A new tumor-associated antigen prognostic scoring system for spontaneous ruptured hepatocellular carcinoma after partial hepatectomy

Objective:Spontaneous hepatocellular carcinoma(HCC)rupture can be fatal,and hepatic resection could achieve a favorable long-term survival among all strategies of tumor rupture.However,there is no available prognostic scoring system for patients with ruptured HCC who underwent partial hepatectomy.Methods:From January 2005 to May 2015,129 patients with spontaneous HCC rupture underwent partial hepatectomy.Preoperative clinical data were collected and analyzed.Independent risk factors affecting overall survival(OS)were used to develop the new scoring system.Harrell’s C statistics,Akaike information criterion(AIC),the relative likelihood,and the log likelihood ratio were calculated to measure the homogeneity and discriminatory ability of a prognostic system.Results:In the multivariable Cox regression analysis,three factors,including tumor size,preoperativeα-fetoprotein level,and alkaline phosphatase level,were chosen for the new tumor-associated antigen(TAA)prognostic scoring system.The 1-year OS rates were 88.1%,43.2%,and 30.2%for TAA scores of 0–5 points(low-risk group),6–9 points(moderate-risk group),and 10–13points(high-risk group),respectively.The TAA scoring system had superior homogeneity and discriminatory ability(Harrell’s C statistics,0.693 vs.0.627 and 0.634;AIC,794.79 vs.817.23 and 820.16;relative likelihood,both<0.001;and log likelihood ratio,45.21 vs.22.77 and 21.84)than the Barcelona Clinic Liver Cancer staging system and the Cancer of the Liver Italian Program in predicting OS.Similar results were found while predicting disease-free survival(DFS).Conclusions:The new prognostic scoring system is simple and effective in predicting both OS and DFS of patients with spontaneous ruptured HCC.

Clinical characteristics and risk factors for mortality in cancer patients with COVID-19

Patients with cancer are at increased risk of severe infections.From a cohort including 3060 patients with confirmed COVID-19,109(3.4%)cancer patients were included in this study.Among them,23(21.1%)patients died in the hospital.Cancer patients,especially those with hematological malignancies(41.6%),urinary carcinoma(35.7%),malignancies of the digestive system(33.3%),gynecological malignancies(20%),and lung cancer(14.3%),had a much higher mortality than patients without cancer.A total of 19(17.4%)cancer patients were infected in the hospital.The clinical characteristics of deceased cancer patients were compared with those of recovered cancer patients.Multivariate Cox regression analysis indicated that a Nutritional Risk Screening(NRS2002)score≥3(adjusted hazard ratio(HR)11.00;95%confidence interval(CI)4.60–26.32;P<0.001),high-risk type(adjusted HR 18.81;95%CI 4.21–83.93;P<0.001),tumor stage IV(adjusted HR 4.26;95%CI 2.34–7.75;P<0.001),and recent adjuvant therapy(<1 month)(adjusted HR 3.16;95%CI 1.75–5.70;P<0.01)were independent risk factors for in-hospital death after adjusting for age,comorbidities,D-dimer,and lymphocyte count.In conclusion,cancer patients showed a higher risk of COVID-19 infection with a poorer prognosis than patients without cancer.Cancer patients with high-risk tumor,NRS2002 score≥3,advanced tumor stage,and recent adjuvant therapy(<1 month)may have high risk of mortality.