The impact of low serum cholinesterase levels on survival in patients with colorectal cancer

Analysis of risk factors of low cardiac output syndrome after pericardiectomy for tuberculous constrictive pericarditis: A retrospective study

OBJECTIVE

Low cardiac output syndrome (LCOS) is the leading cause of death after cardiac surgery. Studies have shown that 24% of postoperative mortality in patients undergoing pericardiectomy is attributed to LCOS. It is necessary to explore the risk factors of LCOS after pericardiectomy in patients with tuberculous constrictive pericarditis (CP).

METHODS

Patients undergoing pericardiectomy for tuberculous CP were included in the study. The personal and clinical data of these patients with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. ROC curve analysis was used to check the accuracy of each risk factor to predict LCOS.

RESULTS

A total of 175 patients with tuberculous CP were included in this study, of which 35 cases developed LCOS postoperatively, resulting in an incidence rate of 20%. The independent predictors of LCOS were preoperative NYHA class III/IV, decreased left ventricular mass index (LVMI), and hypoalbuminemia in these patients (p < 0.05). When albumin (ALB) < 30.35 g/L, it had the highest diagnostic value in predicting postoperative LCOS, with sensitivity and specificity of 59.4% and 86.9%, respectively (p < 0.01).

CONCLUSIONS

For patients with tuberculous CP, preoperative NYHA class III/IV, lower LVMI, and hypoalbuminemia are independent risk factors for LCOS following pericardiectomy. Clinically, these risk factors should be identified as early as possible, and early pericardiectomy should be performed when the patient's cardiac function remains well-preserved to avoid the occurrence of cardiac cachexia, myocardial atrophy and severe hepatic insufficiency.

Serum cholinesterase combined with platelet-to-hemoglobin ratio for predicting survival prognosis in stage I-III colorectal cancer patients undergoing radical surgery: a retrospective cohort study

BACKGROUND

Although surgery-based comprehensive therapy is highly effective for treating stage I-III colorectal cancer, heterogeneity in survival trajectories still exists, necessitating precise prognostic stratification. Serum cholinesterase (CHE) and the platelet-to-hemoglobin ratio (PHR) are emerging as potential prognostic markers reflecting inflammation, nutritional status, and tumor biology. This study aims to investigate their combined value in predicting survival outcomes for stage I-III CRC patients, potentially offering a cost-effective tool for personalized management.

METHODS

The study included 673 stage I-III CRC patients who underwent radical surgery at Harbin Medical University Cancer Hospital from January to August 2019 and January to March 2020. Comprehensive clinicopathological data were collected. The patients from 2019 were used for the primary research analysis. Kaplan-Meier analysis was used for survival comparisons, while Cox regression identified independent prognostic factors. Two nomograms were developed to predict the prognosis of DFS and OS and were validated in 2020 patient cohort.

RESULTS

A total of 475 patients from 2019 patient cohort were classified into three different risk groups: Group 1 (CHE ≥ 6213.3 U/L and PHR ≤ 3.03, n = 305), Group 2 (CHE < 6213.3 U/L or PHR > 3.03, n = 135), and Group 3 (CHE < 6213.3 U/L and PHR > 3.03, n = 35). Survival analysis indicated that CRC patients with low serum CHE levels and high PHR had a poorer prognosis (all p < 0.05), and the combined biomarker CHE-PHR effectively distinguished different prognostic risk groups (p < 0.001). Multivariate analysis identified Crea (p = 0.037), Eosi (p = 0.021), CA199 (p = 0.002), pTNM stage (p < 0.001), number of lymph nodes detected (p = 0.007), and CHE-PHR (p < 0.001) as independent prognostic factors for DFS, while CEA (p = 0.015), CA199 (p = 0.006), pTNM stage (p < 0.001), number of lymph nodes detected (p = 0.007), and CHE-PHR (p < 0.001) were independent prognostic factors for OS. In 2019 patient cohort t, the nomogram's AUC values for 1-, 3-, 5-year DFS are 0.825, 0.766, and 0.748, and for 1-, 3-, 5-year OS, they are 0.787, 0.743, and 0.756. In 2020 patient cohort, the AUC values are 0.776, 0.812, 0.736 for DFS, and 0.756, 0.818, 0.789 for OS.

