008),high preoperative SII(OR=2.795,P<0.001),TNM stage III(OR=1.644,P=0.027),poor differentiation(OR=1.861,P=0.035),and high Ki-67 expression(OR=2.467,P=0.001)were all influencing factors for early postoperative recurrence of CRC with obstruction.The area under the ROC curve of the nomograph model constructed based on this was 0.890,the goodness of fit deviation test was conducted(χ^(2)=3.903,P=0.866),and the decision curve display model demonstrated practical value in clinical practice.CONCLUSION The early recurrence rate of CRC with obstruction is high.CEA,SII,TNM staging,differentiation degree,and Ki-67 expression are factors related to early postoperative recurrence.A nomogram prediction model incorporating these factors can effectively evaluate the risk of early postoperative recurrence in patients with CRC.展开更多
OBJECTIVES:To systematically review the efficacy and safety of Jianpi formulas(健脾剂)in reducing the recurrence of colorectal adenoma(CRA)after polypectomy.METHODS:Randomized controlled trials(RCTs)investigating Jian...OBJECTIVES:To systematically review the efficacy and safety of Jianpi formulas(健脾剂)in reducing the recurrence of colorectal adenoma(CRA)after polypectomy.METHODS:Randomized controlled trials(RCTs)investigating Jianpi formulas for CRA post-polypectomy were systematically retrieved from eight electronic databases.The quality of the methodology was assessed using the Cochrane collaboration tool.The Grades of Recommendations Assessment Development and Evaluation(GRADE)approach was employed for evidence assessment.Statistical analyses were conducted using Statistics and Data Analysis(STATA)17(StataCorp(College Station,TX,USA)and Review Manager(RevMan)5.4(The Cochrane Collaboration(London,UK).RESULTS:The Meta-analysis,encompassing 18 RCTs with 1838 patients,revealed that Jianpi formulas significantly outperformed postoperative routine treatment.It demonstrated a reduction in the half-year recurrence rate[relative risk(RR)=0.41,95%confidence interval(CI)=0.33-0.49,Z=9.08,P<0.00001],the oneyear recurrence rate[RR=0.58,95%CI=0.49-0.69,Z=6.12,P<0.00001],and an enhancement in the clinical effective rate[RR=1.27,95%CI=1.19-1.36,Z=7.06,P<0.00001].The half-year recurrence rate and the clinical effective rate were medium-quality evidence.The one-year recurrence rate was low-quality evidence.Additionally,Jianpi formulas appear to be safe and do not increase adverse reactions compared to postoperative routine treatment alone.CONCLUSION:Jianpi formulas exhibit efficacy in reducing postoperative half-year and one-year recurrence rates while improving the clinical effective rate after polypectomy for CRA.展开更多
Background:Tumor recurrence severely impacts the prognosis of hepatocellular carcinoma(HCC)patients undergoing liver transplantation(LT).We aimed to explore novel and robust biomarkers for precise prediction of tumor ...Background:Tumor recurrence severely impacts the prognosis of hepatocellular carcinoma(HCC)patients undergoing liver transplantation(LT).We aimed to explore novel and robust biomarkers for precise prediction of tumor recurrence and prognosis following LT.Methods:Cancerous tissues of 252 HCC patients who underwent LT across three centers were included in the study.Tissue microarrays and in situ hybridization were utilized to assess the circ0006646 level.Kaplan-Meier method along with the log-rank test was performed to analyze overall survival and recurrence-free survival.To identify prognostic factors,particularly related to tumor recurrence,we conducted univariate and multivariate Cox regression analyses.Nomogram was constructed to predict the risk of tumor recurrence after LT and subsequently the efficacy of the nomogram was validated.Results:Elevated circ0006646 levels in HCC were associated with reduced survival and increased recurrence rates following LT(5-year overall survival:29.2%vs.60.4%,P<0.01;5-year recurrence-free survival:42.3%vs.63.0%,P<0.001).High circ0006646 expression was significantly correlated with higher Child-Pugh grade(P=0.040),larger total tumor diameter(P=0.033),and beyond the Milan criteria(P=0.033).Cox regression analysis unveiled that circ0006646 expression score,preoperative transarterial chemoembolization(TACE),positive HBsAg status,poor tumor differentiation and beyond the Hangzhou criteria were independent risk factors for post-transplant tumor recurrence,leading to the development of a novel nomogram for precise prediction.The nomogram demonstrated a reasonable prognostic effectiveness(area under the receiver operating characteristic curve=0.7636,C-index=0.745)and outperformed conventional models like the Milan criteria.Besides,the inclusion of circ0006646 enhanced the precision of the Milan and Hangzhou criteria.Moreover,circ0006646 served as a potent biomarker in alpha-fetoprotein(AFP)-negative HCC undergoing LT.Conclusions:circ0006646 is a novel and robust prognostic biomarker for predicting post-transplant survival and tumor recurrence in HCC patients.A nomogram integrating circ0006646 stands as a valuable prognostic instrument in LT for HCC.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better...BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.展开更多
