|
1
|
Zhuo Z, Wu H, Xu L, Ji Y, Li J, Liu L, Zhang H, Yang Q, Zheng Z, Lun W. Machine learning-based integration reveals immunological heterogeneity and the clinical potential of T cell receptor (TCR) gene pattern in hepatocellular carcinoma. Apoptosis 2025; 30:955-975. [PMID: 39904860 DOI: 10.1007/s10495-025-02080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2025] [Indexed: 02/06/2025]
Abstract
The T Cell Receptor (TCR) significantly contributes to tumor immunity, whereas the intricate interplay with the Hepatocellular Carcinoma (HCC) microenvironment and clinical significance remains largely unexplored. Here, we aimed to examine the function of TCR signaling in tumor immunity and its clinical significance in HCC. Our objective was to employ TCR signaling genes and a machine learning-based integrative methodology to construct a prognostic prediction system termed the TCR score. Herein, we revealed that the TCR score serves as an independent risk factor for overall survival in HCC patients, demonstrating stable and robust performance. The accuracy of the TCR score significantly exceeds that of traditional clinical variables and published signatures. Additionally, the immune infiltration was abundant in patients with low TCR scores. Single-cell cohort analysis further demonstrates that patients with low TCR scores possess an immune-active tumor microenvironment (TME), with T/NK cells enhancing interactions with myeloid cells through signaling networks such as MIF, MK, and SPP1. In response to these changes in the TME, patients with high TCR scores exhibit poorer outcomes and shorter survival in immunotherapy cohorts. In vitro experiments demonstrated that the key TCR signaling biomarker SOS1 knockdown significantly suppresses the HCC cells' capability to proliferate, invade, and migrate while enhancing tumor cell apoptosis. The TCR score could function as a robust and potential tool to predict immune activity and improve clinical outcomes for HCC patients.
Collapse
MESH Headings
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/pathology
- Liver Neoplasms/genetics
- Liver Neoplasms/immunology
- Liver Neoplasms/pathology
- Humans
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/metabolism
- Receptors, Antigen, T-Cell/immunology
- Machine Learning
- Tumor Microenvironment/immunology
- Tumor Microenvironment/genetics
- Prognosis
- Gene Expression Regulation, Neoplastic
- Signal Transduction/genetics
- Cell Line, Tumor
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Male
- Female
Collapse
Affiliation(s)
- Zewei Zhuo
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Gastroenterology, The Sixth Affiliated Hospital, South China University of Technology, Foshan, 510315, China
- Heyuan People's Hospital, Heyuan, Guangdong, 517001, China
| | - Huihuan Wu
- Department of Gastroenterology, The Sixth Affiliated Hospital, South China University of Technology, Foshan, 510315, China
| | - Lingli Xu
- Dadong Street Community Health Service Center, Guangzhou, 510080, China
| | - Yuran Ji
- Heyuan People's Hospital, Heyuan, Guangdong, 517001, China
| | - Jiezhuang Li
- Heyuan People's Hospital, Heyuan, Guangdong, 517001, China
| | - Liehui Liu
- Heyuan People's Hospital, Heyuan, Guangdong, 517001, China
| | - Hong Zhang
- Department of Lymphoma, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Qi Yang
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China.
| | - Zhongwen Zheng
- Heyuan People's Hospital, Heyuan, Guangdong, 517001, China.
| | - Weijian Lun
- Department of Gastroenterology, The Sixth Affiliated Hospital, South China University of Technology, Foshan, 510315, China.
| |
Collapse
|
|
2
|
Peng J, Chen H, Chen Z, Tan J, Wu F, Li X. Prognostic value of neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma receiving curative therapies: a systematic review and meta-analysis. BMC Cancer 2025; 25:571. [PMID: 40158082 PMCID: PMC11954291 DOI: 10.1186/s12885-025-13972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 03/19/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in HCC patients has been extensively studied; however, the prognostic value of NLR in HCC patients undergoing curative treatment remains unclear. OBJECTIVE This systematic review and meta-analysis aimed to comprehensively evaluate the precise significance of preoperative and postoperative NLR in predicting the prognosis of HCC patients receiving curative treatment. METHODS We conducted a comprehensive search of the PubMed, Cochrane Library, Embase, and Web of Science databases from inception to August 2024. Studies that included univariate and multivariate analyses evaluating the association between NLR and survival outcomes in HCC patients undergoing resection, transplantation, or ablation were included. The prognostic value of NLR in HCC patients receiving curative treatment was analyzed by calculating pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). RESULTS A total of 43 studies involving 9,952 patients were included. Meta-analysis revealed that higher NLR was significantly associated with worse overall survival (OS) (HR = 1.55, 95% CI = 1.39-1.75, P < 0.001), recurrence-free survival (RFS) (HR = 1.77, 95% CI = 1.49-2.10, P < 0.001), and disease-free survival (DFS) (HR = 1.42, 95% CI = 1.25-1.63, P < 0.001) in HCC patients undergoing curative treatment. Subgroup analysis demonstrated a significant association between NLR and poor OS, independent of geographic region, type of survival analysis, preoperative or postoperative measurement, treatment modality, or NLR cutoff value. Publication bias and sensitivity analyses confirmed the robustness of these findings. CONCLUSION Elevated NLR is significantly associated with poorer OS, RFS, and DFS in HCC patients receiving curative treatment. Future research should focus on validating the optimal NLR threshold and exploring its predictive ability in different clinical settings.
Collapse
Affiliation(s)
- Jinxiang Peng
- School of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China
- Medical Department, Hubei Enshi College, Enshi, China
| | - Haozhu Chen
- School of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Zhuang Chen
- Fifth People's Hospital of Jinan, Jinan, China
| | - Jinmei Tan
- Guizhou Medical University, Guiyang, China
| | - Feng Wu
- The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.
| | - Xiaojuan Li
- School of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China.
- Hubei Shizhen Laboratory, Wuhan, 430065, China.
| |
Collapse
|
|
3
|
Yıldırım MS, Güzel Y, Can C, Kaplan İ, Şenses V, Solmaz İ, Başgöz BB, Alakuş ÖF, İleri S, Kömek H. Predictive value of the FIB-4 index, APRI, ALBI score, and GPR for overall survival in treatment-naïve metastatic colorectal cancer patients. BMC Gastroenterol 2025; 25:97. [PMID: 39979908 PMCID: PMC11844044 DOI: 10.1186/s12876-025-03676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 02/11/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND The prevalence of metastatic colorectal cancer (mCRC) is increasing and is linked to poor overall survival (OS). Previous studies have aimed to determine the predictive value of scores and laboratory tests for OS in mCRC patients, but their findings have been inconclusive. In this research, we focused on determining the prognostic significance of the fibrosis-4 (FIB-4) index, the aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), the albumin-bilirubin (ALBI) score, and the gamma-glutamyl transpeptidase to PLT ratio (GPR) with respect to OS in treatment-naïve mCRC patients. METHODS This retrospective study included treatment-naïve mCRC patients. The FIB-4 index, ALBI score, APRI, and GPR were calculated for each participant, and their mortality dates were recorded. The clinical importance of these scores for survival outcomes was evaluated via the Cox regression model, Kaplan-Meier method, and log-rank test. RESULTS The study enrolled 123 untreated mCRC patients. Univariate Cox regression analysis demonstrated that sex and AST/PLT and ALT/PLT counts were not associated with OS (p > 0.05 for all). However, a higher FIB-4 index (p = 0.025), ALBI score (p < 0.001), GPR (p < 0.001), and AST/ALT ratio (p < 0.001) were all associated with poor OS. Additionally, multivariate Cox regression analysis indicated that age (95% CI: 1.009-1.053, p = 0.006), ALBI score (95% CI: 1.234-2.983, p = 0.004), GPR (95% CI: 1.442-2.701, p < 0.001), and AST/ALT (95% CI: 1.193-2.911, p = 0.006) were independent prognostic factors for OS. CONCLUSION The affordable and easily accessible ALBI score, GPR, and AST/ ALT have prognostic value in untreated patients with mCRC.
Collapse
Affiliation(s)
- Mehmet Serdar Yıldırım
- Department of Internal Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Elazig Road 10th Km. No:1 21070 Uçkuyular, Diyarbakir, Turkey
| | - Yunus Güzel
- Department of Nuclear Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - Canan Can
- Department of Nuclear Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - İhsan Kaplan
- Department of Nuclear Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - Veysi Şenses
- Department of Nuclear Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - İhsan Solmaz
- Department of Internal Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Elazig Road 10th Km. No:1 21070 Uçkuyular, Diyarbakir, Turkey
| | - Bilgin Bahadır Başgöz
- Department of Internal Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Elazig Road 10th Km. No:1 21070 Uçkuyular, Diyarbakir, Turkey.
| | - Ömer Faruk Alakuş
- Department of Internal Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Elazig Road 10th Km. No:1 21070 Uçkuyular, Diyarbakir, Turkey
| | - Serdar İleri
- Department of Medical Oncology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - Halil Kömek
- Department of Nuclear Medicine, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| |
Collapse
|
|
4
|
Wang F, Qin Y, Wang ZM, Yan CY, He Y, Liu D, Wen L, Zhang D. A Dynamic Online Nomogram Based on Gd-EOB-DTPA-Enhanced MRI and Inflammatory Biomarkers for Preoperative Prediction of Pathological Grade and Stratification in Solitary Hepatocellular Carcinoma: A Multicenter Study. Acad Radiol 2024; 31:4021-4033. [PMID: 38494348 DOI: 10.1016/j.acra.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/24/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is an inflammatory cancer. We aimed to explore whether preoperative inflammation biomarkers compared to the gadoxetic acid disodium (Gd-EOB-DTPA) enhanced MRI can add complementary value for predicting HCC pathological grade, and to develop a dynamic nomogram to predict solitary HCC pathological grade. METHODS 331 patients from the Institution A were divided chronologically into the training cohort (n = 231) and internal validation cohort (n = 100), and recurrence-free survival (RFS) was determined to follow up after surgery. 79 patients from the Institution B served as the external validation cohort. Overall, 410 patients were analyzed as the complete dataset cohort. Least absolute shrinkage and selection operator (LASSO) and multivariate Logistic regression were used to gradually filter features for model construction. The area under the receiver operating characteristic curve (AUC) and decision curve analysis were used to evaluate model's performance. RESULTS Five models of the inflammation, imaging, inflammation+AFP, inflammation+imaging and nomogram were developed. Adding inflammation to imaging model can improve the AUC in training cohort (from 0.802 to 0.869), internal validation cohort (0.827 to 0.870), external validation cohort (0.740 to 0.802) and complete dataset cohort (0.739 to 0.788), and obtain more net benefit. The nomogram had excellent performance for predicting high-grade HCC in four cohorts (AUCs: 0.882 vs. 0.869 vs. 0.829 vs. 0.806) with a good calibration, and accessed at https://predict-solitaryhccgrade.shinyapps.io/DynNomapp/. Additionally, the nomogram obtained an AUC of 0.863 (95% CI 0.797-0.913) for predicting high-grade HCC in the HCC≤ 3 cm. Kaplan-Meier survival curves demonstrated that the nomogram owned excellent stratification for HCC grade (P < 0.0001). CONCLUSION This easy-to-use dynamic online nomogram hold promise for use as a noninvasive tool in prediction HCC grade with high accuracy and robustness.
