Systemic immune inflammation index,ratio of lymphocytes to monocytes,lactate dehydrogenase and prognosis of diffuse large B-cell lymphoma patients

BACKGROUNDIn malignant tumors, inflammation plays a vital role in the development, invasion, and metastasis of cancer cells. Diffuse large B-cell lymphoma (DLBCL), the most common malignant proliferative disease of the lymphatic system, is commonly associated with inflammation. The international prognostic index (IPI), which includes age, lactate dehydrogenase (LDH), number of extranodal lesions, Ann Arbor score, and Eastern Cooperative Oncology Group (ECOG) score, can evaluate the prognosis of DLBCL. However, its use in accurately identifying high-risk patients and guiding treatment is poor. Therefore, it is important to find novel immune markers in predicting the prognosis of DLBCL patients.AIMTo determine the association between the systemic immune inflammation index (SII), ratio of lymphocytes to monocytes (LMR), ratio of LMR to LDH (LMR/LDH), and prognosis of patients with DLBCL.METHODSA total of 68 patients diagnosed with DLBCL, treated in our hospital between January 2016 and January 2020, were included. χ² test, Pearson’s R correlation, Kaplan Meier curves, and Cox proportional risk regression analysis were used. The differences in the SII, LMR, and LMR/LDH among patients with different clinicopathological features were analyzed. The differences in progression-free survival time among patients with different SII, LMR, and LMR/LDH expressions and influencing factors affecting the prognosis of DLBCL patients, were also analyzed.RESULTSThe LMR and LMR/LDH in patients with Ann Arbor stage III–IV, ECOG score ≥ 2, and SII, IPI score 2–5 were significantly higher than those of patients with Ann Arbor stage I-II and ECOG score < 2 (P < 0.05). Patients with high SII, LMR, and LMR/LDH had progression-free survival times of 34 mo (95%CI: 32.52–38.50), 35 mo (95%CI: 33.42–36.58) and 35 mo (95%CI: 33.49–36.51), respectively, which were significantly lower than those with low SII, LMR, and LMR/LDH (P < 0.05); the SII, LMR, and LMR/LDH were positively correlated (P < 0.05). Cox proportional risk regression analysis showed that the SII, LMR, and LMR/LDH were influencing factors for the prognosis of DLBCL patients (hazard ratio = 1.143, 1.665, and 1.704, respectively; P < 0.05).CONCLUSIONThe SII, LMR, and LMR/LDH are related to the clinicopathological features of DLCBL, and they also influence the prognosis of patients with the disease.     

合并糖尿病及治疗过程中血糖升高对弥漫大B细胞淋巴瘤患者预后的影响

目的探讨弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征和预后因素,评估合并糖尿病(DM)及治疗过程中发生血糖升高对DLBCL预后的影响。方法回顾性收集2009年1月1日至2019年12月31日天津医科大学肿瘤医院及中山大学肿瘤防治中心收治的481例初诊DLBCL患者的临床资料,重点关注其治疗前及治疗中的血糖水平,采用Cox回归风险模型进行单因素分析评估预后影响因素,采用Kaplan-Meier法绘制生存曲线分析血糖异常对DLBCL患者总生存(OS)、无进展生存(PFS)的影响。结果82例(17.0%)患者在诊断DLBCL前患DM,88例(18.3%)患者在DLBCL治疗过程中至少发生一次血糖升高。单因素分析显示,年龄、Ann-Arbor分期、IPI评分、是否合并DM与OS、PFS相关(P值均<0.05)。组间比较显示,合并DM组与治疗过程中血糖升高组的OS和PFS均较无血糖异常组差(OS:P值分别为0.001、0.003,PFS:P值均<0.001),合并DM组与治疗过程中血糖升高组相比OS和PFS的差异均无统计学意义(P值分别为0.557、0.463)。化疗期间血糖控制良好组的OS和PFS优于血糖控制差组(OS:P=0.037,PFS:P=0.007)。结论合并DM是影响DLBCL患者预后的重要因素,治疗过程中血糖升高与DLBCL患者的不良预后相关。     

T-cell immunoglobulin mucin molecule-3, transformation growth factor β, and chemokine-12 and the prognostic status of diffuse large B-cell lymphoma

