Constructing a nomogram to predict overall survival of colon cancer based on computed tomography characteristics and clinicopathological factors

BACKGROUND The colon cancer prognosis is influenced by multiple factors,including clinical,pathological,and non-biological factors.However,only a few studies have focused on computed tomography(CT)imaging features.Therefore,this study aims to predict the prognosis of patients with colon cancer by combining CT imaging features with clinical and pathological characteristics,and establishes a nomogram to provide critical guidance for the individualized treatment.AIM To establish and validate a nomogram to predict the overall survival(OS)of patients with colon cancer.METHODS A retrospective analysis was conducted on the survival data of 249 patients with colon cancer confirmed by surgical pathology between January 2017 and December 2021.The patients were randomly divided into training and testing groups at a 1:1 ratio.Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with OS,and a nomogram model was constructed for the training group.Survival curves were calculated using the Kaplan–Meier method.The concordance index(C-index)and calibration curve were used to evaluate the nomogram model in the training and testing groups.RESULTS Multivariate logistic regression analysis revealed that lymph node metastasis on CT,perineural invasion,and tumor classification were independent prognostic factors.A nomogram incorporating these variables was constructed,and the C-index of the training and testing groups was 0.804 and 0.692,respectively.The calibration curves demonstrated good consistency between the actual values and predicted probabilities of OS.CONCLUSION A nomogram combining CT imaging characteristics and clinicopathological factors exhibited good discrimination and reliability.It can aid clinicians in risk stratification and postoperative monitoring and provide important guidance for the individualized treatment of patients with colon cancer.

Risk stratification in gastric cancer lung metastasis: Utilizing an overall survival nomogram and comparing it with previous staging

BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis in GC patients,it may be po-ssible to construct a good prediction model for both overall survival(OS)and the cumulative incidence prediction(CIP)plot of the tumour.AIM To investigate the predictors of GC with lung metastasis(GCLM)to produce nomograms for OS and generate CIP by using cancer-specific survival(CSS)data.METHODS Data from January 2000 to December 2020 involving 1652 patients with GCLM were obtained from the Surveillance,epidemiology,and end results program database.The major observational endpoint was OS;hence,patients were se-parated into training and validation groups.Correlation analysis determined va-rious connections.Univariate and multivariate Cox analyses validated the independent predictive factors.Nomogram distinction and calibration were performed with the time-dependent area under the curve(AUC)and calibration curves.To evaluate the accuracy and clinical usefulness of the nomograms,decision curve analysis(DCA)was performed.The clinical utility of the novel prognostic model was compared to that of the 7th edition of the American Joint Committee on Cancer(AJCC)staging system by utilizing Net Reclassification Improvement(NRI)and Integrated Discrimination Improvement(IDI).Finally,the OS prognostic model and Cox-AJCC risk stratification model modified for the AJCC system were compared.RESULTS For the purpose of creating the OS nomogram,a CIP plot based on CSS was generated.Cox multivariate regression analysis identified eleven significant prognostic factors(P<0.05)related to liver metastasis,bone metastasis,primary site,surgery,regional surgery,treatment sequence,chemotherapy,radiotherapy,positive lymph node count,N staging,and time from diagnosis to treatment.It was clear from the DCA(net benefit>0),time-de-pendent ROC curve(training/validation set AUC>0.7),and calibration curve(reliability slope closer to 45 degrees)results that the OS nomogram demonstrated a high level of predictive efficiency.The OS prediction model(New Model AUC=0.83)also performed much better than the old Cox-AJCC model(AUC difference between the new model and the old model greater than 0)in terms of risk stratification(P<0.0001)and verification using the IDI and NRI.CONCLUSION The OS nomogram for GCLM successfully predicts 1-and 3-year OS.Moreover,this approach can help to ap-propriately classify patients into high-risk and low-risk groups,thereby guiding treatment.

