Predictive effect of inflammatory biomarkers on prognosis of liver transplantation for hepatocellular carcinoma / 器官移植

Tumor recurrence is the main issue that affects the long-term survival of recipients after liver transplantation for hepatocellular carcinoma. Accurate preoperative evaluation and proper selection of transplant recipients are the key factors affecting the long-term prognosis of recipients undergoing liver transplantation for hepatocellular carcinoma. Neutrophil, lymphocyte, C-reactive protein, platelet and fibrinogen (FIB) are major biomarkers that indicate inflammatory response of the host. Multiple studies have found that these biomarkers may not only represent the inflammatory response, but also could be integrated to predict tumor recurrence and long-term survival rate of the recipients following liver transplantation for hepatocellular carcinoma. These biomarkers mainly consist of neutrophil-to-lymphocyte ratio (NLR), Glasgow prognostic score (GPS), FIB, platelet-to-lymphocyte ratio (PLR) and prognostic nutritional index (PNI), etc. In this article, research progresses on predictive effect of inflammatory biomarkers on prognosis of liver transplantation for hepatocellular carcinoma were reviewed.

Effects of pre-treatment Naples prognostic score on the efficacy and prognosis for patients with thoracic esophageal squamous cell carcinoma receiving chemoradiotherapy / 中华放射医学与防护杂志

Objective:To investigate the effects of pre-treatment Naples prognostic score (NPS), including inflammation-related and nutrition-related indicators, on the treatment efficacy and prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC) receiving chemoradiotherapy.Methods:A retrospective analysis was conducted for 123 patients diagnosed with thoracic ESCC. These patients were treated either with standard curative radiotherapy (RT) alone or with concurrent chemoradiotherapy (CCRT) in the Affiliated Taixing People's Hospital of Yangzhou University between January 2014 and December 2017. The patients were divided into NPS 0 group (18 cases), NPS 1 or 2 group (60 cases), and NPS 3 or 4 group (45 cases). The responsiveness to treatment was analyzed using logistic regression analysis. The Kaplan-Meier method and log-rank test were adopted to calculate and compare the progression-free survival (PFS) and overall survival (OS) rates. Meanwhile, Cox proportional hazards models were used for the multivariate analyses.Results:The overall effective rate across the entire cohort was 65.0%, and the effective rates of the NPS 0 group, NPS 1 or 2 group, and NPS 3 or 4 group were 88.9%, 73.3%, and 44.4%, respectively. As indicated by the univariate logistic analysis, the treatment responses in patients with ESCC were highly associated with TNM stage, treatment method, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and NPS (1 or 2 group and 3 or 4 group) ( HR =1.633, 0.225, 4.002, 0.320, 2.909, 6.591, P<0.05). Subsequently, multivariate logistic regression analysis showed that treatment strategy alone ( HR =0.214, 95% CI 0.105-0.436, P=0.001), NLR ( HR =2.547, 95% CI 1.248-5.199, P=0.010), and NPS (1 or 2 group: HR=1.193, 95% CI 1.377-9.691, P=0.033; 3 or 4 group: HR =3.349, 95% CI 1.548-10.499, P=0.003) were independent risk factors for tumour response. In addition, the univariate analysis indicates that TNM stage, treatment modality, NLR, LMR, and NPS were significantly associated with PFS and OS( HRPFS=1.480, 0.364, 2.129, 0.635, 3.316, 6.599, P < 0.05; HROS=1.149, 0.308, 2.306, 0.609, 3.316, 6.599, P < 0.05). Furthermore, multivariate Cox proportional hazard regression model analysis showed that TNM stage ( HR =1.408, 95% CI 1.069-1.854, P=0.015), treatment modality ( HR =0.367, 95% CI 0.261-0.516, P=0.015), NLR ( HR =1.518, 95% CI 1.078-2.139, P=0.017), and NPS (1 or 2 group: HR=3.279, 95% CI 1.405-7.653, P=0.006; 3 or 4 group: HR =6.233, 95% CI 2.439-15.875, P < 0.001) were considered independent prognostic factors for PFS. Additionally, these parameters were also independent prognostic factors for OS. Conclusions:Using inflammation-related and nutrition-related biomarkers, this study demonstrated that NPS is promising as a predictive indicator for the therapeutic effects and survival prognosis in patients with ESCC receiving CRT or RT alone.

