Cancer-related inflammation and treatment effectiveness

Establishing and validating models integrated with hematological biomarkers and clinical characteristics for the prognosis of non-esophageal squamous cell carcinoma patients

BACKGROUND

This study aimed to construct a novel model and validate its predictive power in non-esophageal squamous cell carcinoma (NESCC) patients.

METHODS

This retrospective study included 151 patients between October 2006 and September 2016. The LASSO Cox and Random Survival Forest (RSF) models were developed with the help of hematological biomarkers and clinical characteristics. The concordance index (C-index) was used to assess the prognostic power of the LASSO Cox model, RSF model, and TNM staging. Based on the risk scores of the LASSO Cox and RSF models, we divided patients into low-risk and high-risk subgroups.

RESULTS

We constructed two models in NESCC patients according to LASSO Cox regression and RSF models. The RSF model reached a C-index of 0.841 (95% CI: 0.792-0.889) in the primary cohort and 0.880 (95% CI: 0.830-0.930) in the validation cohort, which was higher than the C-index of the LASSO Cox model 0.656 (95% CI: 0.580-0.732) and 0.632 (95% CI: 0.542-0.720) in the two cohorts. The integrated C/D area under the ROC curve (AUC) values for the LASSO Cox and RSF models were 0.701 and 0.861, respectively. In both two models, Kaplan-Meier survival analysis and the estimated restricted mean survival time (RMST) values indicated that the low-risk subgroup had a better prognostic outcome than the high-risk subgroup (p < 0.05).

CONCLUSIONS

The RSF model has better prediction power than the LASSO Cox and the TNM staging models. It has a guiding value for the choice of individualized treatment in patients with NESCC.

A score prediction model for predicting the heterogeneity symptom trajectories among lung cancer patients during perioperative period: a longitudinal observational study

INTRODUCTION

Patients undergoing video-assisted thoracoscopic surgery (VATs) for lung cancer (LC) frequently experience prolonged symptoms that can significantly affect their quality of life (QoL).

PATIENTS AND METHODS

This study employed a longitudinal observational design. The MDASI and QLQ-C30 were utilized to evaluate symptoms and QoL one day before surgery, as well as at 1 day, 2 weeks, and 1, 2, and 3 months post-surgery. Latent class growth modeling (LCGM) was employed to identify heterogeneous trajectories. By Logistic regression analysis, a score prediction model was developed based on predictive factors, which was internally validated utilizing 1000 bootstrap samples. The SHaply Additive Explanations (SHAP) was used to calculating the contribution of each factor.

RESULTS

205 participants participated in this study. The predominant postoperative complaints included fatigue, shortness of breath, pain, and coughing. Two distinct classes of symptom trajectories were identified: 'severe group' and 'mild group'. Four independent predictors of heterogeneous symptom trajectories were used to develop a scoring model. The area under the receiver operating characteristic curve for this model was 0.742 (95% CI: 0.651-0.832). And the calibration curves demonstrated strong concordance between anticipated probability and actual data (mean absolute error: 0.033). Furthermore, the decision curve analysis (DCA) indicated higher net benefit than other four single factors. SHAP highlighted WBC and surgical duration time as the most influential features.

CONCLUSIONS

We established a score model to predict the occurrence of severe symptom trajectories 3 months postoperatively, promoting recovery by advancing rehabilitation plan based on preoperative and surgical situation.

REGISTRATION

ClinicalTrials.gov (ChiCTR2100044776).

Lymphocyte-to-C-reactive protein ratio predicts prognosis in unresectable locally advanced non-small cell lung cancer patients

BACKGROUND

The lymphocyte-to-C-reactive protein ratio (LCR) is a promising inflammation-based tool for assessing the status of patients with malignant tumours. This study evaluated the ability of LCR to predict the prognosis of patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC) after chemoradiotherapy.

METHODS

We retrospectively investigated 206 consecutive patients with unresectable LA-NSCLC who underwent chemoradiotherapy between January 2016 and November 2019. The LCR was calculated from the differential count by dividing the absolute lymphocyte count by the C-reactive protein level. The optimal cut-off value of LCR was determined using the receiver operating characteristic (ROC) curve, and the enrolled patients were divided into two groups for further analysis according to LCR. Overall survival (OS) and disease-free survival (DFS) were assessed using univariate and multivariate Cox regression analyses.

RESULTS

In patients with unresectable LA-NSCLC, the level of LCR was significantly associated with pathology (p = 0.042) and TNM stage (p = 0.002). High LCR and low LCR patients had different distinct outcomes (median OS: 36 vs. 34 months, p < 0.0001) and recurrence risk (median DFS: 31 vs. 23 months, p < 0.001). Univariate analysis indicated that Eastern Cooperative Oncology Group (ECOG) performance status, TNM stage, CEA level, response, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic immune inflammation index (SII), and LCR were predictors of OS and DFS. Multivariate analysis showed that a high LCR was an independent prognostic factor for OS (hazard ratio [HR], 0.526; 95% CI, 0.364-0.762; p = 0.001) and DFS (HR, 0.390; 95% CI, 0.275-0.554; p < 0.001).

CONCLUSION

LCR is a promising prognostic index in patients with LA-NSCLC undergoing chemoradiotherapy, and an increase in the LCR level contributes to better outcomes.

Prognostic significance of pre-treatment immune-inflammation biomarkers in anal cancer: A study combining real-world data and a meta-analysis

This study examines the prognostic value of pre-treatment inflammatory biomarkers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) in patients with anal cancer (AC). Blood sample analyses from 340 AC patients treated with curative (chemo)radiotherapy were retrieved from patient records to determine pre-treatment NLR, PLR, and SII values. Using receiver operating characteristic curve (RUC) analysis, the Liu method, optimal cut-offs were calculated to 2.96 for NLR, 145.31 for PLR, and 679.86 for SII. Values above the cut-off were significantly associated with worse disease-free survival (DFS) and overall survival (OS). For DFS, the hazard ratios (HRs) were 2.08 for NLR, 1.85 for PLR, and 2.13 for SII, while for OS, the HRs were 1.73 for NLR, 1.14 for PLR, and 1.76 for SII. In multivariate analyses, NLR, PLR, and SII each remained independently significant predictors of DFS. A comprehensive literature review and meta-analysis further substantiated the association between high pre-treatment NLR and OS in AC, although the findings were marked by considerable heterogeneity. These results suggest that NLR, PLR, and SII are valuable and easily measurable prognostic markers in AC. Integrating these biomarkers into clinical practice could enable more personalized treatment strategies by identifying patients at elevated risk of poorer outcomes. Future research should focus on validating these findings across diverse populations and developing standardized methodologies to optimize the clinical utility of these biomarkers.

Predicting the Prognosis of Bladder Cancer Patients Through Integrated Multi-omics Exploration of Chemotherapy-Related Hypoxia Genes

Bladder cancer is a prevalent malignancy with high mortality rates worldwide. Hypoxia is a critical factor in the development and progression of cancers. However, whether and how hypoxia-related genes (HRGs) could affect the development and the chemotherapy response of bladder cancer is still largely unexplored. This study comprehensively explored the complex molecular landscape associated with hypoxia in bladder cancer by analyzing 260 hypoxia genes based on transcriptomic and genomic data in 411 samples. Employing the 109 dysregulated hypoxia genes for consensus clustering, we delineated two distinct bladder cancer clusters characterized by disparate survival outcomes and distinct oncogenic roles. We defined a HPscore that was correlated with a variety of clinical features, including TNM stages and pathologic grades. Tumor immune landscape analysis identified three immune clusters and close interactions between hypoxia genes and the various immune cells. Utilizing a network-based method, we defined 129 HRGs exerting influence on apoptotic processes and critical signaling pathways in cancer. Further analysis of chemotherapy drug sensitivity identified potential drug-target HRGs. We developed a Risk Score model that was related to the overall survival of bladder cancer patients based on doxorubicin-target HRGs: ACTG2, MYC, PDGFRB, DHRS2, and KLRD1. This study not only enhanced our understanding of bladder cancer at the molecular level but also provided promising avenues for the development of targeted therapies, representing a significant step toward the identification of effective treatments and addressing the urgent need for advancements in bladder cancer management.

A prognostic nomogram for patients with III-IV nasopharyngeal carcinoma based on dynamic changes in the inflammatory and nutrition index

BACKGROUND

The purpose of the study was to explore the value of dynamic changes in inflammatory and nutritional index after comprehensive treatment in patients with stage III-IVA nasopharyngeal carcinoma (NPC). A prognostic model was also established and validated for progression-free survival (PFS) of patients.

METHODS

We retrospectively selected 279 NPC patients with stage III-IVA. Their general clinical data and hematological index were collected and then calculated the changes during treatment. X-tile software was used to determine the optimal cut-off value. COX regression, Lasso method, and Boruta method were used to variable selection and model establishment. Using the bootstrap internal validation method, concordance index (C-index), calibration plot, and Kaplan-Meier curves were used to evaluate the model. To test the prognostic value of the model, we have also evaluated the performance of the nomogram against a conventional tumor metastasis staging system (TNM).

RESULTS

Multivariable COX regression analysis demonstrated that clinical staging, delta lymphocyte, delta monocyte, delta albumin, delta platelet-to-lymphocyte ratio and delta systemic immune inflammation index were related to the PFS of NPC patients. The C-index of the model was 0.712, and the calibration curve indicated that the model had good consistency. The C-index of the TNM staging system was 0.597, which was considerably lower compared to our model (P = 0.015).

CONCLUSION

We demonstrated the predictive value of dynamic changes in inflammatory and nutritional indices for the prognosis of NPC by successfully establishing and validating a prognostic model for predicting 1- and 3-year PFS after comprehensive treatment in patients with stage III-IVA NPC.