Collapse
Affiliation(s)
- Fei Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Yuan Qin
- Department of Radiology, Chongqing University Three Gorges Hospital, No.165, Xincheng Road, Wanzhou District, Chongqing 404031, China
| | - Zheng Ming Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Chun Yue Yan
- Department of gynaecology and obstetrics, Luzhou People's Hospital, No.316, Jiugu Avenue, Jiangyang District, Luzhou 646000, China
| | - Ying He
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Dan Liu
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Li Wen
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Dong Zhang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China.
| |
Collapse
|
|
5
|
Qiao W, Li J, Wang P, Zhang Y, Jin R, Li J. Prognostic nomogram based on the gamma-glutamyl transpeptidase-to-platelet ratio for patients with compensated cirrhotic hepatocellular carcinoma after local ablation. Front Oncol 2024; 14:1406764. [PMID: 39055565 PMCID: PMC11269228 DOI: 10.3389/fonc.2024.1406764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
Background Hepatocellular carcinoma (HCC) patients with compensated cirrhosis typically face a high prevalence and unfavorable prognosis. However, there is currently a deficiency in prediction models to anticipate the prognosis of these patients. Therefore, our study included the Gamma-glutamyl transpeptidase-to-platelet ratio (GPR) in analysis and aimed to develop a nomogram for HCC patients with compensated cirrhosis after local ablation. Methods Enrolling 669 patients who underwent local ablation at Beijing You'an Hospital during the period from January 1, 2014, to December 31, 2022, this study focused on individuals with compensated cirrhotic HCC. In a ratio of 7:3, patients were allocated to the training cohort (n=468) and the validation cohort (n=201). Lasso-Cox regression was employed to identify independent prognostic factors for overall survival (OS). Subsequently, a nomogram was constructed using these factors and was validated through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results GPR, age, and hemoglobin were identified by Lasso-Cox regression as independent prognostic factors of the nomogram. The area under the ROC curves (AUCs) for 3-, 5-, and 8-year OS (0.701, 0.755, and 0.768 for the training cohort; 0.684, 0.707, and 0.778 for the validation cohort), and C-indices (0.695 for training cohort; 0.679 for validation cohort) exhibited the excellent predictive ability of the nomogram. Calibration curves and DCA curves indicated favorable calibration performance and clinical utility. Patients were further stratified into two risk groups according to the median nomogram score. There existed an obvious distinction between the two groups both in the training cohort and validation cohort. Conclusion In summary, this research established and validated a novel nomogram to predict OS, which had good predictive power for HCC patients with compensated cirrhosis after local ablation.
Collapse
Affiliation(s)
- Wenying Qiao
- Hepatic Disease and Oncology Minimally Invasive Interventional Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Changping Laboratory, Beijing, China
| | - Jiashuo Li
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Peiyi Wang
- Qingdao Agricultural University, Qingdao, China
| | - Yuanyuan Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing, China
| | - Ronghua Jin
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Changping Laboratory, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing, China
| | - Jianjun Li
- Hepatic Disease and Oncology Minimally Invasive Interventional Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
6
|
Liu L, Qin S, Lin K, Xu Q, Yang Y, Cai J, Zeng Y, Yuan S, Xiang B, Lau WY, Zhou W. Development and comprehensive validation of a predictive prognosis model for very early HCC recurrence within one year after curative resection: a multicenter cohort study. Int J Surg 2024; 110:3401-3411. [PMID: 38626419 PMCID: PMC11175792 DOI: 10.1097/js9.0000000000001467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/31/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND The high incidence of early recurrence after liver resection (LR) for hepatocellular carcinoma (HCC) is the main obstacle in achieving good long-term survival outcomes. The aim of the present study is to develop a prognostic model in predicting the risk of very early (1-year) recurrence. MATERIAL AND METHODS Consecutive patients who underwent LR for HCC with curative intent at multicenters in China were enrolled in this study. The VERM-pre (the Preoperative Very Early Recurrence Model of HCC) with good performance was derived and validated by internal and external cohorts retrospectively and by another two-center cohort prospectively. RESULTS Seven thousand four hundred one patients were enrolled and divided randomly into three cohorts. Eight variables (tumor diameter, tumor number, macrovascular invasion, satellite nodule, alpha-fetoprotein, level of HBV-DNA, γ-GT, and prothrombin time) were identified as independent risk factors for recurrence-free survival on univariate and multivariate analyses. The VERM-pre model was developed which showed a high capacity of discrimination (C-index: 0.722; AUROC at 1-year: 0.722)) and was validated comprehensively by the internal, external, and prospective cohorts, retrospectively. Calibration plots showed satisfactory fitting of probability of early HCC recurrence in the cohorts. Three risk strata were derived to have significantly different recurrence-free survival rates (low-risk: 80.4-85.4%; intermediate-risk: 59.7-64.8%; high-risk: 32.6-42.6%). In the prospective validation cohort, the swimming plot illustrated consistent outcomes with the beginning predictive score. CONCLUSION The VERM-pre model accurately predicted the 1-year recurrence rates of HCC after LR with curative intent. The model was retrospectively and prospectively validated and then developed as the online tool.
Collapse
Affiliation(s)
- Lei Liu
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital
| | - Shangdong Qin
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning
| | - Kongying Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou
| | - Qingguo Xu
- Organ Transplantation Center, The Institute of Transplantation Science, The Affiliated Hospital of Qingdao University
| | - Yuan Yang
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital
| | - Jinzhen Cai
- Organ Transplantation Center, The Institute of Transplantation Science, The Affiliated Hospital of Qingdao University
| | - Yongyi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou
| | - Shengxian Yuan
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital
| | - Bangde Xiang
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning
| | - Wan Yee Lau
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital
- Key Laboratory of Signaling Regulation and Targeting Therapy of Liver Cancer (SMMU), Ministry of Education
- Shanghai Key Laboratory of Hepatobiliary Tumor Biology (EHBH), Shanghai, People’s Republic of China
| |
Collapse
|
|
7
|
Chen D, Lv Z, Wu Y, Hao P, Liu L, Pan B, Shi H, Che Y, Shen B, Du P, Si X, Hu Z, Luan G, Xue M. Estimating surgical probability: Development and validation of a prognostic model for patients with lumbar disc herniation treated with acupuncture. Medicine (Baltimore) 2023; 102:e36425. [PMID: 38050285 PMCID: PMC10695558 DOI: 10.1097/md.0000000000036425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Lumbar disc herniation (LDH) is a common cause of pain in the lumbar spine and legs. While acupuncture has become the primary conservative treatment for LDH, some patients experience treatment failure and require surgery, causing substantial concern for clinicians. We developed an effective personalized clinical prediction model to identify the independent risk factors associated with acupuncture failure in patients with LDH. Our model aimed to predict the probability of surgery within 6 months of acupuncture failure in patients with LDH. A total of 738 patients with LDH who underwent acupuncture at 4 Chinese hospitals between January 2019 and October 2021 were selected. The patients were divided into training (n = 496) and validation (n = 242) cohorts. Seven predictive variables, including smoking, Oswestry Disability Index (ODI) score, lower-limb herniation, disc herniation type, lumbar spinal stenosis, lumbar lateral recess stenosis, and acupuncture frequency, were selected as risk factors using least absolute shrinkage and selection operato (LASSO) regression. A prediction model was developed using multivariate logistic regression analysis and a nomogram was constructed. The model exhibited good discrimination, with an area under the ROC curve (AUC) of 0.903 for the development cohort and 0.899 for the validation cohort. The Hosmer-Lemeshow goodness-of-fit test was a good fit for both cohorts (P = .956 for the development cohort; P = .513 for the validation cohort). Decision curve analysis (DCA) demonstrated that the threshold probabilities for the 2 cohorts ranged from > 4% and 5-95%, respectively. Therefore, the prediction model had a good net benefit. The nomogram established in this study, incorporating 7 risk factors, demonstrated a good predictive ability. It could predict acupuncture failure in LDH patients and the risk of surgery within 6 months, enabling physicians to conduct individualized treatment measures.
Collapse
Affiliation(s)
- Di Chen
- Nanjing University of Chinese Medicine, Nanjing, China
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Zimeng Lv
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Yicheng Wu
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Panfu Hao
- Acupuncture Rehabilitation Department, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Liu Liu
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Bin Pan
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Haiping Shi
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Youlu Che
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Bo Shen
- Department of Rehabilitation Medicine, Anhui NO.2 Provincial People’s Hospital, Hefei, China
| | - Peng Du
- Department of Tui Na, Anhui Provincial Hospital of Integrated Chinese and Western Medicine, Hefei, China
| | - Xiaohua Si
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Zhongling Hu
- Acupuncture Rehabilitation Department, Traditional Chinese Hospital of Luan, Luan, China
| | - Guorui Luan
- Department of Tui Na, Anhui Provincial Hospital of Integrated Chinese and Western Medicine, Hefei, China
| | - Mingxin Xue
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
|
8
|
Zhang Y, Jin F, Wu Y, Wang B, Xie J, Li Y, Pan Y, Liu Z, Shen W. Prognostic impact of gamma-glutamyl transpeptidase to platelets ratio on hepatocellular carcinoma patients who have undergone surgery: a meta-analysis and systematic review. Eur J Gastroenterol Hepatol 2023; 35:803-811. [PMID: 37395231 DOI: 10.1097/meg.0000000000002572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Gamma-glutamyl transpeptidase to platelet ratio (GPR) is an inflammatory index and has been used as a prognostic index for a variety of tumors. However, the association between GPR and hepatocellular carcinoma (HCC) still remained controversial. Therefore, we performed a meta-analysis to determine the prognostic impact of GPR on HCC patients. PubMed, Embase, Cochrane Library, Web of Science, the Chinese National Knowledge Infrastructure, Wanfang Database, Chinese VIP Database, the US Clinical Trials Registry, and the Chinese Clinical Trials Registry were searched from inception to December 2022. A hazard ratio (HR) with a 95% confidence interval (CI) was used to evaluate the association between preoperative GPR and the prognosis of HCC patients. Ten cohort studies including 4706 HCC patients were identified. This meta-analysis showed that higher GPRs were closely related to worse overall survival (HR: 1.79; 95% CI: 1.35-2.39; P < 0.001; I2 = 82.7%), recurrence-free survival (HR: 1.30; 95% CI: 1.16-1.46; P < 0.001; I2 = 0%), and disease-free survival (HR: 1.84; 95% CI: 1.58-2.15; P < 0.001; I2 = 25.4%) in patients with HCC. This meta-analysis suggests that preoperative GPR appears to be significantly associated with the prognosis of HCC patients who have undergone surgery and may be an effective prognostic marker. Trial registration: PROSPERO: CRD42021296219.
