Long-term survival outcomes of duodenal adenocarcinoma:A cohort study with 15-year single-center experience

BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on long-term survival and the impact of tumor characteristics,surgery,and adjuvant therapy.AIM To bridge this knowledge gap,we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA,along with analyzing the impact of the tumor characteristics,operations and adjuvant therapy on survival outcomes.METHODS A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed.This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics,clinical presentation,treatment modalities,and survival outcomes.The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival(OS)and disease-free survival was evaluated using Kaplan-Meier survival curves,the Cox proportional hazards model,and statistical comparisons of survival distributions.RESULTS The median OS time for the cohort was 39 months,with 3-and 5-year OS rates of 51.2%and 43.6%,respectively.Radical resection was performed in 82.6%of cases,and was significantly associated with an improved 5-year OS,with a rate of 57.8%.Adjuvant therapy showed a survival benefit in the specific patient subsets,particularly in tumor stage Ⅱ or Ⅲ tumors,with an improved OS.Adjuvant therapy(hazard ratio=2.71,95%confidence interval:1.30-5.62,P=0.008),pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.CONCLUSION Radical operation for DA is associated with a remarkable improvement in the 5-year OS.Importantly,postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation,especially in patients with stage III.It highlights the necessity for early diagnosis,tailored surgical approaches,and a nuanced understanding of the role of adjuvant therapy.

A systematic review of progenitor survival and maturation in Parkinsonian models

Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell source.Unlike current therapeutic options for patients,this approach has the potential to provide longterm stem cell–derived reconstruction and restoration of the dopaminergic input to denervated regions of the brain allowing for restoration of certain functions to patients.The ultimate clinical success of stem cell–derived brain repair will depend on both the safety and efficacy of the approach and the latter is dependent on the ability of the transplanted cells to survive and differentiate into functional dopaminergic neurons in the Parkinsonian brain.Because the pre-clinical literature suggests that there is considerable variability in survival and differentiation between studies,the aim of this systematic review was to assess these parameters in human stem cell-derived dopaminergic progenitor transplant studies in animal models of Parkinson's disease.A defined systematic search of the PubMed database was completed to identify relevant studies published up to March 2024.After screening,76 articles were included in the analysis from which 178 separate transplant studies were identified.From these,graft survival could be assessed in 52 studies and differentiation in 129 studies.Overall,we found that graft survival ranged from<1% to 500% of cells transplanted,with a median of 51%of transplanted cells surviving in the brain;while dopaminergic differentiation of the cells ranged from 0% to 46% of cells transplanted with a median of 3%.This systematic review suggests that there is considerable scope for improvement in the differentiation of stem cell-derived dopaminergic progenitors to maximize the therapeutic potential of this approach for patients.

Clinicopathological and radiological characteristics and prediction of survival in colon cancer

There are various histological characteristics which have been proposed to predict the survival rate in colon cancer.However,there is no definitive model to accurately predict the survival.Therefore,it is important to find out one model for the prediction of survival in colon cancer which may also include the preoperative,and operative factors in addition to histopathology.

Development and validation of a nomogram model for predicting overall survival in patients with gastric carcinoma