BACKGROUNDThe effects of T-cell immunoglobulin mucin molecule-3 (Tim-3), transforming growth factor β (TGF-β), and chemokine-12 (CXCL12) expression on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) have not been elucidated.AIMTo examine the correlation between Tim-3, TGF-β and CXCL12 expression and DLBCL prognosis.METHODSLymph node tissues of 97 patients with DLBCL and 93 normal-response hyperplastic lymph node tissues treated from January 2017 to May 2019 were selected as the DLBCL and control groups, respectively. The expression of Tim-3, TGF-β, and CXCL12 was detected immunohistochemically. Patients were followed up for 3 years, and progression-free survival was recorded. Cox multifactorial analysis was performed to analyze the risk factors for poor prognosis.RESULTSThe positive expression rates of Tim-3, TGF-β, and CXCL12 were higher in DLBCL tissues than in non-cancerous (control) tissues (P < 0.05). One-year post-surgery, the positive expression rates of Tim-3, TGF-β, and CXCL12 were higher in patients with effective treatment than in those with ineffective treatment (P < 0.05). The 3-year progression-free survival of 97 patients with DLBCL was 67.01% (65/97). Univariate analysis revealed that clinical stage, bone marrow infiltration, International Prognostic Index (IPI) score, Tim-3 positivity, TGF-β positivity, and CXCL12 positivity were associated with poor prognosis (P < 0.05). Multivariate Cox regression analysis demonstrated that clinical stage III–IV, bone marrow infiltration, mediate-to-high-risk IPI scores, Tim-3 positivity, TGF-β positivity, and CXCL12 positivity were independent risk factors affecting prognosis (P < 0.05).CONCLUSIONDLBCL tissues exhibit high positive expression of Tim-3, TGF-β, and CXCL12, and a high expression of all three indicates a poor prognosis.     

Novel model predicts prognosis for patients with diffuse large B-cell lymphoma in first relapse after initial R-CHOP therapy: a single-institution study in China

ObjectiveTo develop a prognostic model for Chinese patients with relapsed diffuse large B-cell lymphoma (DLBCL) after initial R-CHOP therapy.MethodsWe retrospectively analyzed the characteristics and survival outcomes of 79 patients with relapsed DLBCL initially treated with R-CHOP at Peking Union Medical College Hospital from February 2012 to September 2016. We used the data to develop a novel prognostic model.ResultsThe median age at the start of salvage therapy was 59 (17–85) years and median time from diagnosis to relapse was 319 (49–1018) days. Multivariate analysis identified short time to relapse (TTR) and B symptoms as independent prognostic factors for reduced progression-free survival (PFS) and overall survival (OS). We created a new prognostic scoring system including TTR, lactate dehydrogenase, absolute lymphocyte count at relapse, and B symptoms, referred to as the TLLB model, which could separate patients into three risk groups with 2-year PFS and OS rates of 70.7%, 40.0%, and 11.1%, and 87.5%, 53.7%, and 29.4%, respectively.ConclusionTTR and B symptoms can be used as important predictors of survival in patients with DLBCL. The TLLB system provides a useful prognostic model compared with the previous TTL system.     

CA2-02: Identification of Prognostic Tumor Markers in HIV+ Diffuse Large B-cell Lymphoma

Background/Aims About half of HIV+ diffuse large B-cell lymphoma (DLBCL) patients die within 2 years of diagnosis. Identification of prognostic tumor markers may assist clinical risk stratification and inform therapeutic developments. We examined if certain tumor markers in HIV+ DLBCL are associated with mortality. Methods H&E slides from HIV+ DLBCL cases diagnosed between 1996-2007 in the Kaiser Permanente California Health Plan were reviewed to identify representative tumor blocks for tissue microarray (TMA) construction. Immunohistochemistry staining of TMA cores was used to analyze the expression of selected markers in the following categories: viral factor: EBV cell cycle regulators: Cyclin E, SKP2 and cMYC; B-cell activators: FOXP1, PKC-?2, p27, and Ki-67; and apoptosis regulators: GAL3, p53, BCL2, surviving, and BLIMP1. Percent of DLBCL cells with visible marker staining was scored on a scale from 0-4 (0-9%, 10-24%, 25-49%, 50-74% and =75%). Epstein Barr Virus (EBV) infection was determined by in situ hybridization of EBV RNA. Positivity for each marker was determined based on previously established cut-off values. Information on patient demographics and clinical history, DLBCL characteristics and death was collected from Kaiser Permanente's credited cancer and HIV registries as well as electronic medical records. Each marker's prognostic significance on 2-yr mortality was first evaluated in a univariate Cox model. Markers showing a mortality association at p<0.10 level were examined in a multivariable Cox model, adjusting for stage, presence of B symptom, Germinal Center phenotype, prior AIDS and CD4 cell count. Results Of 194 HIV+ DLBCL cases identified; 80 had sufficient tissue for study inclusion. In the crude analyses, cMYC [hazard ratio (HR)=2.08, 95% confidence interval:0.93-4.63, p=0.07], EBV [HR=2.86 (1.45-5.63), p<0.01] and BLIMP1 [HR=2.57 (0.99-6.67), p=0.05] positivity were associated with 2-yr mortality. In the adjusted analysis, cMYC positivity remained significantly associated with a 3-fold increase in 2-yr mortality [hazard ratio=3.18 (1.15-8.80), p=0.03]. Other markers were not significantly associated with mortality. Discussion cMYC expression may be associated with increased mortality in HIV+ DLBCL patients. Our initial findings should be confirmed in larger studies.     

