Prognostic Value of p27, p53, and Vascular Endothelial Growth Factor in Dukes A and B Colon Cancer Patients Undergoing Potentially Curative Surgery

PURPOSE Early-stage colon cancer patients (Dukes A or B; pT1–T3 pNO pMO) are excluded from adjuvant chemotherapy following potentially curative surgery because they are expected to have good long-term survival. However, 20 percent to 30 percent of these patients ultimately succumb from recurrent disease. This indicates that the conventional staging procedures may be unable to precisely predict cancer prognosis.METHODS In 65 early-stage colon cancers, we investigated by immunohistochemistry the role of molecular markers such as p27, p53, and vascular endothelial growth factor in identifying high-risk patients who may benefit from adjuvant treatments.RESULTS No clinicopathologic factor, namely Dukes stage, t parameter, number of resected nodes, and vascular or lymphatic invasion, was found be an independent significant predictor of disease-specific and disease-free survival. In contrast, each molecular marker predicted survival and recurrence rates much better than the conventional Dukes staging system. The best combination of variables for prediction of long-term outcome and recurrence rate included p27, p53, and vascular endothelial growth factor. Interestingly, the greater the number of molecular alterations, the lower the five-year estimated survival function. Nearly all cancer-related deaths were observed among patients whose colon cancers expressed all three molecular alterations. Regardless of Dukes stage, the recurrence rate was found to increase with the increase in the number of molecular alterations. Early-stage colon cancers expressing p27 down-regulation and high p53 and vascular endothelial growth factor immunoreactivity showed a 100 percent actuarial four-year recurrence rate.CONCLUSIONS Assessment of molecular alterations may be useful to identify a higher-risk group of early-stage colon cancer patients who may benefit from adjuvant chemotherapy.     

Can demographic and anthropometric characteristics predict clinical improvement in patients with chronic non-specific low back pain?

Objective

To identify potential prognostic factors that may predict clinical improvement of patients treated with different physical therapy interventions in the short-term.

不可切除胆道癌致梗阻性黄疸患者行介入术后的生存预测模型建立

目的探讨因不可切除胆道癌致阻黄患者行介入治疗后预后生存的影响因素,并构建列线图个体化预测患者总生存期（OS）。 方法回顾性分析我院2015年6月至2021年7月收治的261例胆道癌行经皮介入降黄患者的资料。总体划分为训练组（n = 188）及验证组（n = 73）。单因素和多因素Cox回归分析筛选患者OS的独立影响因素,并以此构建列线图,个体化预测不可切除胆道癌伴有阻黄患者介入治疗术后生存情况。绘制AUC曲线及一致性曲线评估模型预测性能。通过K-M曲线评估分类预测因子的危险分层能力。 结果在261例患者中,训练组中位OS为244 d（IQR：213,275）。验证组中位OS为236 d（IQR：186,285）。单因素及多因素回归分析显示,总胆红素、总胆固醇、血红蛋白、血清钠、糖类抗原199水平和肿瘤亚型为预测不可切除胆道癌伴阻黄患者3、6个月和1年的OS的独立相关因素,并建立诺模图。ROC曲线下面积显示,该模型在训练组（0.817、0.825和0.796）和验证组（0.921、0.880和0.904）对3、6个月和1年的OS预测具有良好的分辨能力,可以较准确地预测患者的总体生存情况。 结论本模型能够较好预测不可切除胆道癌伴阻黄患者3、6个月、1年的生存机会,为临床治疗策略选择提供一定的帮助。     

The challenge of p53 as prognostic and predictive factor in Hodgkin's or non-Hodgkin's lymphoma

 The results of individual studies examining the role of p53 as a predictive and prognostic factor in lymphoid malignancies have varied considerably. In order to summarize the available data on the overexpression or mutation of p53 in Hodgkin's and non-Hodgkin's lymphoma, a systematic literature review was performed. Twenty-four studies met the eligibility criteria. With respect to non-Hodgkin's lymphoma, most studies seem to support the hypothesis that patients whose tumors contain wild-type p53 respond better to treatment and have increased survival rates. If true, the implication may be that patients with p53 mutated tumors could be selected for non-standard treatment. With respect to Hodgkin's lymphoma, comparable associations were rarely reported. However, techniques for assessing the inactivation of p53 varied widely. Furthermore, in most instances, the study design and/or statistical methods did not allow sufficient analyses of the influence of confounding factors such as histologic type, stage, first-line and salvage treatment, etc. Therefore, it remains unclear whether the apparent influence of p53 status on outcome in non-Hodgkin's lymphoma is independent of established parameters such as stage, performance status, etc. Further studies involving large numbers of specimens derived from patients treated in clinical trials with identical regimens, follow-up and salvage strategies are needed. These studies should also be stratified according to histologic subtypes. Received: 22 November 1999 / Accepted: 6 June 2000     

