Objective:Evidence on the prognostic value of autologous stem cell transplantation(ASCT)and minimal residual disease(MRD)dynamics of patients with newly diagnosed multiple myeloma(NDMM)in China is limited.Our objectiv...Objective:Evidence on the prognostic value of autologous stem cell transplantation(ASCT)and minimal residual disease(MRD)dynamics of patients with newly diagnosed multiple myeloma(NDMM)in China is limited.Our objective in the current study was to understand the current care paradigm and outcomes of these patients.Methods:This longitudinal cohort study used historical data from three top-tier hematologic disease care hospitals that contributed to the National Longitudinal Cohort of Hematological Diseases-Multiple Myeloma.Treatment regimens[proteasome inhibitor(PI)-,immunomodulatory drug(IMiD)-,PI+IMiD-based,and conventional],post-induction response,ASCT and MRD status,and survival outcomes[progression-free survival(PFS)and overall survival(OS)]were evaluated.Results:In total,454 patients with NDMM were included(median age,57 years;59.0%males)with a median follow-up of 58.7 months.The overall response rate was 91.0%,83.9%,90.6%,and 60.9%for PI-,IMiD-,PI+IMiD-based,and conventional regimens,respectively.Patients with ASCT during first-line therapy(26.2%)had a longer PFS and OS than patients who did not receive ASCT[median PFS,42.9 vs.21.2 months,P<0.001;median OS,not reached(NR)vs.65.8 months,P<0.001].The median OS was NR,71.5,and 56.6 months among patients with sustained MRD negativity,loss of MRD negativity,and persistent MRD,respectively(P<0.001).Multivariate analysis revealed that the lactic dehydrogenase level,International Staging System stage,extra-medullary disease,and upfront ASCT were independent factors in predicting OS among NDMM patients.Conclusions:Our study showed that novel agent-based regimens,first-line ASCT,and sustained MRD negativity were associated with a superior outcome for patients with NDMM in China(Identifier:NCT04645199).展开更多
Objective Cervical esophageal cancer(CEC)is a relatively rare condition,with limited treatment options.The current study aimed to assess the survival outcomes of patients with CEC who received definitive radiotherapy....Objective Cervical esophageal cancer(CEC)is a relatively rare condition,with limited treatment options.The current study aimed to assess the survival outcomes of patients with CEC who received definitive radiotherapy.Methods In total,63 consecutive patients with CEC who received definitive radiotherapy between 2010 and 2018 were included in this study.The survival outcomes were analyzed based on statistics.Results The median progression-free survival(PFS)and overall survival(OS)of the patients were 12 and 19 months,respectively.There were no significant differences in terms of survival outcomes between the groups who received radiation doses≥60 and<60 Gy.Interestingly,in the proximal CEC subgroup,the PFS(P=0.039),OS(P=0.031),and loco-regional failure-free survival(LRFFS)(P=0.005)improved significantly in patients who received a radiation dose≥60 Gy compared with those who received a radiation dose<60 Gy.However,in the distal CEC subgroup,the PFS,OS,and LRFFS did not significantly improve between patients who received radiation doses≥60 and<60 Gy.Definitive radiotherapy was well tolerated,and no significant differences were observed in terms of treatment-related toxicities between the groups who received radiation doses≥60 and<60 Gy.Conclusion The survival outcomes of patients with CEC should be improved.In proximal CEC,a radiation dose≥60 Gy is significantly correlated with better PFS,OS,and LRFFS.However,further research must be performed to validate this finding.展开更多
Introduction:The overall 5-year survival rate for esophageal cancer patients in low-and middle-income countries was reported to be low,despite the availability of advanced treatments.Thus,this study aimed to assess de...Introduction:The overall 5-year survival rate for esophageal cancer patients in low-and middle-income countries was reported to be low,despite the availability of advanced treatments.Thus,this study aimed to assess determinants of survival outcomes among esophageal cancer patients in Kenya.Methods:A retrospective cohort study was employed among 299 adult esophageal cancer patients.The data were collected using a data abstraction tool consisting of patients’clinical