Influence of preoperative Naples prognostic score on prognosis of patients with thoracic esophageal squamous cell carcinoma / 国际肿瘤学杂志

Objective:To explore the impact of preoperative Naples prognostic score (NPS) on the survival prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC).Methods:From December 2014 to December 2020, a total of 134 patients who underwent radical esophagectomy in Department of Thoracic Surgery, Affiliated Taixing People′s Hospital of Yangzhou University were retrospectively analyzed. The NPS was calculated by the median values of preoperative serum albumin, total cholesterol, neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR), and then the enrolled patients were divided into NPS 0 group (20 cases), NPS 1 or 2 group (62 cases) and NPS 3 or 4 group (52 cases). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univa-riate and multivariate Cox models were used to analyze the relationship between NPS and survival prognosis.Results:The 1-, 3- and 5-year progression free survival (PFS) rates were 95.0%, 70.0% and 60.0% in the NPS 0 group, 66.1%, 24.2% and 24.2% in the NPS 1 or 2 group, and 48.1%, 3.8% and 1.9% in the NPS 3 or 4 group respectively, with a statistically significant difference ( χ2=31.27, P<0.001). In the NPS 0 group, the 1-, 3- and 5-year overall survival (OS) rates were 100.0%, 80.0% and 70.0% respectively. In the NPS 1 or 2 group, the 1-, 3- and 5-year OS rates were 96.8%, 36.7% and 32.3% respectively, while in the NPS 3 or 4 group, the 1-, 3- and 5-year OS rates were 90.4%, 32.7% and 5.8% respectively, and there was a statistically significant difference ( χ2=29.70, P<0.001). Univariate analysis found that sex, T stage, N stage, TNM stage and NPS were closely related to PFS and OS of patients with thoracic ESCC (all P<0.05). Furthermore, multivariate Cox regression analysis showed that T stage ( HR=1.46, 95% CI: 1.07-2.00, P=0.019), N stage ( HR=1.34, 95% CI: 1.02-1.76, P=0.037) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.35, 95% CI: 1.58-7.11, P=0.002; NPS 3 or 4 group: HR=6.15, 95% CI: 2.89-13.11, P=0.001) were independent prognostic factors for PFS. Additionally, T stage ( HR=1.67, 95% CI: 1.01-2.77, P=0.046), N stage ( HR=1.44, 95% CI: 1.00-2.20, P=0.048) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.10, 95% CI: 1.31-7.32, P=0.010; NPS 3 or 4 group: HR=5.09, 95% CI: 2.14-12.11, P=0.001) were independent prognostic factors for OS. Conclusion:Preoperative NPS plays an important role in predicting the survival prognosis of patients with thoracic ESCC.

Comparison of predictive efficacy of two preoperative inflammatory scores in patients with gallbladder cancer / 国际外科学杂志

Objective:To investigate and compare the influence of systemic inflammation score(SIS) and modified glasgow prognostic score(mGPS) on patients undergoing radical surgery for gallbladder cancer.Methods:A cohort study was used to collect the clinical data of total 50 patients with gallbladder cancer who underwent radical surgery in Zhongda Hospital Affiliated to Southeast University from March 2010 to March 2020. Survival analysis was utilized to assess the impact of SIS and mGPS for prognosis.The predictive accuracy of each score was compared by means of subgroup analysis and time dependent receiver operating characteristics analysis.Measurement data with normal distribution were expressed as mean±standard deviation( ± s), and t test was used for comparison between groups. Count data were expressed as cases and percentages (%), and chi-square test was used for comparison between groups. Results:The 1-, 2-and 3-year survival rate of 50 gallbladder cancer patients undergoing radical surgery were 76%, 55%, 37.6%. Cox multivariate analysis showed SIS score ( HR=2.072, P=0.014) was independent prognostic risk factor; Time dependent ROC curve analysis found that the area under the SIS curve was significantly greater than the mGPS at postoperative 1 year (0.748 vs 0.603, P=0.024); Subgroup analysis found in advanced patients, SIS score was statistically significant compared with mGPS ( P=0.03). Conclusions:SIS is superior to mGPS for predicting OS in patients with gallbladder cancer who underwent radical surgery, and SIS is an independent risk factors for prognosis of patients with gallbladder cancer.