BACKGROUND The prevalence and mortality rates of gastric carcinoma are disproportionately elevated in China,with the disease's intricate and varied characteristics further amplifying its health impact.Precise forecasting of overall survival(OS)is of paramount importance for the clinical management of individuals afflicted with this malignancy.AIM To develop and validate a nomogram model that provides precise gastric cancer prevention and treatment guidance and more accurate survival outcome prediction for patients with gastric carcinoma.METHODS Data analysis was conducted on samples collected from hospitalized gastric cancer patients between 2018 and 2020.Least absolute shrinkage and selection operator,univariate,and multivariate Cox regression analyses were employed to identify independent prognostic factors.A nomogram model was developed to predict gastric cancer patient outcomes.The model's predictability and discriminative ability were evaluated via receiver operating characteristic curves.To evaluate the clinical utility of the model,Kaplan-Meier and decision curve analyses were performed.RESULTS A total of ten independent prognostic factors were identified,including body mass index,tumor-node-metastasis(TNM)stage,radiation,chemotherapy,surgery,albumin,globulin,neutrophil count,lactate dehydrogenase,and platelet-to-lymphocyte ratio.The area under the curve(AUC)values for the 1-,3-,and 5-year survival prediction in the training set were 0.843,0.850,and 0.821,respectively.The AUC values were 0.864,0.820,and 0.786 for the 1-,3-,and 5-year survival prediction in the validation set,respectively.The model exhibited strong discriminative ability,with both the time AUC and time C-index exceeding 0.75.Compared with TNM staging,the model demonstrated superior clinical utility.Ultimately,a nomogram was developed via a web-based interface.CONCLUSION This study established and validated a novel nomogram model for predicting the OS of gastric cancer patients,which demonstrated strong predictive ability.Based on these findings,this model can aid clinicians in implementing personalized interventions for patients with gastric cancer.

Modeling post-operative survival in patients with gallbladder cancer resections:The road to improved patient care?

In this letter,we discuss the article by Li et al published in the World Journal of Gastrointestinal Surgery.Gallbladder cancer is a rare but fatal cancer that is often detected unexpectedly and at an advanced stage following routine cholecystectomy.Although the prognosis is poor,curative resections often combined with postoperative chemotherapy and/or radiation therapy can improve survival.However,targeted patient selection for the appropriate therapeutic approach is critical to minimize unnecessary morbidity.Using advanced statistical techniques,the authors developed a nomogram with the potential to predict survival after gallbladder cancer resection,identifying factors associated with long-and shortterm survival.This tool could improve patient selection for surgery and postoperative treatment.In this letter,we provide background on survival nomograms including an in-depth discussion of statistical methods employed in this study,the use of nomograms in other forms of cancer,limitations to the model,and directions for future research.

Development and validation of a nomogram prediction model for overall survival in patients with rectal cancer

BACKGROUND Rectal cancer is prevalent and associated with substantial morbidity and mortality.AIM To develop a nomogram prediction model for overall survival(OS)in patients with rectal cancer by leveraging a comprehensive analysis of demographic,clinicopathological,haematological,and follow-up data to identify independent prognostic factors.METHODS We conducted a prospective cohort study in China involving rectal cancer patients and applied Cox regression and least absolute shrinkage and selection operator regression to assess the significance of various variables as independent prognostic factors for OS.The identified factors were integrated into a nomogram model,which was evaluated for predictive accuracy via the C-index,area under the curve(AUC),calibration curve,and decision curve analysis(DCA).RESULTS Multivariate analysis revealed independent predictors of OS,including the Karnofsky performance status,age,sex,TNM stage,chemotherapy,surgery,targeted therapy,β2-microglobulin,lactate dehydrogenase,and the neutrophil-to-lymphocyte ratio.The nomogram demonstrated a C-index of 0.80 for the training and validation cohorts,with AUC values indicating high predictive accuracy for 1-year,3-year,and 5-year OS.The calibration curves confirmed the model's excellent agreement with the observed survival rates,and DCA revealed the superior clinical utility of the nomogram over the TNM staging system.CONCLUSION In this study,a novel prognostic model that accurately predicts the OS of rectal cancer patients was developed.The model exhibited excellent discriminatory and calibration capabilities,thus offering a reliable tool for health care professionals to estimate patient survival.

Overall survival with frontline vs subsequent anti-epidermal growth factor receptor therapies in unresectable,RAS/BRAF wild-type,leftsided metastatic colorectal cancer

