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.

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.

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.

Deep learning-based multi-modal data integration enhancing breast cancer disease-free survival prediction

Background:The prognosis of breast cancer is often unfavorable,emphasizing the need for early metastasis risk detection and accurate treatment predictions.This study aimed to develop a novel multi-modal deep learning model using preoperative data to predict disease-free survival(DFS).Methods:We retrospectively collected pathology imaging,molecular and clinical data from The Cancer Genome Atlas and one independent institution in China.We developed a novel Deep Learning Clinical Medicine Based Pathological Gene Multi-modal(DeepClinMed-PGM)model for DFS prediction,integrating clinicopathological data with molecular insights.The patients included the training cohort(n=741),internal validation cohort(n=184),and external testing cohort(n=95).Result:Integrating multi-modal data into the DeepClinMed-PGM model significantly improved area under the receiver operating characteristic curve(AUC)values.In the training cohort,AUC values for 1-,3-,and 5-year DFS predictions increased to 0.979,0.957,and 0.871,while in the external testing cohort,the values reached 0.851,0.878,and 0.938 for 1-,2-,and 3-year DFS predictions,respectively.The DeepClinMed-PGM's robust discriminative capabilities were consistently evident across various cohorts,including the training cohort[hazard ratio(HR)0.027,95%confidence interval(CI)0.0016-0.046,P<0.0001],the internal validation cohort(HR 0.117,95%CI 0.041-0.334,P<0.0001),and the external cohort(HR 0.061,95%CI 0.017-0.218,P<0.0001).Additionally,the DeepClinMed-PGM model demonstrated C-index values of 0.925,0.823,and 0.864 within the three cohorts,respectively.Conclusion:This study introduces an approach to breast cancer prognosis,integrating imaging and molecular and clinical data for enhanced predictive accuracy,offering promise for personalized treatment strategies.

High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer

AIM:To assess the clinical significance and the prognostic value of preoperative serum carbohydrate antigen 19-9(CA 19-9)level in gastric cancer.METHODS:Between January 2005 and December2006,1960 patients underwent surgery for histologically confirmed gastric cancer.Of these,163 patients had elevated serum levels of CA 19-9 preoperatively,and1628 patients had normal serum levels of CA 19-9 preoperatively.For this study,325 patients were selected from the group of 1628 patients by age,sex,and cancer stage to serve as controls.Statistically significant differences in survival rates were calculated using the log-rank test.A P value less than 0.05 was considered statistically significant and was determined using SAS software.RESULTS:The baseline characteristics showed some differences between the two groups with regard to histology.Overall survival(OS)in the elevated and nonelevated group was 37.90 and 68.67 mo,respectively(P<0.001).N stage(P=0.001)was a significant predictor of disease-free survival by multivariate analysis.Also,N stage(P<0.001),and the presence of peritoneal metastasis(P<0.001)remained independent factors in predicting OS by multivariate analysis.Additionally,preoperative serum CA 19-9 levels were significantly associated with OS in univariate(P=0.009)and multivariate(P=0.021)analyses.CONCLUSION:Serum CA 19-9 can be considered an independent prognostic factor in predicting OS in patients anticipating surgery for gastric cancer.

Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis

BACKGROUND In pancreatic cancer,acute pancreatitis(AP)is a serious morbidity,but its negative effect on long-term outcomes remains to be elucidated.AIM To investigate the effects of AP on the tumor recurrence pattern of pancreatic ductal adenocarcinoma(PDAC)and tumor-specific survival.METHODS The medical records of 219 patients with curative pancreatectomy for pancreatic cancer at the Pancreatic Surgery Center of West China Hospital from July 2012 to December 2016 were analyzed retrospectively.The severity of acute pancreatitis was classified according to the Atlanta classification of AP.The patient demographics and tumor characteristics were assessed.Early recurrence was defined as a relapse within 12 mo after surgery.Overall and disease-free survival and recurrence patterns were analyzed.Mild acute pancreatitis was excluded because its negative effects can be negligible.RESULTS Early recurrence in AP group was significantly higher than in non-AP group(71.4%vs 41.2%;P=0.009).Multivariate analysis of postoperative early recurrence showed that moderate or severe AP was an independent risk factor for an early recurrence[odds ratio(OR):4.13;95%confidence interval(CI):1.41-12.10;P=0.01].The median time to recurrence was shorter in patients with AP than in those without(8.4 vs 12.8 mo;P=0.003).Multivariate analysis identified AP as an independent prognostic factor for overall survival[relative risk(RR):2.35;95%CI:1.45-3.83]and disease-free survival(RR:2.24;95%CI:1.31-3.85)in patients with PDAC.CONCLUSION Patients with moderate or severe acute pancreatitis developed recurrences earlier than those without.Moderate or severe AP is associated with shorter overall and disease-free survival of patients with PDAC.

