Construction and validation of nomogram for the cancer-specific mortality for HER2-positive breast cancer patients

The cancer-specific mortality (CSM) of patients with human epidermal growth factor receptor 2 positive (HER2+) breast cancer remains dismal and varies widely from person to person. Therefore, we aim to construct a nomogram to predict CSM in HER2+ breast cancer using data from the surveillance, epidemiology, and end results (SEER) database. The clinicopathological data of patients diagnosed with HER2+ breast cancer from 2000 to 2019 were selected from the SEER database. Independent prognostic factors for CSM of patients were identified by competing risk model. Subsequently, we constructed a new predicting nomogram. Calibration curves, receiver operating characteristic curve, and decision curve were used to evaluate the efficiency of the nomogram. A total of 45,362 breast cancer patients in the SEER database were selected for study and randomly separated into training (n = 31,753) and validation (n = 13,609) cohorts. Univariate and multivariate analysis showed that age, race, tumor grade, clinical stage, T stage, surgery status, radiotherapy, chemotherapy, and regional nodes examined were independent risk factors for CSM of HER2+ breast cancer patients. Receiver operating characteristic curves for the prediction nomogram of the CSM for breast cancer patients indicated that the 1-, 3- and 5-year AUCs were 0.874, 0.843, and 0.820 in the training cohort and 0.861, 0.845, and 0.825 in the validation cohort, respectively. The c-index was 0.817 and 0.821 in training cohort and validation cohort, respectively. Moreover, a good agreement was seen between the observed outcome and the predicted probabilities in the calibration curves of the nomogram in training cohort and validation cohort. Further decision curve analysis demonstrated good clinical utilities of the nomogram in training cohort and validation cohort. The nomogram shows good accuracy and reliability in predicting the CSM of breast cancer patients, and it could provide some theoretical support for clinicians to make decisions.

Prognostic factors for liver metastasis in patients with small intestinal stromal tumor: A retrospective analysis of surveillance, epidemiology, and end results

BACKGROUND

Liver metastasis (LIM) is the most common distant site of metastasis in small intestinal stromal tumors (SISTs). The aim of this study was to determine the risk and prognostic factors associated with LIM in patients with SISTs.

METHODS

Patients diagnosed with gastrointestinal stromal tumors between 2010 and 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression models, as well as a Cox regression model were used to explore the risk factors associated with the development and prognosis of LIM. Additionally, the overall survival (OS) of patients with LIM was analyzed using the Kaplan-Meier method. Furthermore, a predictive nomogram was constructed, and the model's performance was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

RESULTS

A total of 1582 eligible patients with SISTs were included, among whom 146 (9.2%) were diagnosed with LIM. Poor tumor grade, absence of surgery, later T-stage, and no chemotherapy were associated with an increased risk of developing LIM. The nomogram prediction model achieved an AUC of 0.810, 95% Confidence Interval (CI) 0.773-0.846, indicating good performance, and the calibration curve showed excellent accuracy in predicting LIM. The OS rate of patients with LIM was significantly lower than that of patients without LIM (p < 0.001).

CONCLUSIONS

Patients with SISTs who are at high risk of developing LIM deserve more attention during follow-up, as LIM can significantly affect patient prognosis. The nomogram demonstrated good calibration and discrimination for predicting LIM.

CD105 expression in cancer-associated fibroblasts: a biomarker for bone metastasis in early invasive ductal breast cancer patients

Introduction: Bone metastasis is one of the causes that mainly decrease survival in patients with advanced breast cancer. Therefore, it is essential to find prognostic markers for the occurrence of this type of metastasis during the early stage of the disease. Currently, cancer-associated fibroblasts, which represent 80% of the fibroblasts present in the tumor microenvironment, are an interesting target for studying new biomarkers and developing alternative therapies. This study evaluated the prognostic significance of the CD105 expression in cancer-associated fibroblasts in early breast cancer patients. Methods: Immunohistochemistry was used to assess CD105 expression in invasive ductal breast carcinomas (n = 342), analyzing its association with clinical and pathological characteristics. Results: High CD105 expression in cancer-associated fibroblasts was associated with an increased risk of metastatic occurrence (p = 0.0003), particularly bone metastasis (p = 0.0005). Furthermore, high CD105 expression was associated with shorter metastasis-free survival, bone metastasis-free survival, and overall survival (p = 0.0002, 0.0006, and 0.0002, respectively). CD105 expression also constituted an independent prognostic factor for metastasis-free survival, bone metastasis-free survival, and overall survival (p = 0.0003, 0.0006, and 0.0001, respectively). Discussion: The high CD105 expression in cancer-associated fibroblasts is an independent prognostic marker for bone metastasis in early breast cancer patients. Therefore, the evaluation of CD105(+) CAFs could be crucial to stratify BCPs based on their individual risk profile for the development of BM, enhancing treatment strategies and outcomes.

Efficacy evaluation of different measurement methods for target lesions after neoadjuvant chemotherapy and radical radiotherapy in locally advanced hypopharyngeal carcinoma

AIM

To assess the diagnostic efficacy in response evaluation of hypopharyngeal carcinoma (HPC) using different CT measurement methods.

METHODS AND MATERIALS

One hundred and three patients with locally advanced HPC receiving neoadjuvant chemotherapy (NACT) and radical radiotherapy (RT) were retrospectively enrolled. The long diameter, short diameter and largest axial area of the tumors and the largest metastatic cervical lymph node (LN) were measured before and after NACT, at the end of RT and 1 month after RT. Tumor regression ratios of the sum of the tumor's long diameter and LN's short diameter (LDTSDL), the sum of tumor and LN's short diameter (TTSDL), the sum of tumor and LN's largest axial area (AATML) were calculated. Analysis was conducted for overall survival (OS), metastasis-free survival, regional recurrence-free survival (RRFS), and local recurrence-free survival (LRFS).

RESULTS

Note that 35, 28, 23, and 16 patients suffered death, local recurrence, regional recurrence and distant metastasis, respectively. TTSDL-defined effective group demonstrated better LRFS (p = .039) and RRFS (p = .047) after NACT and better OS since the end of RT (p = .037); AATML-defined effective groups demonstrated better OS, LRFS, and RRFS since the end of RT (p = .015, .008, and .005). While LDTSDL-defined groups showed differences in OS and LRFS until 1 month after RT (p = .013 and .014).

CONCLUSIONS

The regression rate of TTSDL and AATML can distinguish prognosis at an earlier time and demonstrated better reliability compared with LDTSDL. They were recommended for response evaluation in HPC.

Prognostic factors of second hematopoietic allogeneic stem cell transplantation among hematological malignancy patients relapsed after first hematopoietic stem cell transplantation: A single center study

Introduction

We aimed to evaluate prognostic factors of a second allogeneic stem cell transplantation (allo-HSCT2) among hematological malignancy patients who have relapsed after the first allo-HSCT(allo-HSCT1).

Methods

We retrospectively analyzed 199 hematological malignancy patients who received allo-HSCT2 as a salvage treatment post allo-HSCT1 relapse between November 2012 and October 2021.

