ObjectiveTo investigate the impact of primary tumor site on prognosis of colorectal cancer after radical resection in different stages.MethodsFour hundreds and twenty patients with colorectal cancer in our hospital from Jan. 2008 to Dec. 2016 were selected as study subjects, all patients were confirmed by pathology. According to the location of colorectal cancer, the patients were divided into rectum group (n=220), left colon group (n=105) and right colon group (n=95). The difference of clinicopathological features of patients with different group were compared. The risk factors affecting the prognosis of colorectal cancer patients were analyzed by single factor and multi factor unconditional Cox regression analysis, and the survival curve was drawn by Kaplan-Meier method, and the difference test was carried out by log-rank method.ResultsThere were no significant differences between the three groups in age, BMI, smoking history, alcohol history, family history, vascular tumor thrombus, N staging, tumor diameter, nerve invasion and cancer nodule (P>0.05). There were significant differences in sex, pathological type, anterior intestinal obstruction, TNM staging, T staging and M staging (P<0.05). The results of single factor Cox regression analysis showed that sex, pathological type, anterior intestinal obstruction, TNM staging, T staging, M staging, primary tumor site, nerve invasion and cancer nodule were the risk factors for the prognosis of the patients (P<0.05). Multivariate Cox regression analysis showed that TNM staging, location of primary tumor and nerve invasion were risk factors affecting prognosis of patients (P<0.05). The total 5-year survival rate of the rectal group was 80.45% (177/220), the total 5-year survival rate of the left hemicolon group was 67.62% (71/105), and the total 5-year survival rate of the right hemicolon group was 68.42% (65/95). The survival curves of Kaplan-Meier showed that the difference between the three groups was statistically significant (P<0.05).ConclusonsThe 5-year survival rate of patients with rectal cancer is significantly higher than that of patients with left colon cancer and right colon cancer. For patients with different stage of colorectal cancer after radical resection, the prognosis of colorectal cancer can be predicted by the location of primary tumor.
ObjectiveTo explore transcatheter arterial chemoembolization (TACE) influences on prognosis of patients with BCLC stage 0–A hepatocellular carcinoma (HCC).MethodsThe clinicopathologic data of BCLC stage 0–A HCC patients underwent the radical resection in the Affiliated Hospital of Southwest Medical University from January 2006 to June 2018 were retrospectively analyzed. These patients were divided into a preoperative TACE treatment group (PTT group, n=365) and a directly surgical resection group (DSR group, n=365). The Kplan-Meier method was used to compare the overall survival (OS) and disease free survival (DFS) between the two groups. The Cox proportional hazard model was used to analyze whether the preoperative TACE was an independent factor affecting the prognosis of patient with BCLC stage 0–A HCC.ResultsA total of 465 patients with BCLC stage 0–A HCC were enrolled, including 365 patients in the DSR group and 100 patients in the PTT group. The baseline data of the two groups were similar（P>0.050）. In the cohort, the 1-, 3-, 5-, 10-year OS rates and DFS rates were 95.3%, 83.5%, 74.3%, 56.8% and 88.0%, 63.8%, 51.1%, 36.4%, respectively in the DSR group, which were 92.7%, 72.9%, 52.3%, 35.3% and 78.1%, 54.2%, 40.4%, 31.2%, respectively in the PTT group. The Kplan-Meier survival analysis showed that the OS and DFS in the DSR group were significantly better than those in the PTT group (P=0.009, P=0.033). The multivariate Cox proportional hazard model analysis showed that the preoperative TACE was the independent risk factor for the poor prognosis in the patients with BCLC stage 0–A HCC [ HR=1.389, 95% CI (1.158, 2.199), P=0.021].ConclusionsFor patients with BCLC stage 0–A HCC, preoperative TACE doesn’t improve patient’s prognosis and might reduce survival rate. If there is no special reason, direct surgery should be performed.
ObjectiveTo compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma.MethodsFrom January 2012 to December 2018, 291 patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes.Results Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS.ConclusionThere is no statistical difference in OS between the two groups, but the RATS group gets better DFS.