CONCLUSION

Lower serum CHE and higher PHR levels are linked to poorer DFS and OS outcomes. The CHE-PHR indicator serves as an independent prognostic factor for stage I-III CRC patients post-surgery, aiding in predicting recurrence and metastasis.

Albumin-Butyrylcholinesterase as a Novel Prognostic Biomarker for Hepatocellular Carcinoma Post-hepatectomy: A Retrospective Cohort Study with the Hiroshima Surgical Study Group of Clinical Oncology

BACKGROUND

This study aimed to investigate the association between a new biomarker that incorporates albumin (Alb) and butyrylcholinesterase (BCHE) levels, as well as the prognosis of hepatocellular carcinoma (HCC) after hepatectomy.

METHODS

The study enrolled 1712 patients who underwent primary hepatectomy for HCC between January 2003 and December 2019 at seven institutions belonging to the Hiroshima Surgical Study Group of Clinical Oncology. The entire dataset was randomly split into discovery and validation cohorts in a 7:3 ratio. The product of the preoperative Alb and BCHE levels was defined as the ABC. In the discovery cohort, the patients in the high-ABC group (≥ 951) were compared with those in the low-ABC group (< 951). These findings then were confirmed in the validation cohort.

RESULTS

In the discovery cohort, a significant difference was observed in the 5-year survival rate between the high- and low-ABC groups (p < 0.001), and ABC was identified as an independent prognostic factor for HCC. Similarly, in the validation cohort, a significant difference was observed in the 5-year survival rate between the high- and low-ABC groups (p < 0.001), and ABC was identified as an independent prognostic factor for HCC. Furthermore, in the discovery and validation cohorts, significant differences in the early recurrence rate between the two groups were observed (p < 0.001 and p = 0.020, respectively).

CONCLUSIONS

For patients with HCC, ABC is a useful predictive biomarker because it can be calculated in a simple manner and because it provides accurate prognostic information.

Low Serum Cholinesterase Levels Predict Poor Prognosis in Patients with Ovarian Cancer

Objective

Previous studies reported that low cholinesterase (ChE) levels were associated with poor prognosis in various cancers, including bladder, pancreatic, lung, and colorectal cancers. This study aimed to evaluate the clinical significance of serum ChE levels as a prognostic biomarker in ovarian cancer.

Materials and Methods

A retrospective cohort analysis was conducted on 168 patients diagnosed with epithelial ovarian cancer at the Suzhou Ninth People's Hospital from 2019 to 2020. Serum ChE levels were measured before initiating treatment and stratified into low and high groups based on the median level (7600 U/L). Clinical and pathological data, such as FIGO stage, age, tumor histological type, and survival outcomes, were collected. Kaplan-Meier analysis and Cox proportional hazards regression were used to assess the relationship between ChE levels and overall survival and disease-free survival.

Results

ChE levels were significantly correlated with clinicopathological features of epithelial ovarian cancer, including FIGO stage (p < 0.001), surgery completeness (p = 0.001), and platinum-resistant (p = 0.001). Kaplan-Meier analysis demonstrated that patients in the low ChE group had significantly worse overall survival (p = 0.003) and disease-free survival (p = 0.005) than those in the high ChE group. Multivariate Cox regression analysis identified low serum ChE levels as an independent predictor of poor overall survival and disease-free survival.

Conclusion

Low serum ChE levels are independently associated with poor prognosis in ovarian cancer patients, reflecting systemic inflammation, malnutrition, and potential hepatic dysfunction. These findings suggest that ChE could serve as a cost-effective and non-invasive biomarker for risk stratification and prognosis in clinical practice.

Prognostic Value of Systemic Inflammatory Response in Lymph Node-Negative Colorectal Cancer

BACKGROUND

The aim of this study was to investigate the prognostic value of systematic inflammatory response in patients with lymph node-negative colorectal cancer.