Urolithins: Emerging natural compound targeting castration-resistant prostate cancer (CRPC)

Castration-resistant prostate cancer (CRPC) presents a significant challenge due to its resistance to conventional androgen deprivation therapies. Urolithins, bioactive metabolites derived from ellagitannins, have recently emerged as promising therapeutic agents for CRPC. Urolithins not only inhibit androgen receptor (AR) signaling, a crucial factor in the progression of CRPC, but also play a key role in regulating oxidative stress by their antioxidant properties, thereby inhibiting increased reactive oxygen species, a common feature of the aggressive nature of CRPC. Research has shown that urolithins induce apoptosis and diminish pro-survival signaling, leading to tumor inhibition. This review delves into the intricate mechanisms through which urolithins exert their therapeutic effects, focusing on both AR-dependent and AR-independent pathways. It also explores the exciting potential of combining urolithins with androgen ablation therapy, opening new avenues for CRPC treatment.

Clonal hematopoiesis, cardiovascular disease and cancer treatment-induced cardiotoxicity

Clonal hematopoiesis (CH) arises when a substantial proportion of mature blood cells is derived from a single hematopoietic stem cell lineage. It is considered to be a premalignant state that predisposes individuals to an increased risk of cancers. Recently, emerging evidence has demonstrated a strong association between CH and both the incidence and mortality of cardiovascular diseases (CVD), with the relative risks being comparable to those attributed to traditional cardiovascular risk factors. In addition, CH has been suggested to play a role in CVD and anti-cancer treatment-related cardiotoxicity amongst cancer survivors. Moreover, certain forms of chemotherapy and radiation therapy have been shown to promote the clonal expansion of specific CH-related mutations. Consequently, CH may play a substantial role in the realm of cardio-oncology. In this review, we discuss the association between CH with cancer and CVD, with a special focus on anti-cancer treatment-related cardiotoxicity, discuss possible future research avenues and propose a systematic approach for clinical practice.

Nutritional and inflammatory indicators differ among patients with colorectal cancer with distinct microsatellite stability statuses

BACKGROUND

Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer, which are factors closely associated with the diagnosis and treatment of colorectal cancer (CRC).

AIM

To explore the relationship between nutritional and inflammatory indicators and microsatellite stability (MSS) status in CRC.

METHODS

The clinical data of 56 patients who underwent surgical treatment for CRC were collected. Furthermore, the expressions of nutritional (levels of serum albumin, triglycerides, serum cholesterol, and body mass index) and inflammatory response indicators (absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio) as well as their correlation with microsatellite instability (MSI) status were investigated in patients with CRC.

RESULTS

Compared to the patients with MSS tumors, those with MSI tumors demonstrated significantly lower levels of two nutritional indicators, namely serum albumin and body mass index (P < 0.05). Moreover, patients in the MSI group demonstrated significantly lower absolute lymphocyte counts and higher neutrophil-to-lymphocyte ratio than those in the MSS group (P < 0.05), indicating pronounced differences in inflammatory responses and immune states between the two groups.

CONCLUSION

Certain nutritional and inflammatory indicators exhibit significant differences among patients with MSI and MSS CRC, highlighting their potential role in the clinical treatment and health management of this specific population.

Pan-Immune-Inflammation Value as a Prognostic Biomarker for Hepatocellular Carcinoma Patients Undergoing Hepatectomy

Purpose

Hepatocellular carcinoma (HCC) poses a substantial threat to global health, characterized by its high incidence and mortality rates. This research aims to assess the prognostic value of a systematic serum inflammation index, the pan-immune-inflammation value (PIV), in patients with HCC who have undergone hepatectomy.

Patients and Methods

A total of 1764 HCC patients who underwent surgery were included in the study. These patients were divided into two groups based on the median PIV value. The Cox regression model was utilized to ascertain the independent risk factors that influence the prognosis of patients. A PIV-based nomogram was constructed and its performance was evaluated by the C-index, calibration curve, ROC curve, and DCA curve. Finally, a comparison was made between the nomogram and existing staging models.

Results

Patients with elevated PIV exhibited diminished OS and RFS compared to those with lower PIV. Univariate and multivariate Cox analyses revealed that PIV is an independent predictor of prognosis. The PIV-based nomogram demonstrated excellent discrimination, calibration, and clinical net benefit. The proposed nomogram outperformed the other existing staging systems, as evidenced by a higher AUC value.

Conclusion

PIV exhibits potential as a prognostic factor for both OS and RFS in patients with HCC who have undergone hepatectomy. The PIV-based nomogram can serve as an additional tool in conjunction with the existing liver cancer staging system, thereby facilitating more personalized treatment decisions for clinicians.

From genes to therapy: a lipid Metabolism-Related genetic risk model predicts HCC outcomes and enhances immunotherapy

BACKGROUND

Hepatocellular Carcinoma (HCC) is related to dysregulated lipid metabolism and immunosuppressive microenvironment. This study developed a genetic risk model using lipid metabolism-related genes to predict survival and immune patterns in HCC patients.

METHODS

Differentially expressed genes (DEGs) related to lipid metabolism were identified in HCC via the TCGA-LIHC dataset. A risk model for survival prediction was constructed via DEGs related to survival. The immune signature associated with the risk model was also evaluated by the CIBERSORT algorithm, tumor immune dysfunction and exclusion algorithm, and single sample gene set enrichment analysis.

RESULTS

This study identified six lipid metabolism-related genes, ADH4, LCAT, CYP2C9, CYP17A1, LPCAT1, and ACACA, to construct a lipid metabolism-related gene risk model that can divide HCC patients into low- and high-risk groups. Internal and external validation verified that the risk model could be a signature that could effectively predict HCC patient prognosis. High-risk patients showed disrupted immune cell profiles, reduced tumor-killing capacity, and increased expression of immune checkpoint genes. However, they responded more favorably to immune checkpoint inhibitor (ICB) therapy. The top ten hub genes related to the risk model were associated with tumor progression and deteriorating prognosis. In vitro experiments verified that the downregulation of the top 1 hub gene CDK1 was correlated to the HCC cell proliferation.

CONCLUSION

The risk model constructed using lipid metabolism-related genes could effectively predict prognosis and was related to the immunosuppressive microenvironment and ICB immunotherapy. The hub genes related to the risk model were potential therapeutic targets.

Effects of DHA Oral Supplementation on Plasma Resolvin D1 and D2 Levels in Naïve Breast Cancer Patients

Background/Objectives: Specialized pro-resolving lipid mediators, such as resolvins derived from omega-3 fatty acids, play a key role in resolving inflammation and restoring homeostasis. Resolvin D1 and D2, derived from docosahexaenoic acid (DHA), have demonstrated inflammation pro-resolving properties and potential anticancer effects. This study aimed to evaluate the effects of oral DHA supplementation on plasma resolvin D1 and D2 levels in breast cancer patients and in controls, and by stratifying the patients by disease presentation (sporadic, familial, BRCA1/2 mutated) and immunohistochemical characteristics. Methods: This is a single-center, interventional, controlled study conducted in women with breast cancer and women with benign breast disease, serving as controls. Participants consumed DHA (2 g/day) as algal oil syrup for 10 consecutive days. Plasma resolvin D1 and D2 levels were measured at baseline (T0) and after supplementation (T1) using ELISA kits. Results: At baseline, breast cancer patients exhibited higher plasma resolvin D1 levels compared to controls (median 21.3 vs. 7.3 pg/mL, p = 0.039), with no significant difference in resolvin D2. Following DHA supplementation, resolvin D1 and D2 significantly increased in BRCA1/2-mutated patients (+185.8% and +101.2%, p = 0.037, p = 0.028, respectively). Conversely, the familial breast cancer group showed a significant decrease in resolvin D1 (p = 0.015). Patients with low Ki67 expression showed greater increase over time of resolvin D2 levels compared to those with high Ki67 expression (p = 0.046). Conclusions: DHA supplementation modulated resolvin levels in breast cancer patients, with significant increase in BRCA1/2-mutated patients, suggesting enhanced inflammation pro-resolving responses. The reduction in resolvin D1 in the familial group highlights a potential dysregulated response. These findings indicate the potential of resolvins as biomarkers of resolution of inflammation and novel therapeutic targets in breast cancer.

Exploring the potential antidepressant mechanisms of ibuprofen and celecoxib based on network pharmacology and molecular docking

BACKGROUND

Evidence has shown that ibuprofen and celecoxib are effective in improving depressive symptoms, but their mechanisms of action are unclear. In this study, we aimed to determine the relationship between these two drugs and depressive disorder (DD) and elucidate potential mechanisms of action.

METHODS

Relevant targets for ibuprofen, celecoxib, and DD were obtained and screened from multiple online drug and disease public databases. A protein-protein interaction network was obtained. The Centiscape and CytoHubba plug-ins were applied to screen for core targets. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed. Molecular docking was performed to predict the binding of ibuprofen and celecoxib to core targets. Examined the differences in core target protein expression between DD patients (DDs, n = 18) and healthy controls (HCs, n = 16) as a further experimental validation of the network pharmacology results.

RESULTS

In total, 220 potential targets for ibuprofen and 316 potential targets for celecoxib were identified and associated with DD. The antidepressant effects of both drugs involve many key targets in pathways such as "pathways in cancer" and "neuroactive ligand-receptor interaction," including ALB, BCL2, MAPK3, SRC, STAT3, EGFR, and PPARG. The binding affinity of ALB with ibuprofen is the strongest, and it is connected only by hydrophobic interactions. Celecoxib exhibits higher affinity at multiple targets such as SRC, EGFR, and PPARG, with stronger and more specific intermolecular interactions, including salt bridges and halogen bonds. Clinical trials have found that serum ALB expression in DDs is significantly lower than that in HCs (t = 6.653, p < 0.001), further confirming the potential role of ibuprofen in DD.

CONCLUSIONS

Ibuprofen and celecoxib primarily exert their antidepressant effects through targets and pathways related to inflammation, neural signaling, and cancer, with celecoxib showing a stronger potential antidepressant effect. The expression difference of the core target ALB between depression and healthy individuals further supports the potential effect of the drug on DD. Our findings propose new treatment strategies, support the link between inflammation and depression, and encourage reassessing existing medications for depression.