BACKGROUND The combination of anti-epidermal growth factor receptor(EGFR)therapy and chemotherapy is currently a preferred first-line treatment for patients with unre-sectable,RAS and BRAF wild-type,left-sided metastatic colorectal cancer(mCRC).Several studies have also demonstrated the benefit of anti-EGFR therapy in sub-sequent line settings for this patient population.However,direct evidence com-paring the effectiveness of frontline vs subsequent anti-EGFR therapy remains limited,leaving a crucial gap in guiding optimal treatment strategies.AIM To compare overall survival(OS)between frontline and subsequent anti-EGFR treatment in patients with unresectable,RAS and BRAF wild-type,left-sided mCRC.METHODS We retrospectively reviewed the medical records of mCRC patients treated at The King Chulalongkorn Memorial Hospital and Songklanagarind Hospital,Thailand,between January 2013 and April 2023.Patients were classified into two groups based on the sequence of their anti-EGFR treatment.The primary endpoint was OS.RESULTS Among 222 patients with a median follow-up of 29 months,no significant difference in OS was observed between the frontline and subsequent-line groups(HR 1.03,95%CI:0.73-1.46,P=0.878).The median OS was 35.53 months(95%CI:26.59-44.47)for the frontline group and 31.60 months(95%CI:27.83-35.37)for the subsequent-line group.In the subsequent-line group,71 patients(32.4%)who ultimately never received anti-EGFR therapy had a significantly worse median OS of 19.70 months(95%CI:12.87-26.53).CONCLUSION Frontline and subsequent-line anti-EGFR treatments provide comparable OS in unresectable,RAS/BRAF wild-type,left-sided mCRC patients,but early exposure is vital for those unlikely to receive subsequent therapy.

Long-term survival and risk factors in esophageal squamous cell carcinoma:A Kaplan-Meier and cox regression study

BACKGROUND The global incidence of esophageal cancer(EC)remains high.Despite advan-cements in medical technology and deeper research into the causes and treatment methods of EC,the effectiveness of treatment for EC is still unsatisfactory.Therefore,it is crucial to address the urgent problem of improving the long-term survival rate of EC patients and providing personalized treatment.AIM To analyze the survival prognosis and influencing factors of esophageal squamous cell carcinoma(ESCC).METHODS A retrospective analysis was conducted on the clinical data of 115 patients with pT3N0M0 ESCC who underwent radical surgery alone from January 1,2013,to December 31,2019.The Kaplan–Meier method was used to evaluate the 1-year,3-year,and 5-year survival rates and median survival time of the patients.The Cox proportional hazards regression model was used to assess the hazard ratios(HRs)and 95%confidence intervals(95%CIs)of risk factors.RESULTS The 1-year,3-year,and 5-year overall survival(OS)rates for the 115 EC patients analyzed were 85.22%,50.43%,and 37.48%,respectively.The median OS was 37.00(95%CI:24.93-49.07)months,and the median disease-free survival was 21.00(95%CI:14.71-27.29)months.Both univariate and multivariate Cox regression analyses revealed that high body mass index(BMI;HR=1.137,95%CI:1.054-1.226),positive perineural invasion(PNI;HR=13.381,95%CI:4.899-36.547),and smoking(HR=2.415,95%CI:1.388-4.203)were independent risk factors for a poor prognosis.In contrast,compared to the upper thoracic location of the tumor,middle thoracic(HR=0.441,95%CI:0.240-0.810)and lower thoracic(HR=0.328,95%CI:0.144-0.750)locations were protective factors.CONCLUSION BMI,tumor location,PNI,and smoking are associated with the prognosis of ESCC patients.This study highlights the prognostic risk factors for T3N0M0 ESCC patients and offers personalized insights for clinical treatment.

Cancer survival analysis on population-based cancer registry data in Zhejiang Province,China(2018-2019)