Results

The median age at allo-HSCT2 was 23 (range: 3-60) years. The median time to relapse after HSCT1 was 9 (range: 1-72) months. Prior to allo-HSCT2, patients had the following hematopoietic cell transplantation-comorbidity indexes (HCT-CI): 127 with a score of 0, 52 with a score of 1, and 20 with a score of 2 or greater. Fifty percent of patients received chimeric antigen receptor (CAR) T-cell therapy following HSCT1 relapse. Disease status was minimal residual disease (MRD)-negative complete remission (CR) among 119 patients, MRD-positive CR among 37 patients and non-remission (NR) for 43 patients prior to allo-HSCT2. Allo-HSCT2 was performed from a new donor in 194 patients (97.4%) and 134 patients (67.3%) received a graft with a new mismatched haplotype. The median follow-up time was 24 months (range: 6-98 months), and the 2-year OS and LFS were 43.8% ± 4.0% and 42.1% ± 4.1%, respectively. The 2-year cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) was 30.0%±4.8% and 38.5%±3.8%, respectively. Cox regression multivariate analysis showed that disease statusof MRD-negative CR, HCT-CI score of 0 prior to allo-HSCT2, and new mismatched haplotype donor were predictive factors of improved OS and LFS compared to patients without these characteristics. Based on these three favorable factors, we developed a predictive scoring system for patients who received allo-HSCT2. Patients with a prognostic score of 3 who had the three factors showed a superior 2-year OS of 63.3% ± 6.7% and LFS of 63.3% ± 6.7% and a lower CIR of 5.5% ± 3.1% than patients with a prognostic score of 0. Allo-HSCT2 is feasible and patients with good prognostic features prior to allo-HSCT2 -disease status of CR/MRD- and HCT-CI score of 0 as well as a second donor with a new mismatched haplotype could have the maximal benefit from the second allo-HSCT.

Conclusions

Allo-HSCT2 is feasible and patients with good prognostic features prior to allo-HSCT2 -disease status of CR/MRD- and HCT-CI score of 0 as well as a second donor with a new mismatched haplotype could have the maximal benefit from the second allo-HSCT.

Changes in ALBI Score and PIVKA-II within Three Months after Commencing Atezolizumab Plus Bevacizumab Treatment Affect Overall Survival in Patients with Unresectable Hepatocellular Carcinoma

In this study, we aimed to evaluate the efficacy and safety of atezolizumab plus bevacizumab (Atez/Bev) treatment for unresectable hepatocellular carcinoma (HCC) and to analyze the factors affecting overall survival (OS). A total of 69 patients who received Atez/Bev at our institutions for unresectable HCC were enrolled in this study. OS and progression-free survival (PFS) were estimated using the Kaplan−Meier method. Changes in clinical indicators within 3 months were defined as delta (∆) values, and the Cox proportional hazards model was used to identify which ∆ values affected OS. The median OS, PFS, objective response rate, and disease control rate were 12.5 months, 5.4 months, 23.8%, and 71.4%, respectively. During the observational period, 62 patients (92.5%) experienced AEs (hypertension (33.3%) and general fatigue), and 27 patients (47.4%) experienced grade ≥ 3 AEs (hypertension (10.1%) and anemia (7.2%)). There was a significant deterioration in the albumin-bilirubin (ALBI) score (−2.22 to −1.97; p < 0.001), and a reduction in PIVKA-II levels (32,458 to 11,584 mAU/mL; p = 0.040) within 3 months after commencing Atez/Bev. Both the worsening ∆ ALBI score (p = 0.005) and increasing ∆ PIVKA-II (p = 0.049) were significantly associated with the OS of patients.

High Expression of PRNP Predicts Poor Prognosis in Korean Patients with Gastric Cancer

Gastric cancer (GC) has the highest occurrence and fourth-highest mortality rate of all cancers in Korea. Although survival rates are improving with the development of diagnosis and treatment methods, the five-year survival rate for stage 4 GC in Korea remains <10%. Therefore, it is important to identify candidate prognostic factors for predicting poor prognosis. PRNP is a gene encoding the prion protein PrP, which has been noted for its role in the nervous system and is known to be upregulated in various cancers and associated with both cell proliferation and metastasis. However, the value of PRNP as a prognostic factor for Korean GC patients remains unclear. Here, we analyzed the relationship between PRNP expression and survival in three independent datasets for Korean patients with GC as well as the TCGA-STAD dataset. Survival analysis indicates that high levels of PRNP expression are associated with poor overall survival of patients with GC. Gene set enrichment analysis showed that PRNP is associated with epithelial mesenchymal transition and Hedgehog signaling. In addition, proliferation of GC cell lines was inhibited after siRNA-mediated knockdown of PRNP. In conclusion, our study suggests a potential role for PRNP as a candidate prognostic factor for patients with GC.

Tumor Size Is an Independent Prognostic Factor for Stage I Ovarian Clear Cell Carcinoma: A Large Retrospective Cohort Study of 1,000 Patients

Objective

The aim of this study was to investigate the prognostic value and stratification cutoff point for tumor size in stage I ovarian clear cell carcinoma (OCCC).

Methods

This was a retrospective cohort study using the Surveillance, Epidemiology, and End Results database (version: SEER 8.3.9). Patients diagnosed with stage I OCCC from 1988 to 2018 were included for further analysis. X-Tile software was used to identify the potential cutoff point for tumor size. Stratification analysis, propensity score matching, and inverse probability weighting analysis were used to balance the potential confounding factors.

Results

A total of 1,000 stage I OCCC patients were included. Of these 1,000 patients, median follow-up was 106 months (95% confidence interval [CI]: 89-112 months). Multivariate analysis showed that tumor size, age at diagnosis, and stage IC were significantly associated with stage I OCCC patients. Eight centimeters is a promising cutoff point that can divide stage I OCCC patients into a good or a poor prognosis group. After controlling potential confounding factors with propensity score matching and inverse probability weighting, we demonstrated that stage I OCCC patients with tumor size ≤ 8 cm enjoyed a significantly better 5-year overall survival (OS, 89.8% vs. 81%, p < 0.0001). Tumor size ≤ 8 cm was an independent prognostic factor of stage I OCCC patients (hazard ratio [HR] 0.5608, 95% CI: 0.4126-0.7622, p = 0.0002).

Conclusions

Tumor size is an independent prognostic factor for stage I OCCC, and 8 cm is a promising cutoff point for tumor size for risk stratification. However, using tumor size in the stratification management of stage I OCCC patients warrants further investigation.

Baseline lymphopenia as prognostic factor in patients with metastatic breast cancer treated with palbociclib

Cyclin-dependent-kinase 4-6 inhibitors (CDK4/6i) have improved the management of hormone receptor (HR)⁺/human epidermal growth factor receptor (HER)2^- metastatic breast cancer (mBC). Currently, there are no valid prognostic factors for response to CDK4/6i. Baseline lymphopenia is reported as a prognostic factor in several types of cancer. The present retrospective study aimed to evaluate the effect of baseline absolute lymphocyte count (ALC) on response to palbociclib. Progression-free survival (PFS) was the primary endpoint. Secondary endpoints were overall survival (OS), best response and safety. A total of 114 patients treated for mBC between 2016 and 2019 were included. Median baseline ALC was 1.4 g/l (range, 0.2-4.3 g/l). A total of 65 (57%) and 49 (43%) patients had baseline ALC values of <1.5 and ≥1.5 g/l, respectively. Patients with baseline lymphopenia exhibited significantly shorter PFS (6 vs. 10 months; P=0.004) and OS (20 vs. 33 months; P=0.02). ALC <1.5 g/l independently predicted worse survival, as indicated by multivariate analysis (P=0.04; hazard ratio, 1.76; 95% confidence interval, 1.02-3.02). Patients with baseline ALC <1.5 g/l had significantly less partial response (14 vs. 22%; P=0.016) and more disease progression (46 vs. 20%; P=0.016) than those with ALC ≥1.5 g/l. ALC is a strong and easy-to-use dosage with prognostic factor for patients with HR⁺/HER2^- mBC treated with palbociclib and endocrine therapy. Lymphopenia may also be a predictive factor of early progression. These data need to be verified in a larger prospective study.