Senescence-to-Pyroptosis Nanotuners: Navigating Tumor Inflammatory Microenvironment for Enhanced Immunotherapy

Modulating cancer-related chronic inflammation (CCI) is essential to reverse the immunosuppressive tumor microenvironment (TME) for improved therapeutic outcomes. However, the complexity and dynamism of inflammatory processes within the TME pose formidable challenges. Here, we identify senescent tumor cells as a novel "nest"-like target and design a tailored nanotuner that transforms these cells from adversaries to allies in TME remodeling. Specifically, this nanotuner targets metabolic abnormalities and initiates cascading artificial reactions via chemiluminescence resonance energy transfer mechanisms, which trigger self-initiated and self-sustaining photodynamic processes for boosted 1O2, converting cellular senescence into pyroptosis. Such conversion fosters multifaceted immune activation, including blocking CCI networks, downregulating PD-L1, and enhancing dendritic cell maturation and T-cell recruitment in tumors. Assessments in two tumor models further demonstrate its durable antitumor effects against primary and distant solid tumors when combined with a PD-1 blockade. This work provides a paradigm shift for novel insights into tumor development and immunoregulatory tactics.

Pathological complete response and prognostic predictive factors of neoadjuvant chemoimmunotherapy in early stage triple-negative breast cancer

Background

Neoadjuvant chemoimmunotherapy (nCIT) has shown promise in treating early-stage triple-negative breast cancer (eTNBC), but predictive biomarkers for pathological response and prognosis remain poorly defined.

Objective

This study aimed to explore pathological complete response and prognostic predictive factors in eTNBC patients treated with nCIT.

Materials and methods

We retrospectively analyzed 112 eTNBC patients who underwent surgery after nCIT at Sun Yat-sen University Cancer Center between June 2019 and June 2023. Pathological response was assessed using Miller-Payne grade. Clinicopathological features and hematologic markers were analyzed with univariate and multivariate logistic regression or Cox regression, as well as Kaplan-Meier survival curves. Objective response rate (ORR), pathological complete response (pCR), and disease-free survival (DFS) were evaluated. Nomograms predicting pCR and DFS were constructed based on significant risk factors and the systemic inflammatory response index (SIRI).

Results

Higher baseline lymphocyte counts (P=0.004) were independently associated with a higher pCR rate, while elevated monocyte counts (P=0.006), neutrophil-to-lymphocyte ratio (P=0.005), platelet-to-lymphocyte ratio (p = 0.005), SIRI (P=0.037), systemic immune-inflammation index (P=0.029), and preoperative SIRI (P=0.010) were associated with a lower pCR rate. Higher baseline SIRI (P= 0.009) was correlated with shorter DFS, while higher preoperative lymphocyte counts (P=0.019) predicted longer DFS. Nomograms incorporating SIRI showed high accuracy in predicting pCR and DFS.

Conclusion

Hematologic inflammatory markers, particularly SIRI, are cost-effective and reliable predictors of prognosis and treatment efficacy in eTNBC patients undergoing nCIT, helping clinicians develop personalized treatment strategies.

Clinical trial registration

https://www.medicalresearch.org.cn/, identifier MR-44-24-046099.

Naples Prognostic Score (NPS) as a Novel Prognostic Score for Stage III Breast Cancer Patients: A Real-World Retrospective Study

Objective

This study aims to explore whether Naples prognostic score (NPS) serves as a novel and original prognostic tool for predicting long-term survival in stage III breast cancer patients undergoing operation.

Methods

This retrospective study included 306 cases of stage III breast cancer patients hospitalized in our hospital from January 2014 to December 2018. In this study, NPS was based on five objective markers: (1) serum albumin level; (2) total cholesterol; (3) neutrophil to lymphocyte ratio; (4) lymphocyte to monocyte ratio. Survival curves of DFS and OS differences were visualized by Kaplan-Meier method and Log rank test. The variables with p < 0.05 in univariate analysis were performed in the multivariate Cox proportional hazard model analysis, and the p-values < 0.05 was considered the underlying independent variables. Nomogram was constructed by the multivariate Cox proportional hazard model analysis.

Results

Significant variations for DFS and OS categorized according to prognostic risk for the different NPS (DFS: χ2=24.926, P < 0.0001; OS: χ2=31.207, P < 0.0001). According to multivariable Cox analysis, NPS was an independent prognostic factor of DFS [Group 0 had significantly better prognosis than group 1 (HR = 2.733, 95% CI: 1.446-5.166, P = 0.002) and group 2 (HR = 4.990, 95% CI: 2.555-9.746), P < 0.001)] and OS [Group 0 had significantly better prognosis than group 1 (HR = 2.437, 95% CI: 1.288-4.610, P = 0.006) and group 2 (HR = 5.707, 95% CI: 2.900-11.231), P < 0.001)], respectively. Nomogram prognostic model exhibited excellent predictive performance on DFS [C-index: 0.692 (95% CI: 0.584-0.782)] and OS [C-index: 0.711 (95% CI: 0.606-0.797)] for stage III breast cancer.

Conclusion

NPS serves as a predictive tool for assessing the prognosis of stage III breast cancer after surgery. Nomogram prognostic model based on NPS show good prediction ability.

Preoperative immune prognostic index predicts the prognosis and postoperative adjuvant chemotherapy benefits of esophageal squamous cell carcinoma after minimally invasive esophagectomy

BACKGROUND

The utility of the immune prognostic index (IPI) for esophageal squamous cell carcinoma (ESCC) has yet to be established after minimally invasive esophagectomy (MIE). The purpose of this study was to investigate the value of IPI in predicting the prognosis and postoperative adjuvant chemotherapy (AC) benefits of ESCC patients.

METHODS

Between January 2011 and December 2018, 613 ESCC patients underwent MIE at our center and were divided into two groups: low IPI and high IPI.Log-rank tests were used to compare the overall survival (OS) and disease-free survival (DFS) of patients in different groups based on Kaplan-Meier survival analysis. Differences in clinical characteristics between groups were eliminated by propensity score matching (PSM) analysis. To identify independent risk factors influencing OS and DFS, the Cox proportional risk model was used.

RESULTS

In comparison to the high IPI group, the low IPI group had a better 5-year OS and DFS in both the entire and matched cohorts (P < 0.05). IPI was found to be an independent prognostic factor for OS and DFS in a multivariate analysis of the entire cohort and the matched cohort (P < 0.05). In subgroup analyses of most clinicopathological factors, high IPI was associated with a higher risk of death or recurrence in the matched cohorts. When combined with 8th TNM staging, the 5-year OS and DFS of stage II or III patients with low IPI in the AC group were not different from those in the non-AC group (P > 0.05), and AC of stage III patients with high IPI significantly prolonged 5-year OS and DFS (OS: 37.4% vs 26.2%, P = 0.018; DFS: 33.6% vs 19.8%, P = 0.042).

CONCLUSION

Preoperative IPI is a promising predictor of ESCC after MIE. For stage III ESCC patients with high IPI, AC can significantly reduce the risk of death or recurrence.

Evaluating the Inflammatory Protein Ratio (IPR) as an Inflammation-Based Biomarker for Cancer Diagnosis

Chronic inflammation is increasingly recognized as a key driver of tumorigenesis, affecting both the tumor microenvironment and host response. In this context, circulating inflammatory proteins may provide valuable insights into cancer activity. This study evaluated the diagnostic performance of the inflammatory protein ratio (IPR), a composite index derived from serum protein electrophoresis, in detecting active cancer among hospitalized patients. We retrospectively analyzed clinical and laboratory data from 312 adult patients admitted to the Internal Medicine and Aging Department at Policlinico Foggia, Italy, between November 2023 and July 2024. Patients were stratified according to the presence of active cancer, defined by NICE criteria. The diagnostic accuracy of the IPR was compared with that of conventional inflammatory markers, including C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII). The IPR showed the highest diagnostic performance, with a sensitivity of 88.1%, a specificity of 75.2%, and an area under the receiver operating characteristic curve (AUC) of 0.868. Its negative predictive value reached 97.6%, underscoring its potential as a rule-out tool for malignancy in hospitalized patients. These findings support the IPR as a promising and cost-effective inflammation-based biomarker for cancer detection, warranting further validation in prospective and molecularly characterized cohorts.

Eosinophils and Bioactive Lipid Mediators Regulate Skin Inflammation and Cancer Growth

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, with local immunity playing a key role in regulating outcome. Nonresolving inflammation has been suggested to drive cancer growth; however, a fundamental understanding of the tumor immune microenvironment in cSCC is still lacking. In this study, we demonstrate tissue-associated tumor eosinophilia in both human and murine cSCC and show that eosinophils promote epithelial hyperplasia and tumor outgrowth. The skin eosinophils display tissue adaptation and dynamically alter their transcriptome according to the microenvironment. Furthermore, we show that the skin bioactive lipidome is significantly altered during inflammation and in cSCC and that this is regulated by eosinophils. Inflamed skin and cSCC tissue are dominated by lipid mediators synthesized by lipoxygenase enzymes, and our results suggest that eosinophils influence the balance between proinflammatory and proresolving lipid mediators. We demonstrate that lipid mediators can regulate epithelial cell expansion, with PCTR1 reducing inflammation-driven growth of tumor cells and eosinophil-driven eoxin C4 blocking this effect. Together, these findings highlight that eosinophils and specific bioactive lipid mediators play important roles in skin biology and carcinogenesis and point to potential previously unreported strategies for treatment of inflammatory disorders and epithelial malignancies.

Inhibitors of inflammasome (NLRP3) signaling pathway as promising therapeutic candidates for oral cancer

Inflammasomes are complex protein assemblies responsible for regulating the development and release of proinflammatory cytokines like interleukin-1beta (IL-1β) and interleukin-18 (IL-18) against the intracellular triggers. Among these, the Nod-like receptor protein 3 (NLRP3) inflammasome stands out as the most extensively studied and well-characterized member, implicated in numerous pathological conditions. A systematic literature search was conducted on the PubMed such as PubMed, Scopus, Google Scholar database to identify peer-reviewed publications pertaining to the role of NLRP3 in oral cancer pathogenesis and its inhibitors for targeted therapy. Recent research highlights the emerging significance of the NLRP3 inflammasome in tumorigenesis, garnering attention as a potential target for anticancer therapies. This review delves into the involvement of NLRP3 in cancer development and progression, providing an in-depth overview of its activation (and inhibition) and its impact on oral cancer pathogenesis. The manuscript provides a detailed review of the natural and synthetic compounds inhibiting the NLRP3 signaling pathway, which might act as therapeutic lead molecules in oral cancer. This holds promise to overcome targeted and effective treatment options the development of novel drugs targeting the NLRP3 inflammasome-mediated mechanisms in oral cancer.