Correlation analysis between Naples prognostic score and treatment outcomes for locally advanced rectal cancer / 中华放射肿瘤学杂志

Objective:To analyze the correlation between the Naples prognostic score (NPS) after preoperative neoadjuvant chemoradiotherapy in locally advanced rectal cancer (LARC) and evaluate the prognostic value of NPS in LARC.Methods:136 patients with LARC meeting the recruitment criteria from 2015 to 2020 were selected. Serum albumin, total cholesterol (TC) were collected and neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio were calculated. All patients were scored and graded according to the NPS rule. The survival rate was calculated with Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox models. Results:There was no significant correlation between NPS score and tumor regression or pathological complete response (pCR) of LARC patients after neoadjuvant therapy ( P=0.192, P=0.163). However, Cox multivariate analysis showed that NPS was an independent risk factor for overall survival (OS) and disease-free survival (DFS) of LARC ( P=0.009, P=0.003), and hierarchical analysis suggested that LARC patients with lower NPS score obtained better prognosis. Besides NPS, tumor size was also an independent risk factor for OS, and tumor size and N stage were the independent risk factors for DFS. Conclusion:NPS has no correlation with tumor regression or pCR for LARC after neoadjuvant chemoradiotherapy, whereas it could serve as an effective predictor for long-term prognosis of LARC.

The role of Glasgow prognostic score in prognostic evaluation of nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective:To assess the role of Glasgow prognostic score (GPS) in the prognostic evaluation of nasopharyngeal carcinoma patients.Methods:Clinical data of 129 nasopharyngeal carcinoma patients who received radical radiotherapy in Affiliated Hospital of Jiangnan University from January 2012 to December 2013 were retrospectively analyzed. Clinicopathological characteristics of the patients were collected, including gender, age, TNM staging, pathological type and treatment regimen, etc. The GPS before and at 3 months after radiotherapy were calculated. The survival curve was drawn by the Kaplan- Meier method. Cox regression model was used for analysis of prognostic factors. The area under the receiver operating characteristic (ROC) curve (AUC) was utilized to evaluate the predictive capability of clinical parameters on prognosis. Results:With a median follow-up of 89.0 months (range: 5.1-104.6 months), the 5-year progression-free survival (PFS) of 129 patients was 79.8% and 84.5% for the 5-year overall survival (OS). At 3 months after radiotherapy, the 5-year PFS were 85.6%, 61.1% and 33.3% in the GPS 0, 1 and 2 groups, and 90.4%, 66.7% and 33.3% for the 5-year OS, respectively (all P<0.01). At 3 months after radiotherapy, the GPS, clinical staging (Ⅰ-Ⅲ vs. Ⅳ A) and concurrent chemotherapy were significantly correlated with PFS and OS (all P<0.01). ROC curve showed that at 3 months after radiotherapy, the AUC values of GPS, clinical staging and two combined in predicting OS were 0.694, 0.815 and 0.860, respectively. Conclusions:At 3 months after radiotherapy, higher GPS is an independent poor prognostic factor for nasopharyngeal carcinoma patients. The combination of GPS and clinical staging yields high accuracy in the prognostic evaluation of nasopharyngeal carcinoma patients.

Predictive value of inflammation-based Glasgow prognostic score for the prognosis in patients with ST-segment elevation myocardial infarction / 中国胸心血管外科临床杂志

@#Objective    To analyze prognostic ability of inflammation-based Glasgow prognostic score (GPS) in patients with ST-segment elevation myocardial infarction (STEMI). Methods    We retrospectively analyzed the clinical data of 289 patients with STEMI admitted to the Department of Emergency in West China Hospital from April 2015 to January 2016. All study subjects were divided into three groups: a group of GPS 0 (190 patients including 150 males and 40 females aged 62.63±12.98 years), a group of GPS 1 (78 patients including 58 males and 20 females aged 66.57±15.25 years), and a group of GPS 2 (21 patients including 16 males and 5 females aged 70.95±9.58 years). Cox regression analysis was conducted to analyze the independent risk factors of predicting long-term mortality of patients with STEMI. Results    There was a statistical difference in long-term mortality (9.5% vs. 23.1% vs. 61.9%, P<0.001) and in-hospital mortality (3.7% vs. 7.7% vs. 23.8%, P<0.001) among the three groups. The Global Registry of Acute Coronary Events (GRACE) scores and Gensini scores increased in patients with higher GPS scores, and the differences were statistically different (P<0.001). Multivariable Cox regression analysis showed that the GPS was independently associated with STEMI long-term all-cause mortality (1 vs. 0, HR: 2.212, P=0.037; 2 vs. 0, HR: 8.286, P<0.001). Conclusion    GPS score is helpful in predicting the long-term and in-hospital prognosis of STEMI patients, and thus may guide clinical precise intervention by early risk stratification.