Abnormal clonalities of B-lymphocytes in bovine leukemia virus-infected cattle with persistent lymphocytosis

Peripheral B-lymphocyte clonality of 274 bovine leukemia virus-infected cattle with lymphocytosis was analyzed using clonality PCR based on sequences of the variable region of the bovine immunoglobulin H chain. None of the cattle showed monoclonal proliferation, while 10, 31, and 233 showed minor-clonal, oligoclonal, and polyclonal proliferation, respectively. A total of 163 cattle were analyzable the following year, and lymphocytosis was maintained in 157, indicating persistent lymphocytosis (PL). B-lymphocyte clonality of the 157 PL cattle was minor-clonal in 6 (3.8%), oligoclonal in 8 (5.1%), and polyclonal in 143 (91.1%). A higher rate of enzootic bovine leukosis (EBL) onset within a year was observed in PL cattle with minor-clonal (50.0% (3/6)) and oligoclonal (25.0% (2/8)) proliferation compared to those with polyclonal (5.6% (8/143)) proliferation. Minor-clonal and oligoclonal proliferation in PL cattle may be a prognosis factor for developing EBL.

Risk Factors for the Development of High-risk Stigmata in Branch-duct Intraductal Papillary Mucinous Neoplasms

Objective Strict follow-up is recommended for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) to avoid missing the development of high-risk stigmata (HRS) at a premalignant stage. This study explored the risk factors associated with the development of HRS during follow-up. Methods We performed a retrospective analysis of 283 patients with BD-IPMN, treated at Okayama University Hospital in Japan between January 2009 and December 2016. Only patients with imaging studies indicative of classical features of BD-IPMN without HRS and followed for over one year were included in the study. We performed radiological follow-up every six months and collected patients' demographic data, cyst characteristics, and clinical outcomes and used univariate logistic regression models to determine the odds of developing HRS. Results Ten patients (3.5%) developed HRS after a median surveillance period of 55.8 months. The main pancreatic duct (MPD) size (5-9 mm) and cyst growth rate (>2.5 mm/year) were both suggested to be possible risk factors for the development of HRS [odds ratio, 14.2; 95% confidence interval (CI), 3.1-65.2, p=0.0006, and odds ratio, 6.1; 95% CI 1.5-25.5, p=0.014]. Regarding the number of worrisome features (WFs), the rate of HRS development was 2.0% (4/199) in cases with no WF, 1.6% (1/62) in cases with single WF and 22.7% (5/22) in cases with multiple WFs, respectively. The rate of HRS development was significantly higher in cases with multiple WFs than in the other cases (p<0.0001). Conclusion MPD dilation, rapid cyst growth, and multiple WFs were significant risk factors for the development of HRS. In the presence of such features, it is necessary to closely follow the development of HRS and avoid missing the best opportunity to perform surgical intervention.

Extracellular Vesicles in Acute Leukemia: A Mesmerizing Journey With a Focus on Transferred microRNAs

Despite their small size, the membrane-bound particles named extracellular vesicles (EVs) seem to play an enormous role in the pathogenesis of acute leukemia. From oncogenic hematopoietic stem cells (HSCs) to become leukemic cells to alter the architecture of bone marrow (BM) microenvironment, EVs are critical components of leukemia development. As a carrier of essential molecules, especially a group of small non-coding RNAs known as miRNA, recently, EVs have attracted tremendous attention as a prognostic factor. Given the importance of miRNAs in the early stages of leukemogenesis and also their critical parts in the development of drug-resistant phenotype, it seems that the importance of EVs in the development of leukemia is more than what is expected. To be familiar with the clinical value of leukemia-derived EVs, this review aimed to briefly shed light on the biology of EVs and to discuss the role of EV-derived miRNAs in the development of acute myeloid leukemia and acute lymphoblastic leukemia. By elaborating the advances and challenges concerning the isolation of EVs, we discuss whether EVs could have a prognostic value in the clinical setting for leukemia.

Influence of first line chemotherapy strategy depending on primary tumor location in metastatic colorectal cancer

Background

Primary tumor location (PTL) is a major prognostic factor in metastatic colorectal cancer (mCRC) with left side which present better prognosis than right sided. Uncertainty exists regarding comparative effectiveness of irinotecan or oxaliplatin doublet in mCRC in function of PTL.

Methods

We conducted a retrospective comparing clinical outcomes from both regimens in function of sidedness. Patients with newly diagnosed mCRC candidates to first-line chemotherapy were selected. Clinical outcomes were assessed and stratified by tumor location (left, right and rectal) and type of treatment.

Results

Overall, 702 patients met the inclusion criteria. Primary colon cancer was right-sided in 248 (35.3%) patients, left-sided in 296 (42.2%) and rectal in 158 (22.5%) patients. Whatever PTL monochemotherapy give poor progression-free survival (PFS) and overall survival (OS). Triplet give better PFS and OS only for rectal cancer. When looking at doublet in first line. Folinic acid, 5FU, and irinotecan (FOLFIRI) give better PFS in rectal cancer [PFS of 21.2 (95% CI: 14.9-NR) versus 12.2 (95% CI: 10.1-13.4) months for the folinic acid, 5FU, and oxaliplatin (FOLFOX) group, P=0.009] and at trend for better PFS in right side tumor [14.9 (95% CI: 8.8-20.8) versus 11.3 (95% CI: 8.4-13.2) months for the FOLFOX group. P=0.0755]. No difference was observed in term of OS.

Conclusions

our results support that either FOLFIRI or FOLFOX regimens give similar efficacy in both left and right metastatic colic cancer. FOLFIRI and FOLFIRINOX regimens might be preferred for metastatic rectal carcinoma.

Correlation between serum lipid and prognosis of idiopathic sudden sensorineural hearing loss: a prospective cohort study

BACKGROUND

To investigate the correlation between blood lipids and the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL).

METHODS

We included 232 patients with ISSNHL at the Second Affiliated Hospital of Shanghai University from June 2015 to March 2017 using a prospective cohort study design. We collected information including age, gender, hypertension, diabetes, mellitus, vertigo, as well as the levels of blood total cholesterol (TC), triglycerides (TG), and low-density lipoproteins (LDL-C). We also recorded the ratio between the levels of low-density lipoproteins and the levels of high-density lipoproteins (LDL-C/HDL-C ratio). Correlations between the prognosis of ISSNHL and TC, TG, LDL-C, and LDL-C/HDL-C ratio were analyzed by univariable and multivariable logistic regression analyses.

RESULTS

The clinical effectiveness rate of patients with TC ranging from 5.2 to 6.2 mmol/L was significantly higher than that of patients with TC <5.2 mmol/L (P<0.001). No notable difference was found between patients with TC <5.2 mmol/L and patients with TC ≥6.2 mmol/L. The clinical effectiveness rate of patients in TG ranging from 1.7 mmol/L to 2.3 mmol/L was markedly higher than those in TG <1.7 mmol/L (P<0.001). No significant difference was found between patients with TG ranging from 2.3 to 5.6 mmol/L, TG ≥5.6 mmol/L, and TG <1.7 mmol/L. The clinical effectiveness rate of patients in LDL-C/HDL-C <1.5 was considerably higher than those in LDL-C/HDL-C ranging from 1.5 to 2.5, 2.5 to 3.5, and ≥3.5 (P<0.001).