Breast Cancer Subtypes and Survival in Chinese Women with Operable Primary Breast Cancer

Objective： To investigate the associations between the different breast cancer subtypes and survival in Chinese women with operable primary breast cancer. Methods： A total of 1538 Chinese women with operable primary breast cancer were analyzed in this study, the median follow-up was 77 months. Estrogen receptor （ER）, progesterone receptor （PR）, and HER2 status were available for these patients. Results： Luminal A （ER＋ and/or PR＋, HER2-） had a favorable disease-free survival （DFS） and overall survival （OS） compared with other subtypes in the entire cohort. Using the luminal A as a reference, among the patients with lymph node positive disease, HER2＋ （ER-, PR-, HER2＋） had the worst DFS （hazard ratio, HR=1.80, 95% CI 1.11 to 2.91, P=0.017） and luminal B （ER＋ and/or PR＋, HER2＋） had the worst OS （HR=2.27, 95% CI 1.50 to 3.45, P0.001）; among the patients with lymph node negative disease, triple-negative （ER-, PR-, HER2-） had the worst DFS （HR=2.21, 95% CI 1.43 to 3.41, P0.001）, whereas no significant difference in DFS between HER2＋ and luminal B or luminal A was observed. Conclusion： As compared with luminal A, luminal B and HER2＋ have the worst survival in patients with lymph node positive disease, but this is not the case in patients with lymph node negative disease; triple-negative subtype has a worse survival in both lymph node positive and lymph node negative patients.

Percutaneous radiofrequency ablation for early hepatocellular carcinoma: Risk factors for survival

AIM: To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors.

Long-term survival outcome of laparoscopic liver resection for hepatocellular carcinoma

Long-term survival is the most important outcome measurement of a curative oncological treatment.For hepatocellular carcinoma(HCC),the long-term disease-free and overall survival of laparoscopic liver resection(LLR)is shown to be non-inferior to the current standard of open liver resection(OLR).Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR.It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence.On the other hand,since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized,it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR.Despite the paucity of level 1 evidence,the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled,matched comparative studies.Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions.On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence,the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.

Is there an optimal time to initiate adjuvant chemotherapy to predict benefit of survival in non-small cell lung cancer?

Objective: Adjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time to initiation of AC (TTAC) and survival in NSCLC patients. Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed. TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching (PSM) was performed for survival analysis using the match data. Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A (<= 35 d) and group B (> 35 d). There was no significant difference in the DFS between the two groups (P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283). Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.

Prognostic factors of survival and a new scoring system for liver resection of colorectal liver metastasis

BACKGROUND Hepatic resection has become the preferred treatment of choice for colorectal liver metastasis(CLM)patients.AIM To identify the prognostic factors and to formulate a new scoring system for management of CLM.METHODS Clinicopathologic and long-term survival data were analyzed to identify the significant predictors of survival by univariate and multivariate analyses with the Cox model.A clinical score was constructed based on the analysis results.RESULTS Three factors of worse overall survival were identified in the multivariate analysis.They were number of liver metastases≥5,size of the largest liver lesion≥4 cm,and the presence of nodal metastasis from the primary tumor.These three factors were chosen as criteria for a clinical risk score for overall survival.The clinical score highly correlated with median overall survival and 5-year survival(P=0.002).CONCLUSION Priority over surgical resection should be given to the lowest score groups,and alternative oncological treatment should be considered in patients with the highest score.

Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis standard.METHODS Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively analyzed.RESULTS Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for OS.CONCLUSION Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.

Factors associated with levelⅢlymph nodes positive and survival analysis of its dissection in patients with breast cancer

Objective:Surgical resection remains the mainstream radical therapy in patients with breast cancer.Given that no consensus has been reached on the exact indication for levelⅢlymph node dissection,the aim of this study is to explore factors associated with levelⅢlymph nodes positive and survival analysis of its dissection in patients with breast cancer.Materials and methods:A retrospective study including 61 patients after levelⅠ-Ⅲdissection via a smaller incision of pectoralis major and 61 patients experiencing only levelⅠandⅡclearance was performed.Clinicopathological outcomes were compared initially and survival analysis was conducted subsequently.Results:No significant differences were presented in baseline and clinicopathological characteristics between the two groups.Ten(16.4%)patients’levelⅢnodes were proven positive after levelⅢdissection.Positive nodes in levelⅠandⅡlymph nodes over 9 was demonstrated as an independent predictor of levelⅢnodes positive(OR:200.75[95%CI:7.77e5187.19],p-0.001).Although the levelⅠ-Ⅲlymph node dissection group presented a seemingly better disease-free survival,statistical significance was not detected(p-0.21).Conclusions:This study revealed that having positive nodes in levelⅠandⅡlymph nodes over 9 was a risk factor of levelⅢlymph nodes positive.But levelⅢlymph node dissection does not offer definite survival benefit.

