A Nomogram for Predicting Multiple Metastases in Metastatic Colorectal Cancer Patients: A Large Population-Based Study

Development and validation of a predictive model for postoperative metastasis of upper tract urothelial carcinoma after radical nephroureterectomy and analysis of risk factors for different metastatic sites: a multicenter study

PURPOSE

To develop a prediction model for assessing the risk of postoperative metastasis in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) and to analyze independent risk factors for metastasis at different sites.

METHODS

We retrospectively analyzed data from 555 UTUC patients who underwent RNU at 3 medical centers between January 2012 and August 2023. Patients were randomly divided into a training cohort (n = 388) and a validation cohort (n = 167) at a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed in the training cohort to identify postoperative metastasis risk factors. A nomogram was developed based on these factors and validated. In addition, independent risk factors for metastasis at different sites were analyzed.

RESULTS

Among the 555 patients, 122 (22.0%) developed postoperative metastasis. Middle and lower ureteral tumors, T stage ≥ T3, high-grade tumors, lymphovascular invasion (LVI), and a prognostic nutritional index (PNI) < 48.75 were associated with poorer metastasis-free survival (MFS). The nomogram achieved C-indexes of 0.816 and 0.812 in the training and validation cohorts. Age < 65 years was a risk factor for lymph node metastasis, tumor size and necrosis predicted liver metastasis, and a higher preoperative platelet-to-lymphocyte ratio (PLR) was associated with bone metastasis. Median overall survival (OS) for lymph node, lung, liver, multiple sites, bone, and brain metastasis were 14, 10, 6, 5.5, 5, and 4.5 months, respectively.

CONCLUSION

The prediction model developed effectively assesses postoperative metastasis risk in UTUC patients' aids in guiding individualized treatment. The risk factors for different metastasis sites are generally similar, with slight variations, which may offer new directions for future research on site-specific therapeutic strategies.

Abnormal upregulation of NUBP2 contributes to cancer progression in colorectal cancer

Colorectal cancer (CRC), a digestive tract malignancy with high mortality and morbidity, lacks effective biomarkers for clinical prognosis due to its complex molecular pathogenesis. Nucleotide binding protein 2 (NUBP2) plays a vital role in the assembly of cytosolic Fe/S protein and has been implicated in cancer progression. In this study, we found that NUBP2 was highly expressed in CRC by TCGA database analysis. Subsequently, we verified the expression of NUBP2 in CRC tumor tissues and para-carcinoma tissues using IHC staining, and further investigated its association with clinicopathological parameters. In vitro cell experiments were conducted to assess the role of NUBP2 in CRC by evaluating cell proliferation, migration, and apoptosis upon NUBP2 dysregulation. Furthermore, we established a subcutaneous CRC model to evaluate the impact of NUBP2 on tumor growth in vivo. Additionally, we performed mechanistic exploration using a Human Phospho-Kinase Array-Membrane. Our results showed higher expression of NUBP2 in CRC tissues, which positively correlated with the pathological stage, indicating its involvement in tumor malignancy. Functional studies demonstrated that NUBP2 knockdown reduced cell proliferation, increased apoptosis, and impaired migration ability. Moreover, NUBP2 knockdown inhibited tumor growth in mice. We also observed significant changes in the phosphorylation level of GSK3β upon NUBP2 knockdown or overexpression. Additionally, treatment with CHIR-99021 HCl, an inhibitor of GSK3β, reversed the malignant phenotype induced by NUBP2 overexpression. Overall, this study elucidated the functional role of NUBP2 in CRC progression both in vitro and in vivo, providing insights into the molecular mechanisms underlying CRC and potential implications for targeted therapeutic strategies.

Development and validation of a risk predictive nomogram for colon cancer-specific mortality: a competing risk model based on the SEER database

BACKGROUND

Utilizing the SEER database, we developed a competing risk model along with a nomogram designed for the early identification of colon cancer-specific mortality (CSM) risk.

