Development and validation of a prognostic nomogram for colorectal cancer after surgery

BACKGROUNDA nomogram is a diagram that aggregates various predictive factors through multivariate regression analysis, which can be used to predict patient outcomes intuitively. Lymph node (LN) metastasis and tumor deposit (TD) conditions are two critical factors that affect the prognosis of patients with colorectal cancer (CRC) after surgery. At present, few effective tools have been established to predict the overall survival (OS) of CRC patients after surgery.AIMTo screen out suitable risk factors and to develop a nomogram that predicts the postoperative OS of CRC patients.METHODSData from a total of 3139 patients diagnosed with CRC who underwent surgical removal of tumors and LN resection from 2010 to 2015 were collected from the Surveillance, Epidemiology, and End Results program. The data were divided into a training set (n = 2092) and a validation set (n = 1047) at random. The Harrell concordance index (C-index), Akaike information criterion (AIC), and area under the curve (AUC) were used to assess the predictive performance of the N stage from the American Joint Committee Cancer tumor-node-metastasis classification, LN ratio (LNR), and log odds of positive lymph nodes (LODDS). Univariate and multivariate analyses were utilized to screen out the risk factors significantly correlating with OS. The construction of the nomogram was based on Cox regression analysis. The C-index, receiver operating characteristic (ROC) curve, and calibration curve were employed to evaluate the discrimination and prediction abilities of the model. The likelihood ratio test was used to compare the sensitivity and specificity of the final model to the model with the N stage alone to evaluate LN metastasis.RESULTSThe predictive efficacy of the LODDS was better than that of the LNR based on the C-index, AIC values, and AUC values of the ROC curve. Seven independent predictive factors, namely, race, age at diagnosis, T stage, M stage, LODDS, TD condition, and serum carcinoembryonic antigen level, were included in the nomogram. The C-index of the nomogram for OS prediction was 0.8002 (95%CI: 0.7839-0.8165) in the training set and 0.7864 (95%CI: 0.7604-0.8124) in the validation set. The AUC values of the ROC curve predicting the 1-, 3-, and 5-year OS were 0.846, 0.841, and 0.825, respectively, in the training set and 0.823, 0.817, and 0.835, respectively, in the validation test. Great consistency between the predicted and actual observed OS for the 1-, 3-, and 5-year OS in the training set and validation set was shown in the calibration curves. The final nomogram showed a better sensitivity and specificity than the nomogram with N stage alone for evaluating LN metastasis in both the training set (-4668.0 vs -4688.3, P < 0.001) and the validation set (-1919.5 vs -1919.8, P < 0.001) through the likelihood ratio test.CONCLUSIONThe nomogram incorporating LODDS, TD, and other risk factors showed great predictive accuracy and better sensitivity and specificity and represents a potential tool for therapeutic decision-making.     

Development and external validation of a nomogram predicting overall survival after curative resection of colon cancer

ObjectiveTo develop and externally validate a prognostic nomogram to predict overall survival (OS) in patients with resectable colon cancer.MethodsData for 50,996 patients diagnosed with non-metastatic colon cancer were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned randomly to the training set (n = 34,168) or validation set (n = 16,828). Independent prognostic factors were identified by multivariate Cox proportional hazards regression analysis and used to construct the nomogram. Harrell’s C-index and calibration plots were calculated using the SEER validation set. Additional external validation was performed using a Chinese dataset (n = 342).ResultsHarrell’s C-index of the nomogram for OS in the SEER validation set was 0.71, which was superior to that using the 7th edition of the American Joint Committee on Cancer TNM staging (0.59). Calibration plots showed consistency between actual observations and predicted 1-, 3-, and 5-year survival. Harrell’s C-index (0.72) and calibration plot showed excellent predictive accuracy in the external validation set.ConclusionsWe developed a nomogram to predict OS after curative resection for colon cancer. Validation using the SEER and external datasets revealed good discrimination and calibration. This nomogram may help predict individual survival in patients with colon cancer.     

Develop a nomogram to predict overall survival of patients with borderline ovarian tumors