基金supported by the foundation of Excellent Academic Leaders of Shanghai(XBR2013076)
文摘Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit resection(SUICR) for patients with distal upper urinary tract recurrence of bladder cancer following radical cystectomy.Four patients with high-grade distal upper urinary tract recurrence underwent SUICR 15-108 months after radical cystectomy.The surgical technique details of SUICR,operative results,and follow-up outcomes are reported.The median operation time was 280 min,and estimated blood loss was less than 100 ml One patient suffered from ileus 5 days after surgery and was managed conservatively.Histopathologic evaluation showed high-grade stages pTa-pT1 diseases for these patients,and ureteral margins were all negative.No patient suffered from tumor recurrence,with a median follow-up of 39 months.SUICR preserved the ipsilateral renal unit and conformed to oncological principles during surgery.The oncological outcome was satisfactory for these properly selected patients.This technique provides a valid alternative to nephroureterectomy for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.
文摘Objective Recurrence of local segmental glomerulosderosis(FSGS) in 2 patients with renal allograft was reported. Methods A male child aged 15 years and a male adult aged 25 years with primary FSGS, who were June 2003 Vol12 No2 subjected to cadaveric kidney transplantation, had a recurrent nephritic syndrome showing massive proteinuria, hyperlipidemia and hypertension respectively in 2 weeks and 18 months postoperatively, that was suspected a recurrent FSGS. The child immediately was treated with Benazepril hydrochlocide,30 mg/day plus high dosage of Prednisolone(1 mg/kg every day) for 6 weeks, but proteinuria was not ameliorated The adult was treated with high dosage of Prednisolone(1 mg/kg every) and Tripterygium wifordii for 12 weeks, but the syndrome was not improved. Results Two patients had recurrent FSGS according to renal biopsy revealing characterized by similar features: diffuse effacement of foot processes on electron microscope, segmental or focal sclerosis under light microscope and IgM,
文摘We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for differentiating ER from late recurrence,with implications for postrecurrence survival and overall survival.This offers not only a valuable timeframe for enhancing surveillance strategies in patients at higher risk,especially those who have undergone neoadjuvant chemoradiotherapy(CRT),but also raises questions about its applicability across different populations.Furthermore,the article suggests that while CRT is very effective in reducing locoregional recurrence,this treatment alone may not fully address the overall risk of ER.The authors advocate for personalized risk assessment and intensive surveillance during the postoperative period to improve outcomes,particularly in the first year.Future research should focus on larger,multicenter studies and incorporate advanced diagnostic techniques with genetic and molecular biomarkers to enhance prediction and management of ER.The ultimate goal is to refine treatment and surveillance strategies to improve survival and quality of life for patients with RC.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.
基金supported by grants from the National Natural Science Foundation of China(91959203,82272836 and 82373017)。
文摘Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.
文摘BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.
文摘Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamma-carboxy prothrombin(DCP),lack specificity,limiting their utility in risk strati-fication.YKL-40,a glycoprotein involved in extracellular matrix remodeling,hepatic stellate cell activation,and immune modulation,has emerged as a promising biomarker for post-LT surveillance.Elevated serum levels of YKL-40 are associated with advanced liver disease,tumor progression,and poorer post-LT outcomes,highlighting its potential to address gaps in early detection and personalized management of HCC recurrence.This manuscript synthesizes clinical and mechanistic evidence to evaluate YKL-40’s predictive utility in post-LT care.While preliminary findings demonstrate its specificity for liver-related pathologies,challenges remain,including assay standardization,lack of pro-spective validation,and the need to distinguish between malignant and non-malignant causes of elevated levels.Integrating YKL-40 into multi-biomarker panels with AFP and DCP could enhance predictive accuracy and enable tailored therapeutic strategies.Future research should focus on multicenter studies to validate YKL-40’s clinical utility,address confounding factors like graft rejection and systemic inflammation,and explore its role in predictive models driven by emerging technologies such as artificial intelligence.YKL-40 holds transformative potential in reshaping post-LT care through precision medicine,providing a pathway for better outcomes and improved management of high-risk LT recipients.