Serum parameters as prognostic biomarkers in a real world cancer patient population treated with anti PD-1/PD-L1 therapy

BackgroundImmune checkpoint inhibitors (ICI) are regarded as a standard of care in multiple malignancies. We hypothesized that serum parameters are of prognostic value in ICI treated patients suffering from solid tumours.MethodsData from 114 patients treated with ICIs for solid malignancies from 2015 to 2019 at the Medical University of Vienna were collected retrospectively. Data included baseline characteristics, cancer type, serum parameters such as lactate dehydrogenase (LDH), C-reactive protein (CRP), albumin (Alb) and lymphocyte counts as well as overall survival (OS) and progression free survival. Additionally, the Gustave Roussy Immune Score (GRIm score) and the Glasgow prognostic score (GPS) were calculated. Cox regression models including time-dependent effects and strata for tumour type were used. Prognostic factors were pre-selected using a relaxed LASSO approach.ResultsThe majority of patients were male (64.9%). The most common cancer types were non-small cell lung cancer (30.7%) and renal cell carcinoma (21.9%). Increased LDH and CRP were associated with poor 6-month OS (Hazard ratios (HR)=1.16 and 1.06 per 20% LDH/CRP increase; 95% CI 1.07–1.26 and 95% CI 1.03–1.09, respectively; p < .001). Both GRIm Score and GPS had a significant influence on OS (GRIm: HR = 2.84, 95% CI 1.72–4.69; p < .001 for high vs. low; GPS HR 3.57, 95% CI 1.76–7.25; p < .001 for poor vs. good). The proportion of explained variation (PEV) of our full multivariable model was significantly higher compared to the GRIm and GPS (PEV = 29.5% vs. 14.8% and 14.65%). When grouped into quartiles according to the individual 8-weeks change, both increased LDH and CRP correlated with poor OS (LDH (p=.001) and CRP (p < .001)).ConclusionThe results of this analysis suggest that serum parameters might have prognostic value for the outcome of cancer patients treated with ICI, regardless of the tumour type.

Key messages

• In this retrospective analysis, 114 patients with solid tumours were included. The results of this analysis point out that pre-treatment LDH, CRP and albumin levels are strongly prognostic for a poor 6-month OS.
• In addition to that, a high GRIm-score and poor GPS were associated with a worse OS (GRIm: HR = 2.84, 95% CI 1.72–4.69; p < .001 for high vs. low; GPS HR = 3.57, 95% CI 1.76–7.25; p < .001 for poor vs. good).
• Pre-treatment serum parameters might have prognostic value for the outcome of cancer patients treated with ICI, regardless of the tumour type.

     

GELTAMO-IPI对弥漫性大B细胞淋巴瘤患者的预后价值

目的:评价GELTAMO-IPI对弥漫性大B细胞淋巴瘤(DLBCL)患者的预后价值.方法:回顾性分析2011年9月至2016年3月山西省肿瘤医院收治的238例初治DLBCL患者临床资料,按GELTAMO-IPI对患者进行危险分层和预后评估.采用Kaplan-Meier法分析两组的无进展生存期(PFS)和总生存期(OS)...     