Objective:This is a comprehensive overview of long-term cancer survival in Zhejiang Province,China.Hybrid analysis,a combination of cohort and period analysis,has been proposed to derive up-to-date cancer survival estimates.Using this approach,we aimed to timely and accurately analyze the 5-year relative survival(RS)and net survival(NS)in cancer registries of Zhejiang Province,China.Methods:A total of 255,725 new cancer cases diagnosed during 2013-2017 were included in 14 cancer registries in Zhejiang Province,China,with a follow-up on vital status until the end of 2019.The hybrid analysis was used to calculate the 5-year RS and 5-year NS during 2018-2019 for overall and stratifications by sex,cancer type,region,and age at diagnosis.Results:During 2018-2019,the age-standardized 5-year RS and NS for overall cancer in Zhejiang was 47.5%and 48.6%,respectively.The age-standardized 5-year RS for cancers of women(55.4%)was higher than that of men(40.0%),and the rate of urban areas(49.7%)was higher than that of rural areas(43.1%).The 5-year RS declined along with age,from 84.4%for ages<45 years to 23.7%for ages>74 years.Our results of the RS and NS showed the similar trend and no significant difference.The top five cancers with top age-standardized 5-year RS were thyroid cancer(96.0%),breast cancer(84.3%),testicular cancer(79.9%),prostate cancer(77.2%),and bladder cancer(70.6%),and the five cancers with the lowest age-standardized 5-year RS were pancreatic cancer(6.0%),liver cancer(15.6%),gallbladder cancer(17.1%),esophageal cancer(22.7%),and leukemia(31.0%).Conclusions:We reported the most up-to-date 5-year cancer RS and NS in Zhejiang Province,China for the first time,and found that the 5-year survival for cancer patients in Zhejiang during 2018-2019 was relatively high.The population-based cancer registries are recognized as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems.

Application of Survival Quilts for prognosis prediction of gastrectomy patients based on the Surveillance,Epidemiology,and End Results database and China National Cancer Center Gastric Cancer database

Objective:Accurate prognosis prediction is critical for individualized-therapy making of gastric cancer patients.We aimed to develop and test 6-month,1-,2-,3-,5-,and 10-year overall survival(OS)and cancer-specific survival(CSS)prediction models for gastric cancer patients following gastrectomy.Methods:We derived and tested Survival Quilts,a machine learning-based model,to develop 6-month,1-,2-,3-,5-,and 10-year OS and CSS prediction models.Gastrectomy patients in the development set(n=20,583)and the internal validation set(n=5,106)were recruited from the Surveillance,Epidemiology,and End Re-sults(SEER)database,while those in the external validation set(n=6,352)were recruited from the China National Cancer Center Gastric Cancer(NCCGC)database.Furthermore,we selected gastrectomy patients with-out neoadjuvant therapy as a subgroup to train and test the prognostic models in order to keep the accuracy of tumor-node-metastasis(TNM)stage.Prognostic performances of these OS and CSS models were assessed using the Concordance Index(C-index)and area under the curve(AUC)values.Results:The machine learning model had a consistently high accuracy in predicting 6-month,1-,2-,3-,5-,and 10-year OS in the SEER development set(C-index=0.861,0.832,0.789,0.766,0.740,and 0.709;AUC=0.784,0.828,0.840,0.849,0.869,and 0.902,respectively),SEER validation set(C-index=0.782,0.739,0.712,0.698,0.681,and 0.660;AUC=0.751,0.772,0.767,0.762,0.766,and 0.787,respectively),and NCCGC set(C-index=0.691,0.756,0.751,0.737,0.722,and 0.701;AUC=0.769,0.788,0.790,0.790,0.787,and 0.788,respectively).The model was able to predict 6-month,1-,2-,3-,5-,and 10-year CSS in the SEER development set(C-index=0.879,0.858,0.820,0.802,0.784,and 0.774;AUC=0.756,0.827,0.852,0.863,0.874,and 0.884,respectively)and SEER validation set(C-index=0.790,0.763,0.741,0.729,0.718,and 0.708;AUC=0.706,0.758,0.767,0.766,0.766,and 0.764,respectively).In multivariate analysis,the high-risk group with risk score output by 5-year OS model was proved to be a strong survival predictor both in the SEER development set(hazard ratio[HR]=14.59,95%confidence interval[CI]:1.872-2.774,P<0.001),SEER validation set(HR=2.28,95%CI:13.089-16.293,P<0.001),and NCCGC set(HR=1.98,95%CI:1.617-2.437,P<0.001).We further explored the prognostic value of risk score resulted 5-year CSS model of gastrectomy patients,and found that high-risk group remained as an independent CSS factor in the SEER development set(HR=12.81,95%CI:11.568-14.194,P<0.001)and SEER validation set(HR=1.61,95%CI:1.338-1.935,P<0.001).Conclusion:Survival Quilts could allow accurate prediction of 6-month,1-,2-,3-,5-,and 10-year OS and CSS in gastric cancer patients following gastrectomy.