METHODS

We retrospectively investigated 245 patients with lymph node-negative colorectal cancer who underwent curative resection and evaluated the prognostic impact of systematic inflammatory response, which was represented by neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and C-reactive protein-to-albumin ratio (CAR). Then, the prognostic significance of the systematic inflammatory response on survival was analyzed using the Kaplan-Meier method in patients selected by propensity score matching (PSM) analysis.

RESULTS

In the multivariate analysis, CAR ≥ .081 (P = .004) was independent predictors of disease-free survival, while American Society of Anesthesiologists physical status ≥3 (P = .049) and CAR ≥ .081 (P < .001) were independent predictors of overall survival. By PSM analysis, PSM-high-CAR was significantly associated with worse disease-free survival (P = .043) and overall survival (P = .041) in patients with lymph node-negative colorectal cancer.

CONCLUSIONS

C-reactive protein-to-albumin ratio may be a significant indicator of poor long-term outcomes in patients with lymph node-negative colorectal cancer.

The association between preoperative serum cholinesterase and all-cause mortality in geriatric patients with hip fractures: a cohort study of 2387 patients

OBJECTIVE

This study is to evaluate the association between preoperative cholinesterase levels and all-cause mortality in geriatric hip fractures.

METHODS

Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative cholinesterase levels and mortality in these patients. Analyses were performed using EmpowerStats and the R software.

RESULTS

Two thousand three hundred eighty-seven patients were included in this study. The mean follow-up period was 37.64 months. Seven hundred eighty-seven (33.0%) patients died due to all-cause mortality. Preoperative cholinesterase levels were 5910 ± 1700 U/L. Linear multivariate Cox regression models showed that preoperative cholinesterase level was associated with mortality (HR = 0.83, 95% CI: 0.78-0.88), P < 0.0001) for every 1000 U/L. However, the linear association was unstable, and nonlinearity was identified. A cholinesterase concentration of 5940 U/L was an inflection point. When preoperative cholinesterase level < 5940 U/L, the mortality decreased by 28% for every 1000 U/L increase in cholinesterase (HR = 0.72, 95%CI: 0.66-0.79, P < 0.0001). When cholinesterase was > 5940 U/L, the mortality was no longer decreased with the rise of cholinesterase (HR = 1.01, 95%CI: 0.91-1.11, P = 0.9157). We found the nonlinear association was very stable in the propensity score-matching sensitive analysis.

CONCLUSIONS

Preoperative cholinesterase levels were nonlinearly associated with mortality in elderly hip fractures, and cholinesterase was a risk indicator of all-cause mortality.

TRIAL REGISTRATION

This study is registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323) (08/03/2022).

Preoperative serum cholinesterase as a prognostic factor in patients with colorectal cancer

Aim

Serum cholinesterase (ChE) levels are considered to reflect nutritional status. Although ChE has been well documented as a prognostic factor for some cancers, no clear consensus on its use for colorectal cancer (CRC) has been reached. The aim of this study was to investigate the relationship between preoperative serum ChE and postoperative long-term prognosis in CRC patients.

Methods

A total of 1053 CRC patients who underwent curative surgery were included in this study. The correlations between the preoperative ChE value and overall survival (OS) or cancer-specific survival (CSS) were assessed. By dividing patients into two groups according to their ChE value, OS and CSS were compared between the groups.

Results

Multivariate analysis revealed that the continuous ChE value was a significant predictor of OS (hazard ratio, 0.996; 95% CI, 0.993-0.998; p = 0.002) and CSS (hazard ratio, 0.994; 95% CI, 0.991-0.998; p = 0.001), independent of other variables. The low-ChE (≤234 U/L) group had a significantly poorer prognosis than the high-ChE (>234 U/L) group for both OS (5-year OS for low ChE and high ChE: 79.8% and 93.3%, respectively; p < 0.001) and CSS (5-year CSS for low ChE and high ChE: 84.8% and 95.6%, respectively; p < 0.001).