中期18F-FDG PET/CT的评价方法在弥漫性大B细胞淋巴瘤预后预测中的价值

目的  探讨中期¹⁸F-FDG PET/CT的Deauville 5分法（Deauville 5-PS）、病灶与肝脏最大标准摄取值（SUV_max）的比值（LLR）、化疗前与化疗中期SUV_max的变化率（ΔSUV_max）3种评价方法在弥漫性大B细胞淋巴瘤（DLBCL）预后预测中的价值。方法  回顾性分析117例初治的DLBCL患者资料,采用Deauville 5-PS、LLR、ΔSUV_max对化疗中期PET/CT进行分析。采用ROC曲线计算LLR、ΔSUV_max预测患者无进展生存（PFS）和总生存（OS）的最佳临界值。采用Kaplan-Meier生存分析、单因素和多因素Cox比例风险回归模型对2年PFS率及OS率进行预后分析。结果  117例DLBCL患者中,疾病进展46例（39.3%）,死亡34例（29.1%）。Deauville 5-PS、LLR、ΔSUV_max分别以4分、1.81、75%为界值时,ΔSUV_max预测DLBCL患者PFS和OS的特异性、阳性预测值、准确度均高于LLR,LLR均高于Deauville 5-PS,但Deauville 5-PS预测DLBCL患者PFS、OS的敏感度最高。Deauville 5-PS < 4分组与≥4分组患者2年PFS率和OS率分别为80.8%和93.4%、49.3%和65.6%,差异有统计学意义（P < 0.001）;LLR < 1.81组与≥1.81组患者2年PFS率和OS率分别为82.4%和89.4%、27.2%和56.3%,差异有统计学意义（P < 0.001）。ΔSUV_max>75%与ΔSUV_max≤75%组患者2年PFS率和OS率分别为86.2%和93.1%、20.5%和48.9%,差异有统计学意义（P < 0.001）。单因素分析显示Deauville 5-PS、LLR、ΔSUV_max均是DLBCL患者PFS和OS的预后影响因素（P < 0.01）。多因素分析显示,ΔSUV_max和国际预后指数评分是DLBCL患者PFS、OS的独立危险因素。结论  中期PET/CT的Deauville 5-PS、LLR、ΔSUV_max3种评价方法均能预测DLBCL患者的预后,其中ΔSUV_max预测效能优于Deauville 5-PS和LLR,而且△SUV_max对DLBCL的预后具有独立预测价值。     

18F-FDG PET/CT对弥漫性大B细胞淋巴瘤的预后价值

目的:探讨18F-脱氧葡萄糖(FDG)PET/CT显像中肿瘤总代谢体积(TMTV)对弥漫性大B细胞淋巴瘤(DLBCL)的预后评估价值。方法:回顾性分析2014年4月-2018年8月于我院接受CHOP联合利妥昔单抗化疗方案并经病理证实为DLBCL的65例患者。所有患者临床资料完善,治疗前均行18F-FDG PET/CT显像,获得患者的TMTV。绘制ROC曲线获得TMTV截断值,采用卡方检验或连续性校正的卡方检验、Kaplan-Meier生存曲线、单因素和多因素Cox回归分析确定与预后相关的因素。结果:纳入人群的TMTV平均值为158 cm3,TMTV最佳截断值为146 cm3。低TMTV组2年PFS率、OS率分别为43.1%、45.3%,高TMTV组2年PFS率、OS率分别为5.2%、15.3%(P<0.001)。多因素回归分析显示MYC与BCL-2是PFS的独立预测指标。MYC是OS的独立预测指标。TMTV是PFS和OS共同的独立预测指标。低TMTV患者较高TMTV患者预后更好。结论:18F-FDG PET/CT显像中的TMTV可作为预测DLBCL预后的重要指标。     

