Advancing immunosuppression in liver transplantation: A narrative review

Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a significant risk of serious side effects, i.e., among others, de novo cancers, infections, cardiovascular events, renal failure, metabolic syndrome, and late graft fibrosis, with progressive loss of graft function. Pharmacological research, aimed to develop alternative immunosuppressive agents in LT, is behind other solidorgan transplantation subspecialties, and, therefore, the development of new compounds and strategies should get priority in LT. The research trajectories cover mechanisms to induce T-cell exhaustion, to inhibit co-stimulation, to mitigate non-antigen-specific inflammatory response, and, lastly, to minimize the development and action of donor-specific antibodies. Moreover, while cellular modulation techniques are complex, active research is underway to foster the action of T-regulatory cells, to induce tolerogenic dendritic cells, and to promote the function of B-regulatory cells. We herein discuss current lines of research in clinical immunosuppression, particularly focusing on possible applications in the LT setting.

Diagnostic challenges from conflicting results of tests and imaging

Accurate diagnosis is the foundation of clinical care but accurate diagnosis is not easily reached in some cases.In rare instances,even a sophisticated multidisciplinary team at an academic medical center cannot reliably reach an accurate diagnosis after extensive testing and imaging,and has to wait until histological diagnosis or even autopsy results are available.The underlying reason of challenging diagnoses is mostly conflicting data from history,tests,and imaging that point to different diagnoses.In this issue of World Journal of Clinical Cases,Huffaker et al reported such a challenging case of a tricuspid mass in a patient with Li-Fraumeni syndrome.The case by Huffaker et al powerfully illustrates the occasional diagnostic challenges inherent in our current diagnostic approach and the current technology.Clinicians should realize that in rare situations,agnosticism in diagnosis is unavoidable but a treatment has to be initiated so long as the principle of primum non nocere is upheld.

Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.

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.

Research and application of key technologies for data delivery in railway engineering design based on metadata

In view of the problems of inconsistent data semantics,inconsistent data formats,and difficult data quality assurance between the railway engineering design phase and the construction and operation phase,as well as the difficulty in fully realizing the value of design results,this paper proposes a design and implementation scheme for a railway engineering collaborative design platform.The railway engineering collaborative design platform mainly includes functional modules such as metadata management,design collaboration,design delivery management,model component library,model rendering services,and Building Information Modeling(BIM)application services.Based on this,research is conducted on multi-disciplinary parameterized collaborative design technology for railway engineering,infrastructure data management and delivery technology,and design multi-source data fusion and application technology.The railway engineering collaborative design platform is compared with other railway design software to further validate its advantages and advanced features.The platform has been widely applied in multiple railway construction projects,greatly improving the design and project management efficiency.

Analysis of cancer-specific survival in patients with metastatic colorectal cancer: A evidence-based medicine study

BACKGROUND Metastatic colorectal cancer(mCRC)is a common malignancy whose treatment has been a clinical challenge.Cancer-specific survival(CSS)plays a crucial role in assessing patient prognosis and treatment outcomes.However,there is still li-mited research on the factors affecting CSS in mCRC patients and their corre-lation.AIM To predict CSS,we developed a new nomogram model and risk grading system to classify risk levels in patients with mCRC.METHODS Data were extracted from the United States Surveillance,Epidemiology,and End Results database from 2018 to 2023.All eligible patients were randomly divided into a training cohort and a validation cohort.The Cox proportional hazards model was used to investigate the independent risk factors for CSS.A new nomogram model was developed to predict CSS and was evaluated through internal and external validation.RESULTS A multivariate Cox proportional risk model was used to identify independent risk factors for CSS.Then,new CSS columns were developed based on these factors.The consistency index(C-index)of the histogram was 0.718(95%CI:0.712-0.725),and that of the validation cohort was 0.722(95%CI:0.711-0.732),indicating good discrimination ability and better performance than tumor-node-metastasis staging(C-index:0.712-0.732).For the training set,0.533,95%CI:0.525-0.540;for the verification set,0.524,95%CI:0.513-0.535.The calibration map and clinical decision curve showed good agreement and good potential clinical validity.The risk grading system divided all patients into three groups,and the Kaplan-Meier curve showed good stratification and differentiation of CSS between different groups.The median CSS times in the low-risk,medium-risk,and high-risk groups were 36 months(95%CI:34.987-37.013),18 months(95%CI:17.273-18.727),and 5 months(95%CI:4.503-5.497),respectively.CONCLUSION Our study developed a new nomogram model to predict CSS in patients with synchronous mCRC.In addition,the risk-grading system helps to accurately assess patient prognosis and guide treatment.