Fibrinogen-to-albumin ratio predicts overall survival of hepatocellular carcinoma

BACKGROUND Fibrinogen-to-albumin ratio(FAR)has been found to be of prognostic significance for several types of malignant tumors.However,less is known about the association between FAR and survival outcomes in hepatocellular carcinoma(HCC)patients.AIM To explore the association between FAR and prognosis and survival in patients with HCC.METHODS A total of 366 histologically confirmed HCC patients diagnosed between 2013 and 2018 in a provincial cancer hospital in southwestern China were retrospectively selected.Relevant data were extracted from the hospital information system.The optimal cutoff for baseline serum FAR measured upon disease diagnosis was established using the receiver operating characteristic(ROC)curve.Univariate and multivariate Cox proportional hazards models were used to determine the crude and adjusted associations between FAR and the overall survival(OS)of the HCC patients while controlling for various covariates.The restricted cubic spline(RCS)was applied to estimate the dose-response trend in the FAR-OS association.RESULTS The optimal cutoff value for baseline FAR determined by the ROC was 0.081.Multivariate Cox proportional hazards model revealed that a lower baseline serum FAR level was associated with an adjusted hazard ratio of 2.43(95%confidence interval:1.87–3.15)in the OS of HCC patients,with identifiable dose-response trend in the RCS.Subgroup analysis showed that this FAR-OS association was more prominent in HCC patients with a lower baseline serum aspartate aminotransferase or carbohydrate antigen 125 level.CONCLUSION Serum FAR is a prominent prognostic indicator for HCC.Intervention measures aimed at reducing FAR might result in survival benefit for HCC patients.

Nomogram based on clinical characteristics for predicting overall survival in gastric cancer patients with preoperative anemia

BACKGROUND Preoperative anemia is associated with increased postoperative morbidity and mortality and increased perioperative transfusion risk.For surgical patients,this affects physical and cognitive ability and quality of life,but it is an important and modifiable risk factor.AIM To determine the effect of preoperative anemia on the prognosis of gastric cancer(GC)patients and generate a prognostic nomogram to predict the postoperative overall survival(OS)of GC patients with preoperative anemia.METHODS Clinicopathological and follow-up data of GC patients treated at Zhejiang Provincial People's Hospital(China)from 2010 to 2015 were collected.Independent prognostic factors were screened by univariate and multivariate Cox regression analyses.Then,these factors were used to construct a nomogram to predict 1-,3-,and 5-year postoperative OS in preoperative anemic GC patients.The nomogram was assessed by calibration curves,receiver operating characteristic(ROC)curves,and decision curve analysis(DCA).RESULTS Nine hundred and sixty GC patients were divided into two groups(preoper atively anemic and nonanemic),and postoperative survival analysis was performed on both groups,yielding a shorter postoperative survival for preoperatively anemic patients than for nonanemic patients.A total of 347 GC patients with preoperative anemia were included.Age,preoperative alpha-fetoprotein level,monocyte count,lymphocyte count,clinicopathological stage,liver metastasis,and GC type were identified as independent prognostic factors for OS.The area under the ROC curve(AUC)of the nomogram for predicting 1-,3-,and 5-year OS was 0.831,0.845,and 0.840,respectively,for the training cohort,and the corresponding AUC values in the validation cohort were 0.827,0.829,and 0.812,respectively.Calibration curves and DCA indicated good performance of the nomogram.CONCLUSION In all,we have successfully produced and verified a useful nomogram for predicting OS in GC patients with preoperative anemia.This nomogram based on a variety of clinicopathological indices can provide an effective prognostic assessment and help clinicians choose an appropriate treatment strategy for GC patients with preoperative anemia.

Nomogram model predicting the overall survival for patients with primary gastric mucosa-associated lymphoid tissue lymphoma