Clinical impacts of inflammatory markers and clinical factors in patients with relapsed or refractory diffuse large B-cell lymphoma

BACKGROUND: Systemic inflammatory response can be associated with the prognosis of diffuse large B cell lymphoma (DLBCL). We investigated the systemic factors significantly related to clinical outcome in relapsed/refractory DLBCL.METHODS: In 242 patients with DLBCL, several factors, including inflammatory markers were analyzed. We assessed for the correlation between the survivals [progression-free survival (PFS) and overall survival (OS)] and prognostic factors.RESULTS: In these patients, a high derived neutrophil/lymphocyte ratio (dNLR) (PFS, HR=2.452, P=0.002; OS, HR=2.542, P=0.005), high Glasgow Prognostic Score (GPS) (PFS, HR=2.435, P=0.002; OS, HR=2.621, P=0.002), and high NCCN-IPI (PFS, HR=2.836, P=0.003; OS, HR=2.928, P=0.003) were significantly associated with survival in multivariate analysis. Moreover, we proposed a risk stratification model based on dNLR, GPS, and NCCN-IPI, thereby distributing patients into 4 risk groups. There were significant differences in survival among the 4 risk groups (PFS, P<0.001; OS, P<0.001).CONCLUSION: In conclusion, dNLR, GPS, and NCCN-IPI appear to be excellent prognostic parameters for survival in relapsed/refractory DLBCL.

Liver transplantation in acute-on-chronic liver failure patients:a single center experience of 159 consecutive cases / 中华器官移植杂志

Objective To evaluate the outcome of 1iver transplantation for acute-on-chronic liver failure (ACLF) patients .Methods We included 453 consecutive patients with previously cirrhosis who underwent liver transplantation between January 2013 and December 2017 .Patients were categorized as no ACLF (n=294) and ACLF(n=159) according to EASL-CLIF consortium criteria .Furthermore ,we used ACLF grades to categorize the ACLF patients .Their clinical data were reviewed and their 90-days survival outcomes were compared .Results Compared with the no ACLF group ,the length of stay in the ICU was significantly prolonged for all patients with ACLF ,and the 90-days survival rate after transplantation was significantly reduced in ACLF group .The length of stay in the ICU was shorter in Grade 1 and Grade 2 group when compared to Grade 3 group .The 90-days survival rate of no ACLF ,Grade 1 ,Grade 2 and Grade 3 group were 93 .20％ ,92 .59％ ,93 .33％ and 73 .68％ ,respectively .There were no statistically significant differences in 90-days survival rate among the no ACLF ,Grade 1 and Grade 2 group .However , the 90-days survive rate of Grade 3 group was lower than that of other groups .Conclusions Liver transplantation has been shown to be safe and effective with good outcome in patients with ACLF and should be offered in early course of ACLF before onset of multi-organ failure .

Recent advances in the diagnosis and management of primary myelofibrosis

Primary myelofibrosis (PMF) is a myeloproliferative neoplasm (MPN) in which dysregulation of the Janus kinase/signal transducers and activators of transcription (JAK/STAT) signaling pathways is the major pathogenic mechanism. Most patients with PMF carry a driver mutation in the JAK2, MPL (myeloproliferative leukemia), or CALR (calreticulin) genes. Mutations in epigenetic regulators and RNA splicing genes may also occur, and play critical roles in PMF disease progression. Based on revised World Health Organization diagnostic criteria for MPNs, both screening for driver mutations and bone marrow biopsy are required for a specific diagnosis. Clinical trials of JAK2 inhibitors for PMF have revealed significant efficacy for improving splenomegaly and constitutional symptoms. However, the currently available drug therapies for PMF do not improve survival. Although allogeneic stem cell transplantation is potentially curative, it is associated with substantial treatment-related morbidity and mortality. PMF is a heterogeneous disorder and decisions regarding treatments are often complicated, necessitating the use of prognostic models to determine the management of treatments for individual patients. This review focuses on the clinical aspects and outcomes of a cohort of Japanese patients with PMF, including discussion of recent advances in the management of PMF.

