目的 评估非小细胞肺癌患者中癌症相关性乏力的发生情况及其与患者临床病理特征和生存期之间的相互关系。 方法 应用简明疲劳量表中文版评估2008年12月－2009年12月间收治的72例初治肺癌患者，入组患者均完成根治性手术及术后生存随访。 结果 72例早期非小细胞肺癌患者中，无乏力9例（12.5%），轻度乏力48例（66.7%），中度乏力15例（20.8%），重度乏力0例（0%），乏力总体发生率为87.5%。乏力指数与患者的年龄、性别、吸烟史均无相关性，与患者的体力状况评分（ECOG PS）、TNM分期呈正相关，与中位生存期呈负相关，均有统计学意义（P＜0.05）。 结论 癌症相关性乏力作为非小细胞肺癌患者中普遍存在的一种症状，不仅能够反映患者当时的主观感受和生活状况，还可能是判断患者术后病理分期及最终总生存期的预测因素。
目的 探讨血管内皮生长因子（VEGF）及受体Flt-1蛋白表达与卵巢恶性肿瘤临床病理和预后的关系。 方法 2000年1月-2004年6月，以SABC免疫组织化学方法检测48例卵巢恶性肿瘤组织中VEGF及其受体Flt-1蛋白的表达。 结果 VEGF和Flt-1蛋白表达与卵巢恶性肿瘤的病理学类型、分化级别及临床分期无明显相关性（P＞0.05）。有淋巴结转移者VEGF和Flt-1蛋白的表达阳性率均明显高于无淋巴结转移者（P＜0.05）。 VEGF 和Flt-1共同表达者平均总生存期为27.88个月，明显短于没有共同表达者的36.04个月（95%CI 为33.42～38.65，P=0.022 3）。 结论 VEGF和Flt-1蛋白表达与卵巢恶性肿瘤的淋巴结转移相关，可作为预测肿瘤转移及预后的指标。
ObjectiveTo explore the prognostic value of modified Glasgow Prognostic Score (mGPS) in lung cancer patients.MethodsThe clinical data and follow-up information of patients with lung cancer diagnosed for the first time in West China Hospital of Sichuan University from August 2008 to May 2013 were retrospectively analyzed. Overall survival (OS) of patients with different mGPS were compared by Kaplan-Meier test and log-rank test. Univariate and multivariate Cox proportional hazard analysis were performed, and hazard ratio (HR) and 95% confidence interval (CI) were counted to evaluate the predictive value of different prognostic factors in patients with lung cancer.ResultsA total of 289 patients were included. According to the mGPS score, 127 patients had 0 point, 90 patients had 1 point, and 72 patients had 2 points. The OS of lung cancer patients with mGPS=0 was better than that of patients with mGPS=1 and mGPS=2 (P<0.001). Cox proportional hazards of univariate analysis revealed that age< 65 (P=0.022), stage for Ⅰand Ⅱ (P<0.001), surgery (P<0.001), chemotherapy (P=0.018), and mGPS=0 (1 vs. 0, P=0.008; 2 vs. 0, P<0.001) were the protective factors for lung cancer patients (P<0.05). Multiple-factor analysis showed that age [HR=0.680, 95%CI (0.508, 0.911), P=0.010], stage [HR=0.580, 95%CI (0.359, 0.939), P=0.027], operation [HR=0.254, 95%CI (0.140, 0.459), P<0.001], chemotherapy [HR=0.624, 95%CI (0.435, 0.893), P=0.010], mGPS (1 vs. 0) [HR=1.548, 95%CI (1.101, 2.176), P=0.012] and mGPS (2 vs. 0) [HR=1.425, 95%CI (1.003, 2.024), P=0.048] were independent predictors of OS in patients with lung cancer.ConclusionmGPS could be considered as an independent prognostic factor in lung cancer.
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 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.
Objective To evaluate the relationship of systemic immune inflammatory index (SII) with the clinical features and prognosis of osteosarcoma patients. Methods The clinical data of patients with osteosarcoma surgically treated in Fuzhou Second Hospital between January 2012 and December 2017 were retrospectively collected. The preoperative SII value was calculated, which was defined as platelet × neutrophil/lymphocyte count. The best critical value of SII was determined by receiver operating characteristic (ROC) curve analysis, and the relationship between SII and clinical features of patients was analyzed by χ2 test. Kaplan-Meier method and Cox proportional hazard model were used to study the effect of SII on overall survival (OS). The nomogram prediction model was established according to the independent risk factors of patients’ prognosis. Results A total of 108 patients with osteosarcoma were included in this study. Preoperative high SII was significantly correlated with tumor diameter, Enneking stage, local recurrence and metastasis (P<0.05). The median follow-up time was 62 months. The 1-, 3-, 5-year survival rates of the low SII group were significantly higher than those of the high SII group (100.0%, 96.4%, 85.1% vs. 95.4%, 73.7%, 30.7%), and the survival of the two groups were statistically different (P<0.05). Univariate Cox regression analyses showed that tumor diameter, Enneking stage, local recurrence, metastasis and SII were associated with OS (P<0.05). Multiple Cox regression analysis showed that Enneking stage (P=0.031), local recurrence (P=0.035) and SII (P=0.001) were independent risk factors of OS. The nomogram constructed according to the independent risk factors screened by the Cox regression model had good discrimination and consistency (C-index=0.774), and the calibration curve showed that the nomogram had a high consistency with the actual results. In addition, the ROC curve indicated that the nomogram had a good prediction efficiency (area under the curve=0.880). Conclusions The preoperative SII level is expected to become an important prognostic parameter for patients with osteosarcoma. The higher the SII level is, the worse the prognosis of patients will be. The nomogram prediction model built on preoperative SII level, Enneking stage and local recurrence has a good prediction efficiency, and can be used to guide the diagnosis and treatment of clinical osteosarcoma.
