Prognostic factors for disease-free survival in postoperative patients with hepatocellular carcinoma and construction of a nomogram model

BACKGROUND Hepatocellular carcinoma(HCC)is the most common type of liver cancer and has a high risk of invasion and metastasis along with a poor prognosis.AIM To investigate the independent predictive markers for disease-free survival(DFS)in patients with HCC and establish a trustworthy nomogram.METHODS In this study,445 patients who were hospitalized in The First Affiliated Hospital of Anhui Medical College between December 2009 and December 2014 were retrospectively examined.The survival curve was plotted using the Kaplan–Meier method and survival was determined using the log-rank test.To identify the prognostic variables,multivariate Cox regression analyses were carried out.To predict the DFS in patients with HCC,a nomogram was created.C-indices and receiver operator characteristic curves were used to evaluate the nomogram’s performance.Decision curve analysis(DCA)was used to evaluate the clinical application value of the nomogram.RESULTS Longer DFS was observed in patients with the following characteristics:elderly,I–II stage,and no history of hepatitis B.The calibration curve showed that this nomogram was reliable and had a higher area under the curve value than the tumor node metastasis(TNM)stage.Moreover,the DCA curve revealed that the nomogram had good clinical applicability in predicting 3-and 5-year DFS in HCC patients after surgery.CONCLUSION Age,TNM stage,and history of hepatitis B infection were independent factors for DFS in HCC patients,and a novel nomogram for DFS of HCC patients was created and validated.

The effect of long-term traditional Chinese medicine treatment on disease-free survival of postoperative stage I-III lung cancer patients:a retrospective cohort study

Objective:Traditional Chinese medicine(TCM)has been extensively used as one of popular alternative therapies for several cancers.However,it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients.In this study,we explored the effect of long-term TCM treatment on patients with different stages of lung cancer.Methods:All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study.Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group(control group).All patients were regularly followed up by clinic appointment or phone,and all survival data were collected from databases after the last follow-up in October 2017.Results:A total of 575 patients were included in this study,with 299 patients in the TCM group and 276 in the control group.For all patients,5-year disease-free survival(DFS)was 62.2% in TCM group and 42.1% in the control group,and 6-year DFSs were 51.8% and 35.4%,respectively(HR=0.51,95% CI:0.40 to 0.66,log-rank P≤0.001).For patients with stage I,5-year DFSs were 83.7%(TCM group)and 57.5%(control group)and 6-year DFSs were 73.7% and 51.9%,respectively(HR=0.30,95% CI:0.18 to 0.50,log-rank P≤0.001).For patients with stage II in the TCM group and the control group,5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%,respectively(HR=0.31,95% CI:0.19 to 0.52,log-rank P≤0.001),and for patients with stage III,5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group(HR=1.06,95% CI:0.72 to 1.56,log-rank P=0.76).Conclusions:This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients,especially in patients with stage I and II disease.However,these observational findings need being validated by large sample randomized controlled trials.

Liver transplantation for hepatocellular carcinoma- factors influencing outcome and disease-free survival

Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However, there are several factors that influence disease-free survival after transplantation. This review addresses the pre-, intra- and postoperative factors that influence the risk of tumor recurrence after liver transplantation.

Correlative analysis between clinical stage of hepatocellular carcinoma and disease-free survival after hepatectomy

objective: To explore the correlation between clinical stages of hepatocellular carcinoma (HCC) and disease-free survival,and the importance of screening in the high risk population of HCC. Methods: A ret rospective survey of 1 725 cases with HCC after radical and relatively radical operation was performed. The follow-up rate was 84. 5%. The significant factors were analysed using Cox proportional hazards survival analysis model,and the disease-free survival was analysed using Kapalan-Meier estimination. Results: Uni variate analysis shows twelve prognostic clinicopathological factors. Multivariate analysis revealed 4 signifi cant prognostic factors: preoperative tumor number,tumor size,daughter nodules and vascular invasion. Ka palan-Meier estimination showed disease-free survival in subclinical stage was much better than in stage 2 or 3. Conclusion:Screening in the high risk population of HCC and having check-up of AFP and B ultrasono graphy of liver regularly themselvs can detect tumor of patients in early stage,so that they can have surgical treatment in subclinical stage,and have their disease-free survival time increased much more.

