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Xing Y, Hosaka H, Moki F, Tomaru S, Itoi Y, Sato K, Hashimoto Y, Tanaka H, Kuribayashi S, Takeuchi Y, Nagai K, Uraoka T. Gender Differences in Patients with Gastric Adenocarcinoma. J Clin Med 2024; 13:2524. [PMID: 38731053 PMCID: PMC11084512 DOI: 10.3390/jcm13092524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Gastric cancer (GC) epidemiology and outcomes vary by gender. Methods: We reviewed 18,436 GC patients from 2008 to 2018 and looked for gender differences in clinical characteristics and survival. Results: The gender proportion was 71% male and 29% female. Males had a significantly (p < 0.001) higher proportion of differentiated GC (66.3%) and a lower proportion of undifferentiated GC (26.3%). Diagnosis through medical check-ups was more common in males (30.0% vs. 26.4%, p < 0.001). Clinical staging revealed 54.6% of males and 52.9% of females had localized disease without lymph node metastasis (LNM), while distant metastasis occurred in 17.4% of males and 16.9% of females (p < 0.001). Kaplan-Meier survival curves indicated females had a significantly higher overall survival (p = 0.0018). The survival advantage for females was evident in the early stages, with a significant difference in localized disease without LNM (p < 0.001) and localized disease with LNM (p = 0.0026, log-rank test) but not in the advanced stages. Multivariate Cox regression analysis showed a significantly reduced mortality risk in females (p < 0.001). Conclusions: Significant gender differences exist with regard to pathological type, presentation, clinical stage, and overall survival. These findings suggest gender-specific strategies for screening, diagnosis, and treatment.
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Affiliation(s)
- Yujin Xing
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Hiroko Hosaka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Fumitaka Moki
- Gunma Health Foundation, Gunma Prefectural Cancer Registry, 16-1 Horinoshita-machi, Maebashi 371-0005, Gunma, Japan;
| | - Shota Tomaru
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Yuki Itoi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Keigo Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Yu Hashimoto
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Hirohito Tanaka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Yoji Takeuchi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
| | - Kazue Nagai
- Gunma University Center for Food Science and Wellness, 4-2 Aramaki-machi, Maebashi 371-8510, Gunma, Japan;
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Syowa-machi, Maebashi 371-8511, Gunma, Japan; (Y.X.); (H.H.); (S.T.); (Y.I.); (K.S.); (Y.H.); (H.T.); (S.K.); (Y.T.)
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Huang F, Fang M. Prediction model of liver metastasis risk in patients with gastric cancer: A population-based study. Medicine (Baltimore) 2023; 102:e34702. [PMID: 37773864 PMCID: PMC10545098 DOI: 10.1097/md.0000000000034702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/20/2023] [Indexed: 10/01/2023] Open
Abstract
Liver was the most common site of distant metastasis in patients with gastric cancer (GC). The prediction model of the risk of liver metastasis was rarely proposed. Therefore, we aimed to establish a prediction model for liver metastasis in patients with GC. In this retrospective cohort study, we extracted demographic and clinical data of all the GC patients from the Surveillance, Epidemiology, and End Results registration database from 2010 to 2015. Patients were divided into training set (n = 1691) for model development and testing set (n = 3943) for validation. Univariable and multivariable logistic regression analyses were carried out on the training set to screen potential predictors of liver metastasis and constructed a prediction model. The receiver operator characteristics curves with the area under curve values were used to assess the predictive performance of the liver metastasis prediction model. And a nomogram of the prediction model was also constructed. Of the total 5634 GC patients, 444 (7.88%) had liver metastasis. Variables including age, gender, N stage, T stage, Lauren classification, tumor size, histological type, and surgery were included in the liver metastasis prediction model. The study results indicated that the model had excellent discriminative ability with an area under curve of 0.851 (95% confidence interval: 0.829-0.873) in the training set, and that of 0.849 (95% confidence interval: 0.813-0.885) in the testing set. We have developed an effective prediction model with 8 easily acquired predictors of liver metastasis. The prediction model could predict the risk of liver metastasis in GC patients and performed well, which would assist clinicians to make individualized prediction of liver metastasis in GC patients and adjust treatment strategies in time to improve the prognosis.