ObjectiveTo analyze the impact of neoadjuvant regimens on prognosis in patients with rectal cancer in the current version of the Database from Colorectal Cancer (DACCA) database. MethodsPatient information was extracted from the updated version of DACCA on November 24, 2022 according to the established screening criteria, and the following items were analyzed: gender, age, body mass index (BMI), marriage, economic conditions, degree of differentiation, neoadjuvant treatment regimen, and pTNM staging. According to the neoadjuvant treatment regimen, the patients were divided into three groups: chemotherapy group, chemotherapy combined radiotherapy group, and chemotherapy combined targeted therapy group, and the overall survival (OS) and disease-specific survival (DSS) of patients in the three groups were analyzed, and the influencing factors of OS and DSS were analyzed by univariate and multivariate Cox proportional hazard regression models. ResultsAccording to the screening criteria, 1 716 valid data were obtained from the DACCA database, of which 954 (55.6%) were in the chemotherapy group, 332 (19.3%) in the chemotherapy combined radiotherapy group, and 430 (25.1%) in the chemotherapy combined targeted therapy group. The differences in the Kaplan-Merier survival curves of patients with different neoadjuvant regimens for OS and DSS in the three groups were statistically significant (χ2=142.142, P＜0.001; χ2=129.528, P＜0.001). There were significant differences in OS rate and DSS rate between the three groups in 3 years and 5 years (P<0.001). Further comparison of different neoadjuvant therapy groups showed that the OS of the chemotherapy combined targeted therapy group was slightly better than that of the chemotherapy group in 3 years, however, OS and DSS in 5 years were slightly worse than those the chemotherapy group, but the difference were not statistically significant (P>0.05). The OS and DSS of the chemotherapy group and the chemotherapy combined targeted therapy group were better than those of the chemotherapy combined radiotherapy group in 3 years and 5 years, and the differences were statistically significant (P<0.01). The results of multivariate analysis showed that patients’ age, economic conditions, degree of tumor differentiation, new auxiliary scheme and pTNM staging were the influencing factors of OS and DSS. ConclusionNeoadjuvant treatment regimen will affect the long-term survival prognosis of rectal cancer patients.
ObjectiveTo explore the impact of number of positive regional lymph nodes (nPRLN) in N1 stage on the prognosis of non-small cell lung cancer (NSCLC) patients. MethodsPatients with TxN1M0 stage NSCLC who underwent lobectomy and mediastinal lymph node dissection from 2010 to 2015 were screened from SEER database (17 Regs, 2022nov sub). The optimal cutoff value of nPRLN was determined using X-tile software, and patients were divided into 2 groups according to the cutoff value: a nPRLN≤optimal cutoff group and a nPRLN>optimal cutoff group. The influence of confounding factors was minimized by propensity score matching (PSM) at a ratio of 1∶1. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS) and lung cancer-specific survival (LCSS) of patients. ResultsA total of 1316 patients with TxN1M0 stage NSCLC were included, including 662 males and 654 females, with a median age of 67 (60, 73) years. The optimal cutoff value of nPRLN was 3, with 1165 patients in the nPRLN≤3 group and 151 patients in the nPRLN>3 group. After PSM, there were 138 patients in each group. Regardless of before or after PSM, OS and LCSS of patients in the nPRLN≤3 group were superior to those in the nPRLN>3 group (P<0.05). N1 stage nPRLN>3 was an independent prognostic risk factor for OS [HR=1.52, 95%CI (1.22, 1.89), P<0.001] and LCSS [HR=1.72, 95%CI (1.36, 2.18), P<0.001]. ConclusionN1 stage nPRLN>3 is an independent prognostic risk factor for NSCLC patients in TxN1M0 stage, which may provide new evidence for future revision of TNM staging N1 stage subclassification.
ObjectiveTo compare the long-term survival of elderly patients with esophageal squamous cell carcinoma (ESCC) treated with surgical versus non-surgical treatment. MethodsA retrospective analysis was conducted on the clinical data of elderly patients aged ≥70 years with ESCC who underwent esophagectomy or radiotherapy/chemotherapy at Sichuan Cancer Hospital from January 2009 to September 2017. Patients were divided into a surgical group (S group) and a non-surgical group (NS group) according to the treatment method. The propensity score matching method was used to match the two groups of patients at a ratio of 1:1, and the survival of the two groups before and after matching was analyzed. ResultsA total of 726 elderly patients with ESCC were included, including 552 males and 174 females, with 651 patients aged 70-79 years and 75 patients aged≥80 years. There were 515 patients in the S group and 211 patients in the NS group. The median follow-up time was 60.8 months, and the median overall survival of the S group was 41.9 months [95%CI (35.2, 48.5)], while that of the NS group was only 24.0 months [95%CI (19.8, 28.3)]. The 1-, 3-, and 5-year overall survival rates of the S group were 84%, 54%, and 40%, respectively, while those of the NS group were 72%, 40%, and 30%, respectively [HR=0.689, 95%CI (0.559, 0.849), P<0.001]. After matching, 138 patients were included in each group, and there was no statistical difference in the overall survival between the two groups [HR=0.871, 95%CI (0.649, 1.167), P=0.352]. ConclusionCompared with conservative treatment, there is no significant difference in the long-term survival of elderly patients aged≥70 years who undergo esophagectomy for ESCC. Neoadjuvant therapy combined with surgery is still an important choice to potentially improve the survival of elderly patients with ESCC.