METHODS

Clinical and pathological information, along with other significant data, were obtained from the SEER database. Patients were randomly divided into a training set and a validation set. We investigated the independent factors affecting CSM among colon cancer patients using univariate and multivariate analyses within a competing risk framework, ultimately developing a predictive tool for CSM in colon cancer.

RESULTS

Involving 40,261 individuals diagnosed with colon cancer, our study included 10,397 deaths directly due to the disease and an additional 5,828 from other causes. We used a competing risk model to predict cancer-specific mortality (CSM) in these patients. For the training dataset, the model's area under the curve (AUC) for predicting 1-, 3-, and 5-year cancer-specific survival (CSS) was 0.835 (95% confidence interval [CI] 0.826 to 0.844), 0.849 (95% CI 0.843 to 0.855), and 0.843 (95% CI 0.836 to 0.850), respectively. In the validation group, the AUC values for the same time periods were 0.846 (95% CI 0.833 to 0.860), 0.853 (95% CI 0.843 to 0.862), and 0.846 (95% CI 0.835 to 0.856), respectively. In comparison, traditional survival analysis yielded higher cumulative CSM rates over time than those provided by our competing risk approach.

CONCLUSION

We created a competitive risk assessment model along with a predictive tool designed to estimate CSM in patients with colon cancer. This nomogram demonstrates high accuracy and reliability, aiding medical professionals in making clinical decisions and developing patient follow-up plans.

Log odds of positive lymph nodes show better predictive performance on the prognosis of early-onset colorectal cancer

BACKGROUND

As the incidence of colorectal cancer tends to be younger, early-onset colorectal cancer (EOCRC) has attracted more attention in recent years. We aimed to assess the optimal lymph node staging system among EOCRC patients, and then, establish informative assessment models for prognosis prediction.

METHODS

Data of EOCRC were retrieved from the Surveillance, Epidemiology, and End Results database. Survival prediction ability of three lymph node staging systems including N stage of the tumor node metastasis (TNM) staging system, lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) was assessed and compared using Akaike information criterion (AIC), Harrell's concordance index (C-index), and likelihood ratio (LR) test. Univariate and multivariate Cox regression analyses were conducted to identify the prognostic predictors for overall survival (OS) and cancer-specific survival (CSS). Effectiveness of the model was demonstrated by receiver operative curve and decision curve analysis.

RESULTS

A total of 17,535 cases were finally included in this study. All three lymph node staging systems showed significant performance in survival prediction (p < 0.001). Comparatively, LODDS presented a better ability of prognosis prediction with lower AIC (OS: 70,510.99; CSS: 60,925.34), higher C-index (OS: 0.6617; CSS: 0.6799), and higher LR test score (OS: 998.65; CSS: 1103.09). Based on independent factors identified from Cox regression analysis, OS and CSS nomograms for EOCRC were established and validated.

CONCLUSIONS

LODDS shows better predictive performance than N stage or LNR among patients with EOCRC. Novel validated nomograms based on LODDS could effectively provide more prognostic information than the TNM staging system.

A nomogram for predicting the HER2 status of circulating tumor cells and survival analysis in HER2-negative breast cancer

Background

In breast cancer patients with HER2-negative tumors (tHER2-), HER2-positive CTCs (cHER2+) were associated with promising efficacy of HER2-targeted therapy, but controversy has persisted over its prognostic effect. We developed a model including clinicopathologic parameters/blood test variables to predict cHER2 status and evaluated the prognostic value of cHER2+ in tHER2- patients.

Methods

cHER2+ was detected, blood test results and clinicopathological characteristics were combined, and a nomogram was constructed to predict cHER2 status in tHER2- patients according to logistic regression analysis. The nomogram was evaluated by C-index values and calibration curve. Kaplan-Meier curves, log-rank tests, and Cox regression analyses were performed to evaluate the prognostic value of cHER2 status.

