Improving the Prognostic Evaluation Precision of Hospital Outcomes for Heart Failure Using Admission Notes and Clinical Tabular Data: Multimodal Deep Learning Model

BACKGROUND

Clinical notes contain contextualized information beyond structured data related to patients' past and current health status.

OBJECTIVE

This study aimed to design a multimodal deep learning approach to improve the evaluation precision of hospital outcomes for heart failure (HF) using admission clinical notes and easily collected tabular data.

METHODS

Data for the development and validation of the multimodal model were retrospectively derived from 3 open-access US databases, including the Medical Information Mart for Intensive Care III v1.4 (MIMIC-III) and MIMIC-IV v1.0, collected from a teaching hospital from 2001 to 2019, and the eICU Collaborative Research Database v1.2, collected from 208 hospitals from 2014 to 2015. The study cohorts consisted of all patients with critical HF. The clinical notes, including chief complaint, history of present illness, physical examination, medical history, and admission medication, as well as clinical variables recorded in electronic health records, were analyzed. We developed a deep learning mortality prediction model for in-hospital patients, which underwent complete internal, prospective, and external evaluation. The Integrated Gradients and SHapley Additive exPlanations (SHAP) methods were used to analyze the importance of risk factors.

RESULTS

The study included 9989 (16.4%) patients in the development set, 2497 (14.1%) patients in the internal validation set, 1896 (18.3%) in the prospective validation set, and 7432 (15%) patients in the external validation set. The area under the receiver operating characteristic curve of the models was 0.838 (95% CI 0.827-0.851), 0.849 (95% CI 0.841-0.856), and 0.767 (95% CI 0.762-0.772), for the internal, prospective, and external validation sets, respectively. The area under the receiver operating characteristic curve of the multimodal model outperformed that of the unimodal models in all test sets, and tabular data contributed to higher discrimination. The medical history and physical examination were more useful than other factors in early assessments.

CONCLUSIONS

The multimodal deep learning model for combining admission notes and clinical tabular data showed promising efficacy as a potentially novel method in evaluating the risk of mortality in patients with HF, providing more accurate and timely decision support.

Treatment-prognostication-adjustment a new therapeutic idea by analyzing T cell immune checkpoint in tumor microenvironment by algorithm: A bibliometric analysis

To evaluate the temporal and spatial distribution of the knowledge network about tumor microenvironment and prognoses and explore new research hot spots and trends. Articles and reviews on tumor microenvironment and prognoses in the Web of Science journal from January 1999 to April 2022 were included. We used the CiteSpace and VOSviewer software to analyze the knowledge network composed of journals, institutions, countries, authors, and keywords. Frontiers in Immunology, Cancers, and Frontiers in Oncology have published more than 10% of articles in this field. China and the United States have contributed the most articles. Fudan University and Sun Yat-Sen University are the most active institutions. The authors in this field work closely; Zhang Wei and Douglas have made outstanding contributions. The three main research areas of tumor microenvironment and prognoses are microenvironment, prognosis, and immunotherapy. Until 2020, the main keywords were endothelial growth factor and adhesion. In the past three years, survival analysis, immune cell infiltration, and prediction model have been used. It can be seen that the focus in this field has shifted from tumor cell behavior and directly related molecules to prognosis prediction and non-tumor cells in the microenvironment. The future research trend may be to study the changes in the tumor microenvironment to predict the prognosis and guide the treatment. VOSviewer, CiteSpace, and Microsoft Excel 2019 were used to conduct a comprehensive visual analysis of the research on tumor environment and prognoses and provide valuable reference materials for researchers.

Combination of Chest Computed Tomography Value and Clinical Laboratory Data for the Prognostic Risk Evaluation of Patients with COVID-19

Objective

This study aims to investigate the independent prognostic factors of patients with coronavirus disease 2019 (COVID-19) and thereafter construct a related prognostic model.

Methods

The subjects were screened following the COVID-19 diagnostic criteria. The independent prognostic factors were selected based on the indicators, including medical history, clinical manifestation, laboratory tests, imaging examination and clinical prognosis. Subsequently, we constructed a nomogram model to predict short-term prognosis.

Results

Clinical information was obtained from 393 COVID-19 patients admitted to Zhongshan Hospital at Xiamen University between December 2022 and January 2023. The independent risk factors determined by Cox multivariate regression analysis included gender (OR: 0.355, 95% CI: 0.16~0.745), age (OR: 3.938, 95% CI: 1.221~15.9), pectoral muscle index (PMI, OR: 4.985, 95% CI: 2.336~11.443), pneumonia severity score (PSS, OR: 6.486, 95% CI: 2.082~21.416) and lactate dehydrogenase (LDH, OR: 3.857, 95% CI: 1.571~10.266). A short-term prognostic nomogram was developed based on the five independent risk factors above. The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram model was 0.857. The calibration curve confirmed the outcomes of the prognostic model, which exhibited excellent consistency with the actual results.

Conclusion

In summary, gender, age, pectoral muscle index, pneumonia severity score, and lactate dehydrogenase are all independent risk factors for COVID-19 mortality. Thus, the nomogram based on the above indicators can predict the risk of mortality in COVID-19 patients. This may have the potential of being clinical application in prognostic evaluation of COVID-19.

Oncological and surgical outcomes of radical surgery in elderly colorectal cancer patients with intestinal obstruction

Background

The treatment strategy for elderly colorectal cancer patients with intestinal obstruction remains controversial. The choice of reasonable treatment and surgical method directly affects perioperative safety and prognosis. This study investigated the safety and long-term efficacy of radical surgery in elderly colorectal cancer patients over 80 years old with intestinal obstruction.

Methods

The clinicopathological data of elderly patients over 80 years old with intestinal obstruction who underwent colorectal cancer surgery from January 2012 to December 2021 were retrospectively collected and analysed. Patients were assigned to a radical group and a palliative group according to the surgical method. Propensity score matching (PSM) was performed to match patients in the radical group 1:1 with those in the palliative group. The perioperative-related indexes and prognosis were compared between the two groups.

Results

A total of 187 patients were enrolled in this study. After PSM, 58 matched pairs were selected, and the radical and palliative groups were well balanced in terms of the clinical and surgical characteristics (P > 0.05). The proportion of patients transferred to the ICU after surgery in the radical group was significantly higher than that in the palliative group (17.2% vs. 5.2%, P = 0.039). In terms of postoperative complications, the incidence of grade 1-5 complications in the radical group was significantly higher than that in the palliative group (37.9% vs. 15.5%, P = 0.006); however, there was no significant difference in the incidence of grade 3-5 complications between the two groups (6.9% vs. 1.7%, P = 0.364). In addition, the complications were subclassified, and it was found that the incidence of gastrointestinal disorders (20.7% vs. 6.9%, P = 0.031) after surgery was significantly higher in the radical group. The 3-year OS rates were 55.2% and 22.6% in the radical and palliative groups, respectively (P < 0.001). Multivariate analysis revealed that radical surgery was an independent prognostic factor for OS (HR: 4.32; 95% CI, 1.93-12.45; P < 0.001).

Conclusion

Although elderly colorectal cancer patients over 80 years of age with intestinal obstruction are more likely to be admitted to the ICU and develop more postoperative complications after radical surgery, long-term survival benefits can be achieved.

Factors influencing the prognosis of acute basilar artery occlusion patients treated endovascularly: the impact of treatment time window and preoperative symptoms

Objective

The aim of this study was to examine the factors influencing the prognosis of patients diagnosed with acute basilar artery occlusion (BAO) who receive endovascular treatment. Our particular emphasis was on the predictive implications of the time window for treatment (from symptom onset to femoral artery puncture) and preoperative symptoms for prognosis.