文摘Background: Pancreatic cancer is one of the most lethal malignancies, with postoperative recurrence severely affecting patient survival and prognosis. This study aims to develop and validate a clinical prediction model for postoperative recurrence in pancreatic cancer patients, incorporating multiple preoperative, intraoperative, and postoperative factors to assist clinical decision-making. Methods: A retrospective study was conducted on 216 patients who underwent surgical treatment for pancreatic malignancy at the First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2023. An independent external validation cohort of 76 patients from the Second Affiliated Hospital of Chongqing Medical University was used to validate the model. Seven independent risk factors for postoperative recurrence were identified through univariate and multivariate Cox regression analyses. The model’s performance was evaluated using the concordance index (C-index) and ROC curves, and its accuracy and clinical value were assessed using calibration curves and decision curve analysis (DCA). Results: The predictive model demonstrated good discriminatory power, with a C-index of 0.72 in the training cohort and 0.66 in the validation cohort. The ROC curves for predicting recurrence at 3, 6, and 12 months postoperatively showed AUC values ranging from 0.72 to 0.83, indicating strong predictive value. Calibration curves and DCA confirmed the model’s accuracy and clinical utility. Conclusion: This study successfully developed and validated a clinical prediction model that incorporates seven independent risk factors for postoperative recurrence in pancreatic cancer. The model provides a useful tool for predicting recurrence risk, aiding in the identification of high-risk patients, and informing clinical decision-making.
基金supported by a grant from the Exploration Project of Zhejiang Provincial Natural Science Foundation of China(LQ22H160031)。
文摘Background:Hepatocellular carcinoma(HCC)is a common malignancy with high mortality.Liver resection(LR)is a curative treatment for early-stage HCC,but the prognosis of HCC patients after LR is unsatisfactory because of tumor recurrence.Prognostic prediction models with great performance are urgently needed.The present study aimed to establish a novel prognostic nomogram to predict tumor recurrence in HCC patients after LR.Methods:We retrospectively analyzed 726 HCC patients who underwent LR between October 2011 and December 2016.Patients were randomly divided into the training cohort(n=508)and the testing cohort(n=218).The protein expression of 14 biomarkers in tumor tissues was assessed by immunohistochemistry.The nomogram predicting recurrence-free survival(RFS)was established by a multivariate Cox regression analysis model and was evaluated by calibration curves,Kaplan-Meier survival curves,time-dependent areas under the receiver operating characteristic(ROC)curves(AUCs),and decision curve analyses in both the training and testing cohorts.Results:Alpha-fetoprotein[hazard ratio(HR)=1.013,P=0.002],portal vein tumor thrombosis(HR=1.833,P<0.001),ascites(HR=2.024,P=0.014),tumor diameter(HR=1.075,P<0.001),Ecadherin(HR=0.859,P=0.011),EMA(HR=1.196,P=0.022),and PCNA(HR=1.174,P=0.031)immunohistochemistry scores were found to be independent factors for RFS.The 1-year and 3-year AUCs of the nomogram for RFS were 0.813 and 0.739,respectively.The patients were divided into the high-risk group and the low-risk group by median value which was generated from the nomogram,and Kaplan-Meier analysis revealed that the high-risk group had a shorter RFS than the low-risk group in both the training(P<0.001)and testing cohorts(P<0.001).Conclusions:Our newly developed nomogram integrated clinicopathological data and key gene expression data,and was verified to have high accuracy in predicting the RFS of HCC patients after LR.This model could be used for early identification of patients at high-risk of postoperative recurrence.
文摘BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.