characteristics and survival outcome measuring parameters.Statistical Package for the Social Sciences(SPSS)statistical software(version 20.0,IBM.USA)was used to analyze the data.The Kaplan–Meier and Cox regression analyses were used to determine the survival outcome and determinants of mortality,respectively.Results:The mortality rate was 43.1%,and 11.1%of patients demonstrated distant metastases in the follow-up period.Despite treatment,20.1%had progressed disease,and 13.0%did not respond to treatment.Radiotherapy(AHR:3.3,95%CI:1.4−7.8,p=0.007),chemotherapy(AHR:3.9,95%CI:1.2−6.1,p=0.020),and chemoradiation(AHR:5.6,95%CI:1.6−10.2,p=0.006)were the significant determinants of survival in advanced stage(III and and IV)patients.Conclusions:There was a high mortality rate,disease progression,and nonresponse of esophageal cancer patients.Hence,it is essential to improve the survival of patients through early detection and timely initiation of the available treatment options.展开更多
BACKGROUND The optimal time interval between neoadjuvant chemoradiotherapy(nCRT)and esophagectomy in esophageal cancer has not been defined.AIM To evaluate whether a prolonged time interval between the end of nCRT and...BACKGROUND The optimal time interval between neoadjuvant chemoradiotherapy(nCRT)and esophagectomy in esophageal cancer has not been defined.AIM To evaluate whether a prolonged time interval between the end of nCRT and surgery has an effect on survival outcome in esophageal cancer patients.METHODS We searched PubMed,Embase,Web of Science,the Cochrane Library,Wanfang and China National Knowledge Infrastructure databases for relevant articles published before November 16,2019,to identify potential studies that evaluated the prognostic role of different time intervals between nCRT and surgery in esophageal cancer.The hazard ratios and 95%confidence intervals(95%CI)were merged to estimate the correlation between the time intervals and survival outcomes in esophageal cancer,esophageal squamous cell carcinoma and adenocarcinoma using fixed-and random-effect models.RESULTS This meta-analysis included 12621 patients from 16 studies.The results demonstrated that esophageal cancer patients with a prolonged time interval between the end of nCRT and surgery had significantly worse overall survival(OS)[hazard ratio(HR):1.107,95%CI:1.014-1.208,P=0.023]than those with a shorter time interval.Subgroup analysis showed that poor OS with a prolonged interval was observed based on both the sample size and HRs.There was also significant association between a prolonged time interval and decreased OS in Asian,but not Caucasian patients.In addition,a longer wait time indicated worse OS(HR:1.385,95%CI:1.186-1.616,P<0.001)in patients with adenocarcinoma.CONCLUSION A prolonged time interval from the completion of nCRT to surgery is associated with a significant decrease in OS.Thus,esophagectomy should be performed within 7-8 wk after nCRT.展开更多
BACKGROUND: Reports of liver transplantation(LT) in patients with mixed hepatocellular carcinoma/cholangiocarcinoma(HCC/CC) and intrahepatic cholangiocarcinoma(ICC) are modest and have been mostly retrospective after ...BACKGROUND: Reports of liver transplantation(LT) in patients with mixed hepatocellular carcinoma/cholangiocarcinoma(HCC/CC) and intrahepatic cholangiocarcinoma(ICC) are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC.METHODS: From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS: The observed recurrence rate post-LT was 31%(4/13) and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS: Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.展开更多
This meta-analysis aimed to comprehensively assess the efficacy and safety of hepatic resection combined with radiofrequency ablation versus hepatic resection(HR) alone for the treatment of multifocal hepatocellular c...This meta-analysis aimed to comprehensively assess the efficacy and safety of hepatic resection combined with radiofrequency ablation versus hepatic resection(HR) alone for the treatment of multifocal hepatocellular carcinomas(HCC). A literature search was conducted from the database including MEDLINE, Embase, Cochrane Central Register of Controlled Trials(CENTRAL) and China Biology Medicine(CBM) disc. The primary outcomes included the 1-, 3-, 5-year overall survival(OS) and disease-free survival(DFS) rate. The secondary outcomes contained the