Methods

A retrospective analysis of data collected from 51 BAO patients who received endovascular treatment at the Neurosurgery Department of Jinhua Central Hospital from April 2018 to October 2021 was undertaken. The data included immediate post-interventional recanalization rates and the 90-day clinical prognoses of the patients. We used the Modified Rankin Scale (mRs) to categorize patients into two prognosis groups: a favorable prognosis group (mRs score ≤2) and an unfavorable prognosis group (mRs score >2). Preoperative symptoms were gauged using the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores. A logistic regression analysis was conducted to identify risk factors affecting the prognosis of BAO patients following endovascular treatment.

Results

The procedure resulted in complete recanalization in all patients (100%). However, four patients (7.8%) passed away during the postoperative hospitalization period. The remaining 47 patients were followed up for 3 months. It was found that 15 patients (31.91%) had a favorable prognosis, while 32 (68.09%) had an unfavorable prognosis. It was generally observed that patients with an unfavorable prognosis had notably higher preoperative GCS and NIHSS scores (p < 0.05). Logistic regression analysis revealed that preoperative symptom severity, as indicated by NIHSS score, and treatment time window were significant prognostic risk factors for patients undergoing endovascular treatment for BAO (p < 0.05).

Conclusion

Endovascular intervention for BAO appears to be safe and effective, with greater likelihood of a favorable prognosis in patients treated within ≤6 h. The chances of favorable prognosis could potentially be linked to the severity of the patient's preoperative symptoms.

Interpreting and validating complexity and causality in lesion-symptom prognoses

This paper considers the steps needed to generate pragmatic and interpretable lesion-symptom mappings that can be used for clinically reliable prognoses. The novel contributions are 3-fold. We first define and inter-relate five neurobiological and five methodological constraints that need to be accounted for when interpreting lesion-symptom associations and generating synthetic lesion data. The first implication is that, because of these constraints, lesion-symptom mapping needs to focus on probabilistic relationships between Lesion and Symptom, with Lesion as a multivariate spatial pattern, Symptom as a time-dependent behavioural profile and evidence that Lesion raises the probability of Symptom. The second implication is that in order to assess the strength of probabilistic causality, we need to distinguish between causal lesion sites, incidental lesion sites, spared but dysfunctional sites and intact sites, all of which might affect the accuracy of the predictions and prognoses generated. We then formulate lesion-symptom mappings in logical notations, including combinatorial rules, that are then used to evaluate and better understand complex brain-behaviour relationships. The logical and theoretical framework presented applies to any type of neurological disorder but is primarily discussed in relationship to stroke damage. Accommodating the identified constraints, we discuss how the 1965 Bradford Hill criteria for inferring probabilistic causality, post hoc, from observed correlations in epidemiology-can be applied to lesion-symptom mapping in stroke survivors. Finally, we propose that rather than rely on post hoc evaluation of how well the causality criteria have been met, the neurobiological and methodological constraints should be addressed, a priori, by changing the experimental design of lesion-symptom mappings and setting up an open platform to share and validate the discovery of reliable and accurate lesion rules that are clinically useful.

A neutrophil/lymphocyte Ratio as a Significant Predictor for Patients with low-risk and early-stage Extranodal NK-T-cell Lymphoma

Purpose

The neutrophil/lymphocyte ratio (NLR) is a novel prognostic marker in several malignancies, whereas its function in patients with early-stage extranodal NK-T-cell lymphoma (ENKTL) hasn't been explored. Therefore, we expolored the predictive value of NLR for early-stage ENKTL in this study.

Methods

We evaluated the prognostic value of NLR in 132 patients with early-stage ENKTL based on L-asparaginase-containing regimens. Their characteristics, treatment responses, survival outcomes, prognostic factors, and the prognostic value of NLR were analyzed.

Results

All patients were followed up for median 54 months. The optimal NLR cutoff value was 3.77 by receiver operating curve(ROC). For all patients, the complete response (CR) and the overall response rate (ORR) were 74.2% and 85.6%. Patients with NLR < 3.77 had higher CR and ORR than patients with NLR ≥ 3.77(CR, 81% vs. 53.1%; ORR, 90% vs. 71.9%). For all patients, the 3-year overall survival (OS) and progression-free survival (PFS) based on L-asparaginase-containing chemotherapy were 80.4% and 76%. Patients with NLR < 3.77 had better survival outcomes than patients with NLR ≥ 3.77(3-year OS, 86.9% vs. 60.3%, p = 0.002; 3-year PFS, 81.8% vs. 54.5%, p = 0.001). By univariate and multivariate analyses, NLR ≥ 3.77 was an independent poor prognostic factor for both OS and PFS. Additionally, NLR ≥ 3.77 was associated with poor survival outcomes in patients with low-risk International Prognostic Index (IPI) and Prognostic Index of Natural Killer lymphoma with Epstein-Barr virus (PINK-E).

Conclusion

A high NLR is a poor prognostic marker of survival in patients with early-stage ENKTL, and could be applied to risk-stratify for low-risk patients.

Comparison of the clinical efficacies of two L-asparaginase-based chemotherapy regimens for newly diagnosed nasal-type extranodal NK/T-cell lymphoma

BACKGROUND

Nasal-type extranodal natural killer (NK)/T cell lymphoma (ENKTL) is a rare and aggressive type of lymphoma. The optimal chemotherapy regimen for ENKTL has not yet been established. In this study, we compared the LVDP (L-asparaginase, etoposide, dexamethasone, and cisplatin) and GLIDE (gemcitabine, L-asparaginase, ifosfamide, dexamethasone, and etoposide) chemotherapy regimens for the treatment of ENKTL.

METHODS

A total of 267 patients with newly diagnosed ENKTL were included in this retrospective study. Propensity score matching (PSM) was used to adjust for confounders between the LVDP and GLIDE groups. Treatment responses, survival outcomes, and toxicities between the two groups were compared before and after PSM.

RESULTS

At the end of therapy, the objective response rate (ORR) and complete response (CR) were 83.5% and 62.2%, respectively, for all patients. The ORR and CR were 85.5% and 62.2% for the LVDP group compared with 79.3% and 62.2% for the GLIDE group, respectively, and no differences between the two groups were found (ORR, p = 0.212; CR, p = 0.996). With a median 71 months follow-up, the 5-year progression-free survival (PFS) and overall survival (OS) rates were 64.3% and 68.5%, respectively. The 5-year PFS and OS were 65.6% and 70.1% for the LVDP group compared with 61.6% and 64.6% for the GLIDE group, respectively (PFS, p = 0.478; OS, p = 0162). After PSM, no significant differences in short-term efficacy (ORR, p = 0.696; CR, p = 0.264) or long-term efficacy (PFS, p = 0.794; OS, p = 0.867) between the two groups were identified. However, treatment-related toxicities were milder in the LVDP group compared to the GLIDE group, even after adjusting for confounders via PSM.

CONCLUSION

In conclusion, both LVDP and GLIDE regimens are effective for the treatment of ENKTL. However, the LVDP regimen is safer than the GLIDE regimen, with milder treatment-related toxicities. Therefore, the LVDP regimen could be a preferable option for patients with ENKTL.

A controlling nutritional status score is an independent predictor for patients with newly diagnosed nasal-type extranodal NK/T-cell lymphoma based on asparaginase-containing regimens

BACKGROUND

The controlling nutritional status (CONUT) score is a nutritional index that combines serum albumin, total cholesterol, and lymphocyte counts. The potential value of CONUT score for predicting clinical outcomes in patients with nasal-type extranodal NK/T-cell lymphoma (ENKTL) has not been explored.