CT Multidimensional Radiomics Combined with Inflammatory Immune Score For Preoperative Prediction of Pathological Grade in Esophageal Squamous Cell Carcinoma

RATIONALE AND OBJECTIVES

Inflammation and immune biomarkers can promote angiogenesis and proliferation and metastasis of esophageal squamous cell carcinoma (ESCC). The degree of pathological grade reflects the tumor heterogeneity of ESCC. The purpose is to develop and validate a nomogram based on enhanced CT multidimensional radiomics combined with inflammatory immune score (IIS) for predicting poorly differentiated ESCC.

MATERIALS AND METHODS

A total of 266 ESCC patients from the retrospective study were included and randomly divided into a training set (N=186) and a validation set (N=80), and a complete data set (N=266), and overall survival was determined to follow up after surgery. The tumor imaging was segmented to form intratumoral and peritumoral 3 mm areas of 3D volume of interest (VOI) on CT arterial and venous phases, and 3404 radiomics features were extracted. Finally, the radiomics scores were calculated for arterial phase intratumoral (aInRads), peritumoral 3 mm (aPeriRads3), and venous phase intratumoral (vInRads), peritumoral 3 mm (vPeriRads3). Logistic regression was used to fuse the four cohorts of scores to form a Stacking. Additionally, sixteen inflammatory-immune biomarkers were analyzed, including aspartate aminotransferase to lymphocyte ratio (ALRI), aspartate aminotransferase to alanine aminotransferase ratio (AAR), neutrophil times gamma-glutamyl transpeptidase to lymphocyte ratio (NγLR), and albumin plus 5 times lymphocyte sum (PNI), etc. Finally, IIS was constructed using ALRI, AAR, NγLR and PNI. Model performance was evaluated by area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analyse (DCA).

RESULTS

Stacking and IIS were independent risk factors for predicting poorly differentiated ESCC (P<0.05). Ultimately, three models of the IIS, Stacking, and nomogram were developed. Compared with the Stacking and IIS models, nomogram achieved better diagnostic performance for predicting poorly differentiated ESCC in the training set (0.881vs 0.835 vs 0.750), validation set (0.808 vs 0.796 vs 0.595), and complete data set (0.857 vs 0.823 vs 0.703). The nomogram achieved an AUC of 0.881(95%CI 0.826-0.924) in the training set, and was well verified in the validation set (AUC: 0.808[95%CI 0.705-0.888]) and the complete data set (AUC: 0.857[95%CI 0.809-0.897]). Moreover, calibration curve and DCA showed that nomogram achieved good calibration and owned more clinical net benefits in the three cohorts. KaplanMeier survival curves indicated that nomogram achieved excellent stratification for ESCC grade status (P<0.0001).

CONCLUSION

The nomogram that integrates preoperative inflammatory-immune biomarkers, intratumoral and peritumoral CT radiomics achieves a high and stable diagnostic performance for predicting poorly differentiated ESCC, and may be promising for individualized surgical selection and management.

AVAILABILITY OF DATA AND MATERIALS

The original manuscript contained in the research is included in the article. Further inquiries can be made directly to the corresponding author.

Multivisceral resection as a key indicator of recurrence in locally advanced colorectal cancers with pathologic T3 tumors

PURPOSE

This study aimed to elucidate the clinical outcomes of patients with pathologic T3 (pT3) and pathologic T4 (pT4) tumors who underwent radical resection with multivisceral resection (MVR) and to assess the prognostic significance of MVR in locally advanced colorectal cancers (CRCs) in pT3 and pT4 tumors.

METHODS

This multicenter retrospective analysis evaluated the characteristics, clinicopathologic stages, perioperative factors, and clinical outcomes of patients who underwent primary colorectal resection. Patients were divided into 4 groups: those with a pT3 tumor who did not undergo MVR (pT3 - MVR; n = 1108), those with a pT3 tumor who underwent MVR (pT3 + MVR; n = 56), those with a pT4 tumor who did not undergo MVR (pT4 - MVR; n = 306), and those with a pT4 tumor who did underwent MVR (pT4 + MVR; n = 123). Univariate and multivariate regression analyses were performed to identify risk factors for recurrence.

RESULTS

The pT3 + MVR group exhibited a higher 5-year recurrence rate than the pT3 - MVR group, with recurrence rates similar to those of the pT4 - MVR or pT4 + MVR groups (pT3 - MVR, 17.4%; pT3 + MVR, 31.6%; pT4 - MVR, 33.4%; pT4 + MVR, 35.1%). Multivariate analysis identified MVR as an independent risk factor for recurrence, particularly peritoneal dissemination, in pT3 tumors, whereas MVR had less effect on recurrence in pT4 tumors.

CONCLUSION

pT3 tumors requiring MVR had a higher recurrence rate than pT4 tumors. The surgeon's clinical assessment of potential T4 tumors requiring MVR at the time of surgery was an important prognostic indicator in advanced CRC.

Association between prognostic immune nutritional index and disease-free survival in adults with esophageal cancer following surgery: A retrospective cohort study

INTRODUCTION

The clinical significance of the prognostic immune nutritional index in esophageal cancer has not been elucidated. The aim of this study was to evaluate the utility of the preoperative prognostic immune nutritional index in predicting oncological outcomes and the incidence of surgical site infection in patients with esophageal cancer.

METHODS

We analyzed preoperative prognostic immune nutritional index from 150 esophageal cancer patients who underwent surgical treatment between 2008 and 2018 to clarify its clinical relevance.

RESULTS

Patients with low preoperative prognostic immune nutritional index exhibited poor disease-free survival and overall survival (P = 0.030 and P < 0.001, respectively). Although statistical significance was not observed in the multivariate analysis, low prognostic immune nutritional index showed a tendency toward poorer disease-free survival (hazard ratio [HR]: 2.02; 95% confidence interval [CI]: 0.88-4.61; P = 0.096). Regarding overall survival, multivariate analysis revealed that low preoperative prognostic immune nutritional index was an independent prognostic factor for overall survival (HR: 2.67; 95% CI: 1.39-5.16; P = 0.003). Moreover, the low preoperative prognostic immune nutritional index was associated with a tendency toward an increased risk of surgical site infection (odds ratio: 2.38; 95% CI: 0.96-5.91; P = 0.062). In the subgroup analysis of patients who did not receive neoadjuvant therapy, low preoperative prognostic immune nutritional index was identified as an independent prognostic factor for disease-free survival (HR: 3.11; 95% CI: 1.00-9.71; P = 0.050) and overall survival (HR: 5.04; 95% CI: 1.80-14.13; P = 0.002).

CONCLUSION

The preoperative prognostic immune nutritional index is a useful marker for perioperative and oncological management of esophageal cancer patients.

Impact of the Inflammatory Burden Index on Prognosis After Hepatectomy for Colorectal Liver Metastasis

Background/AimThe aim of this study was to investigate the prognostic impact of the inflammatory burden index (IBI), a novel inflammation-based biomarker, in patients with colorectal liver metastases (CRLM) after hepatic resection.Patients and MethodsOne hundred fifty patients with CRLM who underwent hepatectomy were retrospectively analyzed. The IBI was defined as C-reactive protein × neutrophil count/lymphocyte count. The relationship of the IBI with overall survival was investigated by univariate and multivariate analyses.ResultsSeventy-three (49%) patients had a high IBI (>3.45). In univariate analysis, overall survival was significantly worse in patients with lymph node metastases (P = 0.048), high NLR (P = 0.03), and high IBI (P < 0.01). In multivariate analysis, high IBI (P = 0.048) was an independent and significant predictor of overall survival. Patients with a high IBI had more postoperative complications compared with those with a low IBI (P < 0.01).ConclusionThe IBI was a strong predictor for both short- and long-term outcomes in patients who underwent hepatic resection for CRLM.

Prognostic value of preoperative serum C-reactive protein level for survival in mucinous appendix cancer treated with complete CRS/HIPEC

BACKGROUND

The role of systemic inflammation, a significant prognostic factor in various malignancies, is underexplored in mucinous appendix cancer (MAC). We assessed how inflammation, expressed by preoperative serum C-reactive protein (CRP), correlates with survival across MAC histopathologies managed with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).

METHODS

This retrospective cohort study included MAC patients with peritoneal dissemination, who had complete CRS/HIPEC (CC-0/1) (1998-2023). Preoperative serum CRP cut-off was defined with the minimum p-value approach and time-dependent receiver operating characteristic analysis. Survival was analyzed using the Kaplan-Meier method and Cox regression.

RESULTS

Of 273 patients, 163 had low-grade and 110 had high-grade MAC. CRP cut-off was 2.00 mg/dL. Among low-grade, 132 patients had CRP<2 and 31 had CRP≥2. In high-grade, 87 patients had CRP<2 and 23 had CRP≥2. Median follow-up was 86 (95%CI: 48-124) months. In low-grade MAC, 5-year progression-free survival (PFS) was 88.5 % in CRP<2 and 53.9 % in CRP≥2 (p < 0.001), while 5-year overall survival (OS) was 89.2 % and 85.4 %, respectively (p = 0.018). In high-grade tumors, 5-year PFS was 46.5 % in CRP<2 and 19.3 % in CRP≥2 (p = 0.011), while 5-year OS was 56.5 % and 45.3 %, respectively (p = 0.291). Multivariate Cox regression showed a strong association of CRP≥2 with worse PFS (HR 5.10; 95%CI: 2.46-10.58) and OS (HR 3.18; 95%CI: 1.22-8.28) in low-grade MAC only.

CONCLUSIONS

Elevated pre-CRS/HIPEC serum CRP was associated with worse PFS and OS in low-grade, but not in high-grade MAC. These findings highlight CRP's utility in prognosis assessment and can be useful in identifying target MAC subgroups for studying anti-inflammatory agents.

Deciphering the efficiency of preoperative systemic-immune inflammation related markers in predicting oncological outcomes of upper tract urothelial carcinoma patients after radical nephroureterectomy

PURPOSE

To assess the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic immune-inflammation response index (SIRI) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).