intraoperative parameters and postoperative adverse events(AEs). These parameters were all analyzed by Rev Man 5.3 software. After carefully screening relevant studies, four retrospective studies of high quality involving 466 patients(197 in the combined group and 269 in the HR group) were included in this study. The pooled results showed that the 1-, 3-, 5-year OS rate in the combined group were comparable with those in the HR group(OR=0.77, 0.96, 0.88; P=0.33, 0.88, 0.70, respectively). Similarly, there was no significant difference in 1-, 3-, 5-year DFS rate between the combined group and the HR alone group(OR=0.57, 0.83, 0.72; P=0.17, 0.37, 0.32, respectively). And the intraoperative parameters and postoperative AEs were also comparable between the above two cohorts. However, two included studies reported that tumor often recurred in the ablation site in the combined group. The present meta-analysis indicated that the HR combined with RFA could reach a long-term survival outcome similar to curative HR for multifocal HCC patients. And this therapy may be a promising alternative for these patients with marginal liver function or complicated tumor distribution. Furthermore, high quality randomized controlled trials(RCTs) are imperative to verify this conclusion.展开更多
BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival(OS)of patients with gastric cancer(GC).AIM To assess the prognostic performances of three...BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival(OS)of patients with gastric cancer(GC).AIM To assess the prognostic performances of three pathological classifications in GC and develop a novel prognostic nomogram for individually predicting OS.METHODS Patients were identified from the Surveillance,Epidemiology,and End Results program.Univariate and multivariate analyses were performed to identify the independent prognostic factors.Model discrimination and model fitting were evaluated by receiver operating characteristic curves and Akaike information criteria.Decision curve analysis was performed to assess clinical usefulness.The independent prognostic factors identified by multivariate analysis were further applied to develop a novel prognostic nomogram.RESULTS A total of 2718 eligible GC patients were identified.The modified Lauren classification was identified as one of the independent prognostic factors for OS.It showed superior model discriminative ability and model-fitting performance over the other pathological classifications,and similar results were obtained in various patient settings.In addition,it showed superior net benefits over the Lauren classification and tumor differentiation grade in predicting 3-and 5-year OS.A novel prognostic nomogram incorporating the modified Lauren classification showed superior model discriminative ability,model-fitting performance,and net benefits over the American Joint Committee on Cancer 8th edition tumor-nodemetastasis classification.CONCLUSION The modified Lauren classification shows superior net benefits over the Lauren classification and tumor differentiation grade in predicting OS.A novel prognostic nomogram incorporating the modified Lauren classification shows good model discriminative ability,model-fitting performance,and net benefits.展开更多
BACKGROUND Neoadjuvant chemotherapy(NACT)and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas.Survival outcomes following resection have been improving over time while NACT remain larg...BACKGROUND Neoadjuvant chemotherapy(NACT)and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas.Survival outcomes following resection have been improving over time while NACT remain largely unchanged.Indeed,a recent meta-analysis of randomized control trials did not demonstrate a survival benefit in adding NACT,raising the possibility that improved surgical techniques may be reducing the perceived effectiveness of NACT.AIM To compare the effect of addition of NACT to a standardized surgery and lymphadenectomy on overall and disease-free survival in patients undergoing curative oesophagectomy for oesophageal adenocarcinoma.METHODS Patient data were analysed from a prospectively maintained surgical survival database.Demographic,surgical,and survival outcomes were compared between groups according to treatment and nodal count.RESULTS The data of 243 consecutive patients were identified.79 patients were given NACT and 162 had surgery