ABSTRACT
BACKGROUND: As the incidence of colorectal cancer tends to be younger, early-onset colorectal cancer (EOCRC) has attracted more attention in recent years. We aimed to assess the optimal lymph node staging system among EOCRC patients, and then, establish informative assessment models for prognosis prediction. METHODS: Data of EOCRC were retrieved from the Surveillance, Epidemiology, and End Results database. Survival prediction ability of three lymph node staging systems including N stage of the tumor node metastasis (TNM) staging system, lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) was assessed and compared using Akaike information criterion (AIC), Harrell's concordance index (C-index), and likelihood ratio (LR) test. Univariate and multivariate Cox regression analyses were conducted to identify the prognostic predictors for overall survival (OS) and cancer-specific survival (CSS). Effectiveness of the model was demonstrated by receiver operative curve and decision curve analysis. RESULTS: A total of 17,535 cases were finally included in this study. All three lymph node staging systems showed significant performance in survival prediction (p < 0.001). Comparatively, LODDS presented a better ability of prognosis prediction with lower AIC (OS: 70,510.99; CSS: 60,925.34), higher C-index (OS: 0.6617; CSS: 0.6799), and higher LR test score (OS: 998.65; CSS: 1103.09). Based on independent factors identified from Cox regression analysis, OS and CSS nomograms for EOCRC were established and validated. CONCLUSIONS: LODDS shows better predictive performance than N stage or LNR among patients with EOCRC. Novel validated nomograms based on LODDS could effectively provide more prognostic information than the TNM staging system.
Subject(s)
Colorectal Neoplasms , Neoplasms, Second Primary , Humans , Prognosis , Nomograms , Lymph NodesABSTRACT
Background: Controversy persists about neoadjuvant chemotherapy (NAC) within the field of locally advanced colon cancer (LACC). The purpose of this study was to assess the existing and latest literature with high quality to determine the role of NAC in various aspects. Methods: A comprehensive literature search of the PubMed, Embase, Web of Science, and the Cochrane Library databases was conducted from inception to April 2022. Review Manager 5.3 was applied for meta-analyses with a random-effects model whenever possible. Results: Overall, 8 studies were included in this systematic review and meta-analysis, comprising 4 randomized controlled trials (RCTs) and 4 retrospective studies involving 40,136 participants. The 3-year overall survival (OS) (HR: 0.90, 95% CI: 0.66-1.23, P = 0.51) and 5-year OS (HR: 0.89, 95% CI: 0.53-1.03, P = 0.53) were comparable between two groups. Mortality in 30 days was found less frequent in the NAC group (OR: 0.43, 95% CI: 0.20-0.91, P = 0.03), whereas no significant differences were detected concerning other perioperative complications, R0 resection, or adverse events. In terms of subgroup analyses for RCTs, less anastomotic leak (OR: 0.51, 95% CI: 0.31-0.86, P = 0.01) and higher R0 resection rate (OR: 2.35, 95% CI: 1.04-5.32, P = 0.04) were observed in the NAC group. Conclusions: NAC is safe and feasible for patients with LACC, but no significant survival benefit could be demonstrated. The application of NAC still needs to be prudent until significant evidence supporting the oncological outcomes is presented. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier (CRD42022333306).
ABSTRACT
One of the most prevalent malignant tumours is lung cancer. Circulating microRNAs (miRNAs) have shown to have significant promise for lung cancer diagnosis and prognosis, according to a growing body of research. The researchers wanted to explore if serum exosomal miR-1246 has any treatment significance in patients with non-small-cell lung cancer (NON-SCLC). Real-time PCR was used to determine the stage of exosomal miR-1246 serum expression in NON-SCLC patients. The researchers next looked into the link regarding exosomal miR-1246 serum stages and NON-SCLC prognosis. In NON-SCLC patients, exosomal miR-1246 serum appearance was considerably higher. According to a receiver operating characteristic (ROC) research, serum exosomal miR-1246 was effective in discriminating NON-SCLC patients from normal controls and non-malignant respiratory illness patients. Following treatment, the amount of serum exosomal miR-1246 reduced but increased in cases of recurrence. Furthermore, the level of serum exosomal miR-1246 was connected to distant metastases and TNM stages in a significant way. According to a survival analysis, cases with severe levels of exosomal miR-1246 serum had reduced overall or disease-free survival. The level of exosomal miR-1246 serum was found to be an autonomous predictive issue for NON-SCLC in multi-variate analysis. Finally, exosomal miR-1246 serum may be a useful prognosis biomarker for non-small-cell lung cancer.
ABSTRACT
OBJECTIVE: To investigate the influence of non-diabetic hyperglycemia on postoperative complications following laparoscopic colorectal cancer resection. METHODS: Clinical data of 636 patients undergoing laparoscopic colorectal cancer resection in The Affiliated Nanhai Hospital of Southern Medical University between 2009 and 2013 were analyzed retrospectively. After excluding cases with diabetes mellitus, the patients were divided into the hyperglycemia group (blood glucose level>7.8 mmol/L at any time during hospitalization period, n=161) and the non-hyperglycemia group (n=309). RESULTS: Compared to non-hyperglycemia group, hyperglycemia group had more intraoperative blood loss [(186±80) ml vs. (158±74) ml, P=0.007] and longer postoperative hospital stay [(14.0±6.8) d vs. (11.2±5.5) d, P=0.013]. The overall rate of postoperative complication was 24.8% and 16.5% respectively (P=0.030), in the hyperglycemia and the non-hyperglycemia groups, and the mortality was 1.2% and 0.6% respectively (P=0.541). Multivariable analysis showed hyperglycemia was an independent risk factor of postoperative complication (RR=2.425, 95% CI:1.210-4.226, P=0.006). CONCLUSIONS: Non-diabetic hyperglycemia may increase the risk of postoperative complications following laparoscopic colorectal cancer resection. Perioperative blood glucose monitoring should be performed, regardless of patients with or without diabetes.