Retrospective Analysis of Radiofrequency Ablation in Patients with Small Solitary Hepatocellular Carcinoma:Survival Outcomes and Development of a Machine Learning Prognostic Model

Background and Objective The effectiveness of radiofrequency ablation(RFA)in improving long-term survival outcomes for patients with a solitary hepatocellular carcinoma(HCC)measuring 5 cm or less remains uncertain.This study was designed to elucidate the impact of RFA therapy on the survival outcomes of these patients and to construct a prognostic model for patients following RFA.Methods This study was performed using the Surveillance,Epidemiology,and End Results(SEER)database from 2004 to 2017,focusing on patients diagnosed with a solitary HCC lesion≤5 cm in size.We compared the overall survival(OS)and cancer-specific survival(CSS)rates of these patients with those of patients who received hepatectomy,radiotherapy,or chemotherapy or who were part of a blank control group.To enhance the reliability of our findings,we employed stabilized inverse probability treatment weighting(sIPTW)and stratified analyses.Additionally,we conducted a Cox regression analysis to identify prognostic factors.XGBoost models were developed to predict 1-,3-,and 5-year CSS.The XGBoost models were evaluated via receiver operating characteristic(ROC)curves,calibration plots,decision curve analysis(DCA)curves and so on.Results Regardless of whether the data were unadjusted or adjusted for the use of sIPTWs,the 5-year OS(46.7%)and CSS(58.9%)rates were greater in the RFA group than in the radiotherapy(27.1%/35.8%),chemotherapy(32.9%/43.7%),and blank control(18.6%/30.7%)groups,but these rates were lower than those in the hepatectomy group(69.4%/78.9%).Stratified analysis based on age and cirrhosis status revealed that RFA and hepatectomy yielded similar OS and CSS outcomes for patients with cirrhosis aged over 65 years.Age,race,marital status,grade,cirrhosis status,tumor size,and AFP level were selected to construct the XGBoost models based on the training cohort.The areas under the curve(AUCs)for 1,3,and 5 years in the validation cohort were 0.88,0.81,and 0.79,respectively.Calibration plots further demonstrated the consistency between the predicted and actual values in both the training and validation cohorts.Conclusion RFA can improve the survival of patients diagnosed with a solitary HCC lesion≤5 cm.In certain clinical scenarios,RFA achieves survival outcomes comparable to those of hepatectomy.The XGBoost models developed in this study performed admirably in predicting the CSS of patients with solitary HCC tumors smaller than 5 cm following RFA.

Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

Retrospective cohort study on the postoperative survival rate enhancement of patients with colorectal cancer using three traditional Chinese medicine formulations:evidence from 1,361 cases

Background:Prior studies have affirmed the safety and effectiveness of traditional Chinese medicine in treating colorectal cancer patients.However,definitive evidence regarding whether traditional Chinese medicine can significantly enhance the survival of colorectal cancer patients remains elusive.This study seeks to provide conclusive insights by examining the postoperative administration of Xihuang capsules,Pingxiao capsules,and Zilongjin tablets and its impact on the 5-year overall survival(OS)and disease-free survival(DFS)rates among colorectal cancer patients.Methods:A retrospective study was conducted,involving 1,361 patients selected from the medical center.This retrospective study was carried out at a medical center in Tianjin,China.We assessed differences in postoperative OS and DFS between the control group and the medication group using Kaplan–Meier survival analysis and Cox proportional hazards modeling.Additionally,propensity score matching was used to mitigate imbalances in baseline characteristics among patients.Results:Before propensity score matching,Xihuang capsules could prolong the 5-year OS(79.9%vs.81.4%,P=0.0480)and 5-year DFS(74.9%vs.79.5%,P=0.0046)of patients after surgery.Similar conclusions were obtained after propensity score matching:OS(74.8%vs.78.3%,P=0.0084),DFS(72.7%vs.78.9%,P=0.008).Patients taking Pingxiao capsules showed improved 5-year OS(77.2%vs.84.0%,P=0.0383)and 5-year DFS(69.9%vs.80.0%,P=0.0157)after propensity score matching.Patients taking Zilongjin tablets showed improvement in the 2-year OS(84.2%vs.93.1%,P=0.0390)and 1-year DFS(88.2%vs.92.0%,P=0.0320)after propensity score matching.Conclusion:Xihuang capsules and Pingxiao capsules significantly improved the 5-year OS and DFS of patients with colorectal cancer after surgery.Zilongjin tablets showed improvement in the 2-year OS and 1-year DFS after surgery for patients.