ObjectiveTo construct a new model for predicting the overall survival rate of gastric cancer and to guide the clinical work.MethodsThe clinical information and gene expression information of patients with gastric cancer were downloaded through The Cancer Genome Atlas (TCGA) database. The clinicopathologic characteristics and gene expression information affecting the overall survival rate of gastric cancer patients were screened by univariate COX regression and Lasson regression, then the predictive model was constructed by multiple COX regression model, and the predictive model was tested by receiver operating characteristic curve, calibration curve and decision curve analysis curve. The effect of genes included in the predictive model on the overall survival rate of patients with gastric cancer was discussed, and the predictive model diagram was drawn.ResultsThrough repeated screening and comparison of the model, the patient’s age, T stage, N stage, M stage and 12 genes (INCENP, IGHD3-16, ITFG1-AS1, NEK5, MATN3, YWHABP2, SYT12, LINC01210, ZNF385C, LINC01980, CYMP-AS1 and FAT3) were included in the predictive model. The prediction ability of this model was close to or more than 80%, which was significantly higher than that of the traditional TNM staging prediction system. All the indexes included in the model were significantly different by univariate and multivariate COX regression analysis（P<0.05）, and the 12 genes included were the risk factors affecting the overall survival rate of gastric cancer.ConclusionThe gastric cancer prediction model constructed by combining clinical characteristics and genomics has good predictive ability and can guide clinical work.
ObjectiveTo explore the immune biomarkers for prognosis of breast cancer and to construct a risk assessment model.MethodsThe gene expression of breast cancer samples was retrieved from The Cancer Genome Map (TCGA) database and immune related genes (IRGs) were retrieved from the ImmPort database. Cox proportional hazards regression and least absolute shrinkage and selection operator (LASSO) regression were used for prognostic analysis. Gene set enrichment analysis ( GSEA) was used to explore biological signaling pathways. ESTIMATE and CIBERSORT algorithms were used to explore the relationship between risk score and tumor immune microenvironment.ResultsNine kinds of immune-related differentially expressed genes independently related to prognosis were identified: adrenoceptor beta 1 (ADRB1), interleukin 12B (IL12B), syndecan 1 (SDC1), thymic stromal lymphopoietin (TSLP), fibroblast growth factor 19 (FGF19), fatty acid binding protein 7 (FABP7), interferon epsilon (IFNE), tumor necrosis factor receptor superfamily member 18 (TNFRSF18) and interleukin 27 (IL27). The risk assessment equation constructed by these nine kinds of genes had powerful predictive ability. The “neurotrophin signaling pathway” and “adipocyte factor signaling pathway” were activated in patients of high-risk group, and “leukocyte transendothelial migration” “WNT signaling pathway” “FcεRI signaling pathway” “valine, leucine and isoleucine biosynthesis” and “protein export pathway” were activated in patients of low-risk group. A variety of tumor-killing immune cells were significantly enriched in the tumor-infiltrating immune cells of patients in the low-risk group. The immunosuppressive immune cells were significantly enriched in tumor infiltrating immune cells of patients in high-risk group.ConclusionIRGs prognostic signatures are an effective potential predictive classifier in breast cancer treatment.
ObjectiveTo systematically evaluate the potential value of C-reactive protein to albumin ratio (CAR) as an indicator of prognosis and survival in patients with pancreatic cancer. MethodsThe literatures were searched comprehensively in the PubMed, Embase, Web of Science, Cochrane Library, CBM, Wanfang, CNKI, and CQVIP databases from the establishment of the databases to May 20, 2021. The combined hazard ratio (HR) and 95% confidence interval (95%CI) were used to evaluate the correlation between the CAR and the overall survival (OS), progression-free survival (PFS), or disease-free survival (DFS) in the patients with pancreatic cancer. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of the non-randomized controlled studies, and the Stata SE 15.0 software was used for meta-analysis. ResultsA total of 2 985 patients with pancreatic cancer were included in this meta-analysis of 15 studies. The results of meta-analysis showed that the higher CAR value, the shorter OS [effect size (ES)=0.60, 95%CI (0.50, 0.69), Z=12.04, P<0.001], DFS [ES=0.63, 95%CI (0.47, 0.78), Z=3.61, P<0.001], and PFS [ES=0.41, 95%CI (0.19, 0.63), Z=7.91, P<0.001] in the patients with pancreatic cancer. The results of subgroup analysis of OS according to different countries, sample size, mean age, follow-up time, CAR cut-off value, and NOS score showed that the higher CAR value was related to the shorter OS (P<0.05). The result of linear regression analysis showed that there was no correlation between the CAR cut-off value and lnHR of OS (r2=0.947, P=0.455). Conclusion From results of this study, CAR is closely related to OS of patients, and it is expected to be used as a new reference index for monitoring and judging prognosis of patients with pancreatic cancer.