Results

TNM stage, white blood cells (WBCs), neutrophils (NEUs), uric acid (UA), De Ritis ratio [aspartate transaminase (AST)/alanine transaminase (ALT)], and high-density lipoprotein (HDL) were found to be associated with cHER2 status in tHER2- patients in univariate logistic regression analysis, in which UA and De Ritis ratio remained significant in multivariate logistic regression analysis. A model combining these six variables was constructed, the C-index was 0.745 (95% CI: 0.630-0.860), and the calibration curve presented a perfect predictive consistency. In survival analysis, patients of the subgroups "with cHER2+/UA-low" (p = 0.015) and "with cHER2+/De Ritis ratio - high" (p = 0.006) had a significantly decreased disease-free survival (DFS).

Conclusions

Our nomogram, based on TNM stage, WBC, NEU, UA, De Ritis ratio, and HDL, may excellently predict the cHER2 status of tHER2- patients. Incorporation with UA and De Ritis ratio may enhance the prognostic value of cHER2 status.

Impact of Age of Onset on Survival after Hepatectomy for Patients with Colorectal Cancer Liver Metastasis: A Real-World Single-Center Experience

PURPOSE

The incidence of early-onset CRC is increasing. However, the effect of age of onset on the long-term outcome of colorectal cancer liver metastasis (CRLM) remains unclear. This study aimed to evaluate the association between the age of onset and the oncological outcome of CRLM patients and to investigate whether the prognostic role of RAS mutation is altered with age.

METHODS

We retrospectively investigated consecutive patients at our institution who underwent initial liver resection between 2006 and 2020. The inverse probability of treatment weighting (IPTW) method was used to balance the confounders among early- (≤45 years; EOCRLM), intermediate- (46-70 years; IOCRLM), and late-onset (>70 years; LOCRLM) groups. The prognostic role of RAS was assessed based on age group.

RESULTS

A total of 1189 patients were enrolled: 162 in the EOCRLM group, 930 in the IOCRLM group, and 97 in the LOCRLM group. No difference in disease-free survival (DFS) was found between the three groups. However, EOCRLM were more likely to develop extrahepatic and extrapulmonary metastasis and had significantly lower five-year OS rates than IOCRLM. After IPTW, EOCRLM remained a negative prognostic predictor. RAS mutations were significantly associated with worse survival than wild-type RAS in EOCRLM and IOCRLM. However, RAS mutation did not predict the prognosis of patients with LOCRLM.

CONCLUSIONS

Patients with EOCRLM had a significantly lower OS than IOCRLM patients and age influences the prognostic power of RAS status. These findings may be helpful for doctors to guide the clinical treatments and develop follow-up strategies.

Development and validation of a prognostic scoring system for patients with colorectal cancer hepato-pulmonary metastasis: a retrospective study

BACKGROUND

Hepato-pulmonary metastasis of colorectal cancer (CRC) is a rare disease with poor prognosis. This study aims to establish a highly efficient nomogram model to predict overall survival (OS) and cancer-specific survival (CSS) in patients with colorectal cancer hepato-pulmonary metastasis (CRCHPM).

METHODS

We retrospectively analyzed the data of patients with CRCHPM from SEER database and Wuhan Union Hospital Cancer Center (WUHCC). A total of 1250 CRCHPM patients were randomly assigned to the training, internal validation, and external validation cohorts from 2010 to 2016.Univariate and multivariate cox analysis were performed to identify independent clinicopathological predictors of OS and CSS, and a nomogram was constructed to predict OS and CSS in CRCHPM patients.