Collapse
Affiliation(s)
- Yang Zhang
- Department of Internal Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine
| | - Fangfang Jin
- Department of Internal Medicine, Heilongjiang University of Chinese Medicine
| | - Yuan Wu
- Department of Internal Medicine, Heilongjiang University of Chinese Medicine
| | - Bingyu Wang
- Department of Gastroenterology, Heilongjiang Academy of Traditional Chinese Medicine
| | - Jingri Xie
- Department of Internal Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine
| | - Yu Li
- Department of Oncology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin
| | - Yujia Pan
- Cixi People's Hospital Medical and Health Group, Ningbo
| | - Zhaolan Liu
- Evidence Based Medicine Center, Beijing University of Chinese Medicine, Beijing
| | - Wenjuan Shen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| |
Collapse
|
|
9
|
Wu JL, Luo JY, Jiang ZB, Huang SB, Chen GR, Ran HY, Liang QY, Huang MS, Lai LS, Chen JW. Inflammation-related nomogram for predicting survival of patients with unresectable hepatocellular carcinoma received conversion therapy. World J Gastroenterol 2023; 29:3168-3184. [PMID: 37346152 PMCID: PMC10280795 DOI: 10.3748/wjg.v29.i20.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The efficacy of conversion therapy for patients with unresectable hepatocellular carcinoma (HCC) is a common clinical concern.
AIM To analyse the prognostic factors of overall survival (OS) in patients with unresectable HCC who received conversion therapy.
METHODS One hundred and fifty patients who met the inclusion criteria were enrolled and divided into a training cohort (n = 120) and a validation cohort (n = 30). Using the independent risk factors in the training cohort, a nomogram model was constructed to predict OS for patients treated with transarterial chemoembolization following hepatic resection. The nomogram was internally validated with the bootstrapping method. The predictive performance of nomogram was assessed by Harrell’s concordance index (C-index), calibration plot and time-dependent receiver operating characteristic curves and compared with six other conventional HCC staging systems.
RESULTS Multivariate Cox analysis identified that albumin, blood urea nitrogen, gamma-glutamyl transpeptidase to platelet ratio, platelet to lymphocyte ratio, macrovascular invasion and tumour number were the six independent prognostic factors correlated with OS in nomogram model. The C-index in the training cohort and validation cohort were 0.752 and 0.807 for predicting OS, which were higher than those of the six conventional HCC staging systems (0.563 to 0.715 for the training cohort and 0.458 to 0.571 for the validation cohort). The calibration plots showed good consistency between the nomogram prediction of OS and the actual observations of OS. Decision curve analyses indicated satisfactory clinical utility. With a total nomogram score of 196, patients were accurately classified into low-risk and high-risk groups. Furthermore, we have deployed the model into online calculators that can be accessed for free at https://ctmodelforunresectablehcc.shinyapps.io/DynNomapp/.
CONCLUSION The nomogram achieved optimal individualized prognostication of OS in HCC patients who received conversion therapy, which could be a useful clinical tool to help guide postoperative personalized interventions and prognosis judgement.
Collapse
Affiliation(s)
- Jia-Lin Wu
- Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jun-Yang Luo
- Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Zai-Bo Jiang
- Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Si-Bo Huang
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
| | - Ge-Run Chen
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
| | - Hui-Ying Ran
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Qi-Yue Liang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Ming-Sheng Huang
- Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Li-Sha Lai
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510010, Guangdong Province, China
| | - Jun-Wei Chen
- Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| |
Collapse
|
|
10
|
Otto CC, Wang G, Mantas A, Heise D, Bruners P, Lang SA, Ulmer TF, Neumann UP, Heij LR, Bednarsch J. Time to surgery is not an oncological risk factor in HCC patients undergoing liver resection. Langenbecks Arch Surg 2023; 408:187. [PMID: 37160788 PMCID: PMC10169875 DOI: 10.1007/s00423-023-02922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Given limitations of the health care systems in case of unforeseeable events, e.g., the COVID pandemic as well as trends in prehabilitation, time from diagnosis to surgery (time to surgery, (TTS)) has become a research issue in malignancies. Thus, we investigated whether TTS is associated with oncological outcome in HCC patients undergoing surgery. METHODS A monocentric cohort of 217 patients undergoing liver resection for HCC between 2009 and 2021 was analyzed. Individuals were grouped according to TTS and compared regarding clinical characteristics. Overall survival (OS) and recurrence-free survival (RFS) was compared using Kaplan-Meier analysis and investigated by univariate and multivariable Cox regressions. RESULTS TTS was not associated with OS (p=0.126) or RFS (p=0.761) of the study cohort in univariate analysis. In multivariable analysis age (p=0.028), ASA (p=0.027), INR (0.016), number of HCC nodules (p=0.026), microvascular invasion (MVI; p<0.001), and postoperative complications (p<0.001) were associated with OS and INR (p=0.005), and number of HCC nodules (p<0.001) and MVI (p<0.001) were associated with RFS. A comparative analysis of TTS subgroups was conducted (group 1, ≤30 days, n=55; group 2, 31-60 days, n=79; group 3, 61-90 days, n=45; group 4, >90 days, n=38). Here, the median OS were 62, 41, 38, and 40 months (p=0.602 log rank) and median RFS were 21, 26, 26, and 25 months (p=0.994 log rank). No statistical difference regarding oncological risk factors were observed between these groups. CONCLUSION TTS is not associated with earlier tumor recurrence or reduced overall survival in surgically treated HCC patients.
Collapse
Affiliation(s)
- Carlos Constantin Otto
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Guanwu Wang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Anna Mantas
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Daniel Heise
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Philipp Bruners
- Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Lara Rosaline Heij
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Institute of Pathology, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| |
Collapse
|
|
11
|
Shang W, Chang X, Xu Y, Dong B. A Novel Risk-Predicted Nomogram for Perioperative Ischemic Complications of Endovascular Treatment Among Ruptured Anterior Communicating Artery Aneurysms. World Neurosurg 2023; 173:e391-e400. [PMID: 36803690 DOI: 10.1016/j.wneu.2023.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To establish and validate a risk prediction model for perioperative ischemic complication (PIC) of endovascular treatment for ruptured anterior communicating artery aneurysms (ACoAAs). METHODS The general clinical and morphologic data, operation schemes, and treatment outcomes of patients with ruptured ACoAAs treated with endovascular treatment in our center from January 2010 to January 2021 were retrospectively analyzed and assigned to primary (359 patients) and validation (67 patients) cohorts. A risk-predicted nomogram for PIC was developed through multivariate logistic regression analysis in the primary cohort. The discrimination ability, calibration accuracy, and clinical usefulness of the established PIC prediction model were evaluated and verified based on the receiver operating characteristic curves, calibration curves, and decision curve analysis in the primary and external validation cohorts, respectively. RESULTS A total of 426 patients were included, 47 of whom had PIC. The multivariate logistic regression analysis showed that hypertension, Fisher grade, A1 conformation, use of stent-assisted coiling, and aneurysm orientation were independent risk factors for PIC. Then, we developed a simple and easy-to-use nomogram to predict PIC. This nomogram has a good diagnostic performance (area under the curve, 0.773; 95% confidence interval, 0.685-0.862) and calibration accuracy; we then further validated this nomogram by external validation cohort and showed an excellent diagnostic performance and calibration accuracy. Besides, the decision curve analysis confirmed the clinical usefulness of the nomogram. CONCLUSIONS A history of hypertension, high preoperative Fisher grade, complete A1 conformation, use of stent-assisted coiling, and aneurysm orientation (pointing upward) are risk factors for PIC for ruptured ACoAAs. This novel nomogram might serve as a potential early warning sign of PIC for ruptured ACoAAs.
Collapse
Affiliation(s)
- Wei Shang
- Dalian Medical University, Dalian, Liaoning Province, China
| | - Xiaoting Chang
- Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yousong Xu
- Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bin Dong
- Dalian Medical University, Dalian, Liaoning Province, China.
| |
Collapse
|
|
12
|
Carr BI, Guerra V. Serum Inflammation Parameters and Survival in Hepatocellular Carcinoma Patients: Importance of Albumin and Gamma-Glutamyltranspeptidase. Oncology 2023; 101:313-320. [PMID: 36878197 PMCID: PMC10238618 DOI: 10.1159/000527650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Many single and combination blood tests that reflect local or systemic inflammation have been shown to be useful prognosticators in patients with a variety of tumor types. To try to clarify, this issue in patients with nonsurgically treatable hepatocellular carcinoma, multiple serum parameters were evaluated for their relationship to survival. METHODS A prospectively collected database was interrogated of 487 patients with known hepatocellular carcinoma and documented survival and having all the inflammation parameters of interest in this study, together with baseline tumor characteristics from CT scans. Serum parameters included NLR, PLR, CRP, ESR, albumin, and GGT. RESULTS All the parameters had significant hazard ratios on Cox regression model. Combination double parameters with hazard ratios >2.0 were: ESR plus GGT, albumin plus GGT, albumin plus ESR. The triplet combination of albumin plus GGT plus ESR had a hazard ratio of 6.33. Using Harrell's concordance index (C-index), the highest inflammation-based 2-parameter prognostic score was for albumin plus GGT. When clinical characteristics of patients with high values for albumin plus low values for GGT were compared to low values for albumin plus high values for GGT (worse prognosis), statistically significant differences were found for tumor size, tumor focality, macroscopic portal vein invasion, and serum alpha-fetoprotein levels. Addition of ESR did not provide additional tumor information. CONCLUSION The combination of serum albumin plus GGT levels was the most prognostically useful among the inflammation parameters that were tested, and reflected significant differences in tumor aggressiveness characteristics.