Conclusions

Lower preoperative serum ChE levels are a predictive factor of poor prognosis for CRC patients. As serum ChE levels can be measured quickly and evaluated easily, ChE could become a useful marker for predicting the postoperative long-term outcomes of CRC patients.

Association of Cholinesterase With Postoperative Pneumonia After Gastrectomy for Gastric Cancer

INTRODUCTION

Cholinesterase is a classical marker that reflects nutritional and inflammatory status. The aim of the present study was to evaluate the association between serum cholinesterase levels and postoperative infectious complications in patients undergoing gastrectomy for gastric cancer.

MATERIALS AND METHODS

This retrospective study comprised 108 patients who underwent gastrectomy for gastric cancer. We comprehensively investigated the association between clinicopathological variables and postoperative infectious complications after gastrectomy. Then patients were divided into the cholinesterase-high and -low groups to analyze their clinicopathological variables. Finally, we analyzed the types of infectious complications that were most associated with preoperative serum cholinesterase levels.

RESULTS

Twenty-six patients (24%) developed postoperative infectious complications. Multivariate analysis revealed that serum cholinesterase levels (P = 0.026) and N stage (P = 0.009) were independent risk factors for postoperative infectious complications. In particular, the incidence of pneumonia (P = 0.001) was significantly higher in the cholinesterase-low group. Age (P = 0.023), cerebrovascular comorbidities (P = 0.006), serum cholinesterase levels (P = 0.013), and total gastrectomy (P = 0.017) were identified as independent risk factors for postoperative pneumonia.

CONCLUSIONS

Preoperative serum cholinesterase levels were associated with postoperative pneumonia after gastrectomy for gastric cancer, suggesting the importance of preoperative nutritional assessment in gastric cancer surgery.

Prognostic Value of Serum Cholinesterase Levels for In-Hospital Mortality among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Cholinesterase (ChE) is associated with the pathogenesis of chronic obstructive pulmonary disease (COPD), including chronic airway inflammation and oxidation/antioxidant imbalance. However, the relationship between serum ChE levels and survival outcomes of patients hospitalized with acute exacerbations of COPD (AECOPD) is unknown. In this retrospective single-center study, we investigated the ability of the serum ChE level to predict in-hospital death in patients hospitalized with AECOPD. The clinicopathological data, including serum ChE levels as well as clinical and biochemical indicators were extracted for 477 patients from the hospital records and analyzed. Our results demonstrated that AECOPD patients with lower serum ChE levels were associated with increased mortality, frequent hospitalization due to acute exacerbations (AE) in the past year, and longer hospital stay. The optimal cutoff value for the serum ChE level was 4323 U/L. The area under the ROC curve (AUC) values for predicting in-hospital mortality based on the serum ChE level was 0.79 (95% confidence interval (CI), 0.72-0.85). Multivariate logistic regression analysis demonstrated that serum ChE level ≤ 4323 U/L (odds ratio (OR) 9.09, 95% CI 3.43-28.3, p < 0.001), age-adjusted Charlson comorbidity index (aCCI), and the number of hospitalizations due to AE in the past year were independent risk factors for predicting the in-hospital mortality of AECOPD patients. In conclusion, our study demonstrated that low serum ChE levels were associated with significantly higher in-hospital mortality rates of patients hospitalized with AECOPD. Therefore, serum ChE level is a promising prognostic predictor of hospitalized AECOPD patients.

Prognostic significance of osteosarcopenia in older adults with colorectal cancer

Aim

Osteopenia and sarcopenia, features of the aging process, are recognized as major health problems in an aging society. This study investigated the prognostic impact of osteosarcopenia, the coexistence of osteopenia and sarcopenia, in older adults undergoing curative resection for colorectal cancer.