Objective To analyze the relationship between age and prognosis of colorectal patients in the database from colorectal cancer (DACCA). Methods The DACCA version selected for this data analysis was updated on January 5, 2022. The data items analyzed included age, sex, tumor site, tumor pathological nature, obstruction, pathological TNM (pTNM) stage, positive lymph node ratio, survival status and survival time. According to China’s age segmentation standard, the included data were grouped into younger group (<35 years old), middle-aged group (35–59 years old) and elderly group (>59 years old). Overall survival (OS) and disease specific survival (DFS) were analyzed in three age group, and OS and DSS in three age group were analyzed in pTNM stage stratification. Results Three thousand six hundred and twenty-five rows of data were obtained from DACCA database according to the screening conditions. The survival analysis results of different age groups show that: The middle-aged group had better OS compared with the elderly group at 1-year (97.4% vs. 96.0%, P=0.037), 3-year (90.9% vs. 88.0%, P=0.030) and 5-year (81.7% vs. 75.7%, P=0.002). Also, the middle-age group had better 5-year DSS (82.2% vs. 77.7%, P=0.020). There was no statistical difference in survival between the younger group and the elderly group (P>0.05). The survival analysis results of different age groups in each pTNM stage show that: ① The middle-aged group had better medium-term and long-term OS than the elderly group. In the pTNM Ⅰ stage, the 3- and 5-year OS in the middle-aged group were better than those in the elderly group (100% vs. 93.4%, P=0.004; 100% vs. 91.4%, P=0.005). In the pTNM Ⅱ stage, the 5- and 10-year OS in the middle-aged group were better than those in the elderly group (96.5% vs. 91.3%, P=0.018; 88.2% vs. 54.3%, P<0.001). In pTNM Ⅲ stage, 10-year OS in the middle-aged group was better than that in the elderly group (36.5% vs. 36.0%, P<0.001). In pTNM Ⅳ stage, the 5- and 10- year of OS in the middle-aged group were better than those in the elderly group (67.7% vs. 58.4%, P=0.016; 19.1% vs. 7.2%, P=0.049). ② The middle-aged group had better medium-term and long-term DSS than the elderly group. In the pTNM Ⅰ stage, the 3- and 5- year DSS in the middle-aged group wrer better compared to the elderly group (100% vs. 96.9%, P=0.047; 100% vs. 94.9%, P=0.049). In the pTNM Ⅱ stage, the 10-year DSS in the middle-aged group outperformed that in the elderly group (88.2% vs. 61.9%, P=0.002). In the pTNM Ⅳ stage, the 5- and 10-year DSS in the middle-aged group were better than the elderly group (68.3% vs. 59.1%, P=0.020; 20.9% vs. 7.7%, P=0.040). ③ Except pTNM I stage, there was no significant difference in survival of other pTNM stages between young group and old group (P>0.05). In the pTNM Ⅰ stage, 3- and 5- year OS were better in the younger group compared with the elderly group (100% vs. 93.4%, P=0.004; 100% vs. 91.4%, P=0.005), and better 3- and 5- year DSS in the younger group (100% vs. 96.9%, P=0.047; 100% vs. 94.9%, P=0.049). Conclusions The age of colorectal cancer patients may have an impact on long-term survival. Middle-aged patients have better prognosis compared with elderly patients, and the younger group patients have better prognosis in pTNM stage Ⅰ only.
Objective To evaluate the predictive performance of the geometric characteristics, centerline (CL) of pulmonary nodules for prognosis in patients with surgically treatment in the National Lung Screening Trial (NLST). MethodsCT images of 178 patients who underwent surgical treatment and were diagnosed with non-small cell lung cancer (NSCLC) in the low-dose CT (LDCT) cohort from the NLST image database were selected, including 99 males and 79 females, with a median age of 64 (59, 68) years. CT images were processed using commercial software Mimics 21.0 to record the volume, surface area, CL and the area perpendicular to the centerline of pulmonary nodules. Receiver operating characteristic (ROC) curve was used to compare the predictive performance of LD, AD and CL on prognosis. Univariate Cox regression was used to explore the influencing factors for postoperative disease-free survival (DFS) and overall survival (OS), and meaningful independent variables were included in the multivariate Cox regression to construct the prediction model. ResultsThe area under the curve (AUC) of CL for postoperative recurrence and death were 0.650 and 0.719, better than LD (0.596, 0.623) and AD (0.600, 0.631). Multivariate Cox proportional risk regression analysis showed that pulmonary nodule volume (P=0.010), the maximum area perpendicular to the centerline (MApc) (P=0.028) and lymph node metastasis (P<0.001) were independent risk factors for DFS. Meanwhile, age (P=0.010), CL (P=0.043), lymph node metastasis (P<0.001), MApc (P=0.022) and the average area perpendicular to the centerline (AApc) (P=0.016) were independently associated with OS. ConclusionFor the postoperative outcomes of NSCLC patients in the LDCT cohort of the NLST, the CL of the pulmonary nodule prediction performance for prognosis is superior to the LD and AD, CL can effectively predict the risk stratification and prognosis of lung cancer, and spheroid tumors have a better prognosis.