only.The NACT group were younger,and there was less frequent stage I adenocarcinoma.Overall survival was similar between NACT and surgery only groups(5YS:48.7%vs 42.5%;P=0.113),as was diseasefree survival(5YS:40.6%vs 39.9%;P=0.635).There were≥30 nodes removed in 46 patients,and<30 in 197 patients,but were otherwise similar.There was improved survival in patients with≥30 nodes removed than those with<30 nodes(5YS:64.4%vs 40.7%;P=0.015),and a better disease-free survival that neared significance(5YS:54.9%vs 36.6%;P=0.078).CONCLUSION NACT did not appear to affect overall or disease-free survival.However,an overall survival benefit was observed in patients with≥30 lymph nodes removed,and a benefit in disease-free survival which was not significant.展开更多
Background and aim:Whereas Yttrium-90 selective internal radiation therapy(Y-90 SIRT)was shown to improve local tumor control in non-Asian population,the efficacy of this therapy for Asian population in real-world set...Background and aim:Whereas Yttrium-90 selective internal radiation therapy(Y-90 SIRT)was shown to improve local tumor control in non-Asian population,the efficacy of this therapy for Asian population in real-world setting remains poorly detailed.We aimed to determine outcomes and identify predictors of response in hepatocellular carcinoma(HCC)patients treated by Y-90 SIRT.Methods:We retrospectively enrolled 52 HCC patients receiving Y-90 SIRT at our tertiary center between 2014 and 2019.Overall survival(OS),progression free survival(PFS),and predictive factors were determined by KaplaneMeier method and Cox-proportional hazard analysis.Results:Of the 52 patients(81% male,mean age 64.9 years),71%and 29% were classified as Barcelona Clinic Liver Cancer stage C and B HCC,respectively;63% had portal vein thrombosis,and 35% had objective tumor response defined by the modified Response Evaluation Criteria in Solid Tumors(mRE-CIST)criteria.OS and PFS were 11.0 and 2.4 months,respectively.Two patients were successfully down-staged and further underwent surgical resection.Multifocal lesion,alpha-fetoprotein(AFP)≥200 ng/mL,and Eastern Cooperative Oncology Group(ECOG)score≥1 were significantly associated with poor sur-vival,with adjusted hazard ratio(95% confidence interval)of 7.7(2.0e29.8),5.4(2.0e14.7),and 3.1(1.0 e9.6),respectively(all in P<0.05).Conclusions:Y-90 SIRT is an effective treatment for the local tumor control of HCC without serious adverse events.Single lesion,AFP level and ECOG status were predictors of response.展开更多
基金supported by grants from CAMS Innovation Fund for Medical Sciences(CIFMSGrant No.2022-I2M-1-022)。
文摘Objective:Evidence on the prognostic value of autologous stem cell transplantation(ASCT)and minimal residual disease(MRD)dynamics of patients with newly diagnosed multiple myeloma(NDMM)in China is limited.Our objective in the current study was to understand the current care paradigm and outcomes of these patients.Methods:This longitudinal cohort study used historical data from three top-tier hematologic disease care hospitals that contributed to the National Longitudinal Cohort of Hematological Diseases-Multiple Myeloma.Treatment regimens[proteasome inhibitor(PI)-,immunomodulatory drug(IMiD)-,PI+IMiD-based,and conventional],post-induction response,ASCT and MRD status,and survival outcomes[progression-free survival(PFS)and overall survival(OS)]were evaluated.Results:In total,454 patients with NDMM were included(median age,57 years;59.0%males)with a median follow-up of 58.7 months.The overall response rate was 91.0%,83.9%,90.6%,and 60.9%for PI-,IMiD-,PI+IMiD-based,and conventional regimens,respectively.Patients with ASCT during first-line therapy(26.2%)had a longer PFS and OS than patients who did not receive ASCT[median PFS,42.9 vs.21.2 months,P<0.001;median OS,not reached(NR)vs.65.8 months,P<0.001].The median OS was NR,71.5,and 56.6 months among patients with sustained MRD negativity,loss of MRD negativity,and persistent MRD,respectively(P<0.001).Multivariate analysis revealed that the lactic dehydrogenase level,International Staging System stage,extra-medullary disease,and upfront ASCT were independent factors in predicting OS among NDMM patients.Conclusions:Our study showed that novel agent-based regimens,first-line ASCT,and sustained MRD negativity were associated with a superior outcome for patients with NDMM in China(Identifier:NCT04645199).