文摘BACKGROUND Cervical cancer,a prevalent gynecological malignancy,exhibits recurrence rates of 30%-50%post-treatment,with recurrent cases facing a dire 10%-20%long-term survival rate,severely impacting patients’mental health and quality of life.Fear of cancer recurrence(FCR)emerges as a critical psychological challenge,often leading to anxiety,social avoidance,and even suicidal tendencies.Despite its high prevalence,structured,evidence-based interventions for FCR in cervical cancer remain scarce,with most studies focusing on general psychological support rather than targeted strategies.The fear of progression theory provides a theoretical framework,highlighting cognitive-emotional conflicts arising from perceived threats of disease recurrence.Addressing this gap,this study developed a specialized,phased psychological intervention program grounded in fear of progression theory,aiming to reduce FCR and enhance resilience in cervical cancer survivors through multi-disciplinary strategies.AIM To establish a psychological intervention program to support the fear of cervical cancer recurrence and to alleviate the psychological pressure of patients after cervical cancer surgery.METHODS Thirteen experts were selected to conduct two rounds of correspondence through literature review and group discussions to amend the psychological intervention draft and form the basis for the psychological intervention.The selected experts also performed two rounds of correspondence to revise the psychological intervention draft and outline the first draft,and pre-experiments were conducted for further improvement of the psychological intervention program.Experiments were performed in 80 patients with cervical cancer to further improve the psychological intervention program of relapse fear support.RESULTS The expert authority coefficient of the first and second rounds was higher than 0.8,indicating high authority.The coordination coefficient>0.8 indicated high consistency with high significance(all P<0.05).The FCR Inventory,Kessler Psychological Distress Scale,Psychological Distress Thermometer,and General Hospital Anxiety and Depression Scale scores at 3 and 6 months in the study group were lower than those of the control group,and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Perceived Social Support Scale scores were higher than those of the control group(P<0.05).CONCLUSION The psychological intervention program of relapse fear support which considers the individual differences between patients and expert opinions,has a good scientific and practical basis,and can be used to enhance the quality of life of patients.
基金Supported by the Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.
基金partially supported by grants from Key R&D Program of Zhejiang Province(2021C03G2013079)the General Scientific Research Project of Zhejiang Provincial Department of Education(Y202146219)the Postgraduate Education Research Project of Zhejiang University(20220326)。
文摘Background:The high recurrence rate of hepatocellular carcinoma(HCC)following curative resection affects patient survival.The present study combined critical clinicopathological features and molecular markers to develop machine learning models to predict the risk of recurrence and mortality.We aimed to individualize risk stratification,post-surgical management strategies,and ultimately improve long-term prognosis for HCC patients with curative resections.Methods:A total of 815 HCC patients undergoing surgical resection were divided randomly into a training cohort(n=652)and a validation cohort(n=163).To build a high-accuracy recurrent/death classifier using clinicopathological characteristics and molecular biomarkers,four different machine learning models,including the Cox proportional risk model,generalized linear model,extreme gradient boosting(XGBoost)model,and random survival forest(RSF)model,were developed and comprehensively compared.The outcomes were recurrence-free survival(RFS)and overall survival(OS).Results:Factors including diabetes,albumin,tumor numbers,HCC diameter,portal vein tumor thrombus,blood loss,mismatch repair protein 2(MSH2),and epithelial membrane antigen were significantly associated with RFS,while albumin,HCC diameter,MSH2,and Barcelona Clinic Liver Cancer(BCLC)stage were significantly associated with OS.The RSF model not only grouped HCC patients into high-and lowprobability recurrence groups with significant differences in 5-year recurrence probability rate(training cohort:87.3%vs.51.5%,P<0.0001;validation cohort:75.9%vs.64.8%,P<0.0001),but also grouped HCC patients into high-and low-probability death groups with significant differences in 5-year death probability rate(training cohort:56.0%vs.15.3%,P<0.0001;validation cohort:50.0%vs.23.1%,P<0.0001).Conclusions:The RSF model accurately stratified HCC patient into high-and low-risk recurrence or death groups,which guides the surgeons to plan adjuvant therapy after surgery.
基金Supported by Anhui Provincial Key Research and Development Plan,No.202104j07020048.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making precise treatment plans and improving patient prognosis.AIM To establish an intratumoral and peritumoral model for predicting ER in HCC patients following curative ablation.METHODS This study included a total of 288 patients from three Centers.The patients were divided into a primary cohort(n=222)and an external cohort(n=66).Radiomics and deep learning methods were combined for feature extraction,and models were constructed following a three-step feature selection process.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),while calibration curves and decision curve analysis(DCA)were used to assess calibration and clinical utility.Finally,Kaplan-Meier(K-M)analysis was used to stratify patients according to progression-free survival(PFS)and overall survival(OS).RESULTS The combined model,which utilizes the light gradient boosting machine learning algorithm and incorporates both intratumoral and peritumoral regions(5 mm and 10 mm),demonstrated the best predictive performance for ER following HCC ablation,achieving AUCs of 0.924 in the training set,0.899 in the internal validation set,and 0.839 in the external validation set.Calibration and DCA curves confirmed strong calibration and clinical utility,whereas K-M curves provided risk stratification for PFS and OS in HCC patients.CONCLUSION The most efficient model integrated the tumor region with the peritumoral 5 mm and 10 mm regions.This model provides a noninvasive,effective,and reliable method for predicting ER after curative ablation of HCC.