CONCLUSIONS

Our findings indicated that TC, TG, and the LDL-C/HDL-C ratio are strongly associated with the prognosis of ISSNHL. These three indices could be recommended as independent markers to predict outcomes.

Lower Plasma Elabela Levels in Hypertensive Patients With Heart Failure Predict the Occurrence of Major Adverse Cardiac Events: A Preliminary Study

Background: Elabela, a novel cardiac developmental peptide, has been shown to improve heart dysfunction. However, the roles and correlation of Elabela in predicting adverse cardiac events in hypertensive patients with heart failure (HF) remain largely unclear.

Objective: To measure plasma levels of Elabela in hypertensive patients with HF and evaluate its prognostic value.

Methods: A single-site, cohort, prospective, observational study was investigated with all subjects, including control subjects and hypertensive patients with or without HF, whom were recruited in Beijing Chaoyang Hospital Affiliated to Capital Medical University form October 2018 to July 2019. The subjects among different groups were matched based on age and sex. The clinical characteristics were collected, and plasma Elabela levels were detected in all subjects. The hypertensive patients with HF were followed up for 180 days, and the major adverse cardiac events (MACE) were recorded. The Cox regression was used to explore the correlation between Elabela level and MACE in hypertensive patients with or without HF. The receiver operating characteristic curves were used to access the predictive power of plasma Elabela level.

Results: A total of 308 subjects, including 40 control subjects, 134 hypertensive patients without HF, and 134 hypertensive patients with HF were enrolled in this study. Plasma levels of Elabela were lower in hypertensive patients compared with control subjects [4.9 (2.8, 6.7) vs. 11.8 (9.8, 14.0) ng/ml, P < 0.001]. Furthermore, HF patients with preserved ejection fraction had a higher plasma Elabela level than those with impaired left ventricular systolic function (heart failure with mid-range ejection fraction and heart failure with reduced ejection fraction). The hypertensive patients with HF and higher plasma Elabela levels had a better readmission-free and MACE-free survival than those with lower plasma Elabela levels in survival analysis. The Cox regression analysis revealed that plasma Elabela levels were negatively associated with MACE (HR 0.75, 95% CI 0.61–0.99, P = 0.048) in hypertensive patients with HF.

Conclusion: Plasma Elabela levels were decreased in hypertensive patients with left ventricular systolic dysfunction. Thus, Elabela may be potentially used as a novel predictor for MACE in hypertensive patients with HF.

BDCA1+ cDC2s, BDCA2+ pDCs and BDCA3+ cDC1s reveal distinct pathophysiologic features and impact on clinical outcomes in melanoma patients

Objectives

Dendritic cells play a pivotal but still enigmatic role in the control of tumor development. Composed of specialised subsets (cDC1s, cDC2s, pDCs), DCs are critical in triggering and shaping antitumor immune responses. Yet, tumors exploit plasticity of DCs to subvert their functions and escape from immune control. This challenging controversy prompted us to explore the pathophysiological role of cDCs and pDCs in melanoma, where their precise and coordinated involvement remains to be deciphered.

Methods

We investigated in melanoma patients the phenotypic and functional features of circulating and tumor‐infiltrating BDCA1⁺ cDC2s, BDCA2⁺ pDCs and BDCA3⁺ cDC1s and assessed their clinical impact.

Results

Principal component analyses (PCA) based on phenotypic or functional parameters of DC subsets revealed intra‐group clustering, highlighting specific features of DCs in blood and tumor infiltrate of patients compared to healthy donors. DC subsets exhibited perturbed frequencies in the circulation and actively infiltrated the tumor site, while harbouring a higher activation status. Whereas cDC2s and pDCs displayed an altered functionality in response to TLR triggering, circulating and tumor‐infiltrating cDC1s preserved potent competences associated with improved prognosis. Notably, the proportion of circulating cDC1s predicted the clinical outcome of melanoma patients.

Conclusion

Such understanding uncovers critical and distinct impact of each DC subset on clinical outcomes and unveils fine‐tuning of interconnections between DCs in melanoma. Elucidating the mechanisms of DC subversion by tumors could help designing new therapeutic strategies exploiting the potentialities of these powerful immune players and their cross‐talks, while counteracting their skewing by tumors, to achieve immune control and clinical success.

Overexpression of MUC16 (CA125) in extramammary Paget's disease

In this study, we identified the mucin-16 (CA125), a well-known disease marker for ovarian cancer, is overexpressed in the lesions of Extramammary Paget’s disease.

Development of a Novel Clinical Prognostic Model for Patients With Angioimmunoblastic T-Cell Lymphoma

In this study we aimed to identify a set of prognostic factors for angioimmunoblastic T-cell lymphoma (AITL) and establish a novel prognostic model. The clinical data of 64 AITL patients enrolled to the Fourth Hospital of Hebei Medical University (from 2012 Jan to 2017 May) were retrospectively analyzed. The estimated 5-year overall survival and progression-free survival of this cohort of patients were 45.8% and 30.8%, respectively. Univariate analysis showed that age > 60 years, performance status ≥2, Ann Arbor stage III/IV, lactate dehydrogenase > 250 U/L, serum albumin (ALB) < 30 g/l, Coombs test positive, and Ki-67 rate ≥ 70% were significantly associated with poor prognosis. Multivariate analysis demonstrated that age > 60 years, ALB < 30 g/l, Ki-67 rate ≥ 70%, and Coombs test positive were independent prognosis factors for AITL. Here a new prognostic model, named as AITLI, was constructed using the top 5 significant prognostic factors for AITL prognostic prediction. The AITL patients were stratified into 3 risk groups: low, intermediate, and high risk groups. The new prognostic model AITLI showed better performance in predicting prognosis than the International Prognostic Index (IPI) and the prognostic index for PTCL, not otherwise specified (PIT) that were wisely used to predict the outcome for patients with other subtypes of lymphoma.

Correlation between the coexpression of zinc finger and SCAN domain-containing protein 31 and transcriptional activator with PDZ-binding motif and prognosis in hepatocellular carcinoma

Background

Transcriptional coactivator with PDZ binding motif (TAZ) regulates multiple biological processes and has been found to be related to hepatocellular carcinoma (HCC). However, common signaling pathways downstream after TAZ knockdown may also be important.

Methods

TAZ was knocked down in an HCC cell line, and its potential target genes were analyzed. A decrease in the expression of zinc finger and SCAN domain-containing protein 31 (ZSCAN31) was observed. The difference in ZSCAN31 expression was evaluated, and its effect on survival in HCC patients who received surgical resection was determined.

Results

ZSCAN31 was over-expressed in HCC tissues and was associated with low overall survival (OS) in HCC patients after surgical resection. Analysis of tissue samples from 83 HCC patients who underwent surgical resection in our hospital produced similar results. High ZSCAN31 expression was significantly associated with tumor size. High expression levels of both TAZ and ZSCAN31 were related to poor OS. A positive correlation was identified between ZSCAN31 expression and TAZ expression, and the protein binding of ZSCAN31 and TAZ was confirmed by co-immunoprecipitation (Co-IP) assay using an HCC cell line.