Comparative study of three clinical scoring systems in patients with acute pulmonary thromboembolism / 中华急诊医学杂志

Objective To compare the prognostic value of simplified revised Geneva Prognostic Score (sGPS), Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) in patients with acute pulmonary thromboembolism(PTE). Methods A retrospective cohort study was carried out on 276 consecutive patients with identified acute PTE admitted to our hospital from January 1997 to December 2016. We dichotomized patients as low vs. high risk in all three scoring systems. The 30-day mortality of the patients were used as prognostic factors. The prognostic value of each scoring system was evaluated by the area under the receiver operating characteristic curve(ROC). Results (1) The overall 30-day mortality of 276 patients with acute PTE was 22.5％. The 30-day mortality of patients in low vs. high risk groups according to sGPS, PESI and sPESI were 7.6％vs. 47.1％, 1.0％ vs. 34.3％, 2.4％ vs. 30.9％, respectively. The 30-day mortality of patients in high risk groups according to sGPS, PESI and sPESI were significantly higher than those of patients in low risk groups(P<0.01). The 30-day mortality of patients in low risk groups according to sGPS and PESI were significantly different(P=0.020). The 30-day mortality of patients in high risk groups according to sGPS were significantly different from those of patients in high risk groups according to PESI and sPESI, respectively (P=0.033, P=0.006). (2) The areas under the receiver operating characteristic (ROC) curves for evaluating the prognosis of patients with acute PTE according to sGPS, PESI and sPESI were 0.824, 0.891 and 0.846, respectively. The specificity (84.6％), the accuracy (84.4％) and the positive predictive value (61.2％) of PESI were the highest among the three prediction rules, the sensitivity (83.9％) and the negative predictive value (94.8％) of PESI were also relatively high. The negative predictive value of sPESI (98.6％) was the highest among the three prediction rules. Conclusions PESI can be more accurate for the overall risk stratification of patients with acute PTE, while sPESI is more helpful for identifying those patients with acute PTE who can be discharged early.

A new prognostic score system of hepatocellular carcinoma following hepatectomy / 中华肿瘤杂志

Objective@#To establish a new scoring system based on the clinicopathological features of hepatocellular carcinoma (HCC) to predict prognosis of patients who received hepatectomy.@*Methods@#A total of 845 HCC patients who underwent hepatectomy from 1999 to 2010 at Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. 21 common clinical factors were selected in this analysis. Among these factors, the cut-off values of alpha-fetoprotein (AFP), alkaline phosphatase (ALP) and intraoperative blood loss were evaluated by using a receiver operating characteristic (ROC) curve analysis.The Kaplan-Meier method and Cox regression model were used to evaluate the independent risk factors associated with the prognosis of HCC patients after hepatectomy. HCC postoperatively prognostic scoring system was established according to the minimum weighted method of these independent risk factors, and divided the patients into 3 risk groups, including low-risk, intermediate-risk and high-risk group. The relapse-free survival (RFS) and overall survival (OS) were compared among these groups.@*Results@#The univariate analysis showed that clinical symptoms, preoperative α-fetoprotein (AFP) level, serum alkaline phosphatase (ALP) level, tumor size, tumor number, abdominal lymph node metastasis, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, the severity of hepatic cirrhosis, intraoperative blood loss, the liver operative method, pathological tumor thrombus, intraoperative blood transfusion, perioperative blood transfusion were significantly associated with median RFS of these HCC patients (P<0.05). Alternatively, clinical symptoms, preoperative AFP level, serum ALP level, tumor size, tumor number, abdominal lymph node metastasis, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, the severity of hepatic cirrhosis, intraoperative blood loss, the liver operative method, pathological lymphocyte invasion, pathological tumor thrombus, intraoperative blood transfusion, perioperative blood transfusion were significantly associated with the median OS of these HCC patients (P<0.05). The multivariate analysis showed that AFP ≥20 ng/ml, clinical symptoms, tumor diameter ≥5 cm, multiple tumors, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, moderate and severe liver cirrhosis, non- anatomic resection were the independent risk factors of RFS and OS (P<0.05). The independent risk factor of RFS was intraoperative bleeding loss ≥325 ml (P<0.05); The independent risk factors of OS were abdominal lymph node metastasis and pathological tumors thrombus (P<0.05). The respective weight of 11 independent factors was used to establish the scoring system (scores range from 0 to 26). In the score system, 0 to 5 points were defined as the low-risk group (286 cases), 6 to 12 points were determined as the intermediate-risk group (503 cases), more than 13 points were classified as the high-risk group (56 cases). The median RFS of the low-risk, intermediate-risk and high-risk group were 80, 27 and 6 months, respectively. The differences were statistically significant (P<0.001). The median OS of the three groups were 134, 51 and 15 months, respectively, and the differences were statistically significant (P<0.001).@*Conclusion@#This new score system provides effective prediction of postoperative prognosis for HCC patients.