Lymph node dissection does not affect the survival of patients with tumor node metastasis stages Ⅰ and Ⅱ colorectal cancer

BACKGROUND The effect of the number of lymph node dissections(LNDs)during radical resection for colorectal cancer(CRC)on overall survival(OS)remains controver-sial.AIM To investigate the association between the number of LNDs and OS in patients with tumor node metastasis(TNM)stage Ⅰ–Ⅱ CRC undergoing radical resection.METHODS Patients who underwent radical resection for CRC at a single-center hospital between January 2011 and December 2021 were retrospectively analyzed.Cox regression analyses were performed to identify the independent predictors of OS at different T stages.RESULTS A total of 2850 patients who underwent laparoscopic radical resection for CRC were enrolled.At stage T1,age[P<0.01,hazard ratio(HR)=1.075,95%confidence interval(CI):1.019-1.134]and tumour size(P=0.021,HR=3.635,95%CI:1.210-10.917)were independent risk factors for OS.At stage T2,age(P<0.01,HR=1.064,95%CI:1.032-1.098)and overall complications(P=0.012,HR=2.297,95%CI:1.200-4.397)were independent risk factors for OS.At stage T3,only age(P<0.01,HR=1.047,95%CI:1.027-1.066)was an independent risk factor for OS.At stage T4,age(P<0.01,HR=1.057,95%CI:1.039-1.075)and body mass index(P=0.034,HR=0.941,95%CI:0.890-0.995)were independent risk factors for OS.However,there was no association between LNDs and OS in stages Ⅰ and Ⅱ.CONCLUSION The number of LDNs did not affect the survival of patients with TNM stages Ⅰ and Ⅱ CRC.Therefore,insufficient LNDs should not be a cause for alarm during the surgery.

Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)placement is a procedure that can effectively treat complications of portal hypertension,such as variceal bleeding and refractory ascites.However,there have been no specific studies on predicting long-term survival after TIPS placement.AIM To establish a model to predict long-term survival in patients with hepatitis cirrhosis after TIPS.METHODS A retrospective analysis was conducted on a cohort of 224 patients who un-derwent TIPS implantation.Through univariate and multivariate Cox regression analyses,various factors were examined for their ability to predict survival at 6 years after TIPS.Consequently,a composite score was formulated,encompassing the indication,shunt reasonability,portal venous pressure gradient(PPG)after TIPS,percentage decrease in portal venous pressure(PVP),indocyanine green retention rate at 15 min(ICGR15)and total bilirubin(Tbil)level.Furthermore,the performance of the newly developed Cox(NDC)model was evaluated in an in-ternal validation cohort and compared with that of a series of existing models.RESULTS The indication(variceal bleeding or ascites),shunt reasonability(reasonable or unreasonable),ICGR15,post-operative PPG,percentage of PVP decrease and Tbil were found to be independent factors affecting long-term survival after TIPS placement.The NDC model incorporated these parameters and successfully identified patients at high risk,exhibiting a notably elevated mortality rate following the TIPS procedure,as observed in both the training and validation cohorts.Additionally,in terms of predicting the long-term survival rate,the performance of the NDC model was significantly better than that of the other four models[Child-Pugh,model for end-stage liver disease(MELD),MELD-sodium and the Freiburg index of post-TIPS survival].CONCLUSION The NDC model can accurately predict long-term survival after the TIPS procedure in patients with hepatitis cirrhosis,help identify high-risk patients and guide follow-up management after TIPS implantation.