Methods

We retrospectively reviewed data of older adults aged 65-98 y who had undergone curative resection for colorectal cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images. Sarcopenia was evaluated by measuring the skeletal muscle cross-sectional area at the third lumbar vertebra level. Osteosarcopenia was defined as the coexistence of osteopenia and sarcopenia. We explored the relationship of preoperative osteosarcopenia with the disease-free and overall survival after curative resection.

Results

Among the 325 patients included, those with osteosarcopenia had significantly lower overall survival rates than those with osteopenia or sarcopenia alone (P < 0.01). In the multivariate analysis, male sex (P = 0.045), C-reactive protein-to-albumin ratio (P < 0.01), osteosarcopenia (P < 0.01), pathological T4 stage (P = 0.023), and pathological N1/N2 stage (P < 0.01) were independent predictors of disease-free survival, while age (P < 0.01), male sex (P = 0.049), C-reactive protein-to-albumin ratio (P < 0.01), osteosarcopenia (P < 0.01), pathological T4 stage (P = 0.036), pathological N1/N2 stage (P < 0.01), and carbohydrate antigen 19-9 (P = 0.041) were independent predictors of overall survival.

Conclusion

Osteosarcopenia was a strong predictor of poor outcomes in older adults undergoing curative resection for colorectal cancer, suggesting an important role of osteosarcopenia in an aging society.

The influence of serum cholinesterase levels and sarcopenia on postoperative infectious complications in colorectal cancer surgery

PURPOSE

Cholinesterase is a nutritional marker associated with sarcopenia. The present study evaluated the relationship between cholinesterase and postoperative infectious complications in patients undergoing colorectal resection for colorectal cancer.

METHODS

The study involved 231 patients who had undergone colorectal resection for colorectal cancer. We retrospectively investigated the relationship between preoperative serum cholinesterase levels and postoperative infectious complications. Univariate and multivariate analyses were performed to identify independent risk factors for postoperative infectious complications. We then performed stratified analyses to assess the interaction between cholinesterase and clinical variables to predict postoperative infectious complications.

RESULTS

In the multivariate analysis, the body mass index (P = 0.010), serum cholinesterase levels (P = 0.005), sarcopenia (P = 0.003) and blood loss (P < 0.001) were independent risk factors for postoperative infectious complications. In stratified analyses, the association between serum cholinesterase levels and postoperative infectious complications differed by the sarcopenia status (Pinteraction = 0.006).

CONCLUSION

Preoperative serum cholinesterase levels may be useful for predicting postoperative infectious complications in colorectal cancer surgery. The association differs by the sarcopenia status, suggesting a potential interaction between nutritional markers and sarcopenia.

The impact of sarcobesity on incisional hernia after laparoscopic colorectal cancer surgery

PURPOSE

Incisional hernia is a common complication after abdominal surgery, especially in obese patients. The aim of the present study was to evaluate the relationship between sarcobesity and incisional hernia development after laparoscopic colorectal cancer surgery.

METHODS

In total, 262 patients who underwent laparoscopic colorectal cancer surgery were included in the present study. Univariate and multivariate analyses were performed to evaluate the independent risk factors for the development of incisional hernia. We then performed subgroup analyses to assess the impact of visceral obesity according to clinical variables on the development of incisional hernia in laparoscopic surgery for colorectal cancer surgery.

RESULTS

Forty-four patients (16.8%) developed incisional hernias after laparoscopic colorectal cancer surgery. In the univariate analysis, the development of incisional hernia was significantly associated with female sex (P = 0.046), subcutaneous obesity (P = 0.002), visceral obesity (P = 0.002), sarcobesity (P < 0.001), and wound infection (P < 0.001). In the multivariate analysis, sarcobesity (P < 0.001) and wound infection (P < 0.001) were independent predictors of incisional hernia. In subgroup analysis, the odds ratio of visceral obesity was the highest (13.1; 95% confidence interval [CI], 4.51-37.8, P < 0.001) in the subgroup of sarcopenia.

CONCLUSION

Sarcobesity may be a strong predictor of the development of incisional hernia after laparoscopic surgery for colorectal cancer, suggesting the importance of body composition in the development of incisional hernia.