RESULTS

A nomogram of OS was constructed based on seven independent predictors of age, degree of differentiation, T stage, chemotherapy, number of lsampled lymph nodes, number of positive lymph nodes, and tumor size. Nomogram showed favorable sensitivity in predicting OS at 1, 3 and 5 years, with area under the receiver operating characteristic curve (AUROC) values of 0.802, 0.759 and 0.752 in the training cohort;0.814, 0.769 and 0.716 in the internal validation cohort;0.778, 0.756 and 0.753 in the external validation cohort, respectively. A nomogram of CSS was constructed based on three independent predictors of T stage, chemotherapy, and tumor size. The AUROC values of 1, 3 and 5 years were 0.709,0.588,0.686 in the training cohort; 0.751, 0.648,0.666 in the internal validation cohort;0.781,0.588,0.645 in the external validation cohort, respectively. Calibration curves, Concordance index (C-index), and decision curve analysis (DCA) results revealed that using our model to predict OS and CSS is more efficient than other single clinicopathological characteristics.

CONCLUSION

A nomogram of OS and CSS based on clinicopathological characteristics can be conveniently used to predict the prognosis of CRCHPM patients.

Nomogram predicting the cancer-specific survival of early-onset colorectal cancer patients with synchronous liver metastasis: a population-based study

PURPOSE

This research aimed to explore prognostic factors for early-onset colorectal cancer (EO-CRC) patients with liver metastasis (LM) and develop nomogram for predicting cancer-specific survival (CSS) probability quantitatively.

METHODS

Our study included 4368 EO-CRC patients with LM registered in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017. Potential prognostic factors for EO-CRC patients with LM were identified by multivariable Cox regression analysis. Prognostic nomogram was subsequently constructed based on these prognostic factors. The discriminative ability, calibration, and clinical usefulness of the nomogram were assessed by the area under the receiver operating characteristic (ROC) curves (AUC), calibration curves, and decision curve analysis (DCA).

RESULTS

In the training cohort, marital status, primary tumor location, histopathological grade, T stage, number of metastatic organs, carcinoembryonic antigen (CEA), perineural invasion (PI), surgery of primary site, chemotherapy, radiation therapy, and metastatic lymph nodes ratio (LNR) were prognostic factors for cancer-specific mortality of EO-CRC patients with LM. The 1-, 2-, and 3-year AUC values of the prognostic nomogram were 0.777, 0.781, and 0.788, respectively. Calibration curves indicated acceptable agreement between nomogram-predicted survival and actual observed survival at 1, 2, and 3 years. DCA curves exhibited good positive net benefits in the prognostic model in most threshold probabilities at different time points. All of these results were reproducible in the validation cohort.

CONCLUSIONS

This study identified prognostic factors for EO-CRC patients with LM and developed a prognostic nomogram with good performance and clinical usability, which may help clinicians make better treatment decisions.

Carbonic Anhydrase VIII (CAVIII) Gene Mediated Colorectal Cancer Growth and Angiogenesis through Mediated miRNA 16-5p

Carbonic anhydrase VIII (CAVIII) is a member of the CA family, while CA8 is the oncogene. Here we observed increased expression of CAVIII with high expression in colorectal cancer tissues. CAVIII is also expressed in more aggressive types of human colorectal cancer cells. Upregulated CAVIII expression in SW480 cell lines increased vascular endothelial growth factor (VEGF) and reduced miRNA16-5p. Conversely, knockdown of the CAVIII results in VEGF decline by up-regulated miRNA16-5p. Moreover, the collection of different grades of CAVIII expression CRC cells supernatant co-culture with endothelial progenitor cells (EPCs) promotes the ability of tube formation in soft agar and migration in the Transwell experiment, indicating that CAVIII might facilitate cancer-cell-released VEGF via the inhibition of miRNA16-5p signaling. Furthermore, in the xenograft tumor angiogenesis model, knockdown of CAVIII significantly reduced tumor growth and tumor-associated angiogenesis. Taken together, our results prove that the CAVIII/miR-16-5p signaling pathway might function as a metastasis suppressor in CRC. Targeting CAVIII/miR-16-5p may provide a strategy for blocking its metastasis.