Predictive and Prognostic significance of high-sensitivity modified Glasgow Prognostic Score (HS-mGPS) in advanced gastric cancer patients treated with neoadjuvant chemotherapy / 中华肿瘤杂志

Objective@#To study the predictive and prognostic significance of high-sensitivity modified Glasgow Prognostic Score (HS-mGPS) on the effect of neoadjuvant chemotherapy for advanced gastric cancer.@*Methods@#117 patients with advanced gastric cancer received neoadjuvant chemotherapy with SOX (oxaliplatin+ S1) or mFOLFOX 6(oxaliplatin+ CF+ 5-FU) regimen. HS-mGPS was calculated according to blood C-reactive protein (CRP) concentration and serum albumin (ALB) level. The correlation between HS-mGPS and clinicopathological characteristics was determined and the predictors of survival were analyzed.@*Results@#117 patients with stage ⅡB (43 cases), stage Ⅲ (60), and stage Ⅳ (14) received preoperative neoadjuvant chemotherapy. The overall response rate of neoadjuvant chemotherapy was 61.5%(72/117), and the tumor control rate was 88.0% (103/117), with a pathological response rate of 91.5% (107/117). The R0 resection rate was 81.2% (95/117). The median disease-free survival (DFS) was 21.0 (95% CI 6.4-35.6) months. The median overall survival (OS) was 39.0 (95% CI 21.4-56.6) months. Higher HS-mGPS was associated with higher T stage, local lymph-node metastasis, distant metastasis, lower chemotherapy overall response rate and lower pathological response rate (all P<0.05). The univariate analysis and multivariate analysis showed that higher HS-mGPS, presence of local lymph-node metastasis and non R0 resection were associated with poorer DFS and OS (P<0.05).@*Conclusion@#HS-mGPS can be used to predict the benefits of neoadjuvant chemotherapy and as an independent prognostic factor for survival in patients with advanced gastric cancer.

Clinical application of external ventricular drainage for ruptured anterior communicating artery aneurysms / 局解手术学杂志

Objective To investigate the clinical effect of external ventricular drainage on the prognosis of anterior communicating artery aneurysms.Methods Retrospectively collected and analyzed 96 patients of anterior communicating artery aneurysms who were treated in our hospital from June 2013 to October 2015,and they were divided into the observation group which was given external ventricular drainage treatment and the control group which was not given external ventricular drainage treatment.These patients were followed up for 6 months to 2 years,and the results of the 2 groups were graded according to the analysis of postoperative complications and the Glasgow prognostic score (GOS).Meanwhile,evaluated the general function of the patients according to the KPS score.Results The the incidence rate of complications after treatment in observation group was 54.17％,which was lower than 86.96％ in the control group,and the difference was statistically significant(P ＜ 0.05).The cure rate of observation group was 79.16％,which was higher than 50％ in the control group,and the difference was statistically significant (P ＜ 0.05).The postoperative KPS score in the observation group was (79.68 ± 13.24) points,which was higher than (62.57 ± 12.72) points in the control group,and the differences were statistically significant (P ＜ 0.05).Conclusion External ventricular drainage can reduce the compression injury of the brain tissue to a minimum degree,reduce intracranial pressure,relieve cerebral edema caused by intracranial pressure,reduce complications,and improve the prognosis of patients and the cure rate.