Cancer survival statistics in China 2019-2021:a multicenter,population-based study

Background:A milestone goal of the Healthy China Program(2019-2030)is to achieve 5-year cancer survival at 43.3%for all cancers combined by 2022.To assess the progress towards this target,we analyzed the updated survival for all cancers combined and 25 specific cancer types in China from 2019 to 2021.Methods:We conducted standardized data collection and quality control for cancer registries across 32 provincial-level regions in China,and included 6,410,940 newly diagnosed cancer patients from 281 cancer registries during 2008-2019,with follow-up data on vital status available until December 2021.We estimated the age-standardized 5-year relative survival overall and by site,age group,and period of diagnosis using the International Cancer Survival Standard Weights,and quantified the survival changes to assess the progress in cancer control.Results:In 2019-2021,the age-standardized 5-year relative survival for all cancers combined was 43.7%(95%confidence interval[CI],43.6-43.7).The 5-year relative survival varied by cancer type,ranging from 8.5%(95%CI,8.2-8.7)for pancreatic cancer to 92.9%(95%CI,92.4-93.3)for thyroid cancer.Eight cancers had 5-year survival of over 60%,including cancers of the thyroid,breast,testis,bladder,prostate,kidney,uterus,and cervix.The 5-year relative survival was generally lower in males than in females.From 2008 to 2021,we observed significant survival improvements for cancers of the lung,prostate,bone,uterus,breast,cervix,nasopharynx,larynx,and bladder.The most significant improvement was in lung cancer.Conclusions:Progress in cancer control was evident in China.This highlights the importance of a comprehensive approach to control and prevent cancer.

Annual variation of adult survival of a south-temperate House Wren population in Argentina

Identifying factors affecting the survival of individuals is essential for understanding the evolution of life-history traits and population dynamics.Despite numerous studies on this subject in north-temperate environments,there is a lack of equivalent studies at similar latitudes in the south.Here,we used a 14-year dataset of capture,banding,and resighting to estimate the annual variation in the apparent adult survival probability of a south-temperate population of House Wrens(Troglodytes aedon bonariae).We evaluated temporal variation in sur-vival and the effect of environmental(climatic)and demographic variables(adult abundance,total number of fledglings produced during each breeding season)on survival estimators.We found that the probability of adult survival decreased as the abundance of breeding adults increased.This density-dependent effect could be related to the resident lifestyle of southern House Wrens,which could determine an intense competition for territories and resources that ultimately would affect their survival.

Multiple myeloma survival in New South Wales, Australia, by treatment era to 2020

Objective: Australia has relatively high multiple myeloma(MM) incidence and mortality rates. Advancements in MM treatment over recent decades have driven improvements in MM survival in high-income countries;however, reporting in Australia is limited. We investigated temporal trends in population-wide MM survival across 3 periods of treatment advancements in New South Wales(NSW), Australia.Methods: Individuals with an MM diagnosis in the NSW Cancer Registry between 1985 and 2015 with vital follow-up to 2020, were categorized into 3 previously defined treatment eras according to their diagnosis date(1985±1995, chemotherapy only;1996±2007, autologous stem cell transplantation;and 2008±2015, novel agents including proteasome inhibitors and immunomodulatory drugs). Both relative survival and cause-specific survival according to Fine and Gray's competing risks cumulative incidence function were calculated by treatment era and age at diagnosis.Results: Overall, 11,591 individuals were included in the study, with a median age of 70 years at diagnosis. Five-year relative survival improved over the 36-year(1985±2020) study period(31.0% in 1985±1995;41.9% in 1996±2007;and 56.1% in 2008±2015). For individuals diagnosed before 70 years of age, the 5-year relative survival nearly doubled, from 36.5% in 1985±1995 to 68.5% in 2008±2015. Improvements for those > 70 years of age were less pronounced between 1985±1995 and 1996±2007;however, significant improvements were observed for those diagnosed in 2008±2015. Similar overall and age-specific patterns were observed for causespecific survival. After adjustment for gender and age at diagnosis, treatment era was strongly associated with both relative and cause-specific survival(P < 0.0001).Conclusions: Survival of individuals with MM is improving in Australia with treatment advances. However, older age groups continue to experience poor survival outcomes with only modest improvements over time. Given the increasing prevalence of MM in Australia, the effects of MM treatment on quality of life, particularly in older age, warrant further attention.