METHODS

This study included 374 ENKTL patients treated with asparaginase-containing regimens from September 2012 to September 2017. Clinical characteristics, treatment efficacy, prognostic factors, and the predictive value of CONUT score were analyzed.

RESULTS

The complete response (CR) and overall response rate (ORR) were 54.8% and 74.6%, respectively. Patients with CONUT scores <2 had higher CR and ORR compared to patients with scores ≥2 (69.1% vs. 48.9% for CR, p = 0.001; 90.0% vs. 74.6% for ORR, p < 0.001). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 61.9% and 57.3%, respectively. Patients with CONUT scores <2 had better survival outcomes than those with scores ≥2 (5-year OS, 76.1% vs. 56.0%, p < 0.001; 5-year PFS, 74.4% vs. 50.1%, p < 0.001). CONUT score ≥2 was identified as an independent poor prognostic factor for both OS and PFS. A CONUT score ≥2 was also associated with poorer survival outcomes in low-risk ENKTL patients.

CONCLUSION

A CONUT score ≥2 is a prognostic marker for poor survival in patients with ENKTL and could be used to stratify risk in low-risk patients.

Global scientific trends on matrix metalloproteinase and osteosarcoma: A bibliometric and visualized analysis

Objective

This study aimed to identify author, country, institutional, and journal collaborations and their impacts, assess the knowledge base, identify existing trends, and uncover emerging topics related to the role of Metalloproteinase in osteosarcoma.

Methods

945 Articles and reviews associated with the role of Metalloproteinase in osteosarcoma were obtained from the WoSCC and analyzed by Citespace and Vosviewer.

Results

The main aspects of research on the role of MMP in OS are invasion and metastasis. The latest hotspots were found to be the mechanism of MMP promoting invasion and metastasis, lung metastasis, and antitumor activity. Notably, invasion, metastasis, and antitumor activity were potentially turning points in the MMP-OS field. In the future, the primary research hotspot in the field of MMP-OS may be to study the mechanism, explore their role in the OS lung metastasis, and determine their role in the cancer therapy process.

Conclusion

This study thus offers a comprehensive overview of the MMP-OS-related field using bibliometrics and visual methods, which will provide a valuable reference for researchers interested in the field of MMP-OS.

The association of efficacy with PD-1/PD-L1 inhibition and tumor mutational burden in advanced nonsmall cell lung cancer: A PRISMA-guided literature review and meta-analysis

BACKGROUND

Tumor mutation burden (TMB) has been reported to emerge as an independent biomarker of response to identify patients who would achieve benefit from immune checkpoint inhibitors. However, it still remains controversy that whether TMB can be a robust biomarker of response to programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibition. We performed this meta-analysis to assess the relationship between TMB and the efficacy with PD-1/PD-L1 inhibition in advanced nonsmall cell lung cancer (NSCLC).

METHODS

Following the recommendations of the PRISMA statement, electronic databases literature search was done on the published articles till March 2021, including Pubmed, Embase, and Cochrane library databases. Studies were selected that focused on comparing the efficacy of TMB-high group and TMB-low group in NSCLC patients received with immune checkpoint inhibitors. Meta-analysis Revman 5.3 software was utilized to calculate the pooled outcomes.

RESULTS

A systematic literature search was conducted 8 articles, including 11 comparative articles. Findings of our studies shown that patients with TMB-high group was associated with better clinical outcomes than TMB-low group, including progression-free survival (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.29-0.49; P < .00001), complete response (OR, 4.71; 95% CI, 2.32-9.57; P < .0001), durable clinical benefit (OR, 3.76; 95% CI, 2.38-5.96; P < .00001) and the objective response rate (OR, 3.14; 95% CI, 1.83-5.37; P < .0001). While, it failed to predict overall survival benefits (OR, 0.74; 95% CI, 0.45-1.20; P = .22).

CONCLUSIONS

Our study found that NSCLC with high TMB who benefit from immunotherapy. The findings suggest that TMB could associated with a greater predictive power of response. Possibly a more TMB-oriented prediction model might gain more benefits from PD-1/PD-L1 inhibitors.

Mir-34a: a regulatory hub with versatile functions that controls osteosarcoma networks

Osteosarcoma (OS) is one of the most prevalent and highly aggressive bone malignancies. The treatment strategies of OS is under standard regimens, including surgical resection, chemotherapy, and other adjuvant therapy. However, the 5-year survival rate is still unsatisfactory. Previous studies have demonstrated that the expression of miR-34a decreases in osteosarcoma, which is involved in regulating numerous genes directly or indirectly at the post-transcriptional level and other pathways. Thus, miR-34a plays an important role in mediating OS cell proliferation, differentiation, migration, and apoptosis, and might be a pivotal biomarker for OS with diagnostic and therapeutic potentials. In this review, we aim to summarize the relationship between miR-34a and OS, with an emphasis on the specific mechanisms in OS development referring to miR-34a. Moreover, the potential role of miR-34a as a diagnostic, prognostic, and therapeutic candidate for OS would be presented in detail. However, the molecular mechanisms related to miR-34a and OS remain elusive, and more investigations are needed to reach a comprehensive understanding.

Prognostic value and immune characteristics of RUNX gene family in human cancers: a pan-cancer analysis

Background: Runt-related transcription factors (RUNX) are involved in numerous fundamental biological processes and play crucial parts in tumorigenesis and metastasis both directly and indirectly. However, the pan-cancer evidence of the RUNX gene family is not available.

Methods: In this study, we analyzed the potential association between RUNX gene family expression and patient’s prognosis, immune cell infiltration, drug response, and genetic mutation data across different types of tumors using based on The Cancer Genome Atlas, Gene Expression Omnibus, and Oncomine database.

Results: The results showed that the expression of the RUNX gene family varied among different cancer types, revealing its heterogeneity in cancers and that expression of RUNX2 was lower than that of RUNX1 and RUNX3 across all cancer types. RUNX gene family gene expression was related to prognosis in several cancers. Furthermore, our study revealed a clear association between RUNX gene family expression and ESTIMATE score, RNA stemness, and DNA stemness scores. Compared with RUNX1 and RUNX2, RUNX3 showed relatively low levels of genetic alterations. RUNX gene family genes had clear associations with immune infiltrate subtypes, and their expression was positively related to immune checkpoint genes and drug sensitivity in most cases. Two immunotherapy cohorts confirm that the expression of RUNX was correlated with the clinical response of immunotherapy.

Conclusions: These findings will help to elucidate the potential oncogenic roles of RUNX gene family genes in different types of cancer and it can function as a prognostic marker in various malignant tumors.

Effect of Direct Bilirubin Level on Clinical Outcome and Prognoses in Severely/Critically Ill Patients With COVID-19

Objectives

We aimed to investigate how changes in direct bilirubin (DBiL) levels in severely/critically ill the coronavirus disease (COVID-19) patients during their first week of hospital admission affect their subsequent prognoses and mortality.

Methods

We retrospectively enrolled 337 severely/critically ill COVID-19 patients with two consecutive blood tests at hospital admission and about 7 days after. Based on the trend of the two consecutive tests, we categorized patients into the normal direct bilirubin (DBiL) group (224), declined DBiL group (44) and elevated DBiL group (79).