Genetic polymorphisms of autophagy-related gene 5 (ATG5) rs473543 predict different disease-free survivals of triple-negative breast cancer patients receiving anthracycline- and/or taxane-based adjuvant chemotherapy

Background:Autophagy plays a crucial role in chemotherapy resistance of triple-negative breast cancer(TNBC).Hence,autophagy-related gene 5(ATG5),an essential molecule involved in autophagy regulation,is presumably associated with recurrence of TNBC.This study was aimed to investigate the potential influence of single-nucleotide polymorphisms in ATG5 on the disease-free survival(DFS)of early-stage TNBC patients treated with anthracycline-and/or taxane-based chemotherapy.Methods:We genotyped ATG5 SNP rs473543 in a cohort of 316 TNBC patients treated with anthracycline-and/or taxane-based chemotherapy using the sequenom’s MassARRAY system.Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were used to analyze the association between ATG5 rs473543 genotypes and the clinical outcome of TNBC patients.Results:Three genotypes,AA,GA,and GG,were detected in the rs473543 of ATG5 gene.The distribution of ATG5 rs473543 genotypes was significantly different between patients with and without recurrence(P=0.024).Kaplan-Meier survival analysis showed that patients carrying A allele of ATG5 rs473543 had an increased risk of recurrence and shorter DFS compared with those carrying the variant genotype GG in rs473543(P=0.034).In addition,after adjust-ing for clinical factors,multivariate Cox regression analyses revealed that the AA/GA genotype of rs473543 was an independent predictor for DFS(hazard risk[HR],1.73;95%confidence interval[CI],1.04-2.87;P=0.034).In addition,DFS was shorter in node-negative patients with the presence of A allele(AA/GA)than in those with the absence of A allele(P=0.027).Conclusion:ATG5 rs473543 genotypes may serve as a potential marker for predicting recurrence of early-stage TNBC patients who received anthracycline-and/or taxane-based regimens as adjuvant chemotherapy.

Prognostic factors for disease-free survival in patients with pancreatic ductal adenocarcinoma after surgery: a single center experience

Objective: To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification of the 8th edition American Joint Committee on Cancer (AJCC) staging system. Methods: A cohort of 185 patients with PDAC who underwent surgical resection in the General Surgery Department of Peking University First Hospital from January 2010 to December 2017 was enrolled retrospectively. The clinicopathological characteristics and survival data were analyzed to find out risk factors correlated to DFS. The survival curves were calculated according to the 8th edition of AJCC staging system. Results:Among the 185 PDAC patients, 125 (67.6%) with pancreatic head carcinoma underwent pancreatoduodenectomy or total pancreatectomy, and 60 (32.4%) with tumors located in the pancreatic body and tail underwent distal pancreatectomy and splenectomy. R0 resection was achieved in 97 patients (52.4%), and the R1 and R2 resections rate was 44.9% and 2.7%, respectively. One hundred five patients (56.8%) received postoperative adjuvant chemotherapy. The median overall survival (OS) was 21 (95% confidence interval [CI] 17.7–24.3) months, and median DFS was 15 (95% CI 13.6–16.5) months. Univariate analysis showed that AJCC T and N staging, status of resection margin, grade of tumor differentiation, perineural invasion, intravascular cancer embolus, combined vascular resection, neutrophil-to-lymphocyte ratio (NLR)≥2, carcinoembryonic antigen ≥5ng/mL, carbohydrate antigen 19-9 (CA 19-9)≥400U/mL, and without postoperative adjuvant chemotherapy were correlated with shorter DFS. Furthermore, AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy were independent risk factors for DFS. Both the DFS and OS curves were well separated by stage using the 8th staging classification. Conclusions: The 8th edition of AJCC T, primary tumor;N, regional lymph nodes;M, distant metastasis staging system could predict the prognosis of PDAC accurately. Patients with AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy, have a significantly higher risk of tumor recurrence and shorter DFS after surgery. R0 resection and adjuvant chemotherapy could significantly prolong the DFS of PDAC patients.