Conclusions

ZSCAN31 is associated with TAZ expression in HCC cells, and the targeting of ZSCAN31 and TAZ may represent a novel therapeutic approach in HCC.

TERT Promoter Mutation as an Independent Prognostic Marker for Poor Prognosis MAPK Inhibitors-Treated Melanoma

Although the development of mitogen-activated protein kinase (MAPK) inhibitors has greatly improved the prognosis of BRAFV600 cutaneous melanomas, the identification of molecular indicators for mutated patients at risk of early progression remains a major issue. Using an amplicon-based next-generation-sequencing (NGS) assay that targets cancer-related genes, we investigated co-occurring alterations in 89 melanoma samples. We analyzed both their association with clinicopathological variables and clinical significance in terms of progression-free survival (PFS) and overall survival (OS) according to BRAF genotyping. Among co-occurring mutations, TERT promoter was the most frequently mutated gene. Although no significant difference in PFS was observed in the presence or absence of co-occurring alterations to BRAFV600, there was a trend of longer PFS for patients harboring TERT c.-124C>T mutation. Of most interest, this mutation is an independent marker of good prognosis in subgroups of patients with poor prognosis (presence of brain metastasis and elevated level of lactate dehydrogenase, LDH). Moreover, combination of elevated LDH level, presence of brain metastasis, and TERT c.-124C>T mutation was identified as the best fit model for predicting clinical outcome. Our work revealed the potential interest of c.-124C>T status determination in order to refine the prognosis of BRAFV600 melanoma under mitogen-activated protein kinase (MAPK) inhibitors.

Prognostic Impact of Tumor Extension in Patients With Advanced Temporal Bone Squamous Cell Carcinoma

Objective: The extreme rarity of temporal bone squamous cell carcinoma (TB-SCC) has delayed the accumulation of high-quality clinical evidence. Our objective here was to explore anatomical factors associated with the prognosis of T4 TB-SCC cases.

Study Design: Case series with chart review.

Setting: Two academic tertiary care medical centers.

Subjects and Methods: The medical records of all TB-SCC cases were retrospectively reviewed in two institutions. The resulting data set contained 30 cases of primary T4 cancer eligible for initial definitive (curative) treatment. Disease-specific survival was calculated according to the Kaplan–Meier method. Cox proportional hazards model was used to identify anatomical prognosis factors.

Results: The disease-specific 5-years survival rate of 30 cases of T4 TB-SCC was 53.9%. The tumor invasion to the pterygoid muscle, posterior fossa dura, and sigmoid sinus and destruction of the ossicles were associated with poor prognosis in univariate analysis. The multivariate analysis reveals that the invasion of the ossicles, posterior fossa dura, and sigmoid sinus is an independent prognostic factor [hazard ratio (HR): 4.528 (95% CI: 1.161–17.658), p = 0.030; HR: 5.135 (95% CI: 1.616–16.315), p = 0.006; HR: 4.292 (95% CI: 1.385–13.303), p = 0.012]. The invasion of the carotid canal, petrous apex, middle fossa dura, otic capsule, pterygoid muscle, and middle ear had a high HR (HR > 2). The more invaded anatomical factors present in patients resulted in a poorer patient disease-specific prognosis, with a statistically significant difference.

Conclusions: Assessing which anatomical structures are susceptible to invasion by tumors may be important for predicting TB-SCC patient prognosis and selecting appropriate treatment planning, especially surgical intervention. In addition to previously reported factors, the destruction of the ossicles in the middle ear cavity can be an anatomical prognosis factor.

Clinicopathological characteristics and prognosis of colorectal mucinous adenocarcinoma and nonmucinous adenocarcinoma: a surveillance, epidemiology, and end results (SEER) population-based study

BACKGROUND

Mucinous adenocarcinoma (MC) is a rare histological subtype of colorectal adenocarcinoma. Previous studies investigating the prognosis of MC have conflicting results and the proper treatment of MC remains unclear.

METHODS

This retrospective study presents the clinicopathological characteristics and prognosis of MC. This cohort study collected data from April 1 through August 01, 2018. This study used data on 107,735 patients with nonmucinous adenocarcinoma (NMC) and 9,494 with MC between 2009 and 2013 from the Surveillance, Epidemiology, and End Results program (SEER). Clinicopathological features were analyzed by chi-square test and survival curves by the Kaplan-Meier method. We used propensity score matching (PSM) to account for potential bias. Logistic regression and Cox proportional hazards models were used to compare and calculate adjusted risks of MC death.

RESULTS

MC was more frequent in patients with older age, large tumor size and moderate tumor grade compared with NMC (P<0.001). Five-year survival was lower for MC patients than NMC patients (P<0.001). Older age, later tumor node metastasis (TNM) stage and multiple tumors indicated a poorer prognosis while surgery gave better survival outcomes [hazard ratio (HR) =0.38; 95% confidence interval (CI), 0.33 to 0.44; P<0.001]. Younger age, left-side colon location and early disease stage were associated with better survival after surgery (P<0.001).

CONCLUSIONS

Age, TNM stage, tumor number and treatment were indicators of prognosis and surgery gave better survival for MC patients compared with those without surgery. Our study contributes to their clinical treatment.

恶性孤立性肺结节患者预后因素分析

OBJECTIVE

To explore the prognosis factors that influence the postoperative survival rate in patients with malignant solitary pulmonary nodules and to provide a reference for the prognosis risk stratification of early lung cancer patients.

METHODS

In this study, we retrospectively reviewed 172 patients who were admitted to Peking University First Hospital from April 2006 to December 2013. All cases were radiologically defined as solitary pulmonary nodule and were pathologically confirmed to be stage Ia non-small cell lung cancer after surgical procedure. The patients' clinical and follow-up data were summarized and analyzed. The relevance between survival time and factors that may affect patients' prognosis was evaluated, which included gender, age, clinical symptoms, smoking history, comorbidity index, tumor biomarkers, nodule type, type of surgery, nodule location, nodule histopathological type, nodule size, histopathological differentiation grade, proliferating cell nuclear antigen Ki-67 expression level and epidermal growth factor receptor (EGFR) gene mutation. Kaplan-Meier survival analysis, Cox univariant and multivariant regression analysis were conducted to evaluate the factors affecting prognosis.

RESULTS

The 3-year overall survival rate of the atients with malignant solitary pulmonary nodules was 93.6%, and the 5-year overall survival rate was 89.8%. KaplanMeier survival analysis and Cox univariant regression analysis showed that the overall survival rate of the male patients was significantly lower than that of the female patients. In addition, the elderly patients with histopathology characterized as high Ki-67 proliferation index were also associated with the worse overall survival (P<0.05). Cox multivariant regression analysis demonstrated that age more than 65 years as well as the high Ki-67 expression level were independent risk factors for overall survival in patients with malignant solitary pulmonary nodules (age: P=0.023, HR=3.531, 95%CI 1.190-10.472; Ki-67: P=0.004, HR=1.021, 95%CI 1.007-1.035).

CONCLUSION

For patients with malignant solitary pulmonary nodules, with pathological defined as stage Ia non-small cell lung cancer, age, gender and Ki-67 expression levels might be important prognostic factors. Comprehensive consideration of Ki-67 proliferation index and clinical pathological features may help to stratify the prognosis more accurately and guide the selection of appropriate therapeutic strategies, which needs to be verified by multi-center studies.

