Evaluating the Platelet Distribution Width-to-Plateletcrit Ratio as a Prognostic Marker for Patients With Breast Cancer

The potential of high-order features of routine blood test in predicting the prognosis of non-small cell lung cancer

BACKGROUND

Numerous studies have demonstrated that the high-order features (HOFs) of blood test data can be used to predict the prognosis of patients with different types of cancer. Although the majority of blood HOFs can be divided into inflammatory or nutritional markers, there are still numerous that have not been classified correctly, with the same feature being named differently. It is an urgent need to reclassify the blood HOFs and comprehensively assess their potential for cancer prognosis.

METHODS

Initially, a review of existing literature was conducted to identify the high-order features (HOFs) and classify them based on their calculation method. Subsequently, a cohort of patients diagnosed with non-small cell lung cancer (NSCLC) was established, and their clinical information prior to treatment was collected, including low-order features (LOFs) obtained from routine blood tests. The HOFs were then computed and their associations with clinical features were examined. Using the LOF and HOF data sets, a deep learning algorithm called DeepSurv was utilized to predict the prognostic risk values. The effectiveness of each data set's prediction was evaluated using the decision curve analysis (DCA). Finally, a prognostic model in the form of a nomogram was developed, and its accuracy was assessed using the calibration curve.

RESULTS

From 1210 documents, over 160 blood HOFs were obtained, arranged into 110, and divided into three distinct categories: 76 proportional features, 6 composition features, and 28 scoring features. Correlation analysis did not reveal a strong association between blood features and clinical features; however, the risk value predicted by the DeepSurv LOF- and HOF-models is significantly linked to the stage. Results from DCA showed that the HOF model was superior to the LOF model in terms of prediction, and that the risk value predicted by the blood data model could be employed as a complementary factor to enhance the prognosis of patients. A nomograph was created with a C-index value of 0.74, which is capable of providing a reasonably accurate prediction of 1-year and 3-year overall survival for patients.

CONCLUSIONS

This research initially explored the categorization and nomenclature of blood HOF, and proved its potential in lung cancer prognosis.

Correlation between platelet distribution width and long-term survival in patients with gastric cancer after radical surgery

BACKGROUND

Gastric cancer is a common digestive system tumor, and surgery is the first choice of treatment, but the long-term survival of patients after surgery is still not satisfactory. Previous studies have showed that platelet distribution width (PDW) plays an important role in the occurrence and development of tumor. This study aimed to analyze the correlation between PDW and long-term survival of patients with stage Ⅱ-ⅢA gastric cancer after radical surgery.

AIM

To explore the relationship between PDW and long-term survival in patients with stage Ⅱ-ⅢA gastric cancer after radical surgery.

METHODS

This is a prospective cohort study, in which 124 patients with gastric cancer who received surgical treatment at our hospital from January 2016 to December 2017 were included as the study subjects. All patients were followed for 5 years and their survival time was recorded. The patients were divided into three groups according to whether their PDW increased or not after surgery: PDW decrease group, PDW normal group, and PDW increase group. The clinicopathological characteristics and long-term survival of patients in different groups were compared. Point binary correlation and COX regression were used to test the correlation between postoperative PDW and long-term survival of patients and the impact of PDW on long-term survival. Receiver operating characteristic (ROC) curve analysis was performed to analyze the value of postoperative PDW in predicting long-term survival.

RESULTS

The levels of CEA, CA199, and PDW in gastric cancer patients after treatment were significantly lower than those before treatment (P < 0.05). Among 111 patients with gastric cancer, 35 (31.53%) had decreased PDW, 24 (21.62%) had normal PDW, and 52 (46.85%) had increased PDW. The rates of lymph node metastasis and advanced tumor-node-metastasis (TNM) stage (ⅢA) in the PDW increase group were significantly higher than those of the PDW normal group and PDW decrease group (P < 0.05). However, there were no statistical significant differences among the three groups in terms of age, sex, degree of differentiation, tumor diameter, depth of muscle invasion, TNM stage, and lymph node metastasis (P > 0.05). Among 111 cases of gastric cancer, 31 survived, with a survival rate of 27.93%; the survival time was 11-60 mo, and the median survival time was 43.00 (31.00, 60.00) mo. Point binary correlation test showed that PDW, lymph node metastasis, and TNM stage were positively correlated with long-term survival after radical surgery(r > 0, P < 0.05). COX regression analysis showed that after adjusting for TNM stage and lymph node metastasis, taking the normal PDW group as a reference, the increase of PDW was a risk factor for long-term survival of gastric cancer patients. The median survival time of the patients with decreased, normal, and increased PDW was 49.50 (33.00, 60.00) mo, 53.50 (49.25, 58.00) mo, and 29.00 (20.00, 35.00) mo, respectively, and the difference among the three groups was statistically significant (P < 0.05). ROC curve analysis showed that postoperative PDW level had appreciated value in predicting long-term survival of gastric cancer patients (AUC = 0.718, 95%CI: 0.614-0.822, P < 0.001).

CONCLUSION

PDW is related to the long-term survival of patients with gastric cancer after radical surgery. Increased PDW indicates that the long-term prognosis of gastric cancer patients is poor and the survival period is short. TNM stage and lymph node metastasis are also closely related to the long-term survival of gastric cancer patients.

Breast Lesions Diagnosed as Ductal Carcinoma In Situ by Ultrasound-Guided Core Needle Biopsy: Risk Predictors for Concomitant Invasive Carcinoma and Axillary Lymph Node Metastasis

Background

The major concern over preoperatively diagnosed ductal carcinoma in situ (DCIS) of breast via ultrasound-guided core needle biopsy (US-CNB) is the risk of missing concomitant invasive carcinoma. It is crucial to identify risk predictors for such a phenomenon and evaluate its impact on axillary conditions to help surgeons determine which patients should receive appropriate axillary lymph node management.

Methods

Medical records of 260 patients preoperatively diagnosed with DCIS via 14-gauge CNB were retrospectively analyzed. All of them underwent subsequent surgery at our institution and were successively divided into invasive and non-invasive groups, and metastatic and non-metastatic groups according to pathology of resected specimens and metastasis of axillary lymph nodes (ALNs). Predictive value of preoperative physical examinations, imaging findings, histopathological findings, and hematological indexes for pathological underestimation and metastasis of ALN was assessed by logistic regression analysis.

Results

The concomitant invasive carcinoma was overlooked in 75 out of 260 patients (29.3%). Multivariate analysis revealed that presence of microinvasion, presence of abnormal lymph node on ultrasound, and absent linear or segmental distributed calcification on mammography were independent risk predictors for invasive carcinoma. Fourteen patients had lymph node metastasis, and five of them were in the non-invasive group. The presence of abnormal lymph node on ultrasound and increased ratio of platelet distribution width to platelet crit (PDW/PCT) (>52.85) were identified as independent risk predictors for ALN metastasis.

Conclusion

For patients diagnosed with DCIS preoperatively, appropriate ALN management is necessary if they have risk predictors for concomitant invasive carcinoma and ALN metastasis.