Collapse
Affiliation(s)
- Brian I. Carr
- Liver Transplant Institute, Inonu University Faculty of Medicine, 44280, Malatya, Turkey
| | - Vito Guerra
- National Institute of Gastroenterology, S. de Bellis Research Hospital, Bari, Italy
| |
Collapse
|
|
13
|
Feng J, Wang L, Yang X, Chen Q, Cheng X. Prediction of pathologic complete response prediction in patients with locally advanced esophageal squamous cell carcinoma treated with neoadjuvant immunochemotherapy: A real-world study. BIOMOLECULES AND BIOMEDICINE 2023; 23:153-160. [PMID: 35880397 PMCID: PMC9901900 DOI: 10.17305/bjbms.2022.7696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/17/2022] [Indexed: 02/08/2023]
Abstract
As an emerging hotspot for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC), neoadjuvant immunochemotherapy (nICT) is safe and feasible. Pathological complete response (pCR) is considered to be an important therapeutic effect of neoadjuvant therapy. However, few studies have explored pCR predictors for nICT in LA-ESCC. The purpose of this study was to predict pCR after nICT in LA-ESCC by pretreatment clinical characteristics and hematological indexes. The primary endpoint was to explore the impacts on the predictors for pCR prediction. Clinical characteristics and hematological indexes including systemic immune-inflammation index (SII), neutrophil lymphocyte ratio (NLR), lymphocyte monocyte ratio (LMR), prognostic nutritional index (PNI) and platelet lymphocyte ratio (PLR) were conducted. A total of 150 LA-ESCC patients were enrolled in the current study. There were 14 (9.3%) female and 136 (90.7%) male patients. Fifty-two patients achieved pCR (34.7%). A higher pCR rate was found in low-NLR group (43.7% vs. 26.6%, P=0.028) and high-LMR group (43.8% vs. 21.3%, P=0.004), respectively. Differentiation [odds ratio (OR) =0.464, 95% confidence interval (CI)=0.259-0.830, P=0.010], LMR (OR=0.309, 95% CI=0.132-0.707, P=0.007) and cTNM (OR=0.225, 95% CI=0.115-0.441, P<0.001) were independent predictors for pCR. The nomogram for pCR prediction based on LMR, differentiation and cTNM stage had good discrimination performance and calibration coordination (C-index=0.779). The results of our study are of great significance for designing therapeutic strategies. Nomogram based on LMR, differentiation and cTNM may accurately and effectively predict pCR.
Collapse
Affiliation(s)
- Jifeng Feng
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China,Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China,Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Liang Wang
- Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xun Yang
- Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qixun Chen
- Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China,Correspondence to Qixun Chen: ; Xiangdong Cheng:
| | - Xiangdong Cheng
- Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China,Correspondence to Qixun Chen: ; Xiangdong Cheng:
| |
Collapse
|
|
14
|
Feng J, Wang L, Yang X, Chen Q, Cheng X. Pathologic Complete Response Prediction to Neoadjuvant Immunotherapy Combined with Chemotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma: Real-World Evidence from Integrative Inflammatory and Nutritional Scores. J Inflamm Res 2022; 15:3783-3796. [PMID: 35832830 PMCID: PMC9271687 DOI: 10.2147/jir.s367964] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Neoadjuvant immunotherapy and chemotherapy (nICT) is an emerging hotspot that has been shown to be safe and feasible for locally advanced esophageal squamous cell carcinoma (LA-ESCC). This real-world study aimed to develop and validate a novel predictive model [integrative inflammatory and nutritional score (IINS)] in LA-ESCC patients receiving nICT to predict the pathologic complete response (pCR). Patients and Methods Patients with LA-ESCC who received nICT followed by surgery from Jun 2019 to Dec 2021 were enrolled and randomly divided into two sets (7:3). Using least absolute shrinkage and selection operator (LASSO) logistic regression analysis, the IINS was constructed in LA-ESCC patients received nICT to predict pCR. A nomogram based on IINS for pCR prediction was generated in the training cohort and verified in the validation cohort. Results Of the 285 enrolled LA-ESCC patients received nICT followed by radical resection, 84 (29.5%) patients achieved pCR. A predictive index of IINS based on 8 inflammatory and nutritional indicators was constructed using the LASSO model. According to the cutoff finder, patients were then stratified into two groups (high and low). The pCR rates were significantly higher in high-IINS group than in low-IINS group in both the training cohort (44.7% vs 17.4%, P < 0.001) and validation cohort (50.0% vs 13.3%, P < 0.001). The IINS [odds ratio (OR) = 0.237, 95% confidence interval (CI) = 0.117–0.480, P < 0.001] was an independent significant predictor for pCR in multivariate logistic analyses. The IINS-based nomogram showed an excellent discrimination for pCR prediction (C-indexes = 0.759 and 0.812 for training and validation cohorts, respectively). Conclusion Pretreatment IINS is an independent predictor for pCR in LA-ESCC patients who are treated with nICT. To our knowledge, the IINS-based nomogram is the first model for pCR prediction and may serve as a simple and potential risk stratification model in LA-ESCC who are treated with nICT.
Collapse
Affiliation(s)
- Jifeng Feng
- Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.,Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.,The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Liang Wang
- Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Xun Yang
- Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Qixun Chen
- Department of Thoracic Oncological Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Xiangdong Cheng
- Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| |
Collapse
|
|
15
|
[Establishment of a predictive nomogram model for predicting the death of very preterm infants during hospitalization]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:654-661. [PMID: 35762432 PMCID: PMC9250408 DOI: 10.7499/j.issn.1008-8830.2202027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To establish a nomogram model for predicting the risk of death of very preterm infants during hospitalization. METHODS A retrospective analysis was performed on the medical data of 1 714 very preterm infants who were admitted to the Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University, from January 2015 to December 2019. These infants were randomly divided into a training cohort (1 179 infants) and a validation cohort (535 infants) at a ratio of 7∶3. The logistic regression analysis was used to screen out independent predictive factors and establish a nomogram model, and the feasibility of the nomogram model was assessed by the validation set. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to assess the discriminatory ability, accuracy, and clinical applicability of the model. RESULTS Among the 1 714 very preterm infants, 260 died and 1 454 survived during hospitalization. By the multivariate logistic regression analysis of the training set, 8 variables including gestational age <28 weeks, birth weight <1 000 g, severe asphyxia, severe intraventricular hemorrhage (IVH), grade III-IV respiratory distress syndrome (RDS), and sepsis, cesarean section, and use of prenatal glucocorticoids were selected and a nomogram model for predicting the risk of death during hospitalization was established. In the training cohort, the nomogram model had an AUC of 0.790 (95%CI: 0.751-0.828) in predicting the death of very preterm infants during hospitalization, while in the validation cohort, it had an AUC of 0.808 (95%CI: 0.754-0.861). The Hosmer-Lemeshow goodness-of-fit test showed a good fit (P>0.05). DCA results showed a high net benefit of clinical intervention in very preterm infants when the threshold probability was 10%-60% for the training cohort and 10%-70% for the validation cohort. CONCLUSIONS A nomogram model for predicting the risk of death during hospitalization has been established and validated in very preterm infants, which can help clinicians predict the probability of death during hospitalization in these infants.
Collapse
|
|
16
|
Feng J, Wang L, Wang L, Yang X, Lou G. Clinical significance of Osaka prognostic score based on nutritional and inflammatory status in patients with esophageal squamous cell carcinoma. BMC Cancer 2022; 22:284. [PMID: 35300627 PMCID: PMC8928659 DOI: 10.1186/s12885-022-09406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background It has been reported that Osaka prognostic score (OPS), based on C-reactive protein (CRP), total lymphocyte counts (TLC) and albumin (ALB), was relevant to prognosis in colorectal cancer. However, the role of OPS regarding prognosis in patients with esophageal squamous cell carcinoma (ESCC) has not been reported. The current study aimed to explore the clinical outcome of OPS and establish and validate a nomogram for survival prediction in ESCC after radical resection. Methods This retrospective study included 395 consecutive ESCC patients with radical resection. Then patients were randomly divided into two cohorts: training cohort (276) and validation cohort (119). The OPS, based on TLC, CRP and ALB, was constructed to verify the prognostic value by Kaplan-Meier curves and Cox analyses. A nomogram model for prognosis prediction of cancer-specific survival (CSS) was developed and validated in two cohorts. Results Kaplan-Meier curves regarding the 5-year CSS for the groups of OPS 0, 1, 2 and 3 were 55.3, 30.6, 17.3 and 6.7% (P < 0.001) in the training cohort and 52.6, 33.3, 15.8 and 9.1% (P < 0.001) in the validation cohort, respectively. Then the OPS score in multivariate Cox analysis was confirmed to be a useful independent score. Finally, a predictive OPS-based nomogram was developed and validated with a C-index of 0.68 in the training cohort and 0.67 in the validation cohort, respectively. All above results indicated that the OPS-based nomogram can accurately and effectively predict survival in ESCC after radical resection. Conclusion The OPS serves as a novel, convenient and effective predictor in ESCC after radical resection. The OPS-based nomogram has potential independent prognostic value, which can accurately and effectively predict individual CSS in ESCC after radical resection.
Collapse
Affiliation(s)
- Jifeng Feng
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Lifen Wang
- Department of Operating Theatre, Nursing Department, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Liang Wang
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Xun Yang
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
| | - Guangyuan Lou
- Department of Medical Oncology, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
| |
Collapse
|
|
17
|
Zeng J, Zeng J, Liu J, Zeng J. Development of pre and post-operative nomograms to predict individual survival for ideal liver resection candidates with hepatocellular carcinoma. Liver Int 2021; 41:2974-2985. [PMID: 34416088 DOI: 10.1111/liv.15042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Liver resection is currently the only recommended treatment option for solitary hepatocellular carcinoma (HCC) at an early stage, with well-preserved liver function and no clinically significant portal hypertension. However, this population is heterogeneous, rendering it crucial to develop a risk stratification tool. Therefore, this study aimed to develop preoperative and post-operative nomograms to predict individual survival and stratify patient risk in the ideal candidates for liver resection. METHODS A total of 1405 ideal liver resection candidates were recruited. Independent risk factors were identified by Cox regression model and used to establish two ideal liver resection for overall survival (IROS) nomograms in training cohort. Model performance was assessed by discrimination, calibration, clinical usefulness. The two model also compared with six other prognostic nomograms and six other staging systems. RESULTS Multivariate COX analysis revealed that ALP, ln(AFP), NrLR, PNI, ln(tumor size), microvascular invasion, Edmondson-Steiner grade and tumour capsular were the independent risk factors associated with mortality. 5 preoperative variables were incorporated to construct IROS-pre model; All eight available variables were used to draw IROS-post model. The C-index, K-index, time-dependent AUC and DCA of the two models showed significantly better predictive performances than other models. The models could stratify patients into three different risk groups. The web-based tools are convenient for clinical practice. CONCLUSIONS These two nomograms were developed to estimate survival probability and stratify three strata with significantly different outcomes, outperforming other models in training and validation cohorts, as well as different subgroups. Both IROS models will help guide individualized follow-up.