BACKGROUND Increasingly extranodal marginal B-cell lymphoma of mucosa-associated lymphoid tissue,known as mucosa-associated lymphoid tissue(MALT)lymphoma,is a type of non-Hodgkin’s lymphoma.The prognosis of primary gastric MALT(GML)patients can be affected by many factors.Clinical risk factors,including age,type of therapy,sex,stage and family hematologic malignancy history,also have significant effects on the development of the disease.The available data are mainly focused on epidemiology;in contrast,few studies have investigated the prognostic variables for overall survival(OS)in patients with primary GML.Based on the realities above,we searched a large amount of data on patients diagnosed with primary GML in the Surveillance,Epidemiology and End Results(SEER)database.The aim was to develop and verify a survival nomogram model that can predict the overall survival prognosis of primary GML by com-bining prognostic and determinant variables.AIM To create an effective survival nomogram for patients with primary gastric GML.METHODS All data of patients with primary GML from 2004 to 2015 were collected from the SEER database.The primary endpoint was OS.Based on the LASSO and COX regression,we created and further verified the accuracy and effectiveness of the survival nomogram model by the concordance index(C-index),calibration curve and timedependent receiver operating characteristic(td-ROC)curves.RESULTS A total of 2604 patients diagnosed with primary GML were selected for this study.A total of 1823 and 781 people were randomly distributed into the training and testing sets at a ratio of 7:3.The median follow-up of all patients was 71 mo,and the 3-and 5-year OS rates were 87.2%and 79.8%,respectively.Age,sex,race,Ann Arbor stage and radiation were independent risk factors for OS of primary GML(all P<0.05).The C-index values of the nomogram were 0.751(95%CI:0.729-0.773)and 0.718(95%CI:0.680-0.757)in the training and testing cohorts,respectively,showing the good discrimination ability of the nomogram model.Td-ROC curves and calibration plots also indicated satisfactory predictive power and good agreement of the model.Overall,the nomogram shows favorable performance in discriminating and predicting the OS of patients with primary GML.CONCLUSION A nomogram was developed and validated to have good survival predictive performance based on five clinical independent risk factors for OS for patients with primary GML.Nomograms are a low-cost and convenient clinical tool in assessing individualized prognosis and treatment for patients with primary GML.

Radiomics of rectal cancer for predicting distant metastasis and overall survival

BACKGROUND Rectal cancer(RC)patient stratification by different factors may yield variable results.Therefore,more efficient prognostic biomarkers are needed for improved risk stratification,personalized treatment,and prognostication of RC patients.AIM To build a novel model for predicting the presence of distant metastases and 3-year overall survival(OS)in RC patients.METHODS This was a retrospective analysis of 148 patients(76 males and 72 females)with RC treated with curative resection,without neoadjuvant or postoperative chemoradiotherapy,between October 2012 and December 2015.These patients were allocated to a training or validation set,with a ratio of 7:3.Radiomic features were extracted from portal venous phase computed tomography(CT)images of RC.The least absolute shrinkage and selection operator regression analysis was used for feature selection.Multivariate logistic regression analysis was used to develop the radiomics signature(Rad-score)and the clinicoradiologic risk model(the combined model).Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the models for predicting distant metastasis of RC.The association of the combined model with 3-year OS was investigated by Kaplan-Meier survival analysis.RESULTS A total of 51(34.5%)patients had distant metastases,while 26(17.6%)patients died,and 122(82.4%)patients lived at least 3 years post-surgery.The values of both the Rad-score(consisted of three selected features)and the combined model were significantly different between the distant metastasis group and the nonmetastasis group(0.46±0.21 vs 0.32±0.24 for the Rad-score,and 0.60±0.23 vs 0.28±0.26 for the combined model;P<0.001 for both models).Predictors contained in the combined model included the Rad-score,pathological N-stage,and T-stage.The addition of histologic grade to the model failed to show incremental prognostic value.The combined model showed good discrimination,with areas under the curve of 0.842 and 0.802 for the training set and validation set,respectively.For the survival analysis,the combined model was associated with an improved OS in the whole cohort and the respective subgroups.CONCLUSION This study presents a clinicoradiologic risk model,visualized in a nomogram,that can be used to facilitate individualized prediction of distant metastasis and 3-year OS in patients with RC.

Prognostic factors for overall survival in prostate cancer patients with different site-specific visceral metastases: A study of 1358patients

BACKGROUND Distant metastasis,particularly visceral metastasis(VM),represents an important negative prognostic factor for prostate cancer(PCa)patients.However,due to the lower rate of occurrence of VM,studies on these patients are relatively rare.Consequently,studies focusing on prognostic factors associated with PCa patients with VM are highly desirable.AIM To investigate the prognostic factors for overall survival(OS)in PCa patients with lung,brain,and liver metastases,respectively,and evaluate the impact of site-specific and number-specific VM on OS.METHODS Data on PCa patients with VM were extracted from the Surveillance,Epidemiology,and End Results database between 2010 and 2015.Univariate and multivariate Cox regression analyses were used to analyze the association between clinicopathological characteristics and survival of patients with different site-specific VM.Kaplan-Meier analyses and Log-rank tests were performed to analyze the differences among the groups.RESULTS A total of 1358 PCa patients with site-specific VM were identified from 2010 to 2015.Older age(>70 years)(P<0.001),higher stage(T3/T4)(P=0.004),and higher Gleason score(>8)(P<0.001)were found to be significant independent prognostic factors associated with poor OS in PCa patients with lung metastases.Higher stage(T3/T4)(P=0.047)was noted to be the only independent risk factor affecting OS in PCa patients with brain metastases.Older age(>70 years)(P=0.010)and higher Gleason score(>8)(P=0.001)were associated with shorter OS in PCa patients with liver metastases.PCa patients with isolated lung metastases exhibited significantly better survival outcomes compared with PCa patients with other single sites of VM(P<0.001).PCa patients with a single site of VM exhibited a superior OS compared with PCa patients with multiple sites of VM(P<0.001).CONCLUSION This is the first Surveillance,Epidemiology,and End Results-based study to determine prognostic factors affecting OS in PCa patients with different sitespecific VM.Clinical assessments of these crucial prognostic factors become necessary before establishing a treatment strategy for these patients with metastatic PCa.