文摘BACKGROUND Colorectal cancer(CRC)recurrence within a year post-surgery poses significant challenges for stage II/III patients.Few models currently predict this early recu-rrence with multi-dimensional considerations for risk stratification.AIM To develop a model for predicting the risk of recurrence within one year after sur-gery in patients with stage II/III CRC.METHODS We conducted a retrospective cohort study at Zhejiang Provincial Hospital of Chinese Medicine,including 349 stage II/III CRC patients.Clinical data were collected,and the dataset was randomly divided into training(n=244)and testing(n=105)sets.Univariate and multivariate logistic regression analyses identified risk factors for postoperative recurrence.Then a nomogram model was constructed and evaluated via receiver operating characteristic curves,calibration curves and decision curve analysis.RESULTS During the one-year follow-up,10.9%(38/349)of patients experienced recurrence.Univariate analysis identified tumor size,lymph node metastasis(N2 stage),neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,fatigue,and appetite loss as significant correlates of recurrence.Multivariate logistic regression con-firmed N2 stage,appetite loss,tumor size,and neutrophil-to-lymphocyte ratio as independent risk factors.The nomogram model showed excellent performance.The area under the receiver operating characteristic was 0.98(95%confidence interval:0.97-1.00)in training set and 0.91(95%confidence interval:0.84-0.97)in testing set.The decision curve analysis curves showed strong concordance between predicted and observed recurrence probabilities.CONCLUSION The model effectively predicts early postoperative recurrence in stage II/III CRC,integrating clinical,inflam-matory,and symptomatic factors.
基金Supported by National Research Foundation of Korea Grant Funded by the Korea Government,No.RS-2023-00213951.
文摘BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.
文摘BACKGROUND In cases of colorectal cancer(CRC)with obstruction,patients experience local tissue edema due to intestinal obstruction.This condition stimulates the accumulation of inflammatory factors,activates cancer cells,and increases the risk of tumor recurrence.At present,analyses and evaluation tools for factors influencing early postoperative recurrence in patients with CRC and obstruction are limited.AIM To explore the influencing factors and construct a predictive model of the early postoperative recurrence of CRC with obstruction.METHODS Data from 181 patients with CRC and obstruction who underwent surgery in the Department of Gastrointestinal Surgery,Suzhou Ninth Hospital Affiliated to Soochow University,between January 2017 and May 2023 were retrospectively collected.Patients with CRC and obstruction were divided into a recurrence group and a non-recurrence group based on whether recurrence occurred during the 2-year follow-up after surgery.Datasets from the two groups were compared.Subsequently,multiple logistic regression was employed to analyze the influencing factors of the early postoperative recurrence of CRC with obstruction.The nomogram prediction model was drawn using R software,and its performance was evaluated by the goodness of fit test and receiver operating characteristic(ROC)curve analysis.The clinical benefit rate of the model was evaluated by decision curves.RESULTS Among the 181 patients with CRC and obstruction,52(28.73%)experienced tumor recurrence within 2 years after surgery.Significant differences were observed in preoperative carcinoembryonic antigen(CEA),preoperative systemic immuneinflammation index(SII),tumor,node,and metastasis(TNM)stage,differentiation degree,nerve infiltration,and Ki-67 expression between the recurrence and non-recurrence groups(P<0.05).Multivariate logistic regression analysis showed that high preoperative CEA(OR=2.094,P=0.008),high preoperative SII(OR=2.795,P<0.001),TNM stage III(OR=1.644,P=0.027),poor differentiation(OR=1.861,P=0.035),and high Ki-67 expression(OR=2.467,P=0.001)were all influencing factors for early postoperative recurrence of CRC with obstruction.The area under the ROC curve of the nomograph model constructed based on this was 0.890,the goodness of fit deviation test was conducted(χ^(2)=3.903,P=0.866),and the decision curve display model demonstrated practical value in clinical practice.CONCLUSION The early recurrence rate of CRC with obstruction is high.CEA,SII,TNM staging,differentiation degree,and Ki-67 expression are factors related to early postoperative recurrence.A nomogram prediction model incorporating these factors can effectively evaluate the risk of early postoperative recurrence in patients with CRC.