Results

The elevated DBiL group had a significantly larger proportion of critically ill patients (χ²-test, p < 0.001), a higher risk of ICU admission, respiratory failure, and shock at hospital admission (χ²-test, all p < 0.001). During hospitalization, the elevated DBiL group had significantly higher risks of shock, acute respiratory distress syndrome (ARDS), and respiratory failure (χ²-test, all p < 0.001). The same findings were observed for heart damage (χ²-test, p = 0.002) and acute renal injury (χ²-test, p = 0.009). Cox regression analysis showed the risk of mortality in the elevated DBiL group was 2.27 (95% CI: 1.50–3.43, p < 0.001) times higher than that in the normal DBiL group after adjusted age, initial symptom, and laboratory markers. The Receiver Operating Characteristic curve (ROC) analysis demonstrated that the second test of DBiL was consistently a better indicator of the occurrence of complications (except shock) and mortality than the first test in severely/critically ill COVID-19 patients. The area under the ROC curve (AUC) combined with two consecutive DBiL levels for respiratory failure and death was the largest.

Conclusion

Elevated DBiL levels are an independent indicator for complication and mortality in COVID-19 patients. Compared with the DBiL levels at admission, DBiL levels on days 7 days of hospitalization are more advantageous in predicting the prognoses of COVID-19 in severely/critically ill patients.

Childhood-onset Takayasu arteritis presenting as pyoderma gangrenosum-like vasculitic ulceration: Three case reports and a literature review

We report a small case series of childhood-onset Takayasu arteritis (c-TA) presenting as pyoderma gangrenosum (PG)-like vasculitic ulceration. The cutaneous vasculitic ulcers in systemic vasculitis are rare and severe, sometimes leading to delayed diagnosis and treatment. We summarised the clinical features and highlighted the warning signs of c-TA associated with PG-like vasculitic ulceration.

COULD PROTEINURIA PREDICT THE RENAL PROGNOSES OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND DIABETIC NEPHROPATHY?

AIMS

This study investigated the relationship between proteinuria levels, clinicopathological features, and renal prognoses in Chinese patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN).

METHODS

Three hundred patients with T2DM and biopsy-proven DN were enrolled. Patients were stratified by 24-h proteinuria levels: Group 1:≤1g/24h); Group 2:1-3g/24h; and Group 3:≥3g/24h. Renal outcomes were defined as having reached end-stage renal disease (ESRD). The proteinuria level's influence on the renal outcomes was evaluated using Cox regression analysis.

RESULTS

Among subgroups stratified by proteinuria levels, systolic blood pressure, serum creatinine, BUN, cholesterol, DR and hypertension incidence, the incidences of patients who progressed to ESRD were the lowest in group 1 (P<0.05). However, eGFR, serum albumin and hemoglobin were highest in group 1. Patients with higher proteinuria levels had much lower five-year renal survival rates. Univariate analyses revealed that higher proteinuria levels were significant clinical predictors of renal prognosis (P<0.05), although they were not independent risk factors for progression to ESRD in the multivariate Cox proportional hazard analysis (P>0.05).

CONCLUSIONS

The higher the level of proteinuria, the lower the 5-year renal survival rate of DN patients, but there was no significant correlation between proteinuria level and 5-year renal survival rate. Other factors in the proteinuria group may have more significant effects on the 5-year renal survival rate, such as lower baseline eGFR, serum albumin, hemoglobin and higher cholesterol, higher incidences of DR and more severe lesions.

The Expression of Aquaporin-1 and Aquaporin-3 in Extrahepatic Cholangiocarcinoma and their Clinicopathological Significance

BACKGROUND

The aim of the study was to evaluate the expression and clinicopathological significance of aquaporin-1 (AQP1) and aquaporin-3 (AQP3) in extrahepatic cholangiocarcinoma (EHCC).

METHODS

Immunostaining of AQP1 and AQP3 was performed by EnVision immunohistochemistry in benign and malignant biliary tract tissues.

RESULTS

The expression of AQP1 and AQP3 protein were significantly higher in EHCC tumor tissues (P < 0.05 or P < 0.01). Adenoma and paracancerous tissues with positive AQP1 and/or AQP3 protein expression exhibited atypical hyperplasia. AQP1 expression was positive correlated with AQP3 expression in EHCC (P < 0.01). TNM I + II stage and radical surgery, the positive expression of AQP1 and AQP3 In patients with well-differentiation, no invasion, no lymph metastasis, is lower (P < 0.05 or P < 0.01). Average overall survival time of those with positive expression of AQP1 and AQP3 was significant shorter (P < 0.01). Both AQP1 and AQP3 positive expressions were proved to be an independent prognostic factors in EHCC by cox multivariate analysis. The AUC calculated for AQP1 was 0.769 (95% confidence interval [CI]: 0.618-0.920), and that for AQP3 was 0.758 (95%CI: 0.605-0.911, while that for AQP1 and AQP3 was 0.825 (95%CI: 0.658-0.991).

CONCLUSIONS

Positive expression of AQP1 and AQP3 is closely related to the pathogenesis, severe clinicopathological characteristics, aggressive biological behaviors, and dismal prognoses in EHCC.

Dysregulated circular RNAs as novel biomarkers in esophageal squamous cell carcinoma: a meta-analysis

Introduction

Circular RNAs (circRNAs) play critical roles in tumorigenesis, but their clinical efficacy in esophageal squamous cell carcinoma (ESCC) still retains controversial. This meta‐analysis aims at evaluating the associations between circRNA expressions and clinicopathologic features as well as the diagnostic and prognostic values of circRNAs in ESCC.

Materials & Methods

PubMed, EMBASE, and other online databases were systematically searched to collect studies on circRNAs and clinicopathological features, diagnostic, and/or prognostic assessments of ESCC. The quality of included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2) and Newcastle‐Ottawa Scale (NOS) scales. The included studies were quantitatively weighted and merged, and diagnostic indicators, hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated. P values were merged by Fisher᾽s method. Sources of heterogeneity were traced using subgroup, sensitivity, and meta‐regression analyses.

Results

As a result, 12 studies were included, representing 769 ESCC patients. The meta‐analysis showed that abnormal expressions of circRNAs were associated to TNM stage as well as lymph node and distant metastases in ESCC cases. CircRNA was used to distinguish ESCC patients from healthy controls, and the merged sensitivity, specificity, and the area under the curve (AUC) of ESCC were 0.78 (95% CI: 0.74–0.81), 0.79 (95% CI: 0.75–0.83), and 0.86, respectively. The survival analysis showed that upregulated oncogenic circRNA levels in ESCC tissues was associated with the shorter overall survival (OS) of the patients (univariate analysis: HR = 2.25, 95% CI: 1.71–2.95, p = 0.000, I² = 0.0%; multivariate analysis: HR = 2.50, 95% CI: 1.61–3.89, p = 0.000, I² = 0.0%), while the OS of ESCC patients presenting overexpressions of tumor‐suppressive circRNAs was significantly ameliorated (HR = 0.29, 95% CI: 0.20–0.42, p = 0.000, I² = 0.0%). The subgroup analyses based on circRNA biofunctions, sample size, and reference gene also revealed robust results.

Conclusion

CircRNAs can be used as promising molecular biomarkers for the early diagnosis and prognosis monitoring of ESCC.

Obesity and gynecological cancers: A toxic relationship

Despite the evidence supporting the relevance of obesity and obesity‐associated disorders in the development, management, and prognosis of various cancers, obesity rates continue to increase worldwide. Growing evidence supports the involvement of obesity in the development of gynecologic malignancies. This article explores the molecular basis governing the alteration of hallmarks of cancer in the development of obesity‐related gynecologic malignancies encompassing cervical, endometrial, and ovarian cancers. We highlight specific examples of how development, management, and prognosis are affected for each cancer, incorporate current knowledge on complementary approaches including lifestyle interventions to improve patient outcomes, and highlight how new technologies are helping us better understand the biology underlying this neglected pandemic.