基金Supported by a grant from the Natural Science Foundation of Hubei Province(No.2015CFB541).
文摘Objective Cervical esophageal cancer(CEC)is a relatively rare condition,with limited treatment options.The current study aimed to assess the survival outcomes of patients with CEC who received definitive radiotherapy.Methods In total,63 consecutive patients with CEC who received definitive radiotherapy between 2010 and 2018 were included in this study.The survival outcomes were analyzed based on statistics.Results The median progression-free survival(PFS)and overall survival(OS)of the patients were 12 and 19 months,respectively.There were no significant differences in terms of survival outcomes between the groups who received radiation doses≥60 and<60 Gy.Interestingly,in the proximal CEC subgroup,the PFS(P=0.039),OS(P=0.031),and loco-regional failure-free survival(LRFFS)(P=0.005)improved significantly in patients who received a radiation dose≥60 Gy compared with those who received a radiation dose<60 Gy.However,in the distal CEC subgroup,the PFS,OS,and LRFFS did not significantly improve between patients who received radiation doses≥60 and<60 Gy.Definitive radiotherapy was well tolerated,and no significant differences were observed in terms of treatment-related toxicities between the groups who received radiation doses≥60 and<60 Gy.Conclusion The survival outcomes of patients with CEC should be improved.In proximal CEC,a radiation dose≥60 Gy is significantly correlated with better PFS,OS,and LRFFS.However,further research must be performed to validate this finding.
文摘Introduction:The overall 5-year survival rate for esophageal cancer patients in low-and middle-income countries was reported to be low,despite the availability of advanced treatments.Thus,this study aimed to assess determinants of survival outcomes among esophageal cancer patients in Kenya.Methods:A retrospective cohort study was employed among 299 adult esophageal cancer patients.The data were collected using a data abstraction tool consisting of patients’clinical characteristics and survival outcome measuring parameters.Statistical Package for the Social Sciences(SPSS)statistical software(version 20.0,IBM.USA)was used to analyze the data.The Kaplan–Meier and Cox regression analyses were used to determine the survival outcome and determinants of mortality,respectively.Results:The mortality rate was 43.1%,and 11.1%of patients demonstrated distant metastases in the follow-up period.Despite treatment,20.1%had progressed disease,and 13.0%did not respond to treatment.Radiotherapy(AHR:3.3,95%CI:1.4−7.8,p=0.007),chemotherapy(AHR:3.9,95%CI:1.2−6.1,p=0.020),and chemoradiation(AHR:5.6,95%CI:1.6−10.2,p=0.006)were the significant determinants of survival in advanced stage(III and and IV)patients.Conclusions:There was a high mortality rate,disease progression,and nonresponse of esophageal cancer patients.Hence,it is essential to improve the survival of patients through early detection and timely initiation of the available treatment options.
基金Supported by the National Natural Science Foundation of China,No.81970481Sichuan Science and Technology Program,No.2018HH0150 and Chengdu Science and Technology Bureau,No.2016GH0200020HZ.