基金Jinhua Traditional Chinese Medicine Science and Technology Research Project:Gut Microbiota Distribution Characteristics in Spleen-Deficiency Colorectal Adenoma Patients(No.2023KR04)Jinhua Traditional Chinese Medicine Science and Technology Major Research Project:Clinical Efficacy and Mechanism of Shugan Jianpi Tiaochang Pills in Preventing Postoperative Recurrence of Colorectal Adenomas based on Metabolomics Technology(No.2024ZD03)。
文摘OBJECTIVES:To systematically review the efficacy and safety of Jianpi formulas(健脾剂)in reducing the recurrence of colorectal adenoma(CRA)after polypectomy.METHODS:Randomized controlled trials(RCTs)investigating Jianpi formulas for CRA post-polypectomy were systematically retrieved from eight electronic databases.The quality of the methodology was assessed using the Cochrane collaboration tool.The Grades of Recommendations Assessment Development and Evaluation(GRADE)approach was employed for evidence assessment.Statistical analyses were conducted using Statistics and Data Analysis(STATA)17(StataCorp(College Station,TX,USA)and Review Manager(RevMan)5.4(The Cochrane Collaboration(London,UK).RESULTS:The Meta-analysis,encompassing 18 RCTs with 1838 patients,revealed that Jianpi formulas significantly outperformed postoperative routine treatment.It demonstrated a reduction in the half-year recurrence rate[relative risk(RR)=0.41,95%confidence interval(CI)=0.33-0.49,Z=9.08,P<0.00001],the oneyear recurrence rate[RR=0.58,95%CI=0.49-0.69,Z=6.12,P<0.00001],and an enhancement in the clinical effective rate[RR=1.27,95%CI=1.19-1.36,Z=7.06,P<0.00001].The half-year recurrence rate and the clinical effective rate were medium-quality evidence.The one-year recurrence rate was low-quality evidence.Additionally,Jianpi formulas appear to be safe and do not increase adverse reactions compared to postoperative routine treatment alone.CONCLUSION:Jianpi formulas exhibit efficacy in reducing postoperative half-year and one-year recurrence rates while improving the clinical effective rate after polypectomy for CRA.
基金supported by grants from Youth Fund of the National Natural Science Foundation of China(82303379)General Program of the National Natural Science Foundation of China(81970552)the Natural Science Foundation of Zhejiang Province(LQ23H160030)。
文摘Background:Tumor recurrence severely impacts the prognosis of hepatocellular carcinoma(HCC)patients undergoing liver transplantation(LT).We aimed to explore novel and robust biomarkers for precise prediction of tumor recurrence and prognosis following LT.Methods:Cancerous tissues of 252 HCC patients who underwent LT across three centers were included in the study.Tissue microarrays and in situ hybridization were utilized to assess the circ0006646 level.Kaplan-Meier method along with the log-rank test was performed to analyze overall survival and recurrence-free survival.To identify prognostic factors,particularly related to tumor recurrence,we conducted univariate and multivariate Cox regression analyses.Nomogram was constructed to predict the risk of tumor recurrence after LT and subsequently the efficacy of the nomogram was validated.Results:Elevated circ0006646 levels in HCC were associated with reduced survival and increased recurrence rates following LT(5-year overall survival:29.2%vs.60.4%,P<0.01;5-year recurrence-free survival:42.3%vs.63.0%,P<0.001).High circ0006646 expression was significantly correlated with higher Child-Pugh grade(P=0.040),larger total tumor diameter(P=0.033),and beyond the Milan criteria(P=0.033).Cox regression analysis unveiled that circ0006646 expression score,preoperative transarterial chemoembolization(TACE),positive HBsAg status,poor tumor differentiation and beyond the Hangzhou criteria were independent risk factors for post-transplant tumor recurrence,leading to the development of a novel nomogram for precise prediction.The nomogram demonstrated a reasonable prognostic effectiveness(area under the receiver operating characteristic curve=0.7636,C-index=0.745)and outperformed conventional models like the Milan criteria.Besides,the inclusion of circ0006646 enhanced the precision of the Milan and Hangzhou criteria.Moreover,circ0006646 served as a potent biomarker in alpha-fetoprotein(AFP)-negative HCC undergoing LT.Conclusions:circ0006646 is a novel and robust prognostic biomarker for predicting post-transplant survival and tumor recurrence in HCC patients.A nomogram integrating circ0006646 stands as a valuable prognostic instrument in LT for HCC.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.