Prognostic nomograms for predicting overall survival and causespecific survival of signet ring cell carcinoma in colorectal cancer patients

BACKGROUND Signet ring cell carcinoma(SRCC)is an uncommon subtype in colorectal cancer(CRC),with a short survival time.Therefore,it is imperative to establish a useful prognostic model.As a simple visual predictive tool,nomograms combining a quantification of all proven prognostic factors have been widely used for predicting the outcomes of patients with different cancers in recent years.Until now,there has been no nomogram to predict the outcome of CRC patients with SRCC.AIM To build effective nomograms for predicting overall survival(OS)and causespecific survival(CSS)of CRC patients with SRCC.METHODS Data were extracted from the Surveillance,Epidemiology,and End Results database between 2004 and 2015.Multivariate Cox regression analyses were used to identify independent variables for both OS and CSS to construct the nomograms.Performance of the nomograms was assessed by concordance index,calibration curves,and receiver operating characteristic(ROC)curves.ROC curves were also utilized to compare benefits between the nomograms and the tumor-node-metastasis(TNM)staging system.Patients were classified as high-risk,moderate-risk,and low-risk groups using the novel nomograms.Kaplan-Meier curves were plotted to compare survival differences.RESULTS In total,1230 patients were included.The concordance index of the nomograms for OS and CSS were 0.737(95%confidence interval:0.728-0.747)and 0.758(95%confidence interval:0.738-0.778),respectively.The calibration curves and ROC curves demonstrated good predictive accuracy.The 1-,3-,and 5-year area under the curve values of the nomogram for predicting OS were 0.796,0.825 and 0.819,in comparison to 0.743,0.798,and 0.803 for the TNM staging system.In addition,the 1-,3-,and 5-year area under the curve values of the nomogram for predicting CSS were 0.805,0.847 and 0.863,in comparison to 0.740,0.794,and 0.800 for the TNM staging system.Based on the novel nomograms,stratified analysis showed that the 5-year probability of survival in the high-risk,moderate-risk,and low-risk groups was 6.8%,37.7%,and 67.0%for OS(P<0.001),as well as 9.6%,38.5%,and 67.6%for CSS(P<0.001),respectively.CONCLUSION Convenient and visual nomograms were built and validated to accurately predict the OS and CSS rates for CRC patients with SRCC,which are superior to the conventional TNM staging system.

Nomogram for predicting overall survival in Chinese triple-negative breast cancer patients after surgery

BACKGROUND There are few nomograms for the prognosis of Chinese patients with triplenegative breast cancer(TNBC).AIM To construct and validate a nomogram for overall survival(OS)of Chinese TNBC patients after surgery.METHODS This study used the data of SEER*stat 8.3.5 and selected Chinese patients with TNBC operated on between 2010 and 2015.Univariate and multivariate Cox proportional hazard regression models were used.The identified variables were integrated to form a predictive nomogram and risk stratification model;it was assessed with C-indexes and calibration curves.RESULTS The median and maximal OS of the 336 patients was 39 and 83 mo,respectively.The multivariate analysis showed that age(P=0.043),marital status(P=0.040),tumor localization(P=0.030),grade(P=0.035),T classification(P=0.012),and N classification(P=0.002)were independent prognostic factors.The six variables were combined to construct a 1-,3-and 5-year OS nomogram.The C-indexes of the nomogram to predict OS were 0.766 and compared to the seventh edition staging system,which was higher(0.766 vs 0.707,P<0.001).In order to categorize patients into different prognostic groups,a risk stratification model was created.There was a significant difference between the Kaplan–Meier curves of the entire cohort and each disease stage according to the nomogram.CONCLUSION The nomogram provided prognostic superiority over the traditional tumor,node and metastasis system.It could help clinicians make individual OS or risk predictions for Chinese TNBC patients after surgery.

Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis

BACKGROUND The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positronemission tomography(18 F-FDG PET)scan for determining overall survival(OS)in breast cancer(BC)patients is controversial.AIM To evaluate the OS predictive value of preoperative PET positivity after 15 years.METHODS We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008.PET positivity was determined by anatomical region of interest(AROI)findings for breast and axillary,sternal,and distant sites.The prognostic role of PET was examined as a qualitative binary factor(positive vs negative status)and as a continuous variable[maximum standard uptake value(SUVmax)]in multivariate survival analyses using Cox proportional hazards models.Among the 104 identified patients who received PET,36 were further analyzed for the SUVmax in the AROI.RESULTS Poor OS within the 15-year study period was predicted by PET-positive status for axillary(P=0.033),sternal(P=0.033),and combined PET-axillary/sternal(P=0.008)nodes.Poor disease-free survival was associated with PET-positive axillary status(P=0.040)and combined axillary/sternal status(P=0.023).Cox models confirmed the long-term prognostic value of combined PETaxillary/sternal status[hazard ratio(HR):3.08,95%confidence interval:1.42-6.69].SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25(P=0.048)and 1.54(P=0.029),corresponding to relative increase in the risk of death of 25%and 54%per SUVmax unit,respectively.In addition,the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor(P=0.027),with 1.94 HR,indicating a two-fold relative increase of mortality risk.CONCLUSION Preoperative PET is valuable for prediction of long-term survival.Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.

Updated overall survival and circulating tumor DNA analysis of ensartinib for crizotinib-refractory ALK-positive NSCLC from a phase II study

Background:The initial phase II stuty(NCT03215693)demonstrated that ensartinib has shown clinical activity in patients with advanced crizotinib-refractory,anaplastic lymphoma kinase(ALK)-positive non-small cell lung cancer(NSCLC).Herein,we reported the updated data on overall survival(OS)and molecular profiling from the initial phase Ⅱ study.Methods:In this study,180 patients received 225 mg of ensartinib orally once daily until disease progression,death or withdrawal.OS was estimated by Kaplan‒Meier methods with two-sided 95%confidence intervals(CIs).Next-generation sequencing was employed to explore prognostic biomarkers based on plasma samples collected at baseline and after initiating ensartinib.Circulating tumor DNA(ctDNA)was detected to dynamically monitor the genomic alterna-tions during treatment and indicate the existence of molecular residual disease,facilitating improvement of clinical management.Results:At the data cut-off date(August 31,2022),with a median follow-up time of 53.2 months,97 of 180(53.9%)patients had died.The median OS was 42.8 months(95%CI:29.3-53.2 months).A total of 333 plasma samples from 168 patients were included for ctDNA analysis.An inferior OS correlated sig-nificantly with baseline ALK or tumor protein 53(TP53)mutation.In addition,patients with concurrent TP53 mutations had shorter OS than those without con-current TP53 mutations.High ctDNA levels evaluated by variant allele frequency(VAF)and haploid genome equivalents per milliliter of plasma(hGE/mL)at baseline were associated with poor OS.Additionally,patients with ctDNA clear-ance at 6 weeks and slow ascent growth had dramatically longer OS than those with ctDNA residual and fast ascent growth,respectively.Furthermore,patients who had a lower tumor burden,as evaluated by the diameter of target lesions,had a longer OS.Multivariate Cox regression analysis further uncovered the independent prognostic values of bone metastases,higher hGE,and elevated ALK mutation abundance at 6 weeks.Conclusion:Ensartinib led to a favorable OS in patients with advanced,crizotinib-resistant,and ALK-positive NSCLC.Quantification of ctDNA levels also provided valuable prognostic information for risk stratification.