MATERIALS AND METHODS

One hundred seven patients were retrospectively enrolled. Chi-square (χ²) tests were adopted to assess the association of the inflammatory ratios and indexes to clinical risk factors. Overall survival (OS), metastasis-free survival (MFS), local, lymph node, and contralateral recurrence-free survival (RFS) were estimated by the Kaplan-Meier method and the corresponding curves were compared using log-rank test. Univariate and multivariate survival analysis were performed using general linear models to identify risk factors for prognosis.

RESULTS

NLR, MLR, PLR, SII, and SIRI were predictive of OS (p=0.024, p=0.025, p=0.004, p=0.006, and p=0.03, respectively). Besides, PLR was predictive of local (p<0.001) and lymph node RFS (p=0.014) and SII was associated to lymph node and contralateral RFS prediction (p=0.034 and p=0.023, respectively). All candidate markers adding high NLR+high MLR+high PLR combination were independent risk factors of OS. PLR was an independent risk factor of local and lymph node RFS whereas the above cited combination and NLR were independent prognosticators of local and contralateral RFS respectively. All markers were correlated to poor postoperative clinical characteristics mainly pathological grade (p<0.05).

CONCLUSIONS

Preoperative NLR, MLR, PLR, SII, and SIRI were associated with higher pathologic features and worse oncological outcomes in patients treated with RNU for UTUC.

Pan-immune-inflammation value and its association with all-cause and cause-specific mortality in the general population: a nationwide cohort study

Introduction

The Pan-Immune-Inflammation Value (PIV) is a novel biomarker derived from counts of neutrophils, platelets, monocytes, and lymphocytes, providing a comprehensive measure of systemic immune and inflammatory status. While it has shown prognostic value in specific disease settings, its association with mortality in the general population remains unclear. This study aims to evaluate the predictive value of PIV for all-cause and cause-specific mortality, including cardiovascular, cancer, and diabetes-related deaths, within a general adult population.

Methods

Data were obtained from the NHANES cohort, with 48,662 participants aged 20 and older. Participants were followed for an average of 117.44 months, with PIV quartiles calculated at baseline. Cox proportional hazard models were used to assess mortality risk across PIV quartiles, while restricted cubic spline models examined nonlinear dose-response relationships. Subgroup and sensitivity analyses further explored the robustness of PIV's associations.

Results

Higher PIV levels were significantly associated with increased risks of all-cause, cardiovascular, cancer, and diabetes mortality. Nonlinear relationships were observed between PIV and all-cause, cardiovascular, and cancer mortality, with a risk threshold at PIV values above 254.07. Subgroup analyses supported these findings, and sensitivity analyses confirmed the consistency of PIV's prognostic value.

Conclusion

Elevated PIV serves as an independent risk factor for multiple mortality outcomes in the general population. This study underscores the potential of PIV as a predictive biomarker for mortality risk, with implications for its use in clinical and epidemiological settings. Further studies are needed to confirm PIV's clinical utility across diverse populations and conditions.

Early prediction of anastomotic leakage after rectal cancer surgery: Onodera prognostic nutritional index combined with inflammation-related biomarkers

BACKGROUND

Anastomotic leakage (AL) is a serious complication following rectal cancer surgery and is associated with increased recurrence, mortality, extended hospital stays, and delayed chemotherapy. The Onodera prognostic nutritional index (OPNI) and inflammation-related biomarkers, such as the neutrophil-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been studied in the context of cancer prognosis, but their combined efficacy in predicting AL remains unclear.

AIM

To investigate the relationships between AL and these markers and developed a predictive model for AL.

METHODS

A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023. The patients were divided into two groups on the basis of the occurrence of AL: One group consisted of patients who experienced AL (n = 49), and the other group did not (n = 385). The investigation applied logistic regression to develop a risk prediction model utilizing clinical, pathological, and laboratory data. The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.

RESULTS

In the present study, 11.28% of the participants (49 out of 434 participants) suffered from AL. Multivariate analysis revealed that preoperative levels of the OPNI, NLR, and PLR emerged as independent risk factors for AL, with odds ratios of 0.705 (95%CI: 0.641-0.775, P = 0.012), 1.628 (95%CI: 1.221-2.172, P = 0.024), and 0.994 (95%CI: 0.989-0.999, P = 0.031), respectively. These findings suggest that these biomarkers could effectively predict AL risk. Furthermore, the proposed predictive model has superior discriminative ability, as demonstrated by an area under the curve of 0.910, a sensitivity of 0.898, and a specificity of 0.826, reflecting its high level of accuracy.

CONCLUSION

The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators, emphasizing their importance in the preoperative evaluation process.

C-reactive Protein-albumin-lymphocyte Index Is a Useful Indicator for Recurrence and Survival Following Curative Resection of Stage I-III Colorectal Cancer

Objectives

Recently, several simple inflammation-based prognostic scores that can be calculated easily from serum parameters, have been reported to be related to colorectal cancer prognosis. This study aimed to investigate factors influencing the prognosis of patients, including inflammation-based prognostic scores, with stage I-III colorectal cancer following curative resection.

Methods

This single-center study included 608 patients with stage I-III colorectal cancer who underwent curative resection between April 2010 and December 2018. A retrospective analysis was performed to identify the prognosis-associated variables in these patients. As a multi-center study, the Hiroshima Surgical study Group of Clinical Oncology database was used to analyze 1659 patients with stage I-III colorectal cancer who underwent curative resection to confirm the results of our single-center study.

Results

Of the inflammation-based prognostic scores, only preoperative C-reactive protein-albumin-lymphocyte index was revealed to predict a poor prognosis in patients with stage I-III colorectal cancer following curative resection. The low C-reactive protein-albumin-lymphocyte index was associated with poor overall survival and recurrence-free survival, which was similar in patients from multi-center database. The C-reactive protein-albumin-lymphocyte index was found to be associated with patient age, systemic condition, comorbidities, and tumor factors. The time-dependent area under the curve for the postoperative proghosis of the C-reactive protein-albumin-lymphocyte index was superior to those of other inflammation-based prognostic scores in most postoperative observation periods.

Conclusions

The preoperative C-reactive protein-albumin-lymphocyte index was independently associated with long-term prognosis in patients with stage I-III colorectal cancer following curative resection.

Navigating second-line therapy in metastatic renal cell carcinoma: a comparative analysis of immune checkpoint inhibitors and tyrosine kinase inhibitors: a study of Turkish Oncology Group Kidney Cancer Consortium

Background

Despite progress in treatment, many metastatic renal cell carcinoma (mRCC) patients still experience progression after first-line tyrosine kinase inhibitor (TKI), necessitating effective second-line options. While guidelines endorse combination therapies, accessibility limitations often restrict therapy to TKI monotherapy.

Objectives

Existing decision-making relies on limited evidence, lacking direct comparisons between the leading second-line options (cabozantinib and nivolumab) which surpass everolimus in advanced mRCC. To address this gap, this study compares the efficacy of TKI versus nivolumab in second line while investigating factors influencing outcomes.

Design

This was a retrospective cohort study.

Methods

Turkish Oncology Group Kidney Cancer Consortium includes more than 1000 mRCC patients from 13 centers in Türkiye. It has the largest national data. We extracted 214 patients treated with a TKI in the first line and nivolumab or TKI in the second line.

Results

The median overall survival (OS) and time to treatment failure (TTF) were similar in the TKI-TKI and TKI-immune checkpoint inhibitor (ICI; 41.1 and 44.8 months, p = 0.446 for OS; 27.4 and 29.8 months, p = 0.857 for TTF). The presence of previous nephrectomy for TTF made a significant difference in univariable and multivariable analysis. Bone metastases negatively affected TTF in both univariable and multivariable analyses. In the neutrophil-to-lymphocyte ratio (NLR)-high group, OS and TTF were longer in patients treated with TKI-ICI than in the TKI-TKI. In multivariable analysis, NLR was an independent prognostic factor for OS and TTF to select ICI in the second-line.

Conclusion

Our analysis revealed no significant difference in OS between patients receiving ICIs or TKIs as second-line therapy. In the subgroup of patients with elevated NLR, ICI therapy was found to cause no improvement in OS. This finding suggests the potential utility of NLR as a biomarker to guide targeted selection of ICI therapy among patients progressing after first-line TKIs. Furthermore, our study identified other noteworthy prognostic factors influencing outcomes, including the presence of bone or liver metastases, Eastern Cooperative Oncology Group performance status, and International Metastatic Renal Cell Carcinoma Database Consortium risk score.

Not all colon cancer patients with preoperative hyperinflammatory status are at high risk of muscle loss and poor prognosis

PURPOSE

Growing evidence indicates that preoperative hyperinflammation is an independent risk factor for postoperative sarcopenia and poor prognosis in patients with colon cancer. However, inflammation fluctuates with tumor burden and immune status after surgery, and its role in muscle degradation remains unclear. This study aimed to explore the impact of different inflammatory trajectories on muscle wasting.

METHODS

This retrospective study included 193 patients who are diagnosed with stage II or III colon cancer between 2015 and 2021. The preoperative and postoperative neutrophil-to-lymphocyte ratio (NLR) and prognostic immunological and nutritional index (PINI) were used to assess inflammation, and the subjects divided into four groups: a group with consistently low inflammation (G1), a group with initially high but postoperative decreased inflammation (G2), a group with initially low but postoperative increased inflammation (G3), and a group with consistently high inflammation (G4). Logistic regression identified risk factors for postoperative sarcopenia, while multivariate linear regression assessed the impact of inflammation on skeletal muscle index (SMI%) and density loss rate (SMD%). Cox models calculated overall survival (OS) and recurrence-free survival (RFS).

RESULTS

For all the assessed markers, the SMI% and SMD% in G4 significantly increased compared to G1 (P < 0.05), while G2 and G3 showed no significant change at 12 months (P > 0.05). Elevated inflammation was an independent risk factor for postoperative sarcopenia (P < 0.05). Postoperative sarcopenia and PINI in G4 independently influenced OS and RFS.

