Prognostic value of metabolic tumor burden in lung cancer

Accurate prognosis in patients with lung cancer is important for clinical decision making and treatment selection. The TNM staging system is currently the main method for establishing prognosis. Using this system, patients are grouped into one of four stages based on primary tumor extent, nodal disease, and distant metastases. However, each stage represents a range of disease extent and may not on its own be the best reflection of individual patient prognosis. 18F-fluorodeoxyglucose_positron emission tomography （18F-FDG-PET） can be used to evaluate the metabolic tumor burden affecting the whole body with measures such as metabolic rumor volume （MTV） and total lesion glycolysis （TLG）. MTV and TLG have been shown to be significant prognostic factors in patients with lung cancer, independent of TNM stage. These metabolic tumor burden measures have the potential to make lung cancer staging and prognostication more accurate and quantitative, with the goal of optimizing treatment choices and outcome predictions.

C-reactive protein is a prognostic indicator in patients with perihilar cholangiocarcinoma

AIM： To evaluate prognostic indicators for the outcome of patients with perihilar extrahepatic cholangiocarcinoma in an unselected cohort. METHODS： We retrospectively analyzed 98 patients with perihilar cholangiocarcinoma. Twenty-three patients （23.5%） underwent tumor resection. Patients with non-resectable tumors underwent either transpapillary or percutaneous transhepatic biliary drainage. Additionally, 32 patients （32.7%） received photodynamic therapy （PDT） and 18 patients （18.4%） systemic chemotherapy. Predefined variables at the time of diagnosis and characteristics considering the mode of treatment were entered into a Cox＇s proportional hazards model. Included in the analysis were age, tumor stage following the modified Bismuth-Corlette classification, bilirubin, prothrombin time （PT）, C-reactive protein （CRP）, carbohydrate antigen 19-9 （CA19-9）, history of weight loss, surgical resection, chemotherapy and PDT. RESULTS： The Kaplan-Meier estimate of overall median survival was 10.5 （95%CI： 8.4-12.6） mo. In the univariate analysis, low Bismuth stage, low CRP and surgical resection correlated significantly with better survival. In the multivariate analysis, only CRP （P = 0.005） and surgical resection （P = 0.029） were found to be independently predictive of survival in the cohort. Receiver operating characteristic （ROC） analysis identified a CRP level of 11.75 mg/L as the value associated with the highest sensitivity and specificity predicting a survival 〉 5 too. Applying Kaplan-Meier analysis, patients with a CRP 〈 12 mg/L at the time of diagnosis had a significantly longer median survival than patients with higher values （16.2 vs 7.6 mo; P = 0.009）.CONCLUSION： This retrospective analysis identified CRP level at the time of diagnosis as a novel indicator for the prognosis of patients with perihilar cholangiocarcinoma. It should be evaluated in future prospective trials on this entity.