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Affiliation(s)
- Fang Huang
- Department of Oncology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, P. R. China
| | - Meihua Fang
- Department of Oncology, Shanghai Jiading District Hospital of Traditional Chinese Medicine, Shanghai, P. R. China
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Yang H, Sun J, Liu H, Liu X, She Y, Zhang W, Zhou J. Clinico-radiological nomogram for preoperatively predicting post-resection hepatic metastasis in patients with gastric adenocarcinoma. Br J Radiol 2022; 95:20220488. [PMID: 36181505 PMCID: PMC9733617 DOI: 10.1259/bjr.20220488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To establish and validate a model comprising clinical and radiological features to pre-operatively predict post-resection hepatic metastasis (HM) in patients with gastric adenocarcinoma (GAC). METHODS We retrospectively analyzed 461 patients (HM, 106 patients); and non-metastasis (NM, 355 patients) who were confirmed to have GAC post-surgery. The patients were randomly divided into the training (n = 307) and testing (n = 154) cohorts in a 2:1 ratio. The main clinical risk factors were filtered using the least absolute shrinkage and selection operator algorithm according to their diagnostic value. The selected factors were then used to establish a clinical-radiological model using stepwise logistic regression. The Akaike's information criterion and receiver operating characteristic (ROC) analyses were used to evaluate the prediction performance of the model. RESULTS Logistic regression analysis showed that the peak enhancement phase, tumor location, alpha-fetoprotein, cancer antigen (CA)-125, CA724 levels, CT-based Tstage and arterial phase CT values were important independent predictors. Based on these predictors, the areas under the ROC curve of the training and testing cohorts were 0.864 and 0.832, respectively, for predicting post-operative HM. CONCLUSION This study built a synthetical nomogram using the pre-operative clinical and radiological features of patients to predict the likelihood of HM occurring after GAC surgery. It may help guide pre-operative clinical decision-making and benefit patients with GAC in the future. ADVANCES IN KNOWLEDGE 1. The combination of clinical risk factors and CT imaging features provided useful information for predicting HM in GAC.2. A clinicoradiological nomogram is a tool for the pre-operative prediction of HM in patients with GAC.
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Affiliation(s)
| | - Jianqing Sun
- Central Research Institute, United Imaging Healthcare, Shanghai, China
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Luan X, Niu P, Wang W, Zhao L, Zhang X, Zhao D, Chen Y. Sex Disparity in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis. J Oncol 2022; 2022:1269435. [PMID: 36385957 PMCID: PMC9646304 DOI: 10.1155/2022/1269435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 07/25/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to ascertain whether sex-based differences influence clinicopathological characteristics and survival outcomes of gastric cancer patients. BACKGROUND Gastric cancer in females has received less attention than in males. Clinicopathological features and survival outcomes of females with gastric cancer have been reported in several studies with controversial results. METHODS We systematically reviewed clinical studies from PubMed, Cochrane Library, Embase, and Web of Science published up to June 2022. The effect sizes of the included studies were estimated using odds ratios (ORs). Heterogeneity was investigated using the χ2 and I 2 tests, while sensitivity analyses were performed to identify the source of substantial heterogeneity. All data used in this study were obtained from previously published studies obviating the need for ethical approval and patient consent. RESULTS Seventy-six studies with 775,003 gastric cancer patients were included in the meta-analysis. Gastric cancer patients were less likely to be females (P < 0.00001). Female patients were younger in age (P < 0.00001) and showed a higher percentage of distal (P < 0.00001), non-cardia (P < 0.00001), undifferentiated (P < 0.00001), diffuse (P < 0.00001), and signet-ring cell carcinoma (P < 0.00001). Female patients showed better prognosis in both 3-year (P = 0.0003) and 5-year overall survival (OS) (P < 0.00001), especially White patients. However, females were associated with lower 5-year OS relative to males in the younger patients (P = 0.0001). CONCLUSIONS In conclusion, gender differences were observed in clinicopathological characteristics and survival outcomes of gastric cancer. Different management of therapy will become necessary for different genders.
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Affiliation(s)
- Xiaoyi Luan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Penghui Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Wanqing Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Lulu Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Xiaojie Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Dongbing Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Yingtai Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
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Choi Y, Kim N, Kim KW, Jo HH, Park J, Yoon H, Shin CM, Park YS, Lee DH, Oh HJ, Lee HS, Park YS, Ahn SH, Suh YS, Park DJ, Kim HH, Kim JW, Kim JW, Lee KW, Chang W, Park JH, Lee YJ, Lee KH, Kim YH. Sex-based differences in histology, staging, and prognosis among 2983 gastric cancer surgery patients. World J Gastroenterol 2022; 28:933-947. [PMID: 35317055 PMCID: PMC8908285 DOI: 10.3748/wjg.v28.i9.933] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/08/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few studies have been conducted on sex differences in the incidence, pathophysiology, and prognosis of gastric cancer (GC).
AIM To analyze the differences in GC characteristics according to sex in patients who underwent surgical treatment for GC.
METHODS A total of 2983 patients diagnosed with gastric adenocarcinoma who received surgical treatment at the Seoul National University Bundang Hospital between 2003 and 2017 were included. Baseline clinicopathological characteristics, histologic type of GC, overall and GC-specific survival rates, and associated risk factors were analyzed.
RESULTS Among the 2983 patients, 2005 (67.2%) and 978 (32.8%) were males and females, respectively. The average age of the female group (59.36 years) was significantly younger than that of the male group (61.66 years; P < 0.001). Cancer of the gastric body (P < 0.001) and diffuse-type histology (P < 0.001) were more common in females than in males. This trend was more prominent in females younger than 60 years of age, with a significantly higher proportion of diffuse-type cancer than in the male group. Regardless of sex, diffuse-type GC was more common in younger patients, and the proportion of intestinal-type GC increased with age. The overall survival rate was significantly higher in females (P < 0.001). However, this difference disappeared for GC-specific survival (P = 0.168), except for the poor GC-specific survival rate in advanced-stage cancer (stage III or above) in females (P = 0.045). The risk factors for GC-related mortality were older age, upper location of GC, and diffuse- or mixed-type histology. In terms of comorbidities, more males died from diseases other than GC, including other malignancies such as lung cancer, hepatocellular carcinoma, and pancreatic cancer, and respiratory diseases such as interstitial lung disease and chronic obstructive pulmonary disease, while there were relatively more cardiovascular or cerebrovascular deaths in females.