Prognostic value of inflammation-based scores and TNM stage for pancreatic cancer patients after radical resection / 中华胰腺病杂志

Objective To compare the prognostic value of different inflammation-based prognostic scores and Tumor Node Metastasis ( TNM) stage for patients undergoing radical resection of pancreatic cancer with the routine TNM stage in clinical practice.Methods Clinical data of 185 patients with pancreatic cancer who underwent radical surgery were retrospectively analyzed.Based on the inflammation-based prognostic scores ( Glasgow prognostic score ( GPS ) , neutrophil lymphocyte ratio ( NLR ) , platelet lymphocyte ratio ( PLR) , prognostic nutritional index ( PNI ) and prognostic index ( PI ) ) before surgery, univariate and multivariate analyses were used for identifying influential factors on patients′survival.Homogeneity of different scoring systems was compared using likelihood ratio chi-quare test, and linear trend chi-square test, and receiver operating characteristic ( ROC) curve were performed to compare the differentiating ability and single trend of the selected scores with those of routine TNM stage.Results In univariate analysis, preoperative weight loss, serum C-reactive protein, serum albumin, CA19-9, radical surgery, NLR, PLR, GPS, PI, PNI and TNM stage were all significantly associated with patients′overall survival after surgery (P<0.001).In multivariate cox risk model analysis, TNM stage, radical surgery, GPS, NLR, PLR, PI and PNI were independent risk factors for patients′survival after surgery.ROC curve showed that GPS had higher AUC than other scoring systems, but TNM stage had the highest AUC.The homogeneity, differentiating ability and single trend of GPS were higher compared to other inflammation-based prognostic scores, but those of TNM stage were the highest.Conclusions The inflammation-based prognostic scores like GPS, NLR, PLR, PI and PNI were independent prognostic factors for pancreatic caner patients′survival after surgery, and the prognostic value of GPS was superior to that of NLR, PLR, PI and PNI.

Post-treatment prognostic score model establishment and stratified therapy for newly diagnosed metastatic nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To establish a post?treatment prognostic score model for newly diagnosed metastatic nasopharyngeal carcinoma, and to investigate the feasibility of stratified therapy. Methods A total of 263 eligible patients with newly diagnosed metastatic nasopharyngeal carcinoma from 2002 to 2010 were enrolled as subjects. The primary tumor was treated with conventional radiotherapy, three?dimensional conformal radiotherapy, or intensity?modulated radiotherapy, and radiation areas included nasopharyngeal tumor and cervical lymphatic drainage region. The metastatic bone tumor was mainly treated with conventional external radiotherapy, while the metastatic liver or lung tumor was mainly treated with surgical resection, radiotherapy, or radiofrequency ablation. The first?line therapy for most of patients was cisplatin?based combination chemotherapy. Factors including the general characteristics, tumor status, and therapy for patients were involved in multivariate analysis, and a prognostic model was established based on the n value (HR=en ) of the prognostic factors. Results The factors influencing the overall survival (OS) in patients were a Karnofsky performance score (KPS) not higher than 70(P= 0?? 00), multiple organ metastases (P=0?? 00), combination with liver metastasis (P= 0?? 00), a number of metastases not less than 2(P= 0?? 00), a level of lactate dehydrogenase (LDH) higher than 245 IU/ L (P= 0?? 00), a number of chemotherapy cycles ranging between 1 and 3( P= 0?? 00), a poor response for metastatic tumor ( stable disease or progressive disease)(P= 0?? 00), and primary tumor not treated with radiotherapy (P= 0?? 01). Based on the prognostic score, patients were divided into low?risk group (0?1?? 5 points), intermediate?risk group (2?? 0?6?? 5 points), and high?risk group (≥7?? 0 points), and the 5?year OS rates in the three groups were 59?? 0%, 25?? 1%, and 0%, respectively. Conclusions The prognostic score model based on the KPS, serum level of LDH, multiple organ metastases, combination with liver metastasis, and number of metastases can effectively predict the survival in patients. Active treatment including at least 4 chemotherapy cycles and radiotherapy for primary tumor can prolong the survival time of patients in the low?and intermediate?risk groups. However, patients in the high?risk group were mainly treated with palliative radiotherapy due to no improvement in the survival by radiotherapy for primary tumor.

The Modified Glasgow Prognostic Scores as a Predictor in Diffuse Large B Cell Lymphoma Treated with R-CHOP Regimen