Collapse
Affiliation(s)
- Jinshu Zeng
- Department of Ultrasonic Medical, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, China
| | - Jianxing Zeng
- The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jingfeng Liu
- The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jinhua Zeng
- The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
|
18
|
Mao S, Yu X, Shan Y, Fan R, Wu S, Lu C. Albumin-Bilirubin (ALBI) and Monocyte to Lymphocyte Ratio (MLR)-Based Nomogram Model to Predict Tumor Recurrence of AFP-Negative Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1355-1365. [PMID: 34805014 PMCID: PMC8594894 DOI: 10.2147/jhc.s339707] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/30/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose In this study, we aimed to develop a novel liver function and inflammatory markers-based nomogram to predict recurrence-free survival (RFS) for AFP-negative (<20 ng/mL) HCC patients after curative resection. Patients and Methods A total of 166 pathologically confirmed AFP-negative HCC patients were included at the Ningbo Medical Center Lihuili Hospital. A LASSO regression analysis was used for data dimensionality reduction and element selection. Univariate and multivariate Cox regression analyses were performed to identify the independent risk factors relevant to RFS. Finally, clinical nomogram prediction model for RFS of HCC was established. Nomogram performance was assessed via internal validation and calibration curve statistics. Receiver operating characteristic (ROC) and decision curve analysis (DCA) curve were used to validate the performance and clinical utility of the nomogram. Results Multivariate Cox regression analysis indicated that ALBI grade (hazard ratio, [HR] = 2.624, 95% confidence interval [CI]: 1.391-4.949, P = 0.003), INR (HR = 2.605, 95% CI: 1.061-6.396, P = 0.037), MLR (HR = 1.769, 95% CI: 1.073-2.915, P = 0.025) and MVI (HR = 4.726, 95% CI: 2.365-9.444, P < 0.001) were independent prognostic factors of RFS. Nomogram with independent factors was established and achieved a better concordance index of 0.753 (95% CI: 0.672-0.834) for predicting RFS. The ROC found that the area under curve (AUC) was consistent with the C-index and the sensitivity was 85.4%. The risk score calculated by nomogram could divide AFP-negative HCC patients into high-, moderate- and low-risk groups (P < 0.05). DCA analysis revealed that the nomogram could augment net benefits and exhibited a wider range of threshold probabilities by the risk stratification than the AJCC T and BCLC stage in the prediction of AFP-negative HCC recurrence. Conclusion The ALBI grade- and MLR-based nomogram prognostic model for RFS showed high predictive accuracy in AFP-negative HCC patients after surgical resection.
Collapse
Affiliation(s)
- Shuqi Mao
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Xi Yu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Yuying Shan
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Rui Fan
- Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Shengdong Wu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Caide Lu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China
| |
Collapse
|
|
19
|
Zang Y, Long P, Wang M, Huang S, Chen C. Development and validation of prognostic nomograms in patients with hepatocellular carcinoma: a population-based study. Future Oncol 2021; 17:5053-5066. [PMID: 34676798 DOI: 10.2217/fon-2020-1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. The existing staging system has a limited budget capacity for HCC recurrence. The authors aimed to establish and verify two nomogram models to predict disease-free survival (DFS) and overall survival (OS) in patients with HCC. Methods: Patients diagnosed with HCC between August 2011 and March 2016 were recruited. Data were randomly divided into a training cohort and a validation cohort. Based on univariate and multivariate Cox regression analysis, independent risk factors for DFS and OS were identified, and two nomogram models were established to predict patient survival. Results: Sex, tumor size, Barcelona Clinic Liver Cancer (BCLC) stage, tumor capsule, macrovascular invasion, AST-to-platelet ratio index, AST-to-lymphocyte ratio index, neutrophil-lymphocyte ratio and alpha-fetoprotein (AFP) were used to build the nomogram for DFS, while age, tumor size, BCLC stage, tumor capsule, macrovascular invasion, systemic immune-inflammation index, AST, total bilirubin and AFP were used to build the nomogram for OS. Calibration curves showed good agreement between the nomogram prediction and actual observation. C-indices in both nomograms were significantly higher than BCLC. Conclusion: The two nomograms improved the accuracy of individualized prediction of DFS and OS, which may help doctors screen patients with a high risk of recurrence to formulate individualized treatment plans.
Collapse
Affiliation(s)
- Youya Zang
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Peiyun Long
- Department of Oncology, Yue Bei People's Hospital, Shaoguang, Guangdong 512000, China
| | - Ming Wang
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Shan Huang
- Department of Oncological Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Chuang Chen
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| |
Collapse
|
|
20
|
Wu W, Wang Q, Han D, Li J, Nie Y, Guo D, Yang L, Tao K, Zhang X, Dou K. Prognostic value of preoperative inflammatory markers in patients with hepatocellular carcinoma who underwent curative resection. Cancer Cell Int 2021; 21:500. [PMID: 34535132 PMCID: PMC8447627 DOI: 10.1186/s12935-021-02204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/07/2021] [Indexed: 02/08/2023] Open
Abstract
Background The prognosis of hepatocellular carcinoma (HCC) is not optimistic. Our study focused on present inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-lymphocyte ratio (ALR) and fibrinogen-to-albumin ratio (FAR), and explored their optimal combination for the prognosis of HCC after resection. Methods A total of 347 HCC patients who underwent curative resection were enrolled. The optimal cutoff values of the inflammatory markers were calculated using receiver operating characteristic (ROC) curve analysis, and used to divide patients into two groups whose differences were compared by Kaplan–Meier analysis. Cox univariate and multivariate analyses were used to analyze the independent prognostic inflammatory markers. The χ2 test was chosen to determine the relationship between independent prognostic inflammatory markers and clinicopathological features. We created combined scoring models and evaluated them by Cox univariate and multivariate methods. The concordance index (C-index), Akaike information criterion (AIC) and likelihood ratio were calculated to compare the models. The selected optimal inflammatory markers and their combinations were tested in different stages of HCC by Kaplan–Meier analysis. Results The ALR and GPR were independent prognostic factors for disease-free survival (DFS); the ALR, PLR, and GPR were independent prognostic factors for overall survival (OS). The proposed GPR and ALR-GPR-PLR score models were independent predictors for DFS and OS, respectively. Conclusion The preoperative GPR and ALR-GPR-PLR score models were independent predictors for DFS and OS, respectively, and performed well in stratifying patients with HCC. The higher the score in the model was, the worse the prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02204-3.
Collapse
Affiliation(s)
- Wenlong Wu
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Quancheng Wang
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Dandan Han
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Jianhui Li
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Ye Nie
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Dongnan Guo
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Long Yang
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Kaishan Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Xuan Zhang
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Kefeng Dou
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| |
Collapse
|
|
21
|
Yang D, Wu H, Nong W, Zheng M, Li A, Wang Y, Li M, Chen Q, Yuan S, Yu J, Liao W. A new model based on gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts prognostic outcome after curative resection of solitary hepatocellular carcinoma. Clin Res Hepatol Gastroenterol 2021; 45:101509. [PMID: 33744828 DOI: 10.1016/j.clinre.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study intends to explore the potential clinical value of gamma-glutamyl transpeptidase to platelet ratio (GPR) and the new multi-factor scoring model for recurrence and prognosis prediction in solitary HCC patients who received radical resection. METHODS This study retrospectively analyzed 295 HCC patients after curative resection. According to the Receiver Operating Characteristic (ROC) curve, the optimal cut-off value of GPR for predicting prognosis of HCC after resection was determined. The Kaplan Meier method and Cox regression analysis were performed to assess the important potential factors in the prognosis of HCC and determine the independent risk factors. Assign a value to each independent risk factor and establish a new scoring model. Then, using GPR and the new scoring model to evaluate overall survival (OS) and postoperative recurrence probability. RESULTS When GPR's cut-off value was selected as 0.30, its predictive efficiency for postoperative prognosis was more favorable than those of other cut-off values (0.76, 0.84 and 0.94). GPR, tumor size, microvascular invasion and neutrophil to lymphocyte ratio (NLR) were identified as independent prognostic predictors. Using these variables, a novel prognostic scoring model was devised and established to identify different levels of risk: high, intermediate and low risk groups. We found that patients with high GPR level and of high risk group would have a poorer OS and a higher recurrence rate after radical resection. CONCLUSIONS GPR may serve as a promising predictor for postoperative prognosis and recurrence probability of HCC, and the new prognostic scoring model may be available for postoperative management among HCC patients.
Collapse
Affiliation(s)
- Dongye Yang
- Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, PR China; Section of Academic Affairs of Guilin Medical University, Guilin, 541001, Guangxi, PR China
| | - Hongliang Wu
- Otolaryngology Head and Neck Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, PR China
| | - Wenxiong Nong
- Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, PR China
| | - Min Zheng
- Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, PR China
| | - Angui Li
- Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, PR China
| | - Yang Wang
- Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, PR China
| | - Mu Li
- Department of Cardiothoracic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, PR China
| | - Qian Chen
- Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, PR China
| | - Shengguang Yuan
- Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, PR China.
| | - Junxiong Yu
- Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, PR China.
| | - Weijia Liao
- Laboratory of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, PR China.
| |
Collapse
|
|
22
|
Feng JF, Zhao JM, Chen S, Chen QX. Naples Prognostic Score: A Novel Prognostic Score in Predicting Cancer-Specific Survival in Patients With Resected Esophageal Squamous Cell Carcinoma. Front Oncol 2021; 11:652537. [PMID: 34123805 PMCID: PMC8193841 DOI: 10.3389/fonc.2021.652537] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background Naples prognostic score (NPS) serves as a new prognostic index based on nutritional and inflammatory status in recent years. The aim of the current study was to explore the prognostic effect of NPS and to develop and validate a reliable nomogram based on NPS for individual cancer-specific survival (CSS) prediction in patients with resected ESCC without neoadjuvant therapy. Methods The clinical data for 287 (Jan. 2010 to Jun. 2012, Training sets) and 118 (Jan. 2015 to Dec 2015, Validation sets) consecutive resected ESCC cases were retrospectively analyzed. Two NPS models based on the different cut-off values of parameters were compared. Cut-off values in model 1 were derived from previous published studies, while cut-off values in model 2 were obtained in this study based on receiver operating characteristic (ROC) curves. The relationships between NPS and clinical characteristics and CSS were analyzed. The prediction model of nomogram was developed with independent prognostic factors in the training sets and was validated in the validation sets. Results The 5-year CSS for NPS 0, 1 and 2 were 61.9%, 34.6% and 13.4% in model 1 and 75.0%, 42.4% and 13.0% in model 2, respectively (P<0.001). Subgroup analyses revealed that NPS was also significantly associated with CSS in both model 1 and model 2 in different TNM stages. Multivariate analyses revealed that NPS was an independent prognostic marker regarding CSS in patients with resected ESCC (P<0.001). A predictive nomogram based on NPS was established and validated. The C-indexes of the nomogram in the training sets and validation sets were 0.68 and 0.72 in model 1 and 0.69 and 0.73 in model 2, respectively. These results confirmed that NPS-based nomogram was a more accurate and effective tool for predicting CSS in patients with resected ESCC. Conclusion The current study confirmed that NPS was still a useful independent prognostic score in patients with resected ESCC. The NPS-based nomogram was successfully developed and validated, which may contribute to individual CSS prediction for resected ESCC patients.