Surgical Treatment of Anterior Shoulder Instabilities Using the Latarjet Technique (about 40 Cases)

Purpose: Surgical treatment of chronic anterior shoulder instability is a difficult therapeutic challenge for contact athletes. The aim of our study is to evaluate the clinical and radiological results of 40 cases of chronic anterior shoulder instability treated in our institution by Latarjet technique. Methods: We report our experience with the intervention of Latarjet modified by the analysis of a retrospective study of 40 cases. They were all young athletic men, with an average age of 29 years with a predominance of the dominant shoulder. Results: Eighty percent had bone lesions, the first dislocation being traumatic (plating). One patient had a recurrence of his instability due to a new trauma and 67% resumed sport within an average period of eight months, some of whom still had functional discomfort in sports practice (9 patients). After an average follow-up of 75 months, 93% of patients were satisfied with their intervention. Only two mechanical complications were observed. Conclusion: Chronic anterior shoulder instability is pathology of young and active subjects. The preregulenoid coracoid block according to Latarjet represents the therapeutic method of choice in the treatment of chronic anterior instabilities of the shoulder, especially in young and athletic subjects. The result of this intervention remains good despite the complications that can occur such as pseudarthrosis, osteoarthritis, lysis or mobility of the screw.

Existence of Entropy Solution for Degenerate Parabolic-Hyperbolic Problem Involving p(x)-Laplacian with Neumann Boundary Condition

We consider a strongly non-linear degenerate parabolic-hyperbolic problem with p(x)-Laplacian diffusion flux function. We propose an entropy formulation and prove the existence of an entropy solution.

Analysis of Perinatal Outcomes of Twin Pregnancy in a Referral Hospital for High Risk

Introduction: The incidence of twin pregnancies has increased significantly in recent decades. These pregnancies require more attention due to their worse outcomes than singleton pregnancies. Objective: To analyze the characteristics and perinatal outcomes of twin pregnancies at the Caxias do Sul General Hospital. Methods: This is a descriptive and retrospective study that included all births related to twin pregnancies between March 1998 and June 2018. Maternal and perinatal variables were analyzed. Descriptive analyses were carried out using measures of central tendency and dispersion for continuous variables (mean and standard deviation or median and interquartile range), according to a prior assessment of distribution using the Shapiro-Wilk test, and absolute (n) and relative (n%) frequencies for categorical variables. Results: 172 pairs of twins/21,972 births (0.8%) were identified. There was a high percentage of interpartum interval of less than 12 months, adherence and prenatal visits, body mass index, and need for neonatal intensive care. Stillbirth and neomortality rates were within acceptable parameters. Conclusion: The sample studied showed a percentage similar to that in the literature, a high rate of maternal and perinatal complications, characterizing it as a high-risk fetal pregnancy.

Vulvectomy: Indications and Results in the General Surgery Department of the Ignace Deen Chu Hospital in Conakry

Introduction: The aim of this study was to report the indications and evaluate the results of vulvectomy in the general surgery department of Ignace Deen Hospital, CHU Conakry. Materials and Methods: This was a retrospective descriptive study, conducted over a period of five (05) years from January 1, 2018 to December 31, 2022, in the general surgery department of Ignace Deen Hospital, CHU Conakry. We included in our study all patient records in whom vulvectomy was performed. Results: We recorded 15 cases of vulvectomy out of 453 perineal surgeries, i.e. 3.31%, with a mean age of 43.56 years and extremes of 35 and 69 years. Vulvar cancer was the most common diagnosis (46.67%), followed by Buschke-Lowenstein (33.33%) and anal canal cancer extending to the vulva (20%). Six patients had undergone biopsy (40%). Vulvectomy with lymph node dissection was performed in only 9 patients (60%), and all surgical specimens were sent to anatomical pathology (100%). Conclusion: Vulvectomy is a surgical technique most often indicated for the treatment of vulvar cancer.

Impact of Laboratory Value Flowsheet in Electronic Health Record (EHR) Documentation Time

Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .

Evaluation of the Mechanisms Acting on the Atlantic Meridional Overturning Circulation in CESM2 for the 1pctCO_(2) Experiment

The Atlantic Meridional Overturning Circulation(AMOC)is a crucial component of the Earth’s climate system due to its fundamental role in heat distribution,carbon and oxygen transport,and the weather.Other climate components,such as the atmosphere and sea ice,influence the AMOC.Evaluating the physical mechanisms of those interactions is paramount to increasing knowledge about AMOC’s functioning.In this study,the authors used outputs from the Community Earth System Model version 2 and observational data to investigate changes in theAMOC and the associated physical processes.Two DECK experiments were evaluated:piControl and 1pctCO_(2),with an annual increase of 1%of atmospheric CO_(2).The analysis revealed a significant decrease in the AMOC,associated with changes in mixed layer depth and buoyancy in high latitudes of the North Atlantic,resulting in the shutdown of deep convection and potentially affecting the formation of North Atlantic Deep Water and Antarctic Bottom Water.A vital aspect observed in this study is the association between increased runoff and reduced water evaporation,giving rise to a positive feedback process.Consequently,the rates of freshwater spreading have intensified during this period,which could lead to an accelerated disruption of the AMOC beyond the projections of existing models.

Study of Fractional Order Dynamical System of Viral Infection Disease under Piecewise Derivative

This research aims to understand the fractional order dynamics of the deadly Nipah virus(NiV)disease.We focus on using piecewise derivatives in the context of classical and singular kernels of power operators in the Caputo sense to investigate the crossover behavior of the considered dynamical system.We establish some qualitative results about the existence and uniqueness of the solution to the proposed problem.By utilizing the Newtonian polynomials interpolation technique,we recall a powerful algorithm to interpret the numerical findings for the aforesaid model.Here,we remark that the said viral infection is caused by an RNA type virus which can transmit from animals and also from an infected person to person.Fruits bats which are also known as flying foxes are one of the sources of transmission of NiV disease.Here in this work,we investigate its transmission mechanism through some new concepts of fractional calculus for further analysis and prediction.We present the approximate results for different compartments using different fractional orders.By using the piecewise derivative concept,we detect the crossover ormulti-steps behavior in the transmission dynamics of the mentioned disease.Therefore,the considered form of the derivative is used to deal with problems exhibiting crossover behaviors.

Epidemiology and outcome of individuals with intraductal papillary neoplasms of the bile duct

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically displays mucin-hypersecretion or a papillary growth pattern,and results in cystic dilatation[1].IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts,and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma.IPNBs have similar phenotypic changes in the occurrence and development of all subtypes,and the prognosis is significantly better than that of traditional(nonpapillary)cholangiocarcinoma.AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.METHODS Invasive IPNB,invasive intraductal papillary mucinous neoplasm of the pancreas(IPMN),and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Annual percentage changes(APCs)in the incidence and incidence-based(IB)mortality were calculated.We identified the independent predictors of overall survival(OS)and cancer-specific survival(CSS)in indivi duals with invasive IPNB.RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases,with an APC of-4.5%(95%CI:-5.1%to-3.8%)and-3.3%(95%CI:-4.1%to-2.6%)(P<0.001),respectively.Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma.Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma.A total of 1635 individuals with invasive IPNB were included in our prognosis analysis.The most common tumor sites were the pancreaticobiliary ampulla(47.9%)and perihilar tract(36.7%),but the mucin-related subtype of invasive IPNB was the main type,intrahepatically(approximately 90%).In the univariate and multivariate Cox regression analysis,age,tumor site,grade and stage,subtype,surgery,and chemotherapy were associated with OS and CSS(P<0.05).CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward.The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.

上海市疾病预防控制中心就业见习基地运行效果评估:基于结果链模型

目的 对上海市疾病预防控制中心针对高校毕业学年学生开展的就业见习基地运行效果进行评估,并就提升就业见习工作的效果提出政策建议。方法 构建基于结果链模型的评估指标体系,通过客观资料收集,并对2018—2022年的往届见习学员和带教老师,以及2022年末的在岗见习学员,开展满意度调查,分析和评估上海市疾病预防控制中心就业见习基地运行效果。在此基础上,提出改进就业见习工作的建议与措施。结果 基于结果链模型构建包括5个一级指标、14个二级指标、32个三级指标的评估指标体系,并对2018—2022年上海市疾病预防控制中心就业见习基地的运行效果进行评分,得分84.8分。其中,与上海市疾病预防控制中心就业见习基地相关的未得满分指标有:投入环节,管理体系中的组织架构;产出环节,基地产出中的见习岗位类别;结果环节,见习学员和带教老师的政策认知情况。结论 2018—2022年,上海市疾病预防控制中心就业见习基地运行情况良好,取得了一定的成效,但是仍存在不足。建议通过重视政策宣传,多渠道宣传上海市就业见习政策;完善组织架构,落实事前、事中、事后管理;拓展岗位类别,培养多类型公共卫生人才;延长见习期限,重视实践能力培养等措施加以改进。