Preoperative weight loss is associated with poorer prognosis in operable esophageal cancer patients: A single-center retrospective analysis of a large cohort of Chinese patients

Background: Preoperative weight loss has been shown to be a prognostic factor for many cancers. However, whether preoperative weight loss has clinical significance in patients with esophageal cancer is still controversial.

Methods: A total of 2,174 Chinese patients underwent radical resection of esophageal cancer from 2000 to 2008 were included in our study. Patients were divided into two group: no weight loss (-) and weight loss (+), according to whether they had weight loss compared with their usual weight at diagnosis. The influence of preoperative weight loss on disease-free survival (DFS) and overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazard models.

Results: weight loss (+) was significantly associated with age (P=0.001), alcoholism (P<0.001), tumor location (P=0.003), pT category (P=0.003), pN category (P=0.001). Patients of group weight loss (+) had significantly poorer DFS (Mean: 63.3 months (m) vs 76.8 m, P<0.001) and OS (67.4 m vs 83.3 m, P<0.001) than the no weight loss (-) group. In the final multivariate survival analysis with adjustment for covariates, we found that the weight loss (+) group had a 19% higher risk of death (HR=1.19, 95%CI: 1.07-1.33, P=0.002) and had a 13% higher risk of disease progression (HR=1.13, 95%CI: 1.01-1.25, P=0.027), respectively, than the no weight loss (-) group. Subgroup analysis indicated that the association with preoperative weight loss and better DFS or OS was observed in patients with esophageal squamous cell carcinoma (ESCC) and early pathological stage (I-II).

Conclusion: Preoperative weight loss is associated with shorter OS and DFS, which means poor postoperative prognosis in esophageal cancer patients.

The RND1 Small GTPase: Main Functions and Emerging Role in Oncogenesis

The Rho GTPase family can be classified into classic and atypical members. Classic members cycle between an inactive Guanosine DiPhosphate -bound state and an active Guanosine TriPhosphate-bound state. Atypical Rho GTPases, such as RND1, are predominantly in an active GTP-bound conformation. The role of classic members in oncogenesis has been the subject of numerous studies, while that of atypical members has been less explored. Besides the roles of RND1 in healthy tissues, recent data suggest that RND1 is involved in oncogenesis and response to cancer therapeutics. Here, we present the current knowledge on RND1 expression, subcellular localization, and functions in healthy tissues. Then, we review data showing that RND1 expression is dysregulated in tumors, the molecular mechanisms involved in this deregulation, and the role of RND1 in oncogenesis. For several aggressive tumors, RND1 presents the features of a tumor suppressor gene. In these tumors, low expression of RND1 is associated with a bad prognosis for the patients. Finally, we highlight that RND1 expression is induced by anticancer agents and modulates their response. Of note, RND1 mRNA levels in tumors could be used as a predictive marker of both patient prognosis and response to anticancer agents.

Incidence, risk factors, and prognosis in patients with primary hepatocellular carcinoma and lung metastasis: a population-based study

Aims

The study aims to explore the incidence, risk factors, and prognosis in patients with primary hepatocellular carcinoma (HCC) and synchronous lung metastasis using a large-scale population-based cancer registry database.

Patients and methods

Data of 33,177 HCC patients were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Multivariate logistic and Cox regression model analysis were applied for the recognition of risk factors and prognostic factors associated with lung metastasis among HCC patients. The overall survival and cancer-specific survival of HCC patients with initial pulmonary metastasis were estimated by Kaplan– Meier analysis, and the survival curves were compared by log-rank tests.

Results

Total 2,084 (6.28%) HCC patients diagnosed with initial pulmonary metastasis were enrolled for analysis. Male gender, younger age, non-white race, unmarried status, uninsured status, elevated alpha-fetoprotein, larger primary liver tumor size, positive lymph node status, synchronal bone or brain metastasis, and tumor poor pathological differentiation were relevant to higher risk of lung metastasis in HCC cohort. The 1-, 3-, 5-year overall survival and cancer-specific survival rates for HCC lung metastasis patients were 12.8% vs 15.3%, 4.0% vs 5.7%, and 1.6% versus 2.4%, respectively. The median overall and cancer-specific survival time in HCC lung metastasis group were both 3 months, while the corresponding time in HCC lung metastasis-free group were 19 and 25 months (P<0.05). Older age, unmarried status, poor tumor differential grade, and absence of surgery were identified as unfavorable prognosis factors.

Conclusion

The survival of patients with HCC lung metastasis was dismal. Several clinicopathological factors were found to be significantly relevant to the development and prognosis of HCC lung metastasis. These new findings could be useful for a precise and individualized therapeutic schedule.

Prognostic impact of pleural effusion in EGFR-mutant non-small cell lung cancer patients without brain metastasis

Background

In epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC), brain metastasis is known as a poor prognosis factor. However, prognostic factors in the patients without brain metastasis remain unclear. In this study, we aimed to clarify the differences between metastatic site and prognosis in common EGFR‐mutant NSCLC patients without brain metastasis.

Methods

Chemotherapy‐naïve, advanced EGFR‐mutant NSCLC patients without brain metastasis diagnosed between January 2010 and March 2016 were enrolled. We evaluated prognosis according to the presence or absence of bone metastases, liver metastasis, and pleural effusion.

Results

A total of 50 EGFR‐mutant NSCLC patients without brain metastasis were enrolled. The median progression‐free survival and overall survival were significantly shorter in patients with pleural effusion than in those patients without (progression‐free survival 7.0 months, 95% confidence interval [CI] 3.7–13.0 vs. 13.0 months, 95% CI 9.1–21.7, hazard ratio [HR] 2.29, 95% CI 1.11–4.73, P = 0.020; overall survival 19.5 months, 95% CI 5.7–28.8 vs. 55.3 months, 95% CI 24.0–not evaluable, HR 3.00, 95% CI 1.35–6.68, P = 0.005). Pleural effusion was an independent factor of poor prognosis for progression‐free survival (HR 3.44, 95% CI 1.50–7.88, P = 0.003) and overall survival (HR 2.34, 95% CI 1.00–5.44, P = 0.049).

Conclusion

Pleural effusion might be a poor prognosis factor for advanced EGFR‐mutant NSCLC patients without brain metastasis treated with first‐generation EGFR‐tyrosine kinase inhibitors. Further precision medicine according to the metastatic site is required.

Circulating miRNAs in blood and urine as diagnostic and prognostic biomarkers for bladder cancer: an update in 2017

This study presents a critical appraisal of previously published study data of miRNAs in blood, urine and exosomes as biomarkers of bladder cancer (BC). The evaluation included 39 articles published from the beginning of 2010 until September 2017 and searched in PubMed. The heterogeneity of studies, due to their clinicopathological variability, including insufficient consideration of diagnostic and prognostic biomarker guidelines and missing internal and external validation of data, do not currently allow the recommending of a useful miRNA marker as diagnostic or prognostic tool in BC. Future multi-institutional studies are necessary to overcome the deficiencies in these studies in order to prove the usefulness of circulating miRNAs as robust biomarkers for BC.

Impact of diabetes mellitus on the risk and survival of nasopharyngeal carcinoma: a meta-analysis

Background

Diabetes mellitus (DM) has been identified to be both a risk factor and a prognostic factor in a variety of malignancies, but its association with the risk and outcome of nasopharyngeal carcinoma (NPC) is still unclear. To elucidate this issue, we systematically reviewed the evidence concerning the association between DM status and NPC.