This review focuses on how obesity impacts cancer hallmarks in gynecologic malignancies, thus affecting the diagnosis, management, treatment, and prognosis of these diseases.

Pan-Cancer Analysis of the Associations of TGFBI Expression With Prognosis and Immune Characteristics

Transforming growth factor-beta-induced (TGFBI) protein has important roles in tumor growth, metastasis, and immunity. However, there is currently no pan-cancer evidence regarding TGFBI. In this study, we conducted a pan-cancer analysis of TGFBI mRNA and protein expression and prognoses of various cancer types using public databases. We also investigated the associations of TGFBI expression with tumor microenvironment (TME) components, immune cell infiltration, tumor mutational burden (TMB), and microsatellite instability (MSI), along with the TGFBI genetic alteration types. The results showed that TGFBI expression varied among different cancer types, and it was positively or negatively related to prognosis in various cancers. TGFBI expression was also significantly correlated with TME components, TMB, MSI, immune cell infiltration, and immunoinhibitory and immunostimulatory gene subsets. These findings indicate that TGFBI participates in various immune responses and it may function as a prognostic marker in various cancers. The findings may be useful for developing immunotherapies that target TGFBI.

Evaluating the prognostic contributions of TNM classifications and building novel staging schemes for middle ear squamous cell carcinoma

Background

A universally acknowledged cancer staging system considering all aspects of the T‐, N‐, and M‐classifications for middle ear squamous cell carcinoma (MESCC) remains absent, limiting the clinical management of MESCC patients.

Materials and Methods

A total of 214 MESCC patients were extracted from the SEER (the Surveillance, Epidemiology, and End Results) database between 1973 and 2016. The relationships between patient’s characteristics and prognoses were analyzed by Kaplan–Meier and Cox proportional hazards regression models. Novel staging schemes for MESCC were designed by adjusted hazard ratio (AHR) modeling method according to the combinations of Stell’s T‐classification and the eighth AJCC N‐ and M‐classifications, of which performances were evaluated based on five criteria: hazard consistency, hazard discrimination, explained variation, likelihood difference, and balance.

Results

T‐classification was the most significant prognostic factor for MESCC patients in multivariable analysis (p = 0.021). The N‐ and M‐classifications also had obvious prognostic effect but were not statistically significant by multivariate analysis due to the limited metastasis events. Three novel staging schemes (AHR‐Ⅰ–Ⅲ models, different combination of T‐ and N‐classifications) and ST (solely derived from Stell’s T‐classification) were developed, among which the AHR‐Ⅰ staging scheme performed best.

Conclusions

Tumor extension, quantified by Stell’s T‐classification, is the most significant prognostic factor for MESCC patients. However, our AHR‐Ⅰ staging scheme, a comprehensive staging scheme that integrating T‐, N‐, and M‐classifications, might be an optimal option for clinical practitioners to predict MESCC patients’ prognosis and make proper clinical decisions.

Hope, bias and survival expectations of advanced cancer patients: A cross-sectional study

OBJECTIVE

Many patients with advanced illness are unrealistically optimistic about their prognosis. We test for the presence of several cognitive biases, including optimism bias, illusion of superiority, self-deception, misattribution, and optimistic update bias, that could explain unrealistically optimistic prognostic beliefs among advanced cancer patients and quantifies the extent to which hope exacerbates these biases.

METHODS

A cross-sectional survey was administered to 200 advanced cancer patients with physician-estimated prognoses of one year or less. Hope was measured using the Herth Hope Index (HHI). Hypotheses were tested using linear and logistic regressions and a structural-equation model.

RESULTS

Results are consistent with the presence of optimism bias, illusion of superiority, self-deception, and misattribution. All of these biases are amplified by higher levels of hope. Each 1-point higher HHI is associated with a 6% (OR: 1.06; 95% CI: 1.01-1.11) greater odds of believing their illness is curable, a 0.33-year (95% CI: 0.17-0.49) longer expected survival, a 6% (OR: 1.06; 95% CI: 1.02-1.11) higher probability of believing that survival outcomes are better than the average patient, a 5% higher odds of believing primary intent of treatment is curative (OR: 1.05; 95% CI: 1.00-1.10), and a 12% (OR: 1.12; 95% CI: 1.05-1.17) higher odds of believing they are well-informed. Mediation analyses revealed that hope significantly mediates the effect of mental-well-being and loneliness on expected survival.

CONCLUSIONS

Results suggest advanced cancer patients succumb to several cognitive biases which are exacerbated by greater levels of hope. As a result, they are susceptible to possible over-treatment and regret.

Metabolomics Profiling of Critically Ill Coronavirus Disease 2019 Patients: Identification of Diagnostic and Prognostic Biomarkers

OBJECTIVES

Coronavirus disease 2019 continues to spread rapidly with high mortality. We performed metabolomics profiling of critically ill coronavirus disease 2019 patients to understand better the underlying pathologic processes and pathways, and to identify potential diagnostic/prognostic biomarkers.

DESIGN

Blood was collected at predetermined ICU days to measure the plasma concentrations of 162 metabolites using both direct injection-liquid chromatography-tandem mass spectrometry and proton nuclear magnetic resonance.

SETTING

Tertiary-care ICU and academic laboratory.

SUBJECTS

Patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome coronavirus 2, using standardized hospital screening methodologies, had blood samples collected until either testing was confirmed negative on ICU day 3 (coronavirus disease 2019 negative) or until ICU day 10 if the patient tested positive (coronavirus disease 2019 positive).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Age- and sex-matched healthy controls and ICU patients that were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well balanced with the exception that coronavirus disease 2019 positive patients suffered bilateral pneumonia more frequently than coronavirus disease 2019 negative patients. Mortality rate for coronavirus disease 2019 positive ICU patients was 40%. Feature selection identified the top-performing metabolites for identifying coronavirus disease 2019 positive patients from healthy control subjects and was dominated by increased kynurenine and decreased arginine, sarcosine, and lysophosphatidylcholines. Arginine/kynurenine ratio alone provided 100% classification accuracy between coronavirus disease 2019 positive patients and healthy control subjects (p = 0.0002). When comparing the metabolomes between coronavirus disease 2019 positive and coronavirus disease 2019 negative patients, kynurenine was the dominant metabolite and the arginine/kynurenine ratio provided 98% classification accuracy (p = 0.005). Feature selection identified creatinine as the top metabolite for predicting coronavirus disease 2019-associated mortality on both ICU days 1 and 3, and both creatinine and creatinine/arginine ratio accurately predicted coronavirus disease 2019-associated death with 100% accuracy (p = 0.01).

CONCLUSIONS

Metabolomics profiling with feature classification easily distinguished both healthy control subjects and coronavirus disease 2019 negative patients from coronavirus disease 2019 positive patients. Arginine/kynurenine ratio accurately identified coronavirus disease 2019 status, whereas creatinine/arginine ratio accurately predicted coronavirus disease 2019-associated death. Administration of tryptophan (kynurenine precursor), arginine, sarcosine, and/or lysophosphatidylcholines may be considered as potential adjunctive therapies.

Artificial Intelligence-Based Clinical Decision Support for COVID-19-Where Art Thou?