ResMHA-Net:Enhancing Glioma Segmentation and Survival Prediction Using a Novel Deep Learning Framework

Gliomas are aggressive brain tumors known for their heterogeneity,unclear borders,and diverse locations on Magnetic Resonance Imaging(MRI)scans.These factors present significant challenges for MRI-based segmentation,a crucial step for effective treatment planning and monitoring of glioma progression.This study proposes a novel deep learning framework,ResNet Multi-Head Attention U-Net(ResMHA-Net),to address these challenges and enhance glioma segmentation accuracy.ResMHA-Net leverages the strengths of both residual blocks from the ResNet architecture and multi-head attention mechanisms.This powerful combination empowers the network to prioritize informative regions within the 3D MRI data and capture long-range dependencies.By doing so,ResMHANet effectively segments intricate glioma sub-regions and reduces the impact of uncertain tumor boundaries.We rigorously trained and validated ResMHA-Net on the BraTS 2018,2019,2020 and 2021 datasets.Notably,ResMHA-Net achieved superior segmentation accuracy on the BraTS 2021 dataset compared to the previous years,demonstrating its remarkable adaptability and robustness across diverse datasets.Furthermore,we collected the predicted masks obtained from three datasets to enhance survival prediction,effectively augmenting the dataset size.Radiomic features were then extracted from these predicted masks and,along with clinical data,were used to train a novel ensemble learning-based machine learning model for survival prediction.This model employs a voting mechanism aggregating predictions from multiple models,leading to significant improvements over existing methods.This ensemble approach capitalizes on the strengths of various models,resulting in more accurate and reliable predictions for patient survival.Importantly,we achieved an impressive accuracy of 73%for overall survival(OS)prediction.

Transcriptome Analysis of Heterosis in Survival in the Hybrid Progenies of‘Haida No.1’and Orange-Shelled Lines of the Pacific Oyster Crassostrea gigas

Heterosis has been exploited to enhance the yield and adaptability in various shellfish species;however,the molecular basis of it remains unclear.The Pacific oyster Crassostrea gigas is one of the most economically important aquaculture species,and its productive traits can be improved by hybridization.Here,an intraspecific cross between orange shell(O,10th generation)and‘Haida No.1’(H,13th generation)of C.gigas was performed to assess the heterosis of survival trait.Survival rates of hybrid family(OH)and inbred families(HH and OO)were compared at larval stage,and eyed-pediveliger larvae of three families were subjected to transcriptome analysis.The analysis results of best-parent heterosis and mid-parent heterosis showed that the hybrid family exhi-bited a high heterosis in survival relative to the parental families.The OH-M(OH vs.OO)and OH-P(OH vs.HH)had 425 and 512 dif-ferentially expressed genes(DEGs),respectively.Functional enrichment analysis of these DEGs revealed that the significantly enrich-ed genes function in virion binding,C-type lectin receptor signaling pathway,cellular defense response and other immune-related pro-cesses,which involves perlucin-like protein,CD209 antigen-like protein,ZNFX1,caspase-3 and acan genes.These differentially ex-pressed genes in OH-M and OH-P,together with the immune-related processes mentioned above may play an important role in the larval survival of C.gigas.In addition,three genes(CYP450,fucolectin and perlucin-like)are associated with the orange shell and low survival of maternal oyster OO.These findings provide support for the application of hybrid with superior survival and will facilitate the understanding of heterosis formation in the Pacific oyster.