CONCLUSIONS

Only patients with persistent postoperative inflammation, not all patients with preoperative inflammation, are at increased risk for muscle wasting and poor prognosis. These findings suggest that modulating postoperative inflammation could reduce muscle loss and improve survival; these findings guide the future development of anti-inflammatory therapies for suitable populations.

Temporal relationship between chronic inflammation and insulin resistance and their combined cumulative effect on cancer risk: a longitudinal cohort study

BACKGROUND

Cancer, a chronic and dangerous disease, poses a major public health burden. Inflammation and insulin resistance promote tumorigenesis. However, the temporal relationship between the two and their relationship with cancer risk must be elucidated.

OBJECTIVE

This study aimed to investigate the association between chronic inflammation, insulin resistance, and the propensity for cancer incidence.

METHODS

We explored the temporal relationship between triglyceride index (TyG) and high-sensitivity C-reactive protein (hsCRP) levels using cross-lagged modeling. We used COX proportional risk regression modeling to explore the association between high cumulative triglyceride and glucose index (CumTyG) and high cumulative high-sensitivity C-reactive Protein (CumhsCRP) and cancer risk. We further stratified CumTyG according to tertiles to explore the association of CumhsCRP with cancer risk at different insulin resistance levels and vice versa. We analyzed the association of combined chronic inflammation with insulin resistance, risk of different cancer types, and all-cause mortality. Finally, we performed two sensitivity analyses, excluding patients who developed cancer within the first year of follow-up and those with hsCRP levels > 10 mg/L.

RESULTS

The results of the study showed that the standardized correlation coefficient (β1) between hsCRP_2006/2007 and TyG_2010/2011 was 0.02306, which was significantly higher than the correlation (β2) between TyG_2006/2007 and hsCRP_2010/2011, suggesting that inflammation played a more prominent role in future changes in insulin resistance. Chronic inflammation and insulin resistance are positively and synergistically associated with cancer risk, with high chronic inflammation and high insulin levels increasing the risk of carcinogenesis by 71%. Although CumTyG in different CumhsCRP strata and CumhsCRP in different CumTyG strata promoted carcinogenesis, there were differences in the extent of carcinogenesis. High inflammation and insulin resistance, which promote cancer onset, are closely associated with digestive system cancers. The sensitivity analysis was consistent with the primary results and verified their reliability.

CONCLUSIONS

This study revealed the potential impact of inflammation on future changes in insulin resistance. There is a synergy and interaction between chronic inflammation and insulin resistance, which promotes the risk of cancer.

TRIAL REGISTRATION NUMBER

ChiCTR2000029767 ( https://www.chictr.org.cn/showproj.html?proj=48316 ).

TRIAL REGISTRATION DATE

February 13, 2020.

Geriatric Nutritional Risk Index Predicts Postoperative Complications in Elderly Patients Undergoing Robot-Assisted Radical Cystectomy

OBJECTIVE

Malnutrition is a common condition among elderly cancer patients. The Geriatric Nutritional Risk Index (GNRI) is a simple screening tool used to predict the risk of postoperative complications in patients undergoing radical cystectomy. This study aimed to evaluate the effectiveness of preoperative GNRI as a marker for predicting 90-day postoperative complications in elderly patients undergoing robot-assisted radical cystectomy (RARC).

METHODS

We retrospectively evaluated 385 patients who underwent RARC at four affiliated institutes of Tokushima University between 2014 and 2023. Patient background characteristics, pathological findings, and 90-day postoperative complications were analyzed. Preoperative GNRI was calculated using serum albumin and body mass index, with an abnormal nutritional status defined as GNRI < 92.

RESULTS

A total of 166 patients aged ≥ 75 years who underwent RARC were included in the study. Among these, 26 patients (15.7%) had an abnormal GNRI. Eighty-four patients (50.6%) experienced complications within 90 days postoperatively, including 29 patients (17.5%) with major complications (Clavien-Dindo classification ≥ 3). The 90-day postoperative mortality rate was 3.0% (five patients). Patients with an abnormal GNRI had a significantly higher rate of 90-day postoperative complications (p < 0.001). Multivariable logistic regression analysis identified abnormal GNRI as a significant predictor of 90-day postoperative complications (odds ratio: 9.963; 95% confidence interval: 2.125-46.718; p = 0.004).

CONCLUSIONS

Poor nutritional status is associated with a higher rate of 90-day postoperative complications in elderly patients undergoing RARC. Preoperative GNRI may be a useful tool for assessing the risk of complications in this patient population.

Cerumenogram as an assay for the metabolic diagnosis of precancer, cancer, and cancer remission

Early diagnosis is crucial for successful cancer treatment. As a mitochondrial metabolic disease, cancer produces volatile organic metabolites that are present in earwax, allowing differentiation between healthy individuals and those with cancer through an assay called cerumenogram. In this case series study, we demonstrated that this assay also enables the diagnosis of precancerous stages, such as hypermetabolic inflammation and dysplasia, which can aid in treatments to prevent cancer progression. Additionally, this assay reveals that oncological metabolism differs from that observed in metaplasias, cysts, and benign tumors, helping to avoid unnecessary oncological procedures due to suspected malignancy. Cerumenogram can also be used to assess cancer remission. Thus, the cerumenogram emerges as an assay that might enable the diagnosis of cancer, monitor remission, and identify precancerous stages, covering key steps of tumorigenesis.

Association of lymphocyte-to-C-reactive protein ratio with all-cause and cause-specific mortality among US cancer survivors

BACKGROUND

Lymphocyte-to-C-reactive protein ratio (LCR) has been linked to survival in malignancies. However, most studies are from Asia. The knowledge about the link between LCR levels and risks of all-cause mortality and cause-specific mortality among cancer participants in the US is lacking.

METHODS

Using multivariable Cox proportional hazards regression, we investigated the associations between LCR and mortalities in 1999 cancer participants from the National Health and Nutrition Examination Survey 1999-2008 with mortality follow-up through December 31, 2019.

RESULTS

The median follow-up time was 156 months. Cancer participants with low LCR levels were associated with increased risks for all-cause and cancer mortality. Based on the full adjustment model, compared to the lowest LCR tertile, the hazard ratios and 95% confidence interval (HR, 95% CI) of all-cause mortality were 0.75 (0.66-0.87) in the second tertile, 0.60 (0.49-0.72) in the top tertile. The HR of cancer mortality was 0.71 (0.52-0.99) in the second tertile and 0.53 (0.35-0.79) in the top tertile. The link between LCR level and all-cause and cancer mortality remained significant when individuals who died within 2 years of follow-up were excluded.

CONCLUSIONS

This prospective study provided evidence of inverse associations between LCR levels and all-cause and cause-specific mortalities based on representative noninstitutional US cancer survivors. Integrating LCR assessment in the clinical routine of US cancer patients may aid in identifying cancer individuals at high risk of mortalities.

PIV and PILE scores predict the clinical outcome in patients with metastatic breast cancer treated with CDK4/6 inhibitors

AIMS AND OBJECTIVES

Cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) therapy, the standard of care for metastatic hormone receptor-positive (HR +)/human epidermal growth factor receptor 2 (HER2) negative breast cancer (BC), has profoundly affected many cell types, including tumor cells, Tregs, cytotoxic T cells, and stem and progenitor cells. Therefore, it is reasonable to assume that the pretreatment status of tumor immunity may have predictive value in CDK4/6i efficacy.

METHODS

A total of 404 patients were included in the analysis. The scores of the panimmune-inflammatory values (PIV) and PILE (PIV-LDH-ECOG), a candidate PIV-based scoring system, were calculated within one week before the initiation of CDK4/6i plus endocrine therapy (ET).

RESULTS

The median overall survival (OS) was 69.0 months (95% CI 51.1-86.8). The low-PIV subgroup had significantly longer progression-free survival (PFS) [23.9 vs. 18.8 months; HR = 1.817, 95% CI = 1.113-2.965, p = 0.017] and OS [73.6 vs. 37.7 months; HR = 2.338, 95% CI = 1.122-4.871, p = 0.023] than the high-PIV subgroup. In the low-risk PILE subgroup, PFS [37.0 vs. 15.8 months; HR = 2.751, 95% CI = 1.736-4.361, p < 0.001] and OS [73.6 vs. 35.1 months; HR = 3.854, 95% CI = 1.855-8.005, p < 0.001] were greater than in the high-risk PILE subgroup. The low-risk PILE subgroup was associated with a significantly better disease control rate (DCR) than the high-risk PILE subgroup (87.2% and 75.0%, p = 0.004). In the analysis of 112 patients treated with ET in the metastatic stage before CDK4/6i as a control group, PIV and PILE were not independent prognostic indicators.

CONCLUSIONS

Our study demonstrated that PIV and PILE scores could be predictive biomarkers for the treatment efficacy of CDK4/6is.

Prognostic value of combined nutritional and inflammatory markers in NSCLC patients receiving ICIs

BACKGROUND

In the treatment of non-small cell lung cancer (NSCLC), immune checkpoint inhibitors (ICIs) have markedly improved patient survival, yet some patients do not benefit. The existing prognostic factors are limited, highlighting the development of reliable and convenient predictive indicators.

METHODS

A retrospective analysis was performed on 219 NSCLC patients treated with ICIs from June 2019 to January 2024. The nutritional risk screening (NRS 2002) and the neutrophil-to-lymphocyte ratio (NLR) were employed to evaluate the patients' nutritional status and inflammatory response, aiming to investigate the correlation between these markers and treatment outcomes.