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer:A propensity score matching analysis

BACKGROUND Although intracorporeal anastomosis(IA)for colon cancer requires longer operative time than extracorporeal anastomosis(EA),its short-term postoperative results,such as early recovery of bowel movement,have been reported to be equal or better.As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum,there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells.However,intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.abdominal cavity in IA.METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020,75 underwent EA(EA group),and 52 underwent IA(IA group).After propensity score matching,the primary endpoint was 3-year disease-free survival rates,and secondary endpoints were 3-year overall survival rates,type of recurrence,surgical site infection(SSI)incidence,number of days on antibiotics,and postoperative biological responses.RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups(87.2%and 82.7%,respectively,P=0.4473).The 3-year overall survival rates also did not significantly differ between the IA and EA groups(94.7%and 94.7%,respectively;P=0.9891).There was no difference in the type of recurrence between the two groups.In addition,there were no significant differences in SSI incidence or the number of days on antibiotics;however,postoperative biological responses,such as the white blood cell count(10200 vs 8650/mm^(3),P=0.0068),C-reactive protein(6.8 vs 4.5 mg/dL,P=0.0011),and body temperature(37.7 vs 37.5℃,P=0.0079),were significantly higher in the IA group.CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

Neoadjuvant chemotherapy with capecitabine combined with oxaliplatin for mid-low locally advanced rectal cancer with negative mesorectal fascia:Long-term outcomes of a prospective trial(PKUCH-R03 trial)

Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.

Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer

BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods,some patients with early CRC still experience postoperative recurrence and metastasis.AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study.Results of blood routine test,liver and kidney function tests and tumor markers were collected before surgery.Patients were followed up through disease-specific database and telephone interviews.Tumor recurrence,metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.RESULTS We comprehensively compared the predictive value of preoperative blood routine,blood biochemistry and tumor markers for disease-free survival(DFS)and overall survival(OS)of CRC.Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS[hazard ratio(HR)=0.995,95% confidence interval(CI):0.991-0.999,P=0.015],while serum carcinoembryonic antigen(CEA)level(HR=1.008,95%CI:1.001-1.016,P=0.027)and serum total cholesterol level(HR=1.538,95%CI:1.026-2.305,P=0.037)were independent risk factors for OS.The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL.Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level,the difference between the two groups was not statistically significant(P=0.075).CONCLUSION For patients with T2N0M0 or T3N0M0 CRC,preoperative platelet count was a protective factor for DFS,while serum CEA level was an independent risk factor for OS.Given that these measures are easier to detect and more acceptable to patients,they may have broader applications.

Preoperative albumin-bilirubin score predicts short-term outcomes and long-term prognosis in colorectal cancer patients undergoing radical surgery

BACKGROUND The albumin-bilirubin(ALBI)score is a serum biochemical indicator of liver function and has been proven to have prognostic value in a variety of cancers.In colorectal cancer(CRC),a high ALBI score tends to be associated with poorer survival.AIM To investigate the correlation between the preoperative ALBI score and outcomes in CRC patients who underwent radical surgery.METHODS Patients who underwent radical CRC surgery between January 2011 and January 2020 at a single clinical center were included.The ALBI score was calculated by the formula(log10 bilirubin×0.66)+(albumin×-0.085),and the cutoff value for grouping patients was-2.8.The short-term outcomes,overall survival(OS),and disease-free survival(DFS)were calculated.RESULTS A total of 4025 CRC patients who underwent radical surgery were enrolled in this study,and there were 1908 patients in the low ALBI group and 2117 patients in the high ALBI group.Cox regression analysis revealed that age,tumor size,tumor stage,ALBI score,and overall complications were independent risk factors for OS;age,tumor stage,ALBI score,and overall complications were identified as independent risk factors for DFS.CONCLUSION A high preoperative ALBI score is correlated with adverse short-term outcomes,and the ALBI score is an independent risk factor for OS and DFS in patients with CRC undergoing radical surgery.

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 disease-free survival in a dog with appendicular osteosarcoma

Postoperative prognosis is generally poor even with adjuvant chemotherapy in dogs with an appendicular osteosarcoma. The purpose of this report was to present the long-term disease-free survival time in a dog with appendicular osteosarcoma receiving amputation,adjuvant chemotherapy and adoptive immunotherapy. A 12-year-old spayed Golden retriever was referred to our hospital with a suspicion of osteosarcoma in right distal radius. The patient underwent the computed tomography (CT) and incisional biopsy on the next day after the first presentation. The CT revealed the osteolysis in the right distal radius and no metastases in the lungs and lymph nodes. The histopathologic diagnosis was made as an osteosarcoma. On the 13th day after,the patient underwent right forelimb amputation. Six doses of carboplatin (250 mg / m2) were postoperatively administered every 3 weeks. The intravenous infusion of lymphokine-activated killer (LAK) cells suspension was performed every 3 ~ 4 weeks after the adjuvant chemotherapy. At the time of our writing this abstract (on the 880thday after the first presentation),no recurrences and metastases were observed after the 32 transfers of LAK cells. In canine appendicular osteosarcoma,some reports have described that postoperative median survival times were 235 ~ 540 d with adjuvant chemotherapy. In our report,the disease free interval and survival time were prolonged compared with the previous reports. We strongly believed that early diagnosis and surgical intervention and adoptive immunotherapy had a great impact on the improvement of survival time in canine appendicular osteosarcoma.