Overall survival associated with surgery,radiotherapy,and chemotherapy in metastatic vulvar cancer:A retrospective cohort study based on the SEER database

Background:Large cancer registries help analyze the prognosis of rare malignancies,such as advanced vulvar cancer.This study aimed to compare the overall survival(OS)rates of patients with metastatic vulvar cancer who had undergone chemoradiotherapy and radiotherapy alone and identify prognostic factors using data from the Surveillance,Epidemiology,and End Results(SEER)registry.Methods:In this retrospective cohort study,we used the SEER database to identify patients with metastatic vulvar cancer diagnosed between 2000 and 2019.Propensity score matching was performed to balance the covariates.Kaplan–Meier curves and Cox models were used to analyze OS.Results:A total of 685 patients were included and divided into chemoradiotherapy and radiotherapy groups,and 400 patients were included after propensity score matching.The chemoradiotherapy group had higher OS in the matched cohort(hazard ratio[HR]=0.7367;95%confidence interval[CI]:0.5906–0.9190;P=0.0049)than the radiotherapy group,which was similar to that in the pre-matched cohort(P<0.0001).Patients who had undergone surgery+radiotherapy with or without chemotherapy showed higher OS rates than those who had received radiotherapy with or without chemotherapy for patients aged<75 years and local tumor excision/destruction or surgical removal of the primary site was the recommended surgical choice(P<0.05).Chemoradiotherapy is sufficient for patients 75 years of age.Conclusions:Patients with metastatic vulvar cancer should undergo surgery if they can tolerate it.Adjuvant chemoradiotherapy should be encouraged because this treatment modality was associated with higher OS than radiotherapy alone.

Nomogram for predicting the overall survival of patients after D2/R0 resection and chemoradiotherapy for stage Ⅲ gastric cancer or gastroesophageal junction cancer

Objective:To explore the independent factors associated with the overall survival(OS)after D2/R0 resection and adjuvant chemoradiotherapy(CRT)for stage Ⅲ gastric cancer(GC)and gastroesophageal junction(GEJ)cancer,and establish and validate a nomogram model to predict the OS in this patient population.Methods:A total of 569 stage Ⅲ GC or GEJ cancer patients who underwent D2/R0 resection and adjuvant CRT at our center from January 2013 to May 2018 were retrospectively enrolled in this study.The patients were randomly divided into training and validation cohorts in a 3:1 ratio.In the training cohort,univariate and multivariate analysis were conducted to identify clinical factors associated with OS,and a nomogram model was established on the basis of the independent factors.The concordance index(C-index)and the calibration curve were used to validate the prediction power of the nomogram.Results:Overall,427 and 142 patients were enrolled in the training and validation cohorts,respectively.In the univariate and multivariate analyses,age,Lauren's classification,TNM stage,and administration of adjuvant CRT were independent factors for OS to construct the nomogram.The C-index values were 0.654 and 0.613 in the training and validation cohorts,respectively.The calibration curves were identical to the actual OS.Risk stratification based on the nomogram model showed good risk stratification for OS in both groups.Conclusion:Our study included adjuvant CRT as a predictive factor and established a nomogram model for predicting the OS in patients with stage III GC or GEJ after D2/R0 resection and adjuvant therapy.This nomogram could facilitate more individualized prediction of OS in clinical practice.

Overall survival,late mortality,and cancer-directed surgery among children and adolescents with ultra-rare pediatric pancreatoblastoma in the United States,1975-2018

Background:Pediatric pancreatoblastoma is an extremely rare malignant tumor,posing diagnostic and treatment difficulties for pediatric surgeons.Using the Surveillance,Epidemiology,and End Results(SEER)database,we present an up-to-date report of the epidemiology,clinicopathological features,survival rates,and prognosis of pancreatoblastoma in pediatric patients.Methods:All pediatric patients diagnosed with pancreatoblastoma between 1975 and 2018 were identified in the SEER regis-tries(SEER 8 registries and SEER 17 registries).We conducted a survival analysis to assess overall survival and 1-and 5-year late mortality rates.Descriptive statistics and log-rank test were performed.Results:A total of 22 children and adolescents with pancreatoblastoma were identified.In this cohort,12 of 22 were male(54.55%),14 were White(63.64%),and 11 were diagnosed between the ages of 1 and 4 years(50.0%).Among the 22 patients,11(50.0%)had distant metastases,whereas 7(31.82%)had localized,and 4(18.18%)had a regional disease.A total of 5 children and adolescents died during the study period,with cumulative survival rates of 14 of 17(82.35%)and 10 of 11(90.95%)among 1-and 5-year survivors,respectively.Cancer-directed surgery was significantly associated with an increased life expectancy(log-rank test,P=.018).Conclusion:Pediatric pancreatoblastoma is a rare entity.Cases that underwent surgery had a greater likelihood of overall survival and reduced late mortality.