文摘BACKGROUND The optimal time interval between neoadjuvant chemoradiotherapy(nCRT)and esophagectomy in esophageal cancer has not been defined.AIM To evaluate whether a prolonged time interval between the end of nCRT and surgery has an effect on survival outcome in esophageal cancer patients.METHODS We searched PubMed,Embase,Web of Science,the Cochrane Library,Wanfang and China National Knowledge Infrastructure databases for relevant articles published before November 16,2019,to identify potential studies that evaluated the prognostic role of different time intervals between nCRT and surgery in esophageal cancer.The hazard ratios and 95%confidence intervals(95%CI)were merged to estimate the correlation between the time intervals and survival outcomes in esophageal cancer,esophageal squamous cell carcinoma and adenocarcinoma using fixed-and random-effect models.RESULTS This meta-analysis included 12621 patients from 16 studies.The results demonstrated that esophageal cancer patients with a prolonged time interval between the end of nCRT and surgery had significantly worse overall survival(OS)[hazard ratio(HR):1.107,95%CI:1.014-1.208,P=0.023]than those with a shorter time interval.Subgroup analysis showed that poor OS with a prolonged interval was observed based on both the sample size and HRs.There was also significant association between a prolonged time interval and decreased OS in Asian,but not Caucasian patients.In addition,a longer wait time indicated worse OS(HR:1.385,95%CI:1.186-1.616,P<0.001)in patients with adenocarcinoma.CONCLUSION A prolonged time interval from the completion of nCRT to surgery is associated with a significant decrease in OS.Thus,esophagectomy should be performed within 7-8 wk after nCRT.
文摘BACKGROUND: Reports of liver transplantation(LT) in patients with mixed hepatocellular carcinoma/cholangiocarcinoma(HCC/CC) and intrahepatic cholangiocarcinoma(ICC) are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC.METHODS: From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS: The observed recurrence rate post-LT was 31%(4/13) and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS: Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.
基金supported by the grants from the National Natural Science Foundation of China(No.71673193)Key Technology Research and Development Program of the Sichuan Province(No.2015SZ0131)
文摘This meta-analysis aimed to comprehensively assess the efficacy and safety of hepatic resection combined with radiofrequency ablation versus hepatic resection(HR) alone for the treatment of multifocal hepatocellular carcinomas(HCC). A literature search was conducted from the database including MEDLINE, Embase, Cochrane Central Register of Controlled Trials(CENTRAL) and China Biology Medicine(CBM) disc. The primary outcomes included the 1-, 3-, 5-year overall survival(OS) and disease-free survival(DFS) rate. The secondary outcomes contained the intraoperative parameters and postoperative adverse events(AEs). These parameters were all analyzed by Rev Man 5.3 software. After carefully screening relevant studies, four retrospective studies of high quality involving 466 patients(197 in the combined group and 269 in the HR group) were included in this study. The pooled results showed that the 1-, 3-, 5-year OS rate in the combined group were comparable with those in the HR group(OR=0.77, 0.96, 0.88; P=0.33, 0.88, 0.70, respectively). Similarly, there was no significant difference in 1-, 3-, 5-year DFS rate between the combined group and the HR alone group(OR=0.57, 0.83, 0.72; P=0.17, 0.37, 0.32, respectively). And the intraoperative parameters and postoperative AEs were also comparable between the above two cohorts. However, two included studies reported that tumor often recurred in the ablation site in the combined group. The present meta-analysis indicated that the HR combined with RFA could reach a long-term survival outcome similar to curative HR for multifocal HCC patients. And this therapy may be a promising alternative for these patients with marginal liver function or complicated tumor distribution. Furthermore, high quality randomized controlled trials(RCTs) are imperative to verify this conclusion.
基金Supported by The China Scholarship Council,No.201908050148.