RESULTS

The median follow-up duration for the overall population was 29 (IQR: 25.96-32.04) months. The analysis showed that the median progression-free survival (mPFS) and median overall survival (mOS) in the high nutritional risk group (NRS2002 ≥ 3, accounting for 23.74%) were significantly lower than those in the low nutritional risk group (NRS2002 < 3, accounting for 76.26%) (mPFS: 2.5 vs 16 months; mOS: 8 vs 16 months, both P < 0.001). Similarly, patients with high NLR values (> 4.92) had significantly shorter OS and PFS than those with low NLR (≤ 4.92) values (mOS: 7 vs 18 months; mPFS: 3 vs 17 months, both P < 0.001). Multivariate Cox analysis revealed that a high NRS 2002 score (HR = 2.76, 95% CI 1.68-4.54, P < 0.001) and high NLR (HR = 2.77, 95% CI 1.65-4.64, P < 0.001) were independent predictors of poor prognosis. Risk stratification was performed using a combined scoring system of NRS 2002 and NLR (0 points-low risk, 1 point-moderate risk, 2 points-high risk), and it was found that as the risk score increased, OS and PFS significantly decreased (mOS: 8 [2.61-13.39] vs 16 [13.04-18.96] vs NA [NA-NA] months; mPFS: 2.5 [0.99-4.02] vs 8.5 [5.47-11.53] vs 16 [11.41-20.59] months, respectively, both P < 0.001). The utility of the combined NLR and NRS2002 scoring model was assessed using a time-dependent receiver operating characteristic (ROC) curve, with results indicating that at 12 months, the AUC value of the combined scoring model was 0.81 (CI 0.72-0.90). At 24 and 36 months, the AUC values were 0.73 (CI 0.66-0.80) and 0.70 (CI 0.64-0.76), respectively. Moreover, the nomogram model exhibited high predictive accuracy in predicting survival prognosis, with AUC values of 0.84 (CI 0.77-0.91), 0.85 (CI 0.79-0.91), and 0.78 (CI 0.69-0.88) at 12, 24, and 36 months, respectively.

CONCLUSION

The combined NRS 2002 and NLR scoring can serve as an effective prognostic tool for NSCLC patients receiving ICIs treatment. This scoring system helps clinicians more accurately identify patients who will benefit from immunotherapy, thereby facilitating more personalized treatment plans. Further validation of this scoring system's applicability and reliability is warranted in future multicenter, large-sample prospective studies.

An Overview of the Etiopathogenic Mechanisms Involved in the Expression of the Oral Microbiota

Background/Objectives: The diversity of the oral microbiota exerts its effects in maintaining dental and overall health. The unique genetic profile of each individual influences the composition of the oral microbiota, determining susceptibility to certain diseases. The aim is to observe its role by highlighting the pathogenic mechanisms involved in oral dysbiosis and identify genetic determinism's influence in maintaining balance. Methods: This study was designed as a narrative review of the oral microbiota, utilizing some of the principles and guidelines of systematic review to increase methodological rigor. We examined 121 articles such as reviews, meta-analyses, editorials, and observational studies, which met the inclusion and exclusion criteria. The inclusion criteria for studies were as follows: (1) studies that evaluated the impact of the microbiota in oral or/and systemic diseases; (2) studies that observed pathogenic mechanisms in the oral microbiota; (3) studies that evaluated the interaction of the microbiota with the immune system (4); studies that evaluated genetic implications in the microbiota. Results: Host genes regulate inflammatory and immunological reactions that play a role in microbiological balance. This explains the increased resistance of some to diseases, including gingivitis or periodontitis. Also, the implications of oral dysbiosis are reflected not only locally, but also generally, being associated with various systemic conditions. Conclusions: Understanding the pathogenic mechanisms and genetic determinants involved in oral dysbiosis may help create individualized therapies for preventing and managing oral and systemic disorders. A healthy lifestyle and adequate oral hygiene can facilitate a diverse and balanced microbiome, crucial for overall health.

Predicting PD-L1 status in NSCLC patients using deep learning radiomics based on CT images

Radiomics refers to the utilization of automated or semi-automated techniques to extract and analyze numerous quantitative features from medical images, such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans. This study aims to develop a deep learning radiomics (DLR)-based approach for predicting programmed death-ligand 1 (PD-L1) expression in patients with non-small cell lung cancer (NSCLC). Data from 352 NSCLC patients with known PD-L1 expression were collected, of which 48.29% (170/352) were tested positive for PD-L1 expression. Tumor regions of interest (ROI) were semi-automatically segmented based on CT images, and DL features were extracted using Residual Network 50. The least absolute shrinkage and selection operator (LASSO) algorithm was used for feature selection and dimensionality reduction. Seven algorithms were used to build models, and the most optimal ones were identified. A combined model integrating DLR with clinical data was also developed. The predictive performance of each model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve analysis. The DLR model, based on CT images, demonstrated an AUC of 0.85 (95% confidence interval (CI), 0.82-0.88), sensitivity of 0.80 (0.74-0.85), and specificity of 0.73 (0.70-0.77) for predicting PD-L1 status. The integrated model exhibited superior performance, with an AUC of 0.91 (0.87-0.95), sensitivity of 0.85 (0.82-0.89), and specificity of 0.75 (0.72-0.80). Our findings indicate that the DLR model holds promise as a valuable tool for predicting the PD-L1 status in patients with NSCLC, which can greatly assist in clinical decision-making and the selection of personalized treatment strategies.

A Novel Serum Inflammation Risk-Index (SIRI-RT)-Driven Nomogram for Predicting Secondary Malignancy Outcomes Post-Radiotherapy

Radiation is often used as the primary treatment for a range of cancers. Nonetheless, its ability to trigger secondary tumors has emerged as a significant issue. Therefore, gaining insight into and predicting radiation-induced secondary cancers is essential for enhancing the long-term prognosis of cancer survivors.

BACKGROUND AND OBJECTIVES

Previous studies have identified several factors; however, research on the use of serum-based inflammatory markers as prognostic tools for predicting radiation-induced secondary malignancies is limited. Investigating the potential of serum-based inflammation prognostic scores could provide a minimally invasive and affordable method for the early prediction of secondary malignancies.

METHODS

We retrospectively analyzed a patient cohort with radiation-induced secondary malignancy from the electronic database MIMIC-IV to investigate whether a serum-based inflammatory marker score can serve as a predictive tool.

RESULTS

This study seeks not only to assess the efficacy of the risk score, but also to develop a clinical utility tool nomogram for predicting the occurrence of radiation-induced secondary cancers. A RISM of 4.28% was observed in a cohort from the MIMIC-IV database using SIRI-RT as a risk index, with the Charlson comorbidity index, chemotherapy, and creatinine levels as significant confounding risk factors.

CONCLUSIONS

Our study suggests that elevated serum-based inflammation prognostic scores and the nomogram developed herein can be used to predict a greater likelihood of developing secondary malignancies following radiation therapy.

Predicting immune status and gene mutations in stomach adenocarcinoma patients based on inflammatory response-related prognostic features

BACKGROUND

Stomach adenocarcinoma (STAD) is an aggressive malignant tumor. Herein, we characterized the prognosis based on inflammatory response-related features and evaluated their potential impact on survival and immune status of STAD patients.

METHODS

Inflammation-related genes obtained from public databases were used to analyze the inflammatory response scores of STAD samples. The differentially expressed genes (DEGs) between STAD and adjacent gastric tissue were then analyzed using the "limma" package. Genes associated with STAD prognosis were obtained from the intersection of inflammation-related genes and DEGs. The key genes screened by last absolute shrinkage and selection operator (LASSO) Cox and stepwise regression analyses were used to construct prognostic models and nomograms. The tumor immune dysfunction exclusion (TIDE) algorithm was used to assess potential differences in immunotherapy response between high- and low-risk groups and to explore gene mutation signatures using the R software maftools package. In addition, GSEA was used to predict pathway characteristics between different subgroups. Finally, scratch and transwell assays were performed to explore the role of SERPINE1 in STAD cells.

RESULTS

We found that a high-inflammatory group was associated with poor prognosis in STAD patients. 14 inflammation-related DEGs out of 126 DEGs were identified to be associated with the prognosis of STAD patients, and the prognostic models and nomograms constructed from the subsequently identified key genes (SLC7A1, CD82, SERPINE1 ROS1 and SLC7A2) demonstrated a good predictive performance in terms of prognosis of STAD. Patients in the STAD high-risk group had higher StromalScore and TIDE scores. It was also found that patients in the STAD low-risk group may have a higher mutation burden. Enrichment analysis revealed significant enrichment of epithelial-mesenchymal transition, angiogenesis and KRAS pathways in the high-risk group. In-vitro experiments showed that down-regulation of SERPINE1 attenuated the migratory and invasive abilities of AGS cells.

CONCLUSION

This study provides new insights into prognostic prediction and immunotherapy for STAD from the perspective of the inflammatory response.

Marine Natural Products in Inflammation-Related Diseases: Opportunities and Challenges

In recent decades, the potentiality of marine natural products (MNPs) in the medical field has been increasingly recognized. Natural compounds derived from marine microorganisms, algae, and invertebrates have shown significant promise for treating inflammation-related diseases. In this review, we cover the three primary sources of MNPs and their diverse and unique chemical structures and bioactivities. This review aims to summarize the progress of MNPs in combating inflammation-related diseases. Moreover, we cover the functions and mechanisms of MNPs in diseases, highlighting their functions in regulating inflammatory signaling pathways, cellular stress responses, and gut microbiota, among others. Meanwhile, we focus on key technologies and scientific methods to address the current limitations and challenges in MNPs.

Tocilizumab improves the efficacy of anti-PD-1 in a patient with advanced gastroesophageal junction cancer: a case report

Background

Cancer-related inflammation contributes to the progression of malignancies and considerably affects therapeutic outcomes. IL-6 acts as a main mediator of both local and systemic inflammatory responses. Although IL-6 therapies have been successful in the treatment of inflammatory conditions, there has been little experience in patients with cancer.

Case presentation

A 66-year-old man was diagnosed with gastroesophageal junction squamous cell carcinoma (stage IV) with liver metastasis. The patient presented with notable cancer-associated systemic inflammatory symptoms, and experienced disease progression after initial two cycles of anti-PD-1 combined with chemotherapy. After tocilizumab treatment, the symptoms improved rapidly. The patient showed favorable response to subsequent anti-PD-1 plus second-line chemotherapy, and survived without disease progression.

Conclusion

Targeting IL-6 holds promise for the management of cancer-associated inflammation and improvement of therapeutic outcomes.