PURPOSE: The modified Glasgow Prognostic Score (mGPS) consisting of serum C-reactive protein and albumin levels, shows significant prognostic value in several types of tumors. We evaluated the prognostic significance of mGPS in 285 patients with diffuse large B cell lymphoma (DLBCL), retrospectively. MATERIALS AND METHODS: According to mGPS classification, 204 patients (71.5%) had an mGPS of 0, 57 (20%) had an mGPS of 1, and 24 (8.5%) had an mGPS of 2. RESULTS: Our study found that high mGPS were associated with poor prognostic factors including older age, extranodal involvement, advanced disease stage, unfavorable International Prognostic Index scores, and the presence of B symptoms. The complete response (CR) rate after 3 cycles of R-CHOP chemotherapy was higher in patients with mGPS of 0 (53.8%) compared to those with mGPS of 1 (33.3%) or 2 (25.0%) (p=0.001). Patients with mGPS of 0 had significantly better overall survival (OS) than those with mGPS=1 and those with mGPS=2 (p=0.036). Multivariate analyses revealed that the GPS score was a prognostic factor for the CR rate of 3 cycle R-CHOP therapy (p=0.044) as well as OS (p=0.037). CONCLUSION: mGPS can be considered a potential prognostic factor that may predict early responses to R-CHOP therapy in DLBCL patients.

Utility of a novel risk score for prediction of ventricular tachycardia and cardiac death in chronic Chagas disease - the SEARCH-RIO study

The SEARCH-RIO study prospectively investigated electrocardiogram (ECG)-derived variables in chronic Chagas disease (CCD) as predictors of cardiac death and new onset ventricular tachycardia (VT). Cardiac arrhythmia is a major cause of death in CCD, and electrical markers may play a significant role in risk stratification. One hundred clinically stable outpatients with CCD were enrolled in this study. They initially underwent a 12-lead resting ECG, signal-averaged ECG, and 24-h ambulatory ECG. Abnormal Q-waves, filtered QRS duration, intraventricular electrical transients (IVET), 24-h standard deviation of normal RR intervals (SDNN), and VT were assessed. Echocardiograms assessed left ventricular ejection fraction. Predictors of cardiac death and new onset VT were identified in a Cox proportional hazard model. During a mean follow-up of 95.3 months, 36 patients had adverse events: 22 new onset VT (mean±SD, 18.4±4‰/year) and 20 deaths (26.4±1.8‰/year). In multivariate analysis, only Q-wave (hazard ratio, HR=6.7; P<0.001), VT (HR=5.3; P<0.001), SDNN<100 ms (HR=4.0; P=0.006), and IVET+ (HR=3.0; P=0.04) were independent predictors of the composite endpoint of cardiac death and new onset VT. A prognostic score was developed by weighting points proportional to beta coefficients and summing-up: Q-wave=2; VT=2; SDNN<100 ms=1; IVET+=1. Receiver operating characteristic curve analysis optimized the cutoff value at >1. In 10,000 bootstraps, the C-statistic of this novel score was non-inferior to a previously validated (Rassi) score (0.89±0.03 and 0.80±0.05, respectively; test for non-inferiority: P<0.001). In CCD, surface ECG-derived variables are predictors of cardiac death and new onset VT.

Is a Revised Tokuhashi Scoring System Useful in Preoperative Evaluation of Metastatic Spinal Tumor Prognosis?

OBJECTIVE: The aim of this study was to evaluate the consistency between revised prognostic score derived from the Tokuhashi scoring system(TSS) and the actual patient survival period after surgical treatment at our institution. METHODS: From 1998 to 2005, surgically treated 44 patients with metastatic spine tumors were reviewed retrospectively at our institution. Among these 44 patients, 32 had died, 2 were alive at the time of the last follow-up evaluation, and 10 were lost to the follow-up. Only 32 patients who died after surgery have been investigated in this study. Preoperatively, patients were staged serveral standard diagnostic modalities, such as, plain radiographs, computed tomography, magnetic resonance imaging and etc. Each patient was evaluated using the TSS and placed in one of three groups depending upon this evaluation. RESULTS: The actual mean(+/-SD) survival period was 6.6 months(+/-1.14) for the first group (predicted survival periods in revised TSS, less than 6 months), 15.1 months(+/- 5.38) for the second group(predicted survival periods in revised TSS, 6 months or more) and 37.5 months(+/-8.70) for the third group(predictied survival period in revised TSS, 1 year or more). The survival periods for these groups were significantly different(p=0.0006). Applying the TSS for evaluation of prognosis of metastatic spinal tumors was found to be very reliable results with a statistically significance. Of six parameters measured in the TSS, Extraspinal bone metastases, metastases to the major internal organs, the primary tumor site contributed to predicting the survival periods. CONCLUSIONS: This study has revealed that the revised prognostic score resulting from the TSS predicts actual survival periods remarkably well. Hence, we thought that the revised TSS could be useful and reliable tool in prognosis of metastic spinal tumors.