Objection To analyze the relationship between blood type and prognosis of colorectal cancer patients in the Database from Colorectal Cancer (DACCA). Methods The DACCA version selected for this data analysis was updated on January 5, 2022. The data items analysis included age, gender, blood type, tumor location, tumor pathological nature, pathological TNM (pTNM) stage, survival status and survival time. According to the ABO blood type classification, it was divided into four blood type groups: A blood type group, B blood type group, AB blood type group, and O blood type group. The overall survival (OS) and disease specific survival (DSS) were analyzed in four blood type groups, and the OS and DSS of each blood type group were analyzed in pTNM stage stratification. Results A total of3 486 rows of data were obtained from the DACCA database according to the screening conditions. There was no significantdifference in OS and DSS among blood typy A, B, AB and O group (P>0.05); At specific time points, the 1-year OS of the blood type A group was worse than that of blood type B (95.8% vs. 99.6%), the 1-year OS of the blood type B group was better than that of blood type O group (99.6% vs. 96.9%), and the differences were statistically significant (P<0.008 7), but the differences between OS and DSS in the remaining 1, 3, 5 and 10 years of patients with different blood type groups were not statistically significant (P>0.008 7). In each pTNM staging subgroup, the differences between 1, 3, 5 and 10-year OS and DSS were not statistically significant among different blood type groups (P>0.008 7). Conclusions Overall, there was no significant difference in prognosis among the blood type A, B, AB, and O groups. Comparing specific blood types and follow-up time, patients with blood type B have slightly better 1-year OS than patients with blood type A or blood type O. Comparisons between other ABO blood groups and between ABO blood groups classified by the pTNM staging subgroup did not show a difference.
ObjectiveTo analyze the relation between marital status and prognosis of patients with colorectal cancer (CRC) in the Database from Colorectal Cancer (DACCA). MethodsThe DACCA version selected for this data analysis was updated on January 13, 2023. The data items analysis included the age, gender, marital status, tumor location, tumor property, pathological TNM (pTNM) stage, survival status, and survival time. According to the marital status, the patients were assigned into five marital statuses: the first marriage, unmarried, divorced, remarriage, and widowed groups. The overall survival (OS) and disease specific survival (DSS) of the 5 marital statuses were analyzed, and then the risk factors affecting OS and DSS were analyzed by the Cox proportional hazards regression model. ResultsA total of 7 373 data were obtained from the DACCA according to the screening conditions, of which 6 696 (90.8%) were first marriage, 108 (1.5%) were unmarried, 198 (2.7%) were divorced, 22 (0.3%) were remarriage, and 349 (4.7%) were widowed. The OS and DSS curves had no statistical differences among the CRC patients with 5 marital statuses (χ2=2.692, P=0.611; χ2=2.927, P=0.570). The 3-year cumulative overall survival rate and disease specific survival rate among the 5 marital status patients had statistical differences among the patients with five marital statuses (χ2=24.65, P<0.001; χ2=18.63, P=0.001), further pairwise comparison showed that the 3-year cumulative overall survival rate and disease specific survival rate in the CRC patients with first marriage were higher than those in the widowed patients (Z=3.36, P<0.01; Z=3.02, P<0.01). The multivariate analysis results by the Cox proportional hazards regression model did not find the marital status was associated with the OS and DSS (P>0.05). ConclusionsFrom the real-world analysis results of this study, it is found that 3-year cumulative overall survival rate and disease specific survival rate in patients with first marriage are higher as compared with widowed patients. It is necessary to pay more attention to the long-term follow-up of CRC patients in unmarried or widowed status.