CONCLUSION Sex-based differences in GC were observed in clinicopathological features, including age at diagnosis, tumor location, histologic type, survival rate, and comorbidities.
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Affiliation(s)
- Yonghoon Choi
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Nayoung Kim
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Ki Wook Kim
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Hyeong Ho Jo
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Jaehyung Park
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Hyuk Yoon
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Cheol Min Shin
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Young Soo Park
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Dong Ho Lee
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Hyeon Jeong Oh
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Ji-Won Kim
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Jin Won Kim
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Keun-Wook Lee
- Department ofInternal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, South Korea
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Abstract
As an indispensable part for cancer precision medicine, biomarkers and signatures for predicting cancer prognosis and therapeutic benefits were urgently required. The purpose of this study was to investigate the prognostic roles of NOP2 in renal clear cell carcinoma (ccRCC) for overall survival (OS) and its relationships with immunity. NOP2-related gene expression matrix associated with clinical information was obtained from the Cancer Genome Atlas (TCGA) ccRCC dataset and NOP2-related pathways were identified by gene set enrichment analysis (GSEA). Associations among the NOP2 expression and MSI, TMB, TNB, and immunity were also explored. Both the NOP2 mRNA and protein/phosphoprotein had a higher expression in ccRCC tumor tissues than in normal kidney tissues (both P < 0.001) and elevated NOP2 expression was associated with poor OS (P < 0.001). Logistic regression analysis revealed the NOP2 expression was significantly linked to stage, age, grade, N stage, T stage, and M stage (all P < 0.05). Univariate/multivariate Cox hazard regression analysis results indicated that NOP2 was an independent prognostic factor for OS in ccRCC and GSEA revealed five NOP2-related signaling pathways. Nomogram based on NOP2 and eight clinical characteristic parameters (grade, age, stage, gender, T stage, race, M stage, N stage) was constructed and carefully evaluated. Furthermore, NOP2 gene expression was also found to be significantly related to MSI, TMB, and immunity. Our findings revealed that NOP2 might be a potential prognostic factor for OS in ccRCC and it was significantly associated with immunity, MSI, and TMB.
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Affiliation(s)
- Gang Wang
- Department of Urology, The Affiliated Jianhu Hospital of Nantong University, Jiangsu Province, China
| | - Fangfang Qu
- Department of Anesthesiology, The Affiliated Jianhu Hospital of Nantong University, Jiangsu Province, China
| | - Shouyong Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jincai Zhou
- Department of Urology, The Affiliated Jianhu Hospital of Nantong University, Jiangsu Province, China
| | - Yi Wang
- Department of Urology, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
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Abstract
BACKGROUND CACNA1C, as a type of voltage-dependent calcium ion transmembrane channel, played regulatory roles in the development and progress of multiple tumors. This study was aimed to analyze the roles of CACNA1C in ovarian cancer (OC) of overall survival (OS) and to explore its relationships with immunity. METHODS Single gene mRNA sequencing data and corresponding clinical information were obtained from The Cancer Genome Atlas Database (TCGA) and the International Cancer Genome Consortium (ICGC) datasets. Gene set enrichment analysis (GSEA) was used to identify CACNA1C-related signal pathways. Univariate and multivariate Cox regression analyses were applied to evaluate independent prognostic factors. Besides, associations between CACNA1C and immunity were also explored. RESULTS CACNA1C had a lower expression in OC tumor tissues than in normal tissues (P < 0.001), with significant OS (P = 0.013) and a low diagnostic efficiency. We further validated the expression levels of CACNA1C in OC by means of the ICGC dataset (P = 0.01), qRT-PCR results (P < 0.001) and the HPA database. Univariate and multivariate Cox hazard regression analyses indicated that CACNA1C could be an independent risk factor of OS for OC patients (both P < 0.001). Five significant CACNA1C-related signaling pathways were identified by means of GSEA. As for genetic alteration analysis, altered CACNA1C groups were significantly associated with OS (P = 0.0169), progression-free survival (P = 0.0404), disease-free survival (P = 0.0417) and disease-specific survival (P = 9.280e-3), compared with unaltered groups in OC. Besides, CACNA1C was dramatically associated with microsatellite instability (MSI) and immunity. CONCLUSIONS Our results shed light on that CACNA1C could be a prognostic predictor of OS in OC and it was closely related to immunity.
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Affiliation(s)
- Xiaohan Chang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 36 Sanhao street, Liaoning Province, 110004, Shenyang, P.R. China
| | - Yunxia Dong
- Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao street, Liaoning Province, 110004, Shenyang, P.R. China.
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