Materials and methods

We identified studies by a literature search of PubMed, Embase, and ISI Web of Knowledge through May 31, 2017, and by searching the reference lists of pertinent articles. Odds ratios (ORs) and hazard ratios (HRs) with 95% CIs were used to estimate the effect size. Heterogeneity across studies was evaluated by the Cochran’s Q and I² statistics.

Results

A total of nine studies were included. Four studies with a total sample size of 221,611 reported the effect of DM on NPC risk, and the other five studies with a sample size of 9,442 reported the impact of DM on survival in NPC patients. All included studies were retrospective, and mostly conducted in Asian populations. Meanwhile, condition of metformin usage was not considered in all studies. A pooled OR of 0.65 (95% CI: 0.43–0.98, P=0.04) revealed an inverse association between DM and NPC. Additionally, pooled analyses of studies investigating the prognosis value of DM revealed that preexisting DM had no effect on overall survival (HR =1.17, 95% CI: 0.94–1.46, P=0.16), local recurrence-free survival (HR =1.16, 95% CI: 0.80–1.67, P=0.44), and distant metastasis-free survival (HR =1.14, 95% CI: 0.92–1.40, P=0.22).

Conclusion

Our results suggested that DM patients might have decreased NPC risk, and have little impact on prognosis of NPC patients. This conclusion should be limited to Asian population. Our results also suggest that more attention should be paid to metformin medication in further studies in order to clarify whether the effects of DM on NPC risk and prognosis are influenced by the anticancer effect of metformin.

HMGB1 overexpression as a prognostic factor for survival in cancer: a meta-analysis and systematic review

As there are millions of cancer deaths every year, it is of great value to identify applicable prognostic biomarkers. As an important alarm, the prognostic role of high mobility group box 1 (HMGB1) in cancer remains controversial. We aim to assess the association of HMGB1 expression with prognosis in cancer patients. Systematic literature searches of PubMed, Embase and Web of Science databases were performed for eligible studies of HMGB1 as prognostic factor in cancer. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate the influence of HMGB1 expression on overall survival (OS) and progression-free survival (PFS) in cancer patients. 18 studies involving 11 different tumor types were included in meta-analysis. HMGB1 overexpression was significantly associated with poorer OS (HR: 1.99; 95% CI, 1.71-2.31) and PFS (HR: 2.26; 95% CI, 1.65-3.10) irrespective of cancer types including gastric cancer, colorectal cancer, hepatocellular carcinoma, pancreatic cancer, nasopharyngeal carcinoma, head and neck squamous-cell carcinoma, esophageal cancer, malignant pleural mesothelioma, bladder cancer, prostate cancer, and cervical carcinoma. Subgroup analyses indicated geographical area and size of studies did not affect the prognostic effects of HMGB1 for OS. Morever, HMGB1 overexpression had a consistent correlation with poorer OS when detected by immunohistochemistry in tissues and enzyme-linked immunosorbent assay in serum, whereas the correlation did not exist by quantitative real-time reverse-transcription polymerase chain reaction in tissues. HMGB1 overexpression is associated with poorer prognosis in patients with various types of cancer, suggesting that it is a prognostic factor and potential biomarker for survival in cancer.

Clinical features and prognostic factors of small cell lung cancer: A retrospective study in 148 patients

To better understand the outcomes of small cell lung cancer (SCLC), we examined the clinical features and prognostic factors of SCLC in this study. A total of 148 patients who were diagnosed as having SCLC between January 2009 and December 2013 in Cancer Center of Union Hospital, Wuhan, China, were enrolled and their clinical features and prognostic factors were retrospectively analyzed. Log-rank test and Cox regression model were employed for analysis of prognostic factors. The 1- and 2-year overall survival (OS) rates were 59.7% and 25.7%, respectively, for limited disease (LD) patients whose median survival time (MST) was 16 months. The 1- and 2-year OS rates were 29.5% and 5.3%, respectively, for extensive disease (ED) patients whose MST was 10 months. The univariate analysis and multivariate analysis revealed that age, tumor stage, serum CEA and Ki-67 antigen were significantly correlated to the outcomes of SCLC, and they were significant prognostic factors for SCLC.

Clinical outcomes of elderly patients (≥70 years) with resectable esophageal squamous cell carcinoma who underwent esophagectomy or chemoradiotherapy: A retrospective analysis from a single cancer institute

A retrospective analysis was conducted to investigate outcomes of elderly patients with resectable esophageal squamous cell carcinoma (ESCC) who underwent surgery or chemoradiotherapy (CRT).We performed a retrospective review of the records of elderly patients (≥70 years) with resectable ESCC who underwent esophagectomy or CRT between January 2009 and March 2013. According to the main treatment strategy, patients were allocated into either surgery group or CRT group. Overall survival (OS), cancer-specific survival and progression-free survival were calculated by the Kaplan-Meier method. Univariate and multivariate survival analyses were performed by the Kaplan-Meier method and Cox proportional hazards model, respectively.A total of 188 patients were enrolled. Eighty-eight patients underwent esophagectomy, and 100 patients underwent CRT. The median age of the patients was 73 years (range, 70-81 years) in the surgery group and 76 years (range, 70-88 years) in the CRT group. The median survival time (MST) for the whole cohort was 25.6 months, and 1-, 3-, and 5-year survival rates were 69.2%, 36.1%, and 21.9%, respectively. The MST in the surgery group and the CRT group was 36 months and 15 months, respectively. The 1-, 3-, and 5-year survival rates in the surgery group were 82.4%, 49.0%, and 33.3%, compared to 58.0%, 24.1%, and 7.8% in the CRT group (P < 0.0001). Multivariate analysis revealed that lymph node status (hazard ratio [HR] = 0.598, P = 0.011) and treatment strategies (HR = 0.538, P = 0.001) were independent and significant prognostic factors for OS in elderly patients.Surgery was the main treatment strategy for elderly patients with ESCC. Advanced age and comorbidities should not be the cause for elderly patients to avoid aggressive regimens. Delivered therapeutic approaches should be individualized on the basis of carefully evaluating the balance of benefits, risks, and life expectancy.

The prognostic factors in the elderly patients with small cell lung cancer: a retrospective analysis from a single cancer institute

OBJECTIVES

We conducted a retrospective study to evaluate the prognostic factors of elderly patients with small cell lung cancer (SCLC).

PATIENTS AND METHODS

The records of elderly patients (≥ 65 years) with histologically-proven SCLC were reviewed. The patients' information including demographic, clinical and laboratory parameters, staging status on the Veterans Administration Lung Study Group staging system, and treatment modalities were registered. Univariate and multivariate survival analysis was performed by the Kaplan-Meier method and Cox proportional hazards model, respectively.

RESULTS

Between January 2004 and December 2012, 247 elderly patients with SCLC were analyzed, 129 patients initially presented with limited stage (LS) and 118 with extensive disease (ES). The median age of the patients was 70.7 years (range, 65-83 years). The median follow-up period for all patients was 22.0 months (range, 1.0-84.0 months) and 39.9 months for the surviving patients (range, 4.7-84.0 months). The median survival time (MST) was 17.3 months, and the 2-year and 3-year OS rates were 36.3% and 22.7%, respectively. The MST, 2-year and 3-year OS rates were 22 months, 45.0% and 30.5% in patients with limited stage, versus 13.4 months, 26.5% and 13.7% in patients having extensive diseases, respectively. Multivariate analysis revealed that disease extent (HR = 3.034; P < 0.001) and the number of chemotherapy cycles (HR = 0.486; P = 0.003) were independent prognostic factors for the OS. Additionally, a normal serum NSE level (HR = 0.447, P = 0.017) at the time of diagnosis was independent positive prognostic factors for patients with LS-SCLC, but not for ES-SCLC.