Long-Term Survival Trend of Gynecological Cancer:A Systematic Review of Population-Based Cancer Registration Data

Gynecological cancer significantly affect the health of women.This review aimed to describe the global patterns and trends in the survival of patients with gynecological cancers.We searched PubMed,Embase,Web of Science,SinoMed,and SEER for survival analyses of cancer registration data of cervical,endometrial,and ovarian cancers published between 1980 and 2022.Globally,the highest 5-year observed survival rate for cervical cancer was 76.5% in Anshan,Liaoning,China(2008-2017).The 5-year observed survival rates of endometrial and ovarian cancers were higher in Finland(1995-1999,82.5%)and Singapore(1988-1992,62.0%).The 5-year relative survival rate of cervical cancer patients was higher in Haining,Zhejiang,China(2011-2014,85.8%).Korea ranked first at 89.0% and 64.5% for endometrial and ovarian cancers,respectively.Survival rates have improved for cervical,endometrial,and ovarian cancers.Patients aged≥75 years and those with advancedstage disease had the worst 5-year survival rates.Survival rates were better for squamous cell carcinoma in cervical cancer,for endometrial carcinoma and mucinous adenocarcinoma in endometrial cancer,and for germ cell and sex-cord stromal tumors in ovarian cancer.Over the past four decades,the survival rates of gynecological cancers have increased globally,with notable increases in cervical and endometrial cancers.Survival rates are higher in developed countries,with a slow-growing trend.Future studies should focus on improving survival,especially in ovarian cancer patients.

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.

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.

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.

Effect of Different Feeds on Growth and Survival of the Sergestid Shrimp Acetes vulgaris Hansen, 1919 (Decapoda: Sergestidae)

The sergestid shrimp Acetes vulgaris has long been an important fishery species in estuaries and coastal waters along the Pang-Rad River, Rayong province, Thailand. In nature, this shrimp feeds on a wide range of food items, such as phytoplankton, zooplankton, algae, plant matter, debris, sand, and mud. The objective of this study was to compare different feeds on growth and survival of A. vulgaris reared in fiberglass tanks containing 70 m3 of seawater salinity 25 ppt over a period of 70 days. Individual shrimps were fed with four different types of feeds i.e., newly hatched Artemia (Ar), rotifer (Ro), newly hatched Artemia + rotifer (ArRo) and shrimp larvae commercial feed (SF). Results suggested that specific growth rates (both for body weight and body length) of shrimps reared with SF were not significantly different with treatment feed with Ar, ArRo and Ro (p ≥ 0.05). The survival rate of A. vulgaris did not vary significantly (p ≥ 0.05) among the Ar, Ro and ArRo treatments. However, the highest survival rate of shrimp (81.78% ± 3.08%) was observed in SF treatment and the percentage of survival rate was significantly different with treatment feed with Ar, Ro and ArRo (p ≤ 0.05). The findings reflected the ability of Acetes shrimps to consume diverse food types including both live feed and pelleted feed. Insights obtained from this research suggested that artificial feed can be as efficient as live feeds. This new knowledge is a needed addition to a currently lacking knowledge base for aquaculture of this Acetes species.

Determinants of Early Survival of Breast Cancer Patients in Yaoundé-Cameroon

Introduction: Breast cancer is one of the leading causes of death worldwide. We carried out this study with the aim of evaluating the determinants of early survival of women with breast cancer in two hospitals in the city of Yaoundé. Methodology: This was an analytical cross-sectional study with retrospective and prospective data collection of breast cancer patients during 6 years in two Hospitals of Yaoundé from January 2017 to December 2022. We consulted the files in search of epidemiological, clinical, paraclinical, therapeutic and survival variables. We completed the survival data directly from the patients or their relatives after their consent. We analyzed the data using SPSS version 23.0 software. Survival analysis was done using the Kaplan-Meier method and survival curves were compared using the Log Rank test. Factors influencing survival were evaluated using the Cox model. The significance threshold (P value) was set at 0.05 at 95% confidence interval. The study was approved by the ethics committees. Results: We included 500 patients whose ages varied between 22 and 83 years with a mean age of 47.19 ± 11.61 years. The most represented age group was 30 to 45 years old (45.8%). Less than half (41.6%) were postmenopausal. The most frequent reason for consultation was a breast lump (79.9%). The most common clinical stage at presentation was stage-3 (47.6%). Infiltrating ductal carcinoma was the most represented histological type (84.7%). The most represented histological grade was grade 2 (40.2%). Immunohistochemistry was performed in 34.20% of cases. The most represented molecular subtype was triple negative (41.8%) followed by Luminal A (30%). Concerning treatment, 17.2% did not receive any, 45% had surgery, 79.4% had chemotherapy, 34.2% hormone therapy, and 14.6% radiotherapy. The survival of patients with breast cancer at 1, 2, 3, 4 and 5 years was respectively 90.6%;83.1%;74.2%;69.8% and 59.2%. The median survival was not reached;however, the first quartile (Q1) was 36 months (3 years). Independent factors associated with reduced survival were breast ulceration (aHR = 3.23;p = 0.002), bilateral tumor location (aHR = 9.2;p < 0.001) and clinical stage 3 (aHR = 1.72;p = 0.010) while patients classified ACR3 on imaging (aHR = 0.19;p = 0.005) had improved survival. Conclusion: Breast cancer survival from 1 to 5 years decrease from 90 to 59%. Mortality was highest in the first 40 months. Independent factors associated with reduced survival were breast ulceration, bilateral tumor location and clinical stage 3 while patients classified ACR3 on imaging had improved survival.