Functional and patient-reported outcomes of bone-anchored hearing aids (BAHA): A prospective case series study

Objective:The purpose of this study was to evaluate the functional and patient-reported outcomes,and their correlation,after percutaneous bone-anchored hearing aid(BAHA)implantation.Methods:A prospective study was conducted between January 2018 and December 2020 in a tertiary care center.All adult patients who were implanted with a percutaneous BAHA device during this evaluation period were included in the study.Complete auditory function and patients reported outcome measures(PROMs)were assessed in the preoperative period and 6 months after the implant activation.The PROMs included a generic form(Medical Outcome Study 36 Short Form Healthy Survey(MOS SF-36)),and three disease-specific forms(Hearing Handicap Inventory(HHI),Satisfaction with Amplification in Daily Life Scale(SADLS),and Tinnitus Handicap Inventory(THI)).Results:Twenty-two patients with an average age of 53 years were included in the study.The overall functional gain with the BAHA in sound-field pure tone average(PTA)was 29 dB,with no statistically significant differences according to surgical indication(F(3,18)=2.319,p=0.110).The greater the preoperative air-bone gap,the greater the functional gain obtained(r=0.505,p<0.05).In the PROMs,we found a significant improvement in HHI scores(p<0.005)and a significant increase in overall SADLS scores(p<0.05)with the use of percutaneous BAHA devices.We did not verify any statistically significant correlation between functional and PROMs results.Conclusions:The BAHA is a safe and effective alternative hearing rehabilitation option in selected patients.The PROMs results prove patient's overall satisfaction.

On Nonlinear Conformable Fractional Order Dynamical System via Differential Transform Method

This article studies a nonlinear fractional order Lotka-Volterra prey-predator type dynamical system.For the proposed study,we consider the model under the conformable fractional order derivative(CFOD).We investigate the mentioned dynamical system for the existence and uniqueness of at least one solution.Indeed,Schauder and Banach fixed point theorems are utilized to prove our claim.Further,an algorithm for the approximate analytical solution to the proposed problem has been established.In this regard,the conformable fractional differential transform(CFDT)technique is used to compute the required results in the form of a series.Using Matlab-16,we simulate the series solution to illustrate our results graphically.Finally,a comparison of our solution to that obtained for the Caputo fractional order derivative via the perturbation method is given.

Risk factors,prognostic predictors,and nomograms for pancreatic cancer patients with initially diagnosed synchronous liver metastasis

BACKGROUND Liver metastasis(LM)remains a major cause of cancer-related death in patients with pancreatic cancer(PC)and is associated with a poor prognosis.Therefore,identifying the risk and prognostic factors in PC patients with LM(PCLM)is essential as it may aid in providing timely medical interventions to improve the prognosis of these patients.However,there are limited data on risk and prognostic factors in PCLM patients.AIM To investigate the risk and prognostic factors of PCLM and develop corresponding diagnostic and prognostic nomograms.METHODS Patients with primary PC diagnosed between 2010 and 2015 were reviewed from the Surveillance,Epidemiology,and Results Database.Risk factors were identified using multivariate logistic regression analysis to develop the diagnostic mode.The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors needed to develop the prognostic model.The performance of the two nomogram models was evaluated using receiver operating characteristic(ROC)curves,calibration plots,decision curve analysis(DCA),and risk subgroup classification.The Kaplan-Meier method with a logrank test was used for survival analysis.RESULTS We enrolled 33459 patients with PC in this study.Of them,11458(34.2%)patients had LM at initial diagnosis.Age at diagnosis,primary site,lymph node metastasis,pathological type,tumor size,and pathological grade were identified as independent risk factors for LM in patients with PC.Age>70 years,adenocarcinoma,poor or anaplastic differentiation,lung metastases,no surgery,and no chemotherapy were the independently associated risk factors for poor prognosis in patients with PCLM.The C-index of diagnostic and prognostic nomograms were 0.731 and 0.753,respectively.The two nomograms could accurately predict the occurrence and prognosis of patients with PCLM based on the observed analysis results of ROC curves,calibration plots,and DCA curves.The prognostic nomogram could stratify patients into prognostic groups and perform well in internal validation.CONCLUSION Our study identified the risk and prognostic factors in patients with PCLM and developed corresponding diagnostic and prognostic nomograms to help clinicians in subsequent clinical evaluation and intervention.External validation is required to confirm these results.