18F-FDG PET/CT代谢参数及临床指标在弥漫性大B细胞淋巴瘤中期评估及预后预测中的意义

目的 探讨¹⁸F-氟代脱氧葡萄糖（¹⁸F-FDG）PET/CT的代谢参数及临床指标在弥漫性大B细胞淋巴瘤（DLBCL）中期评估及预后预测中的意义。方法 收集194例DLBCL患者临床资料,记录患者的中期评估结果,比较不同临床指标[β₂ -微球蛋白（β₂-MG）、双表达、三表达、Ann Arbor分期、淋巴瘤国际预后评分 （IPI）、多维尔5分法（D5PS）评分]和¹⁸F-FDG PET/CT代谢参数[最大标准化摄取值（SUV_max）、病灶累及部位SUV_max的总和（SUV_maxsum）、平均标准化摄取值（SUV_mean）和SUV_max下降幅度（△SUV_max）]中达完全缓解（CR）者所占比例的差异,应用Cox回归和Kaplan-Meier生存分析法分析¹⁸F-FDG PET/CT代谢参数及临床指标对DCBCL患者2年无进展生存期（PFS）的影响,并对SUV_max与β₂-MG、Ann Arbor分期和IPI评分进行相关性分析。结果 β₂-MG > 2.3 mg/L、Ann Arbor分期Ⅲ/Ⅳ期、IPI > 2分、SUV_max > 17.00和SUV_maxsum > 38.60者达CR的比例较低;疗效达CR者△SUV_max大于未达CR者（P均 < 0.05）。Cox单因素分析显示,β₂-MG、Ann Arbor分期、IPI评分、双表达、三表达、SUV_maxsum及D5PS评分均与DLBCL患者2年PFS有关（P均 < 0.05）;多因素分析显示,Ann Arbor分期Ⅲ/Ⅳ期（HR = 4.486,P = 0.001）为DLBCL患者2年PFS的独立危险因素,D5PS 评分1~3分（HR = 0.256,P < 0.001）为DLBCL患者2年PFS的独立保护因素。Spearman秩相关分析显示,SUV_max与β₂-MG（r_s = 0.348,P = 0.001）、Ann Arbor分期（r_s = 0.236,P = 0.022）和IPI评分（r_s = 0.305,P = 0.003）均有关。结论 ¹⁸F-FDG PET/CT的代谢参数与临床指标相关,Ann Arbor分期和D5PS可作为DLBCL患者预后的参考指标。     

移植和一些临床因素对弥漫大B细胞淋巴瘤患者预后影响

本研究回顾性分析经正规R-CHOP方案治疗弥漫大B细胞淋巴瘤（DLBCL）患者的生存状况,探讨自体造血干细胞移植（auto-HSCT）、病理类型、国际预后指数（IPI）等因素对预后的影响。收集2004-2011年在本院接受R-CHOP21≥6次化疗的DLBCL患者116例。分析单纯化疗及化疗联合自体造血干细胞移植取得的疗效,以及不同免疫病理类型、临床观察指标如IPI、超敏C反应蛋白（HSCRP）、a-羟丁酸脱氨酶（HBDH）等因素对DLBCL患者预后的影响,包括对总体生存率（OS）、无进展生存率（PFS）的系统观察。结果表明,接受R-CHOP21方案治疗的116例DLBCL患者5年OS为72.4%,其中30例患者接受自体造血干细胞移植（Ann Arbor分期均为Ⅲ-Ⅳ期）。30例移植组患者预后较86例单纯化疗组好（5年OS为82.5%vs 69.0%,5年PFS为77.1%vs 68.3%）（P〈0.05）;生发中心（GCB）型组患者预后较活化亚型（ABC）组好（P〈0.05）;IPI 3-5分、年龄≥60岁、B症状、LDH升高、HSCRP升高、HBDH升高是预后不良因素（P〈0.05）,其中LDH升高、年龄≥60岁、B症状是本研究患者的独立危险因素（P〈0.05）。结论：自体造血干细胞移植联合R-CHOP治疗方案能明显改善DLBCL患者的预后,GCB型患者预后优于ABC型,B症状、IPI评分、LDH、HSCRP、HBDH是预后的影响因素。     

Evaluation of a five-gene signature associated with stromal infiltration for diffuse large B-cell lymphoma

BACKGROUNDDiffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin lymphoma. The development of immunotherapy greatly improves the patient prognosis but there are some exceptions. Thus, screening for better biomarkers for prognostic evaluation could contribute to the treatment of DLBCL patients.AIMTo screen the novel mediators involved in the development of DLBCL.METHODSThe {"type":"entrez-geo","attrs":{"text":"GSE60","term_id":"60"}}GSE60 dataset was applied to identify the differentially expressed genes (DEGs) in DLBCL, and the principal components analysis plot was used to determine the quality of the included samples. The protein-protein interactions were analyzed by the STRING tool. The key hub genes were entered into to the GEPIA database to determine their expressions in DLBCL. Furthermore, these hub gene alterations were analyzed in cBioportal. The UALCAN portal was employed to analyze the expression of the hub genes in different stages of DLBCL. The Estimation of Stromal and Immune cells in Malignant Tumor tissues using Expression data Score was conducted to evaluate the correlation between the gene expression and tumor purity. The gene-gene correlation analysis was conducted in the GEPIA. The stromal score analysis was conducted in TIMER to confirm the correlation between the gene expression and infiltrated stromal cells. The correlation between the indicated genes and infiltration level of cancer-associated fibroblasts (CAFs) was also completed in TIMER with two methods, MCP-Counter and Tumor immune dysfunction and exclusion. The correlation between fibronectin (FN1) protein level and secreted protein acidic and cysteine-rich (SPARC) messenger ribonucleic acid expression was confirmed in the cBioportal.RESULTSThe top 20 DEGs in DLBCL were identified, and the principal components analysis plot confirmed the quality of the significant DEGs. The pairwise correlation coefficient analysis among all samples showed that these DEGs have a certain co-expression pattern. The DEGs were subjected to STRING to identify the hub genes, alpha-2-macroglobulin (A2M), cathepsin B (CTSB), FN1, matrix metallopeptidase 9 (MMP9), and SPARC. The five hub genes were confirmed to be overexpressed in DLBCL. The cBioportal portal detected these five hub genes that had gene alteration, including messenger ribonucleic acid high amplification and missense mutation, and the gene alteration percentages of A2M, FN1, CTSB, MMP9, and SPARC were 5%, 8%, 5%, 2.7%, and 5%, respectively. Furthermore, the five hub genes had a potential positive correlation with tumor stage. The correlation analysis between the five genes and tumor purity confirmed that the five genes were overexpressed in DLBCL and had a positive correlation with the development of DLBCL. More interestingly, the five genes had a significant correlation with the stromal infiltration scores. The correlation analysis between the fives genes and CAFs also showed a significant value, among which the top two genes, FN1 and SPARC, had a remarkable co-expression pattern.CONCLUSIONThe top DEGs were identified, and the five hub genes were overexpressed in DLBCL. Furthermore, the gene alterations were confirmed and the positive correlation with tumor purity revealed the overexpression of the five genes and close association with the development of DLBCL. More interestingly, the five genes were positively correlated with stromal infiltration, especially in CAFs. The top two genes, FN1 and SPARC, showed a co-expression pattern, which indicates their potential as novel therapeutic targets for DLBCL.     

Risk of incident bleeding after acute kidney injury: A retrospective cohort study

PurposeEnd-stage kidney disease (ESKD) causes bleeding diathesis; however, whether these findings are extrapolable to acute kidney injury (AKI) remains uncertain. We assessed whether AKI is associated with an increased risk of bleeding.MethodsSingle-center retrospective cohort study, excluding readmissions, admissions <24 h, ESKD or kidney transplants. The primary outcome was the development of incident bleeding analyzed by multivariate time-dependent Cox models.ResultsIn 1001 patients, bleeding occurred in 48% of AKI and 57% of non-AKI patients (p = .007). To identify predictors of incident bleeding, we excluded patients who bled before ICU (n = 488). In bleeding-free patients (n = 513), we observed a trend toward higher risks of bleeding in AKI (22% vs. 16%, p = .06), and a higher risk of bleeding in AKI-requiring dialysis (38% vs. 17%, p = .01). Cirrhosis, AKI-requiring dialysis, anticoagulation, and coronary artery disease were associated with bleeding (HR 3.67, 95%CI:1.33–10.25; HR 2.82, 95%CI:1.26–6.32; HR 2.34, 95%CI:1.45–3.80; and HR 1.84, 95%CI:1.06–3.20, respectively), while SOFA score and sepsis had a protective association (HR 0.92 95%CI:0.84–0.99 and HR 0.55, 95%CI:0.34–0.91, respectively). Incident bleeding was not associated with mortality.ConclusionsAKI-requiring dialysis was associated with incident bleeding, independent of anticoagulant administration. Studies are needed to better understand how AKI affects coagulation and clinical outcomes.     