CONCLUSION

Disease extent and the number of chemotherapy cycles were independent prognostic factors of elderly patients with SCLC. The fit cohort might benefit from positive treatment.

High expression level of T-box transcription factor 5 predicts unfavorable survival in stage I and II gastric adenocarcinoma

The expression of T-box transcription factor 5 (TBX5) has previously been observed in human cancer. The aim of the present study was to investigate TBX5 expression and its potential clinical significance in gastric cancer (GC). Using reverse transcription-quantitative polymerase chain reaction, the TBX5 mRNA expression levels in 30 pairs of surgically resected healthy gastric tissues and early stage (stages I and II) GC tissues were evaluated. The TBX5 mRNA expression levels were increased in GC stage I and II tumor tissues (P=0.01, n=30) compared with the matched adjacent non-tumor tissue. However, no significant difference was observed in TBX5 mRNA expression levels in matched adjacent non-tumor tissue compared with the tumor tissue from stage III and IV GC samples (P=0.318, n=30). Immunohistochemical analysis for TBX5 expression was performed on 161 paraffin-embedded stage I and II GC tissue blocks. Statistical analysis was performed to evaluate the associations between TBX5 expression, clinicopathological factors and prognosis. Patients with stage I and II GC and tumors with high TBX5 expression levels presented poor overall survival (OS) rate (P=0.024). The Cox proportional hazards model analysis demonstrated that TBX5 expression was an independent risk factor (P=0.017). The present study indicates that high expression of TBX5 is associated with unfavorable OS rates in patients with stage I and II GC. In conclusion, the expression of TBX5 may be a valuable biomarker for the selection of cases of high-risk stage I and II GC.

Prognosis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles

OBJECTIVE

To identify the prognostic factors for pregnancy after intrauterine insemination with the husband's sperm (IUI-H).

DESIGN

Retrospective study.

SETTING

A single university medical center.

PATIENT(S)

851 couples, for 2,019 IUI-H cycles.

INTERVENTION(S)

After controlled ovarian stimulation, IUI-H performed 36 hours after ovulation triggering or 24 hours after a spontaneous luteinizing hormone (LH) surge.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy rate per cycle (PR) and delivery rate per cycle (DR).

RESULT(S)

The overall PR was 14.8% and DR 10.8%. Higher PR and DR were observed for patients presenting with ovulation disorders (particularly polycystic ovary syndrome) or with male infertility. Secondary infertility in the woman appeared to be a positive prognostic factor as did a basal follicle-stimulating hormone (FSH) level ≤ 7 IU/L and ovulation triggering over spontaneous LH rise. The other parameters influencing the results were the women's age, the number of mature follicles obtained (≥ 2), the endometrial thickness (10-11 mm), and the number of progressive motile spermatozoa inseminated (>1 million).

CONCLUSION(S)

In women aged ≤ 38 years, IUI-H should be considered as an option, particularly in cases of female infertility from ovulation disorders, in cases of a normal ovarian reserve, in cases of secondary infertility, or when ≥ 1 million progressive sperm are inseminated. Bifollicular stimulation is required. In other cases, in vitro fertilization should be discussed as the first-line treatment.

Long-term treatment efficacy in primary inflammatory breast cancer by hormonal receptor- and HER2-defined subtypes

BACKGROUND

Subtypes defined by hormonal receptor (HR) and HER2 status have not been well studied in inflammatory breast cancer (IBC). We characterized clinical parameters and long-term outcomes, and compared pathological complete response (pCR) rates by HR/HER2 subtype in a large IBC patient population. We also compared disease-free survival (DFS) and overall survival (OS) between IBC patients who received targeted therapies (anti-hormonal, anti-HER2) and those who did not.

PATIENTS AND METHODS

We retrospectively reviewed the records of patients diagnosed with IBC and treated at MD Anderson Cancer Center from January 1989 to January 2011. Of those, 527 patients had received neoadjuvant chemotherapy and had available information on estrogen receptor (ER), progesterone receptor (PR), and HER2 status. HR status was considered positive if either ER or PR status was positive. Using the Kaplan-Meier method, we estimated median DFS and OS durations from the time of definitive surgery. Using the Cox proportional hazards regression model, we determined the effect of prognostic factors on DFS and OS. Results were compared by subtype.

RESULTS

The overall pCR rate in stage III IBC was 15.2%, with the HR-positive/HER2-negative subtype showing the lowest rate (7.5%) and the HR-negative/HER2-positive subtype, the highest (30.6%). The HR-negative, HER2-negative subtype (triple-negative breast cancer, TNBC) had the worst survival rate. HR-positive disease, irrespective of HER2 status, had poor prognosis that did not differ from that of the HR-negative/HER2-positive subtype with regard to OS or DFS. Achieving pCR, no evidence of vascular invasion, non-TNBC, adjuvant hormonal therapy, and radiotherapy were associated with longer DFS and OS.

CONCLUSIONS

Hormone receptor and HER2 molecular subtypes had limited predictive and prognostic power in our IBC population. All molecular subtypes of IBC had a poor prognosis. HR-positive status did not necessarily confer a good prognosis. For all IBC subtypes, novel, specific treatment strategies are needed in the neoadjuvant and adjuvant settings.

[Selected arterial infusion chemotherapy combined with target drugs for non-small cell lung cancer with multiple brain metastase]

BACKGROUND AND OBJECTIVE

The aim of this study is to evaluate the efficacy of selected arterial infusion chemotherapy in treating non-small cell lung cancer (NSCLC) with multiple brain metastases and corresponding factors to influencing prognosis.

METHODS

From September 2008 to October 2011, a total of 31 patients of NSCLC with multiple brain metastases (≥3) received selected incranial, bronchial and corresponding target arterial infusion chemotherapy combined with EGFR-TKIs. Interventional treatment was performed every four weeks, two-six cycles with synchronized or sequential targeted drugs (erlotinib, gefitinib or icotinib). Follow-up CT and MRI were regularly finished at interval of four weeks after two cycles of interventional treatment were finished or during taking targeted drugs in order to evaluate efficacy of the therapy. The procedure was stopped for the tumor disease was worse or the patient could not tolerate the toxity of drugs any longer.

RESULTS

31 patients was performed two to six cycles of interventional therapy, 3 cycles at average. Response assessment showed that 5 (16.1%) patients got a complete response (CR), 7 (22.6%) had a partial response (PR), 11 (35.5%) had a stable disease (SD) and 8 (25.8%) had a progressive disease (PD). The objective response rate (ORR) was 38.7%, and the disease control rate was 74.2%. The median progression free survival (PFS) and overall survival (OS) were 13.1 months and 15.1 months. The 6-month survival rate, one-year survival rate and two-year survival rate were 79%, 61.1%, and 31.1%, respectively. The patients' OS and PFS were influenced by smoking state, tumor pathology, extracranial metastases, period of targeted drug taking and performance status, not by sex, age, before therapy and the total of brain metastases.

CONCLUSION

Selected arterial infusion chemotherapy with targeted drugs is one of the most effective and safe treatment to NSCLC with multiple brain metastases. Smoking status, tumor pathology, extracranial metastases, targeted drug taking and performance status are corresponding the patient's prognosis.