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.

Pattern of colorectal surgery and long-term survival:10-year experience from a single center

BACKGROUND The incidence of colorectal cancer(CRC)has increased in recent decades,and ranks fourth among males and third among females in China.Surgical resection remains the most important treatment modality for curative intent in CRC.Several studies found that surgeon volumes and specialization appeared to be associated with improved overall survival(OS).Moreover,numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC surgery.However,few studies have specifically examined the role and long-term survival of all stage CRC in a real-world study.AIM To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world study.METHODS A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was performed.Standard demographic,clinicopathologic,surgical and follow-up data were obtained from the CRC database.Surgeon specialty was categorized as colorectal surgeon(CS)and general surgeon(GS).CRC patients who underwent primary surgical resection were enrolled.RESULTS A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated,1748(34.0%)of these by CS.The percentage of minimally invasive procedures in the CS group showed an increasing trend.There was no benefit associated with surgeon specialization for stage I,II and IV patients.Surgeon specialization exhibited a significant association with OS solely among stage III patients,with 5-year OS rates of 76%and 67%for the CS and GSgroups,respectively(P<0.01).Further analyses found that surgeon specialization was significantly associated with survival only in stage III rectal patients,and the 5-year OS rate in the CS group and GS group was 80%and 67%,respectively(P<0.01).CONCLUSION Surgeon specialization is associated with improved OS after primary surgery in stage III rectal patients.An appropriate surgical technique,perioperative program and adjuvant therapy may contribute to survival benefit in these patients.

Unveiling the secrets of gastrointestinal mucous adenocarcinoma survival after surgery with artificial intelligence:A population-based study

BACKGROUND Research on gastrointestinal mucosal adenocarcinoma(GMA)is limited and controversial,and there is no reference tool for predicting postoperative survival.AIM To investigate the prognosis of GMA and develop predictive model.METHODS From the Surveillance,Epidemiology,and End Results database,we collected clinical information on patients with GMA.After random sampling,the patients were divided into the discovery(70%of the total,for model training),validation(20%,for model evaluation),and completely blind test cohorts(10%,for further model evaluation).The main assessment metric was the area under the receiver operating characteristic curve(AUC).All collected clinical features were used for Cox proportional hazard regression analysis to determine factors influencing GMA’s prognosis.RESULTS This model had an AUC of 0.7433[95% confidence intervals(95%CI):0.7424-0.7442]in the discovery cohort,0.7244(GMA:0.7234-0.7254)in the validation cohort,and 0.7388(95%CI:0.7378-0.7398)in the test cohort.We packaged it into Windows software for doctors’use and uploaded it.Mucinous gastric adenocarcinoma had the worst prognosis,and these were protective factors of GMA:Regional nodes examined[hazard ratio(HR):0.98,95%CI:0.97-0.98,P<0.001]and chemotherapy(HR:0.62,95%CI:0.58-0.66,P<0.001).CONCLUSION The deep learning-based tool developed can accurately predict the overall survival of patients with GMA postoperatively.Combining surgery,chemotherapy,and adequate lymph node dissection during surgery can improve patient outcomes.

Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review

BACKGROUND Gastric cancer is the third most common cause of cancer related death worldwide.Surgery with or without chemotherapy is the most common approach with curative intent;however,the prognosis is poor as mortality rates remain high.Several indexes have been proposed in the past few years in order to estimate the survival of patients undergoing gastrectomy.The preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been developed.The aim of this systematic review was to assess the role of the prognostic nutritional index(PNI)in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative intent.AIM To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction adenocarcinoma.METHODS A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival(OS)of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI value.The PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic review.The review protocol was registered in the International Prospective Register of Systematic Reviews(PRO) RESULTS Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic review.The patients were divided into high-and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual study.The 5-year OS of patients in the low-PNI groups ranged between 39%and 70.6%,while in the high-PNI groups,it ranged between 54.9%and 95.8%.In most of the included studies,patients with high preoperative PNI showed statistically significant better OS than the low PNI groups.In multivariate analyses,low PNI was repeatedly recognised as an independent prognostic factor for poor survival.CONCLUSION According to the present study,low preoperative PNI seems to be an indicator of poor OS of patients undergoing gastrectomy for gastric or gastroesophageal cancer.

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.