Predictors and treatment response with cardiac resynchronization therapy in patients with heart failure characterized by dyssynchrony: a pre-defined analysis from the CARE-HF trial.

AIMS: The cardiac resynchronization therapy in heart failure trial (CARE-HF) demonstrated that cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure and cardiac dyssynchrony. The aim of this study was to develop a prognostic model to evaluate the relationship between prospectively defined patient characteristics and treatment on the trial primary outcome of death from any cause or unplanned hospitalization for a major cardiovascular event. METHODS AND RESULTS: A total of 813 patients were enrolled in the CARE-HF study and were followed for a mean of 29.4 months. A Cox Proportional Hazards Model was fitted to identify predictors of the primary outcome and any predictors that modified the effect of CRT. Ischaemic aetiology, more severe mitral regurgitation and increased N-terminal pro-brain natriuretic peptide, were associated with an increased risk of death or unplanned cardiovascular hospitalization irrespective of cardiac resynchronization [Hazard ratio (HR) 1.89, 95% CI 1.45-2.46, HR 1.71, 95% CI 1.38-2.12 and HR 1.31, 95% CI 1.17-1.47, respectively] and increasing systolic blood pressure with a decreasing risk of an event (HR 0.99, 95% CI 0.98-1.00). The benefits of cardiac resynchronization were modified by systolic blood pressure and interventricular mechanical delay (IVMD). Patients with increasing systolic blood pressure appear to receive reduced benefit from CRT (HR 1.02, 95% CI 1.00-1.03), whereas those patients with more severe IVMD appear to benefit more from treatment (HR 0.99, 95% CI 0.98-1.00). CONCLUSION: Patients with echocardiographic evidence of more severe cardiac dyssynchrony and low systolic blood pressure obtain greater benefit from CRT, although benefits were substantial across the range of subjects included in the trial.     

Prognosis prediction signature of seven immune genes based on HPV status in cervical cancer

Cervical cancer (CC) has a high incidence and mortality rate, with a low 5-year survival rate, and human papillomavirus (HPV) is one of its carcinogenic risks. However, little evidence exists on the impact of HPV infection on the survival of patients with CC. In the present study, the CC cohort and immune genes were downloaded from the TCGA database and the ImmPort database, respectively. Subsequently, the Gene Set Enrichment Analysis was performed and found that HPV status was involved in multiple immune signaling pathways, which revealed that HPV infection might play critical roles in the immune response. Then seven prognostic immune genes were identified according to HPV status in CC. Using the seven immune genes, we established an immune risk score (IRS) signature and the Kaplan-Meier curve showed that high IRS was significantly correlated with poor prognosis of CC in both the training sets (HR = 2.32, 95% CI = 1.66–3.33; AUC = 0.712) and the validation sets (HR = 1.38, 95% CI = 1.02–1.85 and AUC = 0.583 in TCGA-HNSCC; HR = 2.58, 95% CI = 1.364–4.893, AUC = 0.676 in GSE44001). A nomogram of IRS combined with clinical features was established, and further analyses demonstrated that the power of the nomogram to predict the prognosis of CC was more reliable than that of a single independent factor. In conclusion, this study provided a more comprehensive understanding of the correlation between HPV and immune mechanisms as well as a novel signature that can effectively predict the prognosis of CC patients.     