Collapse
Affiliation(s)
- Ji-Feng Feng
- Department of Thoracic Oncological Surgery, Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jian-Ming Zhao
- Department of Thoracic Surgery, Jinhua Guangfu Hospital, Jinghua, China
| | - Sheng Chen
- Department of Thoracic Oncological Surgery, Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qi-Xun Chen
- Department of Thoracic Oncological Surgery, Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| |
Collapse
|
|
23
|
Xu J, Weng J, Yang J, Shi X, Hou R, Zhou X, Zhou Z, Wang Z, Chen C. Development and validation of a nomogram to predict the mortality risk in elderly patients with ARF. PeerJ 2021; 9:e11016. [PMID: 33854838 PMCID: PMC7953875 DOI: 10.7717/peerj.11016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Acute respiratory failure (ARF) is a life-threatening complication in elderly patients. We developed a nomogram model to explore the risk factors of prognosis and the short-term mortality in elderly patients with ARF. Methods A total of 759 patients from MIMIC-III database were categorized into the training set and 673 patients from our hospital were categorized into the validation set. Demographical, laboratory variables, SOFA score and APS-III score were collected within the first 24 h after the ICU admission. A 30-day follow-up was performed for all patients. Results Multivariate logistic regression analysis showed that the heart rate, respiratoryrate, systolic pressure, SPO2, albumin and 24 h urine output were independent prognostic factors for 30-day mortality in ARF patients. A nomogram was established based on above independent prognostic factors. This nomogram had a C-index of 0.741 (95% CI [0.7058-0.7766]), and the C-index was 0.687 (95% CI [0.6458-0.7272]) in the validation set. The calibration curves both in training and validation set were close to the ideal model. The SOFA had a C-index of 0.653 and the APS-III had a C-index of 0.707 in predicting 30-day mortality. Conclusion Our nomogram performed better than APS-III and SOFA scores and should be useful as decision support on the prediction of mortality risk in elderly patients with ARF.
Collapse
Affiliation(s)
- Junnan Xu
- Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China
| | - Jie Weng
- Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China
| | - Jingwen Yang
- Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, China
| | - Xuan Shi
- Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, China
| | - Ruonan Hou
- Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China
| | - Xiaoming Zhou
- Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China
| | - Zhiliang Zhou
- Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China
| | - Zhiyi Wang
- Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China, China.,Center for Health Assessment, Wenzhou Medical University, Wenzhou, China, China
| | - Chan Chen
- Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, China
| |
Collapse
|
|
24
|
Lin K, Huang Q, Wang L, Zeng J, Ding Z, Liu H, Fu J, Guo P, Chen Z, Zeng Y, Zhou W, Liu J. Pre- and Postoperative Models for Prediction of Recurrence in Non-B, Non-C Hepatocellular Carcinoma. Front Oncol 2021; 11:612588. [PMID: 33680963 PMCID: PMC7930483 DOI: 10.3389/fonc.2021.612588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims The incidence of non-B, non-C hepatocellular carcinoma (NBNC-HCC) is increasing. Like in hepatitis B virus (HBC)/HCV-associated HCC, treatment of NBNC-HCC after resection is challenging due to its high recurrence rate. However, few studies on the recurrence of NBNC-HCC have been published in the past decades. Hence, we aimed to investigate the risk factors for recurrence of NBNC-HCC and construct pre- and postoperative prognostic models for predicting recurrence in these patients who underwent curative resection. Methods We retrospectively analyzed 608 patients who underwent liver resection for NBNC-HCC. A multivariate Cox proportional hazard regression analysis was conducted to identify the independent risk factors of recurrence, based on which the prediction nomogram models were constructed and validated. The predictive performance of the models was assessed using the concordance index, time-dependent receiver operating characteristic curve, prediction error cure, and calibration curve. To facilitate clinical use, we stratified the patients into three distinct risk groups based on the score of the models. The cutoff scores of the models were determined by a survival tree analysis. Results Multivariable analysis identified neutrophil-to-lymphocyte ratio, alpha fetoprotein, tumor number, and tumor diameter as independent preoperative risk factors for recurrence. In addition to these variables, microvascular invasion was an independent postoperative risk factor for recurrence. The pre- and postoperative nomograms were constructed based on these variables. The C-index of the pre- and postoperative nomograms was 0.689 and 0.702 in the training cohort, 0.682 and 0.688 in the validation cohort, respectively, which were both higher than those of the conventional Barcelona Clinic Liver Cancer (BCLC) and 8th edition of the American Joint Committee on Cancer (AJCC8th) staging systems. In addition, the pre- and postoperative nomograms could also re-stratify patients with BCLC stage 0/A or AJCC8th stage IA/IB/II into distinct risk groups. Conclusions We constructed pre- and postoperative prognostic models for predicting recurrence in patients with NBNC-HCC who underwent curative resection. They can play a supplementary role to the traditional staging system.
Collapse
Affiliation(s)
- Kongying Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Qizhen Huang
- Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Lei Wang
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jianxing Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Zongren Ding
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Hongzhi Liu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jun Fu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Pengfei Guo
- The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Zhenwei Chen
- The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yongyi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jingfeng Liu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| |
Collapse
|
|
25
|
Akkiz H, Carr BI, Bag HG, Karaoğullarından Ü, Yalçın K, Ekin N, Özakyol A, Altıntaş E, Balaban HY, Şimşek H, Uyanıkoğlu A, Balkan A, Kuran S, Üsküdar O, Ülger Y, Güney B, Delik A. Serum levels of inflammatory markers CRP, ESR and albumin in relation to survival for patients with hepatocellular carcinoma. Int J Clin Pract 2021; 75:e13593. [PMID: 32583494 PMCID: PMC7758189 DOI: 10.1111/ijcp.13593] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Hepatocellular carcinoma is associated with several chronic inflammatory conditions. It is increasingly understood that the inflammation may be part of the carcinogenic process and prognostically important. OBJECTIVE To evaluate the serum levels of three inflammation markers in relation to survival in HCC patients. METHODS We retrospectively examined the serum levels of CRP, albumin and ESR, both singly and in combination, in relation to patient survival. RESULTS Survival worsened with increase in CRP or ESR or decrease in albumin levels. Combinations of CRP plus albumin or CRP plus ESR were associated with an even greater range of survival (3-fold), together with significant differences in maximum tumor diameter (PVT) and percent of patients with portal vein thrombosis (PVT). The triplet of CRP plus albumin plus ESR was associated with a sevenfold difference in survival, comparing low vs high parameter levels. These significant differences were found in patients with small or large tumors. CONCLUSIONS Combinations of CRP with albumin or ESR or all three parameters together significantly related to differences in survival and to differences in MTD and percent PVT, in patients with both small and large size HCCs.
Collapse
|
|
26
|
Dai T, Deng M, Ye L, Lin G, Liu R, Deng Y, Li R, Liu W, Li H, Yang Y, Chen G, Wang G. Nomograms based on clinicopathological factors and inflammatory indicators for prediction of early and late recurrence of hepatocellular carcinoma after surgical resection for patients with chronic hepatitis B. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:12. [PMID: 33553305 PMCID: PMC7859768 DOI: 10.21037/atm-20-1353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies have focused on the prognostic values of inflammation-related factors for different phases of recurrence in hepatocellular carcinoma (HCC). We aimed to identify the different risk factors for overall, early, and late recurrence, and to establish nomograms based on inflammation-related parameters for predicting the risks of recurrence in a group of HCC patients undergoing hepatectomy. METHODS We retrospectively enrolled 383 HCC patients with chronic hepatitis B (CHB) who underwent hepatectomy. Univariate and multivariate Cox analyses were conducted to identify independent risk factors for recurrence. Nomograms for overall, early, and late recurrence-free survival (RFS) were established. The discrimination and calibration abilities of the nomograms were evaluated by concordance indexes (C-index), calibration plots, and Kaplan-Meier curves. Finally, receiver operating characteristic (ROC) curves were used to compare the derived nomograms with other existing models. RESULTS Fibrinogen, lymphocyte-to-monocyte ratio, and S-index inflammation-related factors were independently related to overall and early RFS, but only the S-index correlated with late recurrence. Nomograms with tumor number, diameter, and pathological differentiation for overall and early RFS were established, while nomogram for late recurrence was constructed with tumor number and Child-Pugh grade. The C-indexes for overall, early, and late RFS were 0.679, 0.677, and 0.728, respectively. The calibration plots fit well. The nomograms showed superior discrimination capacities and better performance prediction with larger areas under the curve for recurrence. CONCLUSIONS The developed nomograms that integrated inflammation-related factors showed high predictive accuracy for overall, early, and late recurrence in HCC patients with CHB after hepatectomy.
Collapse
Affiliation(s)
- Tianxing Dai
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Mingbin Deng
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Linsen Ye
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guozhen Lin
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqiang Liu
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yinan Deng
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Organ Transplantation Institute of Sun Yat-Sen University, Guangzhou, China
| | - Rong Li
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Liu
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hua Li
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Organ Transplantation Institute of Sun Yat-Sen University, Guangzhou, China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Organ Transplantation Institute of Sun Yat-Sen University, Guangzhou, China
| | - Guihua Chen
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Organ Transplantation Institute of Sun Yat-Sen University, Guangzhou, China
| | - Guoying Wang
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Organ Transplantation Institute of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
|
27
|
Xu W, Liu F, Shen X, Li R. Prognostic Nomograms for Patients with Hepatocellular Carcinoma After Curative Hepatectomy, with a Focus on Recurrence Timing and Post-Recurrence Management. J Hepatocell Carcinoma 2020; 7:233-256. [PMID: 33154956 PMCID: PMC7606947 DOI: 10.2147/jhc.s271498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022] Open
Abstract
Background Prognoses of patients with hepatocellular carcinoma (HCC) after curative hepatectomy remain unsatisfactory because of the high incidence of postoperative recurrence. Published predictive systems focus on pre-resection oncological characteristics, ignoring post-recurrence factors. Purpose This study aimed to develop prognostic nomograms for 3- and 5-year overall survival (OS) of patients with HCC after curative hepatectomy, focusing on potentially influential post-recurrence factors. Patients and Methods Clinicopathological and postoperative follow-up data were extracted from 494 patients with HCC who underwent curative hepatectomy between January 2012 and June 2019. Early recurrence (ER) and late recurrence (LR) were defined as recurrence at ≤2 and >2 years, respectively, after curative hepatectomy. Nomograms for the prediction of 3- and 5-year OS were established based on multivariate analysis. The areas under time-dependent receiver operating characteristic curves (AUCs) for the nomograms were calculated independently to verify predictive accuracy. The nomograms were internally validated based on 2000 bootstrap resampling of 75% of the original data. Results In total, 494 patients with HCC who underwent curative hepatectomy met the eligibility criteria. Cox proportional hazard regression analysis identified factors potentially influencing 3- and 5-year OS. Multivariate analysis indicated that patient age, Hong Kong Liver Cancer stage, γ-glutamyl transferase (γ-GGT) level, METAVIR inflammation activity grade, ER and post-recurrence treatment modality were influencing factors for 3-year OS (AUC, 0.891; 95% CI, 0.8364-0.9447). γ-GGT > 60 U/L, hepatectomy extent, LR and post-recurrence treatment modality were influencing factors for 5-year OS (AUC, 0.864; 95% CI, 0.8041-0.9237). Calibration plots showed satisfactory concordance between the predicted and actual observation cohorts. Conclusion We propose new prognostic nomograms for OS prediction with a focus on the differentiation of recurrence timing and post-recurrence management. These nomograms overcome the shortcomings of previous predictive nomograms and significantly improve predictive accuracy.