Prognostic factors of patients with advanced lung cancer treated with anlotinib: a retrospective cohort study

ObjectiveOur study aimed to evaluate the main factors affecting the efficacy of anlotinib to determine the therapeutically dominant populations.MethodsThe medical records of patients with lung cancer who were treated with anlotinib from July 2018 to February 2020 at Renji Hospital, School of Medicine, Shanghai Jiaotong University were retrospectively reviewed. The optimal cutoff prognostic nutritional index (PNI) value for predicting efficacy was determined according to receiver operating characteristic curves. Progression-free survival (PFS) and overall survival (OS) were calculated and compared using the Kaplan–Meier method and log‐rank test. The prognostic values of each variable were evaluated with univariate and multivariate Cox proportional hazard regression analyses.ResultsThe overall disease control rate of 44 patients with lung cancer was 93.2% (41/44). The median PFS was 5.0 months (95% [confidence interval] CI: 2.2–7.8), and the median OS was 6.5 months (95% CI: 3.6–9.3). The multivariate analysis results indicated that hand–foot syndrome and high PNI values were independent protective factors of PFS and OS.ConclusionsAnlotinib was effective in treating locally advanced or advanced lung cancer. High pretreatment PNI scores and the presence of hand–foot syndrome after treatment were independent prognostic markers for favorable OS and PFS.     

Long-term use of combined conventional medicine and Chinese herbal medicine decreases the mortality risk of patients with lung cancer

BackgroundWe explored the effect of Chinese herbal medicine (CHM) on the long-term survival of lung cancer patients and hazard ratio (HR) and to analyse CHM herbs and formulas for lung cancer treatment.MethodsWe conducted a retrospective cohort study on diagnosed lung cancer patients in 2003–2016 from Taipei and Dalin Tzu Chi General Hospital Cancer Registry Database and from outpatient database from Chinese Medicine and Conventional Medicine Department. We categorised the patients into CHM user and CHM nonuser groups according to the CHM consumption time. After passing the proportional hazard assumption, we used the Cox PH model to calculate the groups’ survival hazard ratio (HR) and examine the statistical difference and effect of CHM on lung cancer survival.ResultsWe classified 2557 lung cancer patients into 1643 CHM nonusers and 228 CHM users. The CHM users had lower mortality than the CHM nonusers. With the multivariable Cox model, we observed that the CHM use was associated with 35% lower risk of mortality (adjusted HR: 0.65; 95% confidence interval: 0.51-0.76). Continuous CHM use of >180 days may further lessen the mortality risk by 64%. Finally, eight herbs and two formulas could significantly lower the mortality. After pairing the eight herbs for analysis, seven combinations could reduce the mortality better than only using one herb.ConclusionCHM users had significantly lower mortality than CHM nonusers. The longer the CHM use, the more the mortality HR declined. Glehnia littoralisF. Schmidt ex Miq., Polyporus umbellatus(Pers.) Fries and Trichosanthes kirilowii Maxim. possess a highly substantial anticancer activity compared with other herbs.     

Systemic immune-inflammation index is a promising non-invasive biomarker for predicting the survival of urinary system cancers: a systematic review and meta-analysis

ObjectiveSystemic immune-inflammation index (SII) has been reported in numerous studies to effectively predict the survival outcomes of urinary system cancers; however no agreement has been reached. This meta-analysis aimed to explore the prognostic significance of pre-treatment SII in tumours of the urinary system.MethodsRelevant published articles were selected from Web of Science, PubMed, Embase, and the Cochrane Library up to 30 August 2020. The hazard ratios (HRs) with 95% confidence intervals (CIs) were computed to estimate the associations of pre-treatment SII with overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS) in urinary system cancers.Results13 papers were included in our meta-analysis. From the combined data, we found that a high pre-treatment SII indicated a markedly worse OS (HR = 1.98; 95% CI: 1.75–2.23; p < .001), PFS (HR: 2.08; 95% CI: 1.32–3.26; p = .002), and CSS (HR: 2.41, 95% CI: 1.73–3.35, p < .001). Additionally, patients with an elevated SII value might have undesirable pathological characteristics, including a large tumour size, a poor differentiation grade, and an advanced tumour stage (all p < .001).ConclusionsPre-treatment SII could be used as a non-invasive and promising biomarker to indicate the prognosis of urinary system cancer patients.