Impact of Relative Dose Intensity (RDI) on Survival in Non-Metastatic Breast Cancer: Nigerian Experience

Background: This study was initiated to determine practices patterns in adjuvant chemotherapy for non-metastatic breast cancer and to examine the relationship between received dose intensity (RDI) and survival in patients with breast cancer Nigeria. Methods: Our study was a retrospective analysis of patients with breast cancer recruited from 2012 and 2015. A total of 204 patients were initially entered into the study, 102 were lost to follow-up leaving 102 patients who were suitable for the survival analysis. Survival time was calculated from 106 days, the scheduled end of chemotherapy. Results: The total average RDI for patients was 74%. Over the 204 patients that were reviewed, 144 (70.6%) had some reduction of RDI. This subgroup had an average RDI of 63%. On average, 79% of the intended dose of chemotherapy was given. The time to completion of chemotherapy was 1.33 times that specified by the protocol. Dose delays an overall reduction was mainly attributed to intolerability and financial constraints. Survival by RDI showed a significant decrease in survival rate for patients with RDI of >49% (Hazard Ratio = 3.473, 95% CI 1.21 - 9.91, P = 0.020);RDI of 50% - 59% (Hazard Ratio = 3.916, 95% CI 1.01 - 15.18, P = 0.048);RDI of 60% - 69% (Hazard Ratio = 4.462, 95% CI 1.65 - 12.03, P = 0.003) compared with patients who received an RDI of 100%. Although associated with poorer prognosis, there were no significant changes in the survival rate for patients with RDI of 70% - 79% (Hazard Ratio = 1.667, 95% CI 0.56 - 4.96, P = 0.359);RDI of 80% - 89% (Hazard Ratio = 1.620, 95% CI 0.47 - 5.53, P = 0.441);RDI 90% - 99% (Hazard Ratio = 1.590, 95% CI 0.53 - 4.73, P = 0.405) compared with patients who received an RDI of 100%. Conclusion: This study provides evidence that decreased RDI of <70% in non-metastatic breast cancer patients is strongly associated with decreased overall survival.

Treatment patterns and survival outcomes in patients with nonmetastatic early-onset pancreatic cancer

BACKGROUND The incidence of patients with early-onset pancreatic cancer(EOPC;age≤50 years at diagnosis)is on the rise,placing a heavy burden on individuals,families,and society.The role of combination therapy including surgery,radiotherapy,and chemotherapy in non-metastatic EOPC is not well-defined.AIM To investigate the treatment patterns and survival outcomes in patients with non-metastatic EOPC.METHODS A total of 277 patients with non-metastatic EOPC who were treated at our institution between 2017 and 2021 were investigated retrospectively.Overall survival(OS),disease-free survival,and progression-free survival were estimated using the Kaplan-Meier method.Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors.RESULTS With a median follow-up time of 34.6 months,the 1-year,2-year,and 3-year OS rates for the entire cohort were 84.3%,51.5%,and 27.6%,respectively.The median OS of patients with localized disease who received surgery alone and adjuvant therapy(AT)were 21.2 months and 28.8 months,respectively(P=0.007).The median OS of patients with locally advanced disease who received radiotherapy-based combination therapy(RCT),surgery after neoadjuvant therapy(NAT),and chemotherapy were 28.5 months,25.6 months,and 14.0 months,respectively(P=0.002).The median OS after regional recurrence were 16.0 months,13.4 months,and 8.9 months in the RCT,chemotherapy,and supportive therapy groups,respectively(P=0.035).Multivariate analysis demonstrated that carbohydrate antigen 19-9 level,pathological grade,T-stage,N-stage,and resection were independent prognostic factors for non-metastatic EOPC.CONCLUSION AT improves postoperative survival in localized patients.Surgery after NAT and RCT are the preferred therapeutic options for patients with locally advanced EOPC.

The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram

Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.