Collapse
Affiliation(s)
- Wei Xu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Fei Liu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Xianbo Shen
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Ruineng Li
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| |
Collapse
|
|
28
|
Development and validation of a prognostic model based on the albumin-to-fibrinogen ratio (AFR) and gamma-glutamyl transpeptidase-to-platelet ratio (GPR) in hepatocellular carcinoma patients. Clin Chim Acta 2020; 511:107-116. [PMID: 33035501 DOI: 10.1016/j.cca.2020.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/12/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our study aimed to formulate a nomogram based on the albumin-to-fibrinogen ratio (AFR) and gamma-glutamyl transpeptidase-to-platelet ratio (GPR) to predict the prognosis of hepatocellular carcinoma (HCC) patients after curative hepatic resection. METHODS A total of 825 HCC patients who underwent curative resection from 2008 to 2015 in West China Hospital of Sichuan University were divided into a training (n = 616) and a validation (n = 209) cohort. The AFR-GPR risk stratification was generated and confirmed by multivariate analysis. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were constructed. The concordance indexes (C-index), calibration, and decision curve analysis (DCA) were used to assess the predictive performance and clinical benefits of the nomograms. RESULTS The AFR-GPR risk stratification was the independent prognostic factor for RFS (p = 0.044) and OS (p = 0.002) in the training cohort and integrated into the construction of nomograms. The C-indexes of RFS and OS in the training and validation cohorts were 0.654 (95%CI: 0.626-0.681)/0.699 (95%CI: 0.654-0.743) and 0.699 (95%CI: 0.668-0.729)/0.736 (95%CI: 0.684-0.787), respectively. Furthermore, the C-indexes of the nomograms were greater than those of other conventional staging systems. CONCLUSION Our nomograms based on the AFR-GPR risk stratification presented the more reliable, convenient and accurate prognostic predictions for HCC patients.
Collapse
|
|
29
|
Zeng J, Zeng J, Wu Q, Lin K, Zeng J, Guo P, Zhou W, Liu J. Novel inflammation-based prognostic nomograms for individualized prediction in hepatocellular carcinoma after radical resection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1061. [PMID: 33145280 PMCID: PMC7575986 DOI: 10.21037/atm-20-1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background The prognosis for patients with hepatocellular carcinoma (HCC) after liver resection ranges widely and is unsatisfactory. This study aimed to develop two novel nomograms that combined tumor characteristics and inflammation-related indexes to predict overall survival (OS) and recurrence-free survival (RFS). Methods In total, 3,071 patients who underwent radical resection were recruited. Independent risk factors were identified by Cox regression analysis and used to conduct prognostic nomograms. The C-index, time-dependent areas under the receiver operating characteristic curve (time-dependent AUC), decision curve analysis (DCA), and calibration curves were used to assess the performance of the nomograms. Results Multivariate analysis revealed that alpha-fetoprotein (AFP), resection margin, neutrophil times γ-glutamyl transpeptidase-to-lymphocyte ratio (NrLR), platelet-to-lymphocyte ratio (PLR), γ-glutamyl transpeptidase-to-platelet ratio (GPR), tumor size, tumor number, microvascular invasion, and Edmondson-Steiner grade were the independent risk factors associated with OS. The independent risk factors associated with RFS were hepatitis, AFP, albumin-bilirubin (ALBI), NrLR, PLR, PNI, GPR, tumor size, tumor number, microvascular invasion, and Edmondson-Steiner grade. The C-index of the nomograms in the training and validation cohort were 0.71 [95% confidence interval (CI): 0.70–0.73] and 0.71 (95% CI: 0.69–0.74) for the OS, and 0.71 (95% CI: 0.70–0.73) and 0.74 (95% CI: 0.72–0.76) for RFS, respectively. The C-index, time-dependent AUC, and DCA of the nomograms showed significantly better predictive performances than those of commonly used staging systems. The models could stratify patients into three different risk groups. The web-based tools are convenient for clinical practice. Conclusions Two novel nomograms in which integrated inflammation-related indexes and accessible clinical parameters were developed to predict OS and RFS in HCC patients who underwent radical resection. Such models will help guide postoperative individualized follow-up and adjuvant therapy.
Collapse
Affiliation(s)
- Jianxing Zeng
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jinhua Zeng
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, China
| | - Qionglan Wu
- Department of Pathology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Kongying Lin
- Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jianyang Zeng
- Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Pengfei Guo
- Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jingfeng Liu
- Department of Hepatic Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.,The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, China
| |
Collapse
|
|
30
|
Luo D, Li H, Yu H, Zhang M, Hu J, Jin C, Chua M, Han B. Predictive value of preoperative and postoperative peripheral lymphocyte difference in hepatitis B virus-related hepatocellular cancer patients: Based on the analysis of dynamic nomogram. J Surg Oncol 2020; 122:1553-1568. [PMID: 32862430 DOI: 10.1002/jso.26195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammation plays an important role in the progression and prognosis of hepatocellular carcinoma (HCC). Our aim is to explore the prognostic value of preoperative and postoperative peripheral lymphocyte differences and to develop a dynamic prognosis nomogram in hepatitis B virus-related HCC patients. METHODS Important indicators related to overall survival (OS) are screened out by Cox proportional hazard models. The receiver operating characteristic curves, decision curve analysis curves, net reclassification improvement, and integrated discrimination improvement were used to evaluate the performance of the model. RESULTS Lymphocyte (L) difference was an independent risk factor. It was further verified that the performance of the nomogram was significantly improved after the L difference was incorporated into the nomogram. The nomogram generated had the area under curves of 0.779, 0.775, and 0.793 at 3, 5, and 7 years after surgery, respectively. Our nomogram models showed significantly better performance in predicting the HCC prognosis compared to other models. And online webserver and scoring system table was built based on the proposed nomogram for convenient clinical use. CONCLUSIONS It is newly found that L difference is an effective predictor of OS, and the nomogram based on this indicator can accurately predict the prognosis of HCC patients.
Collapse
Affiliation(s)
- Dingan Luo
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haoran Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Heng Yu
- Department of Radiation Oncology, Stanford Medical School, Stanford University, Stanford, California
| | - Mao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianchong Hu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Jin
- Department of Radiation Oncology, Stanford Medical School, Stanford University, Stanford, California
| | - Meisze Chua
- Department of Surgery, Asian Liver Center, Stanford University School of Medicine, Stanford, California
| | - Bing Han
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
|
31
|
Dai T, Deng M, Ye L, Liu R, Lin G, Chen X, Li H, Liu W, Yang Y, Chen G, Wang G. Prognostic value of combined preoperative gamma-glutamyl transpeptidase to platelet ratio and fibrinogen in patients with HBV-related hepatocellular carcinoma after hepatectomy. Am J Transl Res 2020; 12:2984-2997. [PMID: 32655824 PMCID: PMC7344083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
The gamma-glutamyl transpeptidase to platelet ratio (GPR) has been reported as a non-invasive parameter for evaluating hepatic fibrosis and cirrhosis. However, only a few of studies investigated the relationship between GPR and liver cancer. Here, we sought to clarify the prognostic value of GPR as well as its combination with fibrinogen in patients with HBV-related hepatocellular carcinoma (HCC). We performed a retrospective study using data collected from 302 HCC patients, and evaluated the association between GPR, fibrinogen and clinicopathological characteristics using the chi-square test. Additionally, we assessed disease-free survival (DFS) and overall survival (OS) using the Kaplan-Meier method and log-rank test, then performed univariate and multivariate COX analyses to identify the prognostic factors. The prognostic performance of combined GPR and fibrinogen was evaluated by the receiver operating characteristic curve analysis. Results showed that GPR was associated with gender, history of smoking and drinking, cirrhosis, antiviral treatments, tumor number, and Child-Pugh grade. Univariate analysis revealed a significant correlation between tumor diameter, vascular invasion, BCLC stage, alpha-fetal protein, GPR, fibrinogen, and NLR with both DFS and OS in HCC patients. Only GPR and fibrinogen were found to be independently associated with both DFS and OS according to multivariate analysis. Furthermore, predictive capacity was enhanced by combining GPR with fibrinogen owing to a larger area under the curve than other indexes or models. Overall, preoperative GPR could be an effective non-invasive predictor for prognosis of HBV-related HCC patients, and a combination of GPR and fibrinogen improved the prognostic performance.
Collapse
Affiliation(s)
- Tianxing Dai
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Mingbin Deng
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Linsen Ye
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Rongqiang Liu
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Guozhen Lin
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Xiaolong Chen
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Hua Li
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
- Organ Transplantation Institute of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Wei Liu
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
- Organ Transplantation Institute of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Guihua Chen
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
- Organ Transplantation Institute of Sun Yat-Sen UniversityGuangzhou 510630, China
| | - Guoying Wang
- Department of Hepatic Surgery and Liver Transplant Program, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630, China
- Organ Transplantation Institute of Sun Yat-Sen UniversityGuangzhou 510630, China
| |
Collapse
|
|
32
|
Wang H, Lin C, Fan W, Zhang J, Zhang Y, Yao W, Li J. Dynamic Changes in the Neutrophil-to-Lymphocyte Ratio Predict the Prognosis of Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Cancer Manag Res 2020; 12:3433-3444. [PMID: 32523374 PMCID: PMC7234956 DOI: 10.2147/cmar.s245396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/21/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To examine the effect of dynamic changes in neutrophil-to-lymphocyte ratio (NLR) on tumor response and overall survival (OS) in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). Patients and Methods Data from 181 patients with HCC were retrospectively collected. White blood cell, neutrophil and lymphocyte counts, and the NLR were obtained 1–3 days before as well as 3–6 weeks and 3 months after TACE. Patients were divided into two groups at each time point according to the mean value of NLR, and also divided into continuous decrease, fluctuating increase-decrease (I-D), fluctuating decrease-increase (D-I), and continuous increase groups according to the dynamic changes in the NLR. The dynamic changes in blood counts and NLR were analyzed using repeated-measures ANOVA. The odds ratios (ORs) for tumor response in different NLR groups were examined using a multivariate logistic regression model. Finally, the prognostic value of the dynamic changes in the NLR was examined using Cox regression models. Results Continuous decline of white blood cell counts, neutrophil counts and lymphocyte counts were observed at 3–6 weeks and 3 months after TACE treatment. The NLR increased slightly and then decreased substantially in responders, while it increased slightly and then significantly in non-responders, with a significant interaction effect of Time × Tumor response (P = 0.005). NLR grouping before TACE, 3–6 weeks and 3 months after TACE was not associated with tumor response, and only 3 months after TACE did, it shows a significant difference in univariate survival analyses (NLR > 2.5 vs NLR ≤ 2.5, hazard ratio [HR] = 2.442, 95% confidence interval (CI): 1.545, 3.860). The changes in the NLR were significantly correlated with tumor response and OS. Non-responders for TACE were more common in the continuous NLR increase group (OR = 6.230, 95% CI: 1.848–21.001) and in the fluctuating D-I group (OR = 5.702, 95% CI: 1.480–21.957). Multivariate analyses revealed that these two patient groups also showed poorer OS (HR = 2.351, 95% CI: 1.120–4.605 and HR = 2.320, 95% CI: 1.187–4.533, respectively). Conclusion Dynamic changes in the NLR may be better predictors of tumor response and OS than static NLR values, but more data are needed.