The prognostic value of the hamstring outcome score to predict the risk of hamstring injuries

ObjectivesHamstring injuries are common among soccer players. The hamstring outcome score (HaOS) might be useful to identify amateur players at risk of hamstring injury. Therefore the aims of this study were: To determine the association between the HaOS and prior and new hamstring injuries in amateur soccer players, and to determine the prognostic value of the HaOS for identifying players with or without previous hamstring injuries at risk of future injury.DesignCohort study.MethodsHaOS scores and information about previous injuries were collected at baseline and new injuries were prospectively registered during a cluster-randomized controlled trial involving 400 amateur soccer players. Analysis of variance and t-tests were used to determine the association between the HaOS and previous and new hamstring injury, respectively. Logistic regression analysis indicated the prognostic value of the HaOS for predicting new hamstring injuries.ResultsAnalysis of data of 356 players indicated that lower HaOS scores were associated with more previous hamstring injuries (F = 17.4; p = 0.000) and that players with lower HaOS scores sustained more new hamstring injuries (T = 3.59, df = 67.23, p = 0.001). With a conventional HaOS score cut-off of 80%, logistic regression models yielded a probability of hamstring injuries of 11%, 18%, and 28% for players with 0,1, or 2 hamstring injuries in the previous season, respectively.ConclusionsThe HaOS is associated with previous and future hamstring injury and might be a useful tool to provide players with insight into their risk of sustaining a new hamstring injury risk when used in combination with previous injuries.     

Efficacy of different antifungal drugs as initial treatment for patients with talaromycosis: A systematic review and meta-analysis

There are no standard choices on antifungal drugs for talaromycosis due to various factors, and related studies are also limited. This study summarizes and analyzes efficacy of different antifungal drugs for patients with talaromycosis, which can provide more reference evidence for drugs’ choices in practice. We conducted a meta-analysis on prognostic impacts of different antifungal drugs against talaromycosis, and primary outcome was all-cause mortality. A total of 975 patients from 8 studies were included. One of the 8 studies was a randomized controlled trial and the others were retrospective studies. Among these patients, 582 cases were initiated with amphotericin B, 31 cases died (9.28%). The other 393 cases were initiated with itraconazole, and 54 cases died (14.00%). The initial use of amphotericin B for talaromycosis significantly reduced mortality compared with itraconazole (risk ratio (RR): 0.61; 95% confidence interval (CI): 0.41–0.90; P = 0.01; I² = 4%). Initial treatment with amphotericin B for talaromycosis in different regions (internal and external) and studies (sample size < 100) had no obvious prognostic advantages over itraconazole (RR: 0.60, 95% CI: 0.32–1.13; P = 0.11; I² = 44%; RR: 0.61, 95% CI: 0.37– 1.00; P = 0.05; I² = 0%; RR: 0.71, 95% CI: 0.39–1.29; P = 0.26; I² = 0%, respectively). However, when study's sample size was ≥ 100, the mortality of amphotericin B group was significantly reduced (RR: 0.54, 95% CI: 0.32– 0.92; P = 0.02; I² = 46%). In conclusion, amphotericin B is a better choice as initial therapeutic drug for talaromycosis.     

638例舌鳞癌预后及影响因素分析

目的 研究舌鳞癌患者人口学及临床病理特征对总生存率的影响,筛选可能的预后影响因素。方法 选择2003—2013年间在上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科经病理确诊为舌鳞癌、户籍所在地为上海的住院患者。从住院病史中提取年龄、性别等人口学特征,病变部位、TNM分期、临床分期、组织学分级等临床病理特征数据。采用Stata/SE 10.0统计软件,Kaplan-Meier生存分析计算1、3、5年总生存率,Log-rank检验比较各因素不同水平生存分布的差异,Cox 比例风险模型筛选预后影响因素。结果 638例舌鳞癌患者纳入研究,1、3、5年生存率分别为83.52%、68.98%、63.33%。年龄>60岁与≤60岁生存率有统计学差异,>60岁者死亡风险增高（P<0.05）;性别经年龄分层后,≤60岁舌鳞癌患者生存率有性别差异,女性预后较好（P<0.05）;舌体鳞癌患者总生存率比舌根鳞癌患者高（P<0.05）。多因素回归分析显示,与舌鳞癌预后有关的因素有T分期、N分期,分期越高,预后越差（P<0.05）;组织学分级则仅有高分化与低分化对预后影响差异显著,低分化者预后极差（P<0.05）。结论 年龄、性别、肿瘤部位、TNM分期和组织学分级等均是舌鳞癌的预后影响因素。