文摘BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival(OS)of patients with gastric cancer(GC).AIM To assess the prognostic performances of three pathological classifications in GC and develop a novel prognostic nomogram for individually predicting OS.METHODS Patients were identified from the Surveillance,Epidemiology,and End Results program.Univariate and multivariate analyses were performed to identify the independent prognostic factors.Model discrimination and model fitting were evaluated by receiver operating characteristic curves and Akaike information criteria.Decision curve analysis was performed to assess clinical usefulness.The independent prognostic factors identified by multivariate analysis were further applied to develop a novel prognostic nomogram.RESULTS A total of 2718 eligible GC patients were identified.The modified Lauren classification was identified as one of the independent prognostic factors for OS.It showed superior model discriminative ability and model-fitting performance over the other pathological classifications,and similar results were obtained in various patient settings.In addition,it showed superior net benefits over the Lauren classification and tumor differentiation grade in predicting 3-and 5-year OS.A novel prognostic nomogram incorporating the modified Lauren classification showed superior model discriminative ability,model-fitting performance,and net benefits over the American Joint Committee on Cancer 8th edition tumor-nodemetastasis classification.CONCLUSION The modified Lauren classification shows superior net benefits over the Lauren classification and tumor differentiation grade in predicting OS.A novel prognostic nomogram incorporating the modified Lauren classification shows good model discriminative ability,model-fitting performance,and net benefits.
文摘BACKGROUND Neoadjuvant chemotherapy(NACT)and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas.Survival outcomes following resection have been improving over time while NACT remain largely unchanged.Indeed,a recent meta-analysis of randomized control trials did not demonstrate a survival benefit in adding NACT,raising the possibility that improved surgical techniques may be reducing the perceived effectiveness of NACT.AIM To compare the effect of addition of NACT to a standardized surgery and lymphadenectomy on overall and disease-free survival in patients undergoing curative oesophagectomy for oesophageal adenocarcinoma.METHODS Patient data were analysed from a prospectively maintained surgical survival database.Demographic,surgical,and survival outcomes were compared between groups according to treatment and nodal count.RESULTS The data of 243 consecutive patients were identified.79 patients were given NACT and 162 had surgery only.The NACT group were younger,and there was less frequent stage I adenocarcinoma.Overall survival was similar between NACT and surgery only groups(5YS:48.7%vs 42.5%;P=0.113),as was diseasefree survival(5YS:40.6%vs 39.9%;P=0.635).There were≥30 nodes removed in 46 patients,and<30 in 197 patients,but were otherwise similar.There was improved survival in patients with≥30 nodes removed than those with<30 nodes(5YS:64.4%vs 40.7%;P=0.015),and a better disease-free survival that neared significance(5YS:54.9%vs 36.6%;P=0.078).CONCLUSION NACT did not appear to affect overall or disease-free survival.However,an overall survival benefit was observed in patients with≥30 lymph nodes removed,and a benefit in disease-free survival which was not significant.
基金This research was supported by Chulalongkorn University CU-GRS-62-02-30-01.
文摘Background and aim:Whereas Yttrium-90 selective internal radiation therapy(Y-90 SIRT)was shown to improve local tumor control in non-Asian population,the efficacy of this therapy for Asian population in real-world setting remains poorly detailed.We aimed to determine outcomes and identify predictors of response in hepatocellular carcinoma(HCC)patients treated by Y-90 SIRT.Methods:We retrospectively enrolled 52 HCC patients receiving Y-90 SIRT at our tertiary center between 2014 and 2019.Overall survival(OS),progression free survival(PFS),and predictive factors were determined by KaplaneMeier method and Cox-proportional hazard analysis.Results:Of the 52 patients(81% male,mean age 64.9 years),71%and 29% were classified as Barcelona Clinic Liver Cancer stage C and B HCC,respectively;63% had portal vein thrombosis,and 35% had objective tumor response defined by the modified Response Evaluation Criteria in Solid Tumors(mRE-CIST)criteria.OS and PFS were 11.0 and 2.4 months,respectively.Two patients were successfully down-staged and further underwent surgical resection.Multifocal lesion,alpha-fetoprotein(AFP)≥200 ng/mL,and Eastern Cooperative Oncology Group(ECOG)score≥1 were significantly associated with poor sur-vival,with adjusted hazard ratio(95% confidence interval)of 7.7(2.0e29.8),5.4(2.0e14.7),and 3.1(1.0 e9.6),respectively(all in P<0.05).Conclusions:Y-90 SIRT is an effective treatment for the local tumor control of HCC without serious adverse events.Single lesion,AFP level and ECOG status were predictors of response.