Collapse
Affiliation(s)
- Hongyu Wang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Chuyang Lin
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou 510080, People's Republic of China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Jiang Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yingqiang Zhang
- Department of Interventional Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, People's Republic of China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| |
Collapse
|
|
33
|
Cong R, Kong F, Ma J, Li Q, Wu Q, Ma X. Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer. BMC Cancer 2020; 20:464. [PMID: 32448185 PMCID: PMC7245911 DOI: 10.1186/s12885-020-06953-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/12/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately. The aim of this study is to bring the combination of NLR, PLR and MLR into the prognostic assessment system of endometrial cancer (EC) and establish a nomogram to provide an objective prediction model for clinical decisions. METHODS A total of 1111 patients with EC who had accepted surgical treatment during 2013-2017 were involved in the analysis. Their NLR, PLR, and MLR levels were obtained from a routine blood examination within 2 weeks before operation. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs. Chi-square tests analysed the associations of the ratios with other clinicopathological variables. The prognostic value was indicated by overall survival (OS) via Cox proportional hazards models and Kaplan-Meier analysis. R software was used to establish the nomogram based on the combination of NLR, PLR, MLR and other clinicopathological factors. RESULTS The median follow-up period was 40 months, and the median age was 56. The enrolled patients were stratified by cutoffs of 2.14 for NLR, 131.82 for PLR and 0.22 for MLR. Multivariate analyses demonstrated that high NLR over 2.14 (HR = 2.71, 95%CI = 1.83-4.02, P<0.001), high PLR over 131.82 (HR = 2.75, 95%CI = 1.90-3.97, P<0.001), and high MLR over 0.22 (HR = 1.72, 95%CI = 1.20-2.45, P = 0.003) were significantly associated with worse OS. The combined indicator, high NLR + high PLR + high MLR (HR = 4.34, 95%CI = 2.54-7.42, P<0.001), showed the highest prognostic value. The Harrell's concordance index of the nomogram was 0.847 (95% CI = 0.804-0.890), showing good discrimination and calibration of this model. CONCLUSION The combination of NLR, PLR, and MLR is a superior prognostic factor of EC. The nomogram involving the combination of NLR, PLR, MLR and other clinicopathological factors is recommended to predict OS for EC patients clinically.
Collapse
Affiliation(s)
- Rong Cong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Fanfei Kong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Jian Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Qing Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Qijun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaoxin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China.
| |
Collapse
|
|
34
|
Long P, Zang Y, Wang H, Liang X, Xie X, Han Z, Lin D, Wang Z, Huang S, Chen C. Prognostic Nomogram for Patients with Radical Surgery for Non-Metastatic Colorectal Cancer Incorporating Hematological Biomarkers and Clinical Characteristics. Onco Targets Ther 2020; 13:2093-2102. [PMID: 32210575 PMCID: PMC7069577 DOI: 10.2147/ott.s240843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/17/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is a large difference in postoperative survival in patients with non-metastatic colorectal cancer. We aimed to develop nomograms incorporating both hematological biomarkers and clinical characteristics to predict overall survival (OS) in patients with radical surgery for non-metastatic colorectal cancer. METHODS A retrospective analysis was performed on date from 508 patients who underwent radical resection of colorectal cancer at the Affiliated Tumor Hospital of Guangxi Medical University from December 2011 to December 2015. Simple random sampling was performed by dividing these patients into a training set (n=355) and validation set(n=153), which yielded a 7:3 ratio in the sample sizes between these groups. Based on COX regression analysis of the results from the training cohort, a nomogram was developed to predict the three-year and five-year overall survival rate, and internal verification was also performed. The nomogram prediction accuracy and discriminating ability were evaluated by Harrell's C-index (C-index), calibration curves and were compared with the colorectal cancer TNM staging system. RESULTS We found that age, degree of differentiation, T stage, N stage, neurological invasion, neutrophils, monocytes, HGB, and LDH were independent risk factors for predicting OS in patients with colorectal cancer. In the training cohort, the C index was 0.796 (95% CI: 0.761-0.831). In the validation cohort, the C index was 0.671 (95% CI: 0.656-0.686).The nomogram showed a stronger predictive ability than did TNM staging. Decision curve analysis showed that the nomogram had value in terms of clinical application. CONCLUSION Our nomogram combined hematological biomarkers and clinical characteristics and was highly effective in predicting OS in patients with non-metastatic colorectal cancer. Hence, our nomogram may provide a reference tool for clinicians to guide individualized treatment and follow-ups for patients with colorectal cancer.
Collapse
Affiliation(s)
- Peiyun Long
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Youya Zang
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Huan Wang
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Xiumei Liang
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Xuekun Xie
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Zhiwei Han
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Dongyi Lin
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Zongyu Wang
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Shan Huang
- Department of Oncological Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Chuang Chen
- Department of Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| |
Collapse
|
|
35
|
Xu W, Li R, Liu F. Novel Prognostic Nomograms for Predicting Early and Late Recurrence of Hepatocellular Carcinoma After Curative Hepatectomy. Cancer Manag Res 2020; 12:1693-1712. [PMID: 32214844 PMCID: PMC7082541 DOI: 10.2147/cmar.s241959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/25/2020] [Indexed: 01/27/2023] Open
Abstract
Aim Hepatectomy is the main curative method for patients with hepatocellular carcinoma (HCC) in China. Unfortunately, high recurrence rate after hepatectomy poses negative impact on the prognosis of patients. This study aimed to develop prognostic nomograms to predict early recurrence (ER) and late recurrence (LR) of HCC after curative hepatectomy. Patients and Methods Total of 318 HCC patients undergoing curative hepatectomy from January 2012 to January 2018 were retrospectively recruited. Potential risk factors that were significant for predicting ER and LR in univariate analysis were selected for multivariate survival model analysis using the backward stepwise method. Risk factors identified in multivariate analysis were used to develop nomograms to predict ER and LR. The nomogram was internally validated using 2,000 bootstrap samples from 75% of the original data. Results Among 318 patients, 164 showed postoperative recurrence, of which 140 and 24 had ER (≤2 years) and LR (>2 years), respectively. Multivariate analysis showed that age, Hong Kong Liver Cancer Stage, albumin-bilirubin, METAVIR fibrosis grade, and microvascular invasion were risk factors of ER for HCC after curative hepatectomy. The AUC of the ROC curve for ER in the development set (D-set) was 0.888 while that in the validation set (V-set) was 0.812. Neutrophil/lymphocyte ratio and glypican-3 (+) were risk factors for LR in HCC patients after curative hepatectomy. The AUC of the ROC curve for LR predictive nomogram that integrated all independent predictors was 0.831. The AUC of the ROC curve for LR in the D-set was 0.833, while that for LR in the V-set was 0.733. The C-index and AUC of ROC for the proposed nomograms were more satisfactory than three conventional HCC staging systems used in this study. Conclusion We developed novel nomograms to predict ER and LR of HCC patients after curative hepatectomy for clinical use to individualize follow-up and therapeutic strategies.
Collapse
Affiliation(s)
- Wei Xu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha 410005, People's Republic of China
| | - Ruineng Li
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha 410005, People's Republic of China
| | - Fei Liu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha 410005, People's Republic of China
| |
Collapse
|
|
36
|
Lai Q, Vitale A, Manzia TM, Foschi FG, Levi Sandri GB, Gambato M, Melandro F, Russo FP, Miele L, Viganò L, Burra P, Giannini EG. Platelets and Hepatocellular Cancer: Bridging the Bench to the Clinics. Cancers (Basel) 2019; 11:1568. [PMID: 31618961 PMCID: PMC6826649 DOI: 10.3390/cancers11101568] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Growing interest is recently being focused on the role played by the platelets in favoring hepatocellular cancer (HCC) growth and dissemination. The present review reports in detail both the experimental and clinical evidence published on this topic. Several growth factors and angiogenic molecules specifically secreted by platelets are directly connected with tumor progression and neo-angiogenesis. Among them, we can list the platelet-derived growth factor, the vascular endothelial growth factor, the endothelial growth factor, and serotonin. Platelets are also involved in tumor spread, favoring endothelium permeabilization and tumor cells' extravasation and survival in the bloodstream. From the bench to the clinics, all of these aspects were also investigated in clinical series, showing an evident correlation between platelet count and size of HCC, tumor biological behavior, metastatic spread, and overall survival rates. Moreover, a better understanding of the mechanisms involved in the platelet-tumor axis represents a paramount aspect for optimizing both current tumor treatment and development of new therapeutic strategies against HCC.
Collapse
Affiliation(s)
- Quirino Lai
- Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University, 00161 Rome, Italy.
| | - Alessandro Vitale
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, 35122 Padua, Italy.
| | - Tommaso M Manzia
- Department of Transplant Surgery, Polyclinic Tor Vergata Foundation, Tor Vergata University, 00133 Rome, Italy.
| | - Francesco G Foschi
- Department of Internal Medicine, Ospedale per gli Infermi di Faenza, 48018 Faenza, Italy.
| | | | - Martina Gambato
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, 35122 Padua, Italy.
| | - Fabio Melandro
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, 56126 Pisa, Italy.
| | - Francesco P Russo
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, 35122 Padua, Italy.
| | - Luca Miele
- Internal Medicine, Gastroenterology and Liver Unit, A. Gemelli Polyclinic, Sacro Cuore Catholic University, 20123 Rome, Italy.
| | - Luca Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, Italy.
| | - Patrizia Burra
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, 35122 Padua, Italy.
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, Università di Genova, IRCCS-Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| |
Collapse
|