The COVID-19 crisis has brought about new clinical questions, new workflows, and accelerated distributed healthcare needs. Although artificial intelligence (AI)-based clinical decision support seemed to have matured, the application of AI-based tools for COVID-19 has been limited to date. In this perspective piece, the opportunities and requirements for AI-based clinical decision support systems are identified and challenges that impact "AI readiness" for rapidly emergent healthcare challenges are highlighted.

Analysis of the clinical characteristics, drug treatments and prognoses of 136 patients with coronavirus disease 2019

WHAT IS KNOWN AND OBJECTIVE

Since the December 2019 discovery of several cases of coronavirus disease 2019 (COVID-19) in Wuhan, China, the infection has spread worldwide. Our aim is to report on the clinical characteristics, treatments and prognoses of COVID-19.

METHODS

This was a retrospective, single-centre, case series of 136 patients who were diagnosed with COVID-19 at Wuhan Third Hospital in Wuhan, China, between 28 January 2020 and 12 February 2020. The clinical characteristics, laboratory tests, treatment features and prognoses were summarized.

RESULTS AND DISCUSSION

The 136 patients were divided into a moderate (M) group (n = 103, 75.7%) and a severe and critical (SC) group (n = 33, 24.3%). There were significant differences in the incidences of concomitant chronic medical illnesses (eg, hypertension, diabetes and cardiovascular disease), fever, dry cough and dyspnoea among the two groups (P < .05). Compared with those in the M group, lymphocyte count (LYM) decreased significantly in the SC group, while the serum levels of C-reactive protein (CRP), procalcitonin (PCT), creatinine (Cre), D-dimer, lactic dehydrogenase (LDH), myoglobin (MB) and troponin I (cTnl) increased significantly in the SC group (P < .05). The main therapeutic drugs were antivirals, antibiotics, glucocorticoids, immunomodulators, traditional Chinese medicine preparations and symptomatic support drugs. There were significant differences in the incidences of shock, myocardial injury, acute respiratory distress syndrome (ARDS) and renal injury among the two groups (P < .05). Among the 136 patients, 99 (72.7%) were cured, 14 (10.3%) were transferred to other hospital and 23 (16.9%) died.

WHAT IS NEW AND CONCLUSION

Elderly patients with chronic diseases are more likely to develop severe or critical COVID-19 with multiple organ damage or systemic injuries. The improvement of LYM and CRP may be associated with the prognoses of COVID-19. The combined use of three or more antiviral drugs is to be avoided. The combination of broad-spectrum antibacterial drugs is not recommended and the risk of drug-induced liver injury should be monitored. Throughout a patient's hospitalization, their treatment plan should be evaluated and adjusted according to their vital signs, clinical symptoms, laboratory tests and imaging changes. Patients should receive effective psychological counselling.

Appraising circular RNAs as novel biomarkers for the diagnosis and prognosis of gastric cancer: A pair-wise meta-analysis

Background

Circular RNAs (circRNAs), proven as single‐stranded closed RNA molecules, have been implicated in the onset and development of multiple cancers. This study aimed to summarize existing evidences regarding the clinicopathologic, diagnostic, and prognostic significances of circRNAs in gastric cancer (GC).

Methods

Eligible studies were identified using online databases. The quality of the included studies was judged, and patients' clinical characteristics, diagnostic data, and overall survival (OS) were extracted from the electronic medical record. Fisher's method was adopted to determine P values for clinicopathologic features. The diagnostic and prognostic data from all included studies were merged.

Results

Thirty eligible studies were comprised of 2687 GC patients were enrolled in the meta‐analyses. Altered expressions of circRNAs in GC tissues were significantly associated with worse clinicopathologic features. Abnormally expressed circRNAs yielded a pooled sensitivity of 0.76 (95% CI: 0.69‐0.81) and a specificity of 0.77 (95% CI: 0.70‐0.83) in distinguishing GC from noncancerous controls, which corresponded to an area under the curve (AUC) of 0.83. The survival analysis showed that the oncogenic circRNA signature could be an independent risk factor of OS (HR = 2.11, 95% CI: 1.60‐2.78, P = .000). Patients with down‐regulated circRNAs (tumor suppressor genes) presented a significantly shorter OS time than those with high‐level circRNAs (HR = 0.33, 95% CI: 0.27‐0.42, P = .000). Stratified analyses based on sample type, control source, circRNA expression status, and cutoff setting also produced robust results.

Conclusions

CircRNAs may play an important role as potential diagnostic and prognostic biomarkers of GC.

Systemic inflammatory response predicts poor prognoses in Barcelona Clinic Liver Cancer stage B/C hepatocellular carcinoma with transarterial chemoembolization: a prospective study

Background

Chronic inflammation has been demonstrated to be an important factor in the initiation, promotion, and progression of hepatocellular carcinoma (HCC). The aim of this study was to investigate the prognostic values of systemic inflammation markers in Barcelona Clinic Liver Cancer (BCLC) stage B/C HCC.

Methods

A prospective non-randomized study was performed from June 2016 to May 2017; 51 of 123 BCLC stage B/C HCC patients were enrolled and received transarterial chemoembolization (TACE). Clinical and laboratory data were recorded. Serum IL-6, IL-10, C-reactive protein (CRP), and blood-neutrophil-to-lymphocyte ratio (NLR) levels were analyzed during the perioperative period. Patient prognosis was investigated. Twenty-eight stage A cases and 10 stage B/C patients who received resection were also collected as controls.

Results

Compared to the stage A group, the BCLC stage B/C HCC patients had significantly higher serum IL-6, CRP, and blood NLR levels. Serum IL-6, IL-10, CRP, and blood NLR levels increased significantly 3 days after treatment (TACE/resection) and returned to baseline levels after 30 days. By univariate analyses, tumor size, high pretreatment serum IL-6, CRP, and blood NLR levels predicted worse progression-free survival (PFS) after TACE (log-rank test P<0.001, P=0.007, P=0.001, respectively). Multivariate analysis revealed that both high serum IL-6 (P=0.018) and CRP (P=0.042) were independent predictors of worse PFS, meanwhile blood NLR was the only inflammatory factor associated to overall survival (OS) (P=0.046).

Conclusions

Serum IL-6, CRP, and blood NLR levels were significantly elevated in stage B/CHCC. Serum IL-6 and CRP were independent predictors of poor PFS while NLR independently predicted worse OS in BCLC stage B/C HCC.

Clinical Effectiveness and Cost-effectiveness of Target Therapies for Adult Patients with Locally Advanced or Metastatic Non-small Cell Lung Cancer: A Systematic Review

Treatment for advanced non-small cell lung cancer has changed in the last two decades, with many new drugs, mostly target agents, included in the algorithm, improvement of progression free survival and overall survival, but also higher costs for health systems or health insurances. Herein, we analyze the clinical effectiveness of target therapies for non-small cell lung cancer, according to their clinically meaningful outcome criteria and their cost impact.

Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case-control study

OBJECTIVE

Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients.

DESIGN

A nested case-control study.

SETTING

A medical centre located in north Taiwan.

PARTICIPANTS

539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected.

EXPOSURE

Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses.

PRIMARY AND SECONDARY OUTCOME MEASURES

ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes.

RESULTS

The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively.

CONCLUSIONS

The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient's safety improvement in geriatric care.