Peripheral inflammatory factors as prognostic predictors for first-line PD-1/PD-L1 inhibitors in advanced non-small cell lung cancer

Immune checkpoint inhibitors (ICIs) have significantly improved the efficacy and prognosis of patients with non-small cell lung cancer (NSCLC). However, there remains a lack of optimal predictive biomarkers for assessing the response of ICIs. This study aimed to evaluate peripheral inflammatory factors as potential predictive biomarkers for NSCLC patients treated with ICIs. We retrospectively analyzed the correlation between peripheral inflammatory factors and the efficacy and prognosis of 124 patients with driver gene-negative advanced NSCLC who received first-line ICIs at our center from September 2018 to June 2022. Progression-free survival (PFS) was estimated using the Kaplan-Meier method. The association between the factors and multiple endpoints were investigated using univariate and multivariate analyses. A total of 124 patients were enrolled in this study. The objective response rate (ORR) was 49.2% and the disease control rate (DCR) was 97.6%, respectively. The median PFS was 12.7 months. The ORR differed statistically between groups based on the NLR, SII, with higher ORR observed in patients with an NLR ratio < 0.68, SII at 6 weeks < 531.26, and SII ratio < 0.74 (p < 0.05). The univariate analysis indicated that ECOG 0-1, smoking, NLR at 6 weeks < 2.72, NLR ratio < 0.68, LMR < 1.34, LMR ratio ≥ 1.38, and SII at 6 weeks < 531.26 were associated with longer PFS (p < 0.05). The multivariate analysis revealed that smoking (p = 0.013), baseline LMR (p = 0.015), and SII at 6 weeks (p = 0.010) were independent predictors of PFS. NLR, LMR, and SII maybe biomarkers for predicting the efficacy and prognosis of first-line ICIs therapy in driver gene-negative advanced NSCLC.

Functional Materials Targeted Regulation of Gasdermins: From Fundamentals to Functionalities and Applications

Targeted regulation of pyroptosis to modulate the immune landscape has emerged as a novel design strategy for cancer immunotherapy and anti-inflammatory therapy. However, pyroptosis acts as a double-edged sword, making it important to optimize the design strategies of functional materials to appropriately activate pyroptosis for effective disease treatment. This paper summarizes and discusses the structure, pore formation, and molecular mechanisms of "executor" Gasdermins, as well as the events preceding and following these processes. Subsequently, the focus is on reviewing functional materials that directly regulate Gasdermin pore formation to target pyroptosis and those that indirectly regulate the events before and after Gasdermin pore formation to control pyroptosis activity. Finally, the advantages, disadvantages, and future prospects of designing such functional materials are provided, aiming to facilitate the precise design, pharmacological investigation, and clinical translation of pyroptosis-related functional materials.

Relationship between muscular mass, inflammatory status, tumor metabolic activity and oral intake in head and neck cancer at the outset of management

BACKGROUND AND AIMS

Patients with head and neck cancer (HNC) are often malnourished with a low muscular mass at the outset of management. This is thought to be mainly due to poor nutritional intake. The aim of this study was to assess the correlation between tumor metabolic activity, inflammatory status and body composition in HNC patients.

MATERIALS AND METHODS

This retrospective study included 112 patients with HNC. Tumor metabolic activity was assessed using the total lesion glycolysis (TLG) and maximum standardized uptake value (SUVmax). Body composition was measured by the third cervical vertebra skeletal muscle index (C3 SMI). Systemic inflammation was measured by the modified Glasgow Prognostic Score (mGPS) and the neutrophil-to-lymphocyte ratio (NLR). Nutritional status was assessed by the Nutritional Risk Index (NRI).

RESULTS

The majority of patients had advanced tumor stage (75 %). Malnutrition was found in 39.3 % (NRI), and systemic inflammation in 44.7 % (mGPS) and 41.1 % (NLR) of patients. High TLG was associated. with low C3 SMI (p = 0.021), low NRI (p = 0.01), high mGPS (p = 0.001), and high NLR (p = 0.003). A high NLR was associated with a low C3 SMI (p = 0.046) and low body mass index (BMI) (p = 0.01).

CONCLUSION

Our study establishes a relationship between the high metabolic activity of tumor, the loss of muscle mass, and increased systemic inflammation.

Prognostic value of Glasgow prognostic score in hematological malignancies: a systematic review and meta-analysis

OBJECTIVE

The Glasgow prognostic score (GPS) is used to predict the prognosis of several cancers. This first systematic review and meta-analysis evaluated the role of GPS in predicting overall survival (OS) and progression-free survival (PFS) in patients with hematological malignancies.

METHODS

Embase, PubMed, CENTRAL, Scopus, and Google Scholar were screened for studies evaluating the prognostic role of GPS in hematological malignancies.

RESULTS

Twelve studies were eligible. Meta-analysis showed that patients with GPS of ≥1 and ≥2 had worse OS than those with GPS of 0. We noted that both GPS scores of ≥1 and ≥2 were associated with significantly poor PFS in patients with hematological malignancies. Results remained robust on sensitivity analysis.

CONCLUSION

GPS can be used as a predictor of OS and PFS in patients with hematological malignancies. High GPS scores can lead to a twofold higher risk of poor OS and PFS.

Integrating nutritional status and hematological biomarkers for enhanced prognosis prediction in glioma patients: A systematic review

PURPOSE

Multiple inflammatory and nutritional biomarkers have been established as independent prognostic factors across various solid tumors, but their role in outcomes prediction for glioma is still under investigation. Aim of the present systematic review is to report the available evidence regarding the impact of nutritional assessment and intervention for glioma prognosis and patients' quality of life (QoL).

MATERIALS AND METHODS

Our systematic review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The PubMed and EMBASE databases were searched to identify studies assessing the impact of nutritional status and intervention and hematological biomarkers on survival outcomes and quality of life in patients with newly diagnosed gliomas. In the search strategy Medical Subject Headings (MeSH) terms were used. Search terms included ("nutritional status" or "nutritional assessment" or "nutritional intervention") AND ("glioma" or "glioblastoma" or "high-grade glioma" or "low-grade glioma" or "anaplastic astrocytoma" or "anaplastic oligodendroglioma") AND ("prognosis" or "survival outcomes"). The quality of each study was investigated based on the Newcastle-Ottawa Scale (NOS) criteria. Selected papers were in English and included publications in humans. This study was registered on PROSPERO (Registration No. CRD42024555442).

RESULTS

Our search retrieved 20 papers published between 2015 and 2023, all aiming at investigating correlations between hematological biomarkers (albumin, prealbumin, fibrinogen) and/or nutritional tools (Controlling Nutritional Score, CONUT; Prognostic Nutritional Index, PNI) and survival outcomes and quality of life of glioma patients. Nutritional intervention as well was evaluated for outcomes prediction. Overall, most papers contributed to the evidence of how nutritional assessment and inflammatory biomarkers could play an independent prognostic role also in the management of glioma patients.

CONCLUSIONS

PNI, CONUT score and hematological biomarkers (e.g. albumin, globulin, neutrophils, lymphocytes) may serve as useful predictors in patients with gliomas, potentially influencing clinical decisions. Additional large-scale studies are required to validate these findings and determine the mechanisms by which nutritional status, systemic inflammation and immune status affect prognosis in glioma patients.

Reproduction of Original Glioblastoma and Brain Metastasis Research Findings Using Synthetic Data

OBJECTIVE

Synthetic data (SD) is artificially generated information that mimics the statistical characteristics and correlations of real-world data, enabling researchers to simulate variables that are challenging to obtain in routine practice while overcoming confidentiality barriers. This study aims to evaluate the utility, validity, and potential limitations of SD in glioblastoma (GBM) and brain metastases (BM) research.

METHODS

Three published neuro-oncology studies focusing on prognostic factors were selected: 2 involving GBM patients and 1 with BM patients. These studies were replicated using the MDClone platform, a healthcare data exploration tool that enables the creation of SD. Real-world data and SD were compared across patient demographic and outcome variables using summary statistics, normality testing, and t-test as required.

RESULTS

452 GBM patients and 1320 BM patients were generated with SD. Among GBM patients, longer median overall survival was associated with younger age (age<50: 16.3 months [95% CI: 12.8-19.8]; age 50-59: 15.6 [95% CI: 13.1-18.1]; age 60-69: 13.9 [95% CI: 12.1-15.7]; age>70: 8.8 [95% CI: 7.4-10.2], P < 0.001), greater extent of resection (debulking: 16.8 months [95% CI 14.9-18.7] vs. biopsy: 10.9 months [95% CI: 9.6-12.3], P < 0.001), and higher serum albumin (sAlb) (sAlb<30 g/L: 7.0 months [95% CI: 4.8-9.3]; sAlb 30-40 g/L: 12.9 [95% CI: 11.6-14.1]; sAlb>40: 16.2 [95% CI: 13.4-19.1], P < 0.05). Among BM patients, lower systemic inflammation scores (neutrophil-lymphocyte-ratio, leukocyte-lymphocyte-ratio, platelet-lymphocyte-ratio, monocyte-lymphocyte-ratio, and C-reactive-protein/albumin-ratio) were associated with longer overall survival (P < 0.05). These results aligned with the findings reported in the literature.

CONCLUSIONS

Integrating SD into clinical research offers potential for providing accurate predictive insights without compromising patient privacy.

Sarcopenia in gynaecological cancers

Gynaecological cancers (GCs) comprise a group of cancers that originate in the female reproductive organs. Each GC is unique, with different signs and symptoms, risk factors and therapeutic strategies. Worldwide, the majority of GCs are still associated with high mortality rates, especially ovarian, due to difficulty in early detection. Despite numerous studies on the underlying pathophysiology, research in the field of GCs poses unique scientific and technological challenges. These challenges require a concerted multi- and inter-disciplinary effort by the clinical, scientific and research communities to accelerate the advancement of prognostic, diagnostic, and therapeutic approaches. Sarcopenia is a multifactorial disease which leads to the systemic loss of skeletal muscle mass and function. It can be caused by malignancies, as well as due to malnutrition, physical inactivity, ageing and neuromuscular, inflammatory, and/or endocrine diseases. Anorexia and systemic inflammation can shift the metabolic balance of patients with cancer cachexia towards catabolism of skeletal muscle, and hence sarcopenia. Therefore, sarcopenia is considered as an indicator of poor general health status, as well as the possible indicator of advanced cancer. There is a growing body of evidence showing the prognostic significance of sarcopenia in various cancers, including GCs. This review will outline the clinical importance of sarcopenia in patients with GCs.