Survival Analysis of Patients Undergoing Intraoperative Contrast-enhanced Ultrasound in the Surgical Treatment of Malignant Glioma

Objective:Complete resection of malignant gliomas is often challenging.Our previous study indicated that intraoperative contrast-enhanced ultrasound(ICEUS)could aid in the detection of residual tumor remnants and the total removal of brain lesions.This study aimed to investigate the survival rates of patients undergoing resection with or without the use of ICEUS and to assess the impact of ICEUS on the prognosis of patients with malignant glioma.Methods:A total of 64 patients diagnosed with malignant glioma(WHO grade HI and IV)who underwent surgery between 2012 and 2018 were included.Among them,29 patients received ICEUS.The effects of ICEUS on overall survival(OS)and progression-free survival(PFS)of patients were evaluated.A quantitative analysis was performed to compare ICEUS parameters between gliomas and the surrounding tissues.Results:The ICEUS group showed better survival rates both in OS and PFS than the control group.The univariate analysis revealed that age,pathology and ICEUS were significant prognostic factors for PFS,with only age being a significant prognostic factor for OS.In multivariate analysis,age and ICEUS were significant prognostic factors for both OS and PFS.The quantitative analysis showed that the intensity and transit time of microbubbles reaching the tumors were significantly different from those of microbubbles reaching the surrounding tissue.Conclusion:ICEUS facilitates the identification of residual tumors.Age and ICEUS are prognostic factors for malignant glioma surgery,and use of ICEUS offers a better prognosis for patients with malignant glioma.

Options and survival benefits of conversion therapy for unresectable hepatocellular carcinoma

In the study by Wu et al,patients with unresectable hepatocellular carcinoma were subjected to transarterial chemoembolization(TACE)as a conversion therapy in order to render their tumors suitable for resection.A nomogram was devised and shown to be effective in predicting the survival of these patients.Generalization of the results,however,is questionable since the study subjects consisted of patients who had resection after TACE while excluding patients with the same disease but not suitable for TACE.Immunotherapy can be considered to be an option for conversion therapy.However,markers for determining responses to a conversion therapy and for guiding the decision between TACE and sequential immunotherapy have been lacking.The question of whether effective conversion therapy can truly enhance overall survival remains unanswered.

Survival and risk analysis of patients with COVID-19 in Iran

Objective:To evaluate the risk factors of death caused by COVID-19 in Iran.Methods:This study was a retrospective cohort study from February 20,2020,to August 22,2022,in the hospitals in Isfahan,Iran.The data were collected through a researcher-made checklist.To determine the risk factors of the death,logistic regression and Cox regression models were used.For each variable,the odds ratio and 95%confidence interval were also reported.Results:1885 Patients were included.The age of deceased persons was significantly higher than that of the surviving persons.The risk of death for the age group above 60 years was about 14 times higher than that of people aged 19-35 years[95%CI:14.41(2.02-102.99),P<0.01].Hypertension[95%CI:1.92(1.47-2.5),P<0.01],diabetes[95%CI:1.62(1.23-2.13),P<0.001],and chronic obstructive pulmonary disease[95%CI:1.92(1.47-2.50),P<0.01]were also risk factors of mortality.Conclusions:This study reveals that the mortality rate due to COVID-19 is associated with old age,longer hospitalization in the ICU,increased length of stay,and comorbidities of high blood pressure,diabetes,and chronic pulmonary disease.

Is sarcopenia effective on survival in patients with metastatic gastric cancer?

BACKGROUND Sarcopenia is a progressively diminishing state characterized by the reduction of muscle mass and density,which is frequently observed in malignancies of solid organs.AIM To assess how sarcopenia affects the overall survival of individuals who have been diagnosed with metastatic gastric cancer.METHODS The study retrospectively included individuals who had been diagnosed with metastatic gastric cancer between January 2008 and December 2020.Sarcopenia was identified through the calculation of the average Hounsfield units(HUAC)using computed tomography(CT)images taken at the time of diagnosis in patients.RESULTS A total of 118 patients with metastatic gastric cancer were evaluated.Sarcopenia was detected in 29 patients(24.6%).The median survival of all patients was 8(1-43)mo.The median survival of patients with sarcopenia was 2 mo,while it was 10 mo for those without sarcopenia(P<0.001).A significant relationship was found between sarcopenia and survival.CONCLUSION Sarcopenia has been observed to impact survival outcomes in various types of solid tumor cancers.Sarcopenic patients can be identified in a short time,easily and inexpensively,by HUAC measurements from CT images used for diagnosis,and survival could be promoted with nutritional support.