Survival benefits and disparities in radiation therapy for elderly patients with pancreatic ductal adenocarcinoma

BACKGROUND Older patients represent a unique subgroup of the cancer patient population,for which the role of cancer therapy requires special consideration.However,the outcomes of radiation therapy(RT)in elderly patients with pancreatic ductal adenocarcinoma(PDAC)are not well-defined in the literature.AIM To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.METHODS Data from patients with PDAC aged≥65 years between 2004 and 2018 were collected from the Surveillance,Epidemiology,and End Results database.Multivariate logistic regression analysis was performed to determine factors associated with RT administration.Overall survival(OS)and cancer-specific survival(CSS)were evaluated using the Kaplan–Meier method with the log-rank test.Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS.Propensity score matching(PSM)was applied to balance the baseline characteristics between the RT and non-RT groups.Subgroup analyses were performed based on clinical characteristics.RESULTS A total of 12245 patients met the inclusion criteria,of whom 2551(20.8%)were treated with RT and 9694(79.2%)were not.The odds of receiving RT increased with younger age,diagnosis in an earlier period,primary site in the head,localized disease,greater tumor size,and receiving chemotherapy(all P<0.05).Before PSM,the RT group had better outcomes than did the non-RT group[median OS,14.0 vs 6.0 mo;hazard ratio(HR)for OS:0.862,95%confidence interval(CI):0.819–0.908,P<0.001;and HR for CSS:0.867,95%CI:0.823–0.914,P<0.001].After PSM,the survival benefit associated with RT remained comparable(median OS:14.0 vs 11.0 mo;HR for OS:0.818,95%CI:0.768–0.872,P<0.001;and HR for CSS:0.816,95%CI:0.765–0.871,P<0.001).Subgroup analysis revealed that the survival benefits(OS and CSS)of RT were more significant in patients aged 65 to 80 years,in regional and distant stages,with no surgery,and receiving chemotherapy.CONCLUSION RT improved the outcome of elderly patients with PDAC,particularly those aged 65 to 80 years,in regional and distant stages,with no surgery,and who received chemotherapy.Further prospective studies are warranted to validate our results.

Comparison of clinicopathological characteristics and survival outcomes between gallbladder mucinous adenocarcinoma and gallbladder adenocarcinoma:A propensity score-matched study

BACKGROUND Gallbladder mucinous adenocarcinoma(GBMAC)is a rare subtype of gallbladder adenocarcinoma(GBAC),with limited knowledge of its survival outcomes from small case series and single-center retrospective analysis.AIM To compare the clinicopathological characteristics of GBMAC with typical GBAC and its prognostic factors to gain insights into this field.METHODS This study was conducted using data from the Surveillance,Epidemiology,and End Results database,including cases of GBMAC and typical GBAC diagnosed from 2010 to 2017.The Pearson chi-square test or Fisher exact test was used to examine the differences in clinicopathological features between these two cohorts.In addition,propensity score matching(PSM)analysis was performed to balance the selection biases.Univariate and multivariate Cox hazards regression analyses were performed to determine independent prognostic factors for cancer-speci
c survival(CSS)and overall survival(OS).The Kaplan–Meier curves and log-rank tests were used to assess the OS and CSS of GBMAC and typical GBAC patients.RESULTS The clinicopathological and demographic characteristics of GBMAC were different from typical GBAC.They included a larger proportion of patients with unmarried status,advanced American Joint Committee on Cancer(AJCC)stage,higher T stage,higher N1 stage rate and lower N0 and N2 stage rates(P<0.05).Multivariate analyses demonstrated that surgery[OS:Hazard ratio(HR)=2.27,P=0.0037;CSS:HR=2.05,P=0.0151],chemotherapy(OS:HR=6.41,P<0.001;CSS:HR=5.24,P<0.001)and advanced AJCC stage(OS:Stage IV:HR=28.99,P=0.0046;CSS:Stage III:HR=12.31,P=0.015;stage IV:HR=32.69,P=0.0015)were independent prognostic indicators for OS and CSS of GBMAC patients.Furthermore,after PSM analysis,there was no significant difference between GBMAC and matched typical GBAC patients regarding OS(P=0.82)and CSS(P=0.69).CONCLUSION The biological behaviors of GBMAC are aggressive and significantly different from that of typical GBAC.However,they show similar survival prognoses.Surgery,chemotherapy,and lower AJCC stage were associated with better survival outcomes.Further research is needed in the future to verify these results.