KEY MESSAGES:

• This meta-analysis evaluates the predictive value of systemic immune-inflammation index (SII) for patients with urinary system cancer.
• A high pre-treatment SII indicates a poor prognosis.
• SII can serve as a promising non-invasive biomarker to help clinicians assess the prognosis and develop treatment strategies for urinary system cancer patients.

     

射频消融与手术切除结直肠癌肝转移的Meta分析

目的 比较射频消融（RFA）和外科肝切除术（HR）对结直肠癌肝转移的治疗效果。方法 系统检索收集了PubMed、Cochrane Library、EMBASE、中国知网、中国生物医学文献数据库等关于RFA和HR在结直肠癌肝转移的临床对照试验,按Cochrane系统评价方法进行了评价,采用Stata 12.0软件进行Meta分析。结果 最终纳入文献13篇,共2348例患者,其中 RFA 972例,HR1376例。Meta分析结果显示,RFA患者3年、5年生存率明显高于HR患者（OR：0.56,95%CI：0.38~0.83,P=0.004;OR：0.47,95%CI：0.29~0.76,P=0.002）;RFA患者手术后总复发率明显高于HR患者（OR：2.79,95%CI：1.25~6.21,P=0.012）。结论 HR较RFA治疗结直肠癌肝转移术后生存率高,复发率低,可作为临床优先考虑的治疗方法。     

A novel prognostic model for angioimmunoblastic T-cell lymphoma: A retrospective study of 55 cases

ObjectiveTo explore prognostic factors and develop an accurate prognostic prediction model for angioimmunoblastic T-cell lymphoma (AITL).MethodsClinical data from Chinese patients with newly diagnosed AITL were retrospectively analysed. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier method survival curves; prognostic factors were determined using a Cox proportional hazards model. The sensitivity and specificity of the predicted survival rates were compared using area under the curve (AUC) of receiver operating characteristic (ROC) curves.ResultsThe estimated 5-year OS and PFS of 55 eligible patients with AITL were 22% and 3%, respectively. Multivariate analysis showed that the presence of pneumonia, and serous cavity effusions at initial diagnosis were significant prognostic factors for OS. Based on AUC ROC values, our novel prognostic model was superior to IPI and PIT based models and suggested better diagnostic accuracy.ConclusionsOur prognostic model based on pneumonia, and serous cavity effusions at initial diagnosis enabled a balanced classification of AITL patients into different risk groups.     

Meta-Analysis to Assess the Efficacy and Toxicity of Docetaxel-Based Doublet Compared with Docetaxel Alone for Patients with Advanced NSCLC who Failed First-Line Treatment

PurposeThe benefit of docetaxel-based therapy in the second-line treatment of advanced non–small cell lung cancer (NSCLC) is still unclear. The goal of this meta-analysis was to assess the efficacy and toxicity of docetaxel-based doublet compared with docetaxel alone for patients with advanced NSCLC who failed to improve with first-line treatment.MethodsSeveral databases were searched, including PubMed, Embase, and the Cochrane databases. The end points were overall survival, progression-free survival (PFS), objective response rate, disease control rate, and grade 3 or 4 adverse events. Data were extracted from the studies by 2 independent reviewers. The meta-analysis was performed by using Review Manager version 5.2. The pooled hazard ratio (HR) or odds ratio (OR) and 95% CIs were calculated by using fixed or random effects models depending on the heterogeneity of the included trials.FindingsTwelve eligible trials involving 2680 patients were identified. The intention-to-treatment analysis found that docetaxel-based therapy significantly improved overall survival (HR, 0.89 [95% CI, 0.83–0.96]; P < 0.01), PFS (HR, 0.79 [95% CI, 0.71–0.89]; P < 0.01), objective response rate (OR, 1.73 [95% CI, 1.37–2.18; P < 0.01), and disease control rate (OR, 1.30 [95% CI, 1.09–1.55]; P < 0.01). In addition, a subgroup analysis based on type of combined drug showed that there were significant improvement in PFS and overall survival in combining docetaxel with targeted therapy. In addition, a higher incidence of grade 3 or 4 diarrhea and thrombocytopenia was observed in docetaxel-based doublet therapy.ImplicationsBased on the available evidence, docetaxel-based doublet therapy seems superior to docetaxel monotherapy as a second-line treatment for advanced NSCLC. More studies should focus on combining docetaxel with targeted therapy to identify patients who will most likely benefit from the appropriate combination targeted therapy.