Definition of disease-progression risk stratification in untreated chronic lymphocytic leukemia using combined clinical, molecular and virological variables

Prognoses of persons with chronic lymphocytic leukemia (CLL) including time-to-therapy (TTT) and survival is heterogeneous. Risk factors and predictive scoring systems are mostly developed in persons of predominately European descent with CLL. Whether these systems accurately predict TTT and survival of Han Chinese with CLL is unknown. We interrogated clinical and laboratory data from 334 newly diagnosed, untreated Chinese CLL without treatment indication upon diagnosis to identify variables associated with TTT and develop a prognostic score. Binet stage, blood lymphocyte level, TP53 abnormality, unmutated IGHV, prior HBV, and EBV infections were independently associated with TTT in multivariate analyses. We constructed a prognostic score dividing subjects into cohorts with low, intermediate, and high risk from diagnosis to TTT. Median TTTs were 139 months (range, 85-189 months), 25 months (12-38 months), and 4 months (1-7 months; P-value for trend <0.001). We identified variables associated with TTT in Chinese with CLL with no treatment indication and developed a predictive model for survival. Some variables associated with TTT are similar to those of persons of predominately European descent, whereas others, such as HBV and/or EBV infections, operate in Chinese and Europeans but are not currently included in prognostic and predictive staging systems in persons of European descent. They should be investigated.

Predictive Factors for Local Control and Survival in Patients with Cancer of Unknown Primary (CUP) Irradiated for Cerebral Metastases

BACKGROUND/AIM

To identify predictors of local control and survival after whole-brain irradiation (WBI) for cerebral metastases from cancer of unknown primary (CUP).

PATIENTS AND METHODS

In 140 patients receiving WBI alone or following resection, seven factors were investigated including treatment approach, WBI-regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extra-cerebral metastases.

RESULTS

On univariate analysis, resection plus WBI and boost (p=0.002), ECOG 0-1 (p<0.001) and a single lesion (p<0.001) were positively associated with local control. On Cox regression, ECOG-score remained significant (p=0.002). On univariate analysis of survival, surgery plus WBI and boost (p=0.009), ECOG 0-1 (p<0.001), a single lesion (p=0.024) and no extra-cerebral metastases (p<0.001) were associated with better outcomes. On Cox regression, ECOG-score (p<0.001) and extra-cerebral lesions (p<0.001) were significant.

CONCLUSION

Significant predictors of local control and survival were identified that contribute to treatment personalization and design of prospective trials in patients with cerebral metastases from CUP.

The comparison of predictive factors regarding prognoses and invasion of thymic neuroendocrine tumors preoperatively and postoperatively

Background

Thymic neuroendocrine tumors (TNT), in the anterior mediastinum, are extremely rare diseases which have significantly poor prognoses. Studies have rarely provided conclusive evidence of the prognostic factors of TNT. Standard therapies have been controversial.

Methods

TNT patients (n=173) were enrolled from Surveillance, Epidemiology and End Results database (SEER). Univariate and multivariate analyses were utilized to evaluate predictive factors of prognoses. Logistic regression analysis was used to assess the plausible correlation between histological grade, and cancer invasion. Stratification analysis was used to evaluate the effectiveness of adjuvant therapies.

Results

According to our analysis, local Masaoka stage, surgery, radiotherapy, and non-chemotherapy predicted better overall survival (OS) (P<0.05, for all) in 173 TNT patients. We found that the higher the histological grade of the tumor, the greater the rate of metastasis (P<0.05). The focus was on 125 surgically treated patients, who were females with poor prognostic factors of OS, upgraded histological grade, and advanced Masaoka stage (P<0.01, for all). The effectiveness of radiotherapy treatments had discrepancies at different clinical stages. In the local stage, radiotherapy caused significantly worse OS (P=0.011), while in the advanced stage, patients demonstrated significantly better OS with this treatment (P=0.028). Chemotherapy caused worse OS, primarily, in females (P=0.028).

Conclusions

Surgery, Masaoka stage, and adjuvant treatments were prognostic factors. With surgically treated TNT, gender, histological grade, and Masaoka stage predicted significantly worse OS. Chemotherapy decreased female patients' OS. Radiotherapy significantly promoted advanced and local advanced patients' OS; however, it decreased local stage patients' OS. Predicted TNT invasiveness significantly correlated with histological grade.

Clinical significances of p27 in digestive tract cancers: a comprehensive analysis on immunohistochemistry staining, published literatures, microarray and RNA-seq data

In the present study, we conducted a comprehensive analysis on the clinical roles of p27 protein and p27 gene in digestive tract cancers (DTCs). First, we performed immunohistochemistry staining and found that p27 protein was down-regulated in DTCs. Then we collected 62 publications and calculated the combined hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals (95% CIs) to clarify the relationships of p27 protein expression with prognoses and clinicopathological parameters. The overall HRs indicated that the down-regulated p27 protein was an independent prognostic biomarker for overall survival (HR: 1.58, 95% CI: 1.38-1.81, P < 0.0001) but not for disease-free survival and cancer-specific survival. The combined ORs indicated that a low expression of p27 protein was positively related to lymph node metastasis (OR: 2.15, 95% CI: 1.57-2.96, P < 0.0001), distant metastasis (OR: 2.02, 95% CI: 1.12-3.63, P = 0.019) and pathology grading (OR: 2.14, 95% CI: 1.75-2.62, P < 0.0001). Additionally, 60 DTCs-related microarray and RNA-seq datasets were obtained to investigate the expression level and clinical value of p27 gene in DTCs patients. We found that the expression level of p27 gene in DTCs was similar to that in normal controls. And no significant associations of p27 gene expression with prognoses and clinicopathological factors were observed. In conclusion, according to our results, it was p27 protein, but not p27 gene, that can function as an effective biomarker to predict the clinical outcome in patients with DTCs. The down-regulation of p27 protein in DTCs may not result from the altered expression of p27 gene.

ERCC1 rs3212986 A/C polymorphism is not associated with chemotherapy treatment outcomes in gastric cancer patients: evidence from 11 publications in Chinese populations

Background

A number of studies have investigated the roles of excision repair cross-complementation group 1 (ERCC1) gene rs3212986 polymorphisms as potential biomarkers in gastric cancer (GC). However, the results were inconsistent. Here, we performed a meta-analysis to explore ERCC1 rs3212986 polymorphisms in the chemotherapy response and clinical outcome of GC.

Methods

PubMed, Embase, and Web of Science were searched up to July 28, 2017, for studies on the association between ERCC1 rs3212986 A/C polymorphisms and response to chemotherapy as well as overall survival time of GC. A fixed-effect or random-effect model was used to calculate the pooled odds ratios (ORs) based on the results from the heterogeneity tests.

Results

The result revealed that there was no significant association between the ERCC1 rs3212986 A/C polymorphism and response to chemotherapy in GC under comparison models (AA + CA versus CC, OR 0.95, P=0.80, AA versus CA, OR 0.85, P=0.55, AA versus CC, OR 0.74, P=0.47). Further identification suggested that ERCC1 rs3212986 A/C polymorphisms were not linked with the overall survival of GC (AA + CA versus CC, OR 1.09, P=0.52, AA versus CA, OR 1.05, P=0.85, AA versus CC, OR 1.43, P=0.23).

Conclusion

Our meta-analysis indicated that the ERCC1 rs3212986 A/C polymorphism was not associated with response to chemotherapy or overall survival time in GC. Well-designed studies with larger sample sizes and more ethnic groups should be performed to further validate our results.

Mutational spectrum of acute myeloid leukemia patients with double CEBPA mutations based on next-generation sequencing and its prognostic significance

The aim of this study was to profile the spectrum of genetic mutations in acute myeloid leukemia (AML) patients co-occurring with CEBPA double mutation (CEBPA^dm). Between January 1, 2012, and June 30, 2017, 553 consecutive patients with de novo AML were screened for CEBPA mutations. Out of these, 81 patients classified as CEBPA^dm were analyzed further by a sensitive next-generation sequencing assay for mutations in 112 candidate genes. Within the CEBPA gene itself, we found 164 mutations. The most common mutated sites were c.936_937insGAG (n = 11/164, 6.71%) and c.939_940insAAG (n = 11/164, 6.71%), followed by c.68dupC (n = 10/164, 6.10%). The most common co-occurring mutations were found in the CSF3R (n = 16/81, 19.75%), WT1 (n = 15/81, 18.52%), and GATA2 (n = 13/81, 16.05%) genes. Patients with CSF3R mutations had an inferior four-year relapse-free survival (RFS) than those with the wild-type gene (15.3% versus 46.8%, respectively; P = 0.021). Patients with WT1 mutations had an inferior five-year RFS compared with those without such mutations (0% versus 26.6%, respectively, P = 0.003). However, GATA2, CSF3R, WT1 mutations had no significant influence on the overall survival. There were some differences in the location of mutational hotspots within the CEBPA gene, as well as hotspots of other co-occurring genetic mutations, between AML patients from Chinese and Caucasian populations. Some co-occurring mutations may be potential candidates for refining the prognoses of AML patients with CEBPA^dm in the Chinese population.

Association between prophylactic hydration volume and risk of contrast-induced nephropathy after emergent percutaneous coronary intervention

BACKGROUND

Intravenous hydration during percutaneous coronary intervention (PCI) significantly reduces the risk of contrast-induced nephropathy (CIN), but there are no well-defined protocols regard¬ing the optimal hydration volume (HV) required to prevent CIN following emergent PCI. Therefore, this study investigates the association between the intravenous HV and CIN after emergent PCI.

METHODS

711 patients were prospectively recruited who had underwent emergent PCI with hydration at routine speed and the relationship was investigated between HV or HV to weight ratio (HV/W) and the CIN risk, which was defined as a ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine levels from baseline within 48-72 h of exposure to the contrast.

RESULTS

The overall CIN incidence was 24.7%. Patients in the higher HV quartiles had elevated CIN rates. Multivariate analysis showed that higher HV/W ratios were not associated with a decreased risk (using the HV) of CIN, but they were associated with an increased risk (using the HV/W) of CIN (Q4 vs. Q1: adjusted odds ratio 1.99; 95% confidence interval 1.05-3.74; p = 0.034). A higher HV/W ratio was not significantly associated with a reduced risk of long-term death (all p > 0.05).

CONCLUSIONS

The data suggests that a higher total HV is not associated with a decreased CIN risk or beneficial long-term prognoses, and that excessive HV may increase the risk of CIN after emergent PCI.

Prognostic Factors After Whole-brain Radiotherapy Alone for Brain Metastases from Malignant Melanoma

BACKGROUND/AIM

Many patients with brain metastases from melanoma receive whole-brain radiotherapy (WBRT). WBRT-regimens must consider the patient's prognosis in order to deliver the best therapy.

PATIENTS AND METHODS

Seven factors were correlated to intracerebral control and survival after WBRT alone in 92 patients with melanoma: WBRT regimen, age at WBRT, gender, Karnofsky performance score (KPS), number of brain lesions, number of extracranial metastatic sites, and time from melanoma diagnosis to WBRT.

RESULTS

On univariate analyses, KPS ≥80 (p=0.075) showed a trend towards improved intracerebral control. Greater WBRT dose (p=0.029), age ≤60 years (p=0.002), KPS ≥80 (p<0.001) and no extracranial site (p=0.008) were positively correlated with survival. On multivariate analyses, KPS (hazard ratio=2.11, 95% confidence interval=1.28-3.47; p=0.003) and number of extracranial metastatic sites (hazard ratio=1.27, 95% confidence interval=1.02-1.56; p=0.030) maintained significance regarding survival.

CONCLUSION

The study identified predictors of survival for patients with melanoma receiving WBRT for brain metastases that can contribute to selection of individualized therapies.

Strengthening the case that elevated levels of programmed death ligand 1 predict poor prognosis in hepatocellular carcinoma patients

Immunotherapy targeting programmed death receptor 1 and programmed death ligand 1 (PD-L1) has shown impressive antitumor efficacy in several solid cancers, including advanced hepatocellular carcinoma (HCC). Since response rates of various cancers to such immunotherapy appear to correlate with PD-L1 expression levels, several studies have examined whether PD-L1 expression correlates with HCC pathology and patient prognosis. In this paper, we analyzed the strength and limitations of a recent meta-analysis of associations of PD-L1 with HCC characteristics and patient prognosis.

Prognostic Factors in Patients Irradiated for Recurrent Head-and-Neck Cancer

BACKGROUND/AIM

Many patients with recurrent head-and-neck cancer have poor outcomes. Predictive factors allowing judgment of the patient's prognosis are important for treatment individualization. This study aimed to identify such factors after irradiation of locoregional recurrence.

PATIENTS AND METHODS

In 60 patients irradiated for locoregionally recurrent head-and-neck cancer, 12 factors were evaluated regarding freedom from second locoregional recurrence and survival, namely gender, tumor site, initial tumor stage, primary treatment, time between cancer diagnosis and irradiation of locoregional recurrence, age, performance score, tumor and nodal category of recurrence, upfront surgery, radiation dose and concurrent chemotherapy.

RESULTS

On Cox regression analysis, performance score (p=0.002) and nodal category (p=0.004) significantly affected survival. Good performance score (p=0.021) and low nodal category (p=0.002) were also significantly associated with freedom from a second recurrence.

CONCLUSION

Independent predictors of survival and freedom from second locoregional recurrence were identified as factors facilitating individualized treatment of patients with locoregionally recurrent head-and-neck cancer.

Anaplastic thyroid cancer: multimodal treatment results

Background

Anaplastic thyroid cancer is a rare and lethal disease. It accounts for 1–2% of thyroid malignancies, but specific mortality is higher than 90%. It is an aggressive locoregional disease with a high metastatic capacity. There is no agreement with regards to the best treatment. We analysed the results of treatment in a mestizo population treated in the National Cancer Institute (Mexico).

Methods

We reviewed 1,581 files of thyroid carcinomas; of these, 29 (1.83%) had anaplastic thyroid carcinoma. Demographic variables, clinical manifestations, tumour characteristics, and treatments were analysed.

Results

The median age was 64.5 ± 13.2 years. Females were more affected (female/male ratio: 2.6:1); 21 cases occurred in women (72.4%), and eight in males (27.6%). The most common manifestations were neck enlargement (93.10%) and hoarseness (71.31%). The median tumour size was 8 cm (range: 4–20 cm). The percentage of cases which presented in clinical stage IVA was 10.3%, with 62.1% presenting in clinical stage IVb and 27.6% presenting in clinical stage VIc. Complete resection (R0) (p = 0.05), radiation doses of higher than 33.1 Gy (p = 0.04), and multimodal therapy were associated with better survival. Surgery plus radiotherapy with or without systemic treatment (p = 0.006). The median overall survival was 119 days (IC 95%, 36.3–201.6). Six-month, one-year and two-year survival was 37.9%, 21% and 13%, respectively.

Conclusion

Complete surgical resection is associated with better survival but is very difficult to achieve due to aggressive biological behaviour. Multimodal therapy is associated with better survival and a better quality of life. There is a need for more effective systemic treatments as extensive surgical resections have little overall benefit in highly invasive and metastatic disease.