BACKGROUNDThe prognosis of borderline ovarian tumors (BOTs) has been the concern of clinicians and patients. It is urgent to develop a model to predict the survival of patients with BOTs.AIMTo construct a nomogram to predict the likelihood of overall survival (OS) in patients with BOTs.METHODSA total of 192 patients with histologically verified BOTs and 374 patients with epithelial ovarian cancer (EOC) were retrospectively investigated for clinical characteristics and survival outcomes. A 1:1 propensity score matching (PSM) analysis was performed to eliminate selection bias. Survival was analyzed by using the log-rank test and the restricted mean survival time (RMST). Next, univariate and multivariate Cox regression analyses were used to identify meaningful independent prognostic factors. In addition, a nomogram model was developed to predict the 1-, 3-, and 5-year overall survival of patients with BOTs. The predictive performance of the model was assessed by using the concordance index (C-index), calibration curves, and decision curve analysis (DCA).RESULTSFor clinical data, there was no significant difference in body mass index, preoperative CA199 concentration, or tumor localization between the BOTs group and EOC group. Women with BOTs were significantly younger than those with EOC. There was a significant difference in menopausal status, parity, preoperative serum CA125 concentration, Federation International of gynecology and obstetrics (FIGO) stage, and whether patients accepted postoperative adjuvant therapy between the BOT and EOC group. After PSM, patients with BOTs had better overall survival than patients with EOC (P value = 0.0067); more importantly, the 5-year RMST of BOTs was longer than that of EOC (P value = 0.0002, 95%CI -1.137 to -0.263). Multivariate Cox regression analysis showed that diagnosed age and surgical type were independent risk factors for BOT patient OS (P value < 0.05). A nomogram was developed based on diagnosed age, preoperative serum CA125 and CA199 Levels, surgical type, FIGO stage, and tumor size. Moreover, the c-index (0.959, 95% confidence interval 0.8708–1.0472), calibration plot of 1-, 3-, and 5-year OS, and decision curve analysis indicated the accurate predictive ability of this model.CONCLUSIONPatients with BOTs had a better prognosis than patients with EOC. The nomogram we constructed might be helpful for clinicians in personalized treatment planning and patient counseling.     

Development and validation of a novel prognostic model for long-term overall survival in liposarcoma patients: a population-based study

ObjectiveTo construct and validate a clinically accurate and histology-specific nomogram to predict overall survival (OS) among liposarcoma (LPS) patients.MethodsWe retrospectively screened eligible patients with LPS diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results database. We screened independent predictors for the nomogram using univariate and multivariate analyses. We then evaluated the prognostic accuracy of the nomogram by receiver operating characteristic (ROC) curve analysis and Harrell’s concordance index. The prognostic performances of the nomogram and the American Joint Committee on Cancer (AJCC) seventh edition staging system were compared using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analyses (DCA).ResultsA novel nomogram was developed using independent prognostic variables, which exhibited excellent predictive performances for 3- and 5-year OS according to ROC curves. The C-index proved that the proposed nomogram had better prognostic accuracy for LPS than the traditional AJCC system, while the NRI, IDI, and DCA of the nomogram indicated better clinical net benefit.ConclusionsThe proposed nomogram can predict 3- and 5-year OS of LPS patients with reliable accuracy and may thus help clinicians to develop appropriate clinical therapies and counseling strategies to prolong the life expectancy of these patients.     

Log odds of positive lymph nodes is a better prognostic factor for oesophageal signet ring cell carcinoma than N stage

BACKGROUNDSignet ring cell carcinoma is a rare type of oesophageal cancer, and we hypothesized that log odds of positive lymph nodes (LODDS) is a better prognostic factor for oesophageal signet ring cell carcinoma.AIMTo explore a novel prognostic factor for oesophageal signet ring cell carcinoma by comparing two lymph node-related prognostic factors, log odds of positive LODDS and N stage.METHODSA total of 259 cases of oesophageal signet ring cell carcinoma after oesopha-gectomy were obtained from the Surveillance, Epidemiology, and End Results database between 2006 and 2016. The prognostic value of LODDS and N stage for oesophageal signet ring cell carcinoma was evaluated by univariate and multivariate analyses. The Akaike information criterion and Harrell’s C-index were used to assess the value of two prediction models based on lymph nodes. External validation was performed to further confirm the conclusion.RESULTSThe 5-year cancer-specific survival (CSS) and 5-year overall survival (OS) rates of all the cases were 41.3% and 27.0%, respectively. The Kaplan-Meier method showed that LODDS had a higher score of log rank chi-squared (OS: 46.162, CSS: 41.178) than N stage (OS: 36.215, CSS: 31.583). Univariate analyses showed that insurance, race, T stage, M stage, TNM stage, radiation therapy, N stage, and LODDS were potential prognostic factors for OS (P < 0.1). The multivariate Cox regression model showed that LODDS was an significant independent prognostic factor for oesophageal signet ring carcinoma patients after surgical resection (P < 0.05), while N stage was not considered to be a significant prognostic factor (P = 0.122). Model 2 (LODDS) had a higher degree of discrimination and fit than Model 1 (N stage) (LODDS vs N stage, Harell’s C-index 0.673 vs 0.656, P < 0.001; Akaike information criterion 1688.824 vs 1697.519, P < 0.001). The results of external validation were consistent with those in the study cohort.CONCLUSIONLODDS is a superior prognostic factor to N stage for patients with oesophageal signet ring cell carcinoma after oesophagectomy.     

未转移结直肠癌患者术后转移风险预测列线图的构建

目的构建结直肠(colorectal cancer,CRC)患者预后列线图预测模型,并验证其准确性。方法回顾性分析就诊于苏州大学第三附属医院的438例CRC患者的临床病理资料。建立COX单因素、多因素回归模型确定预后的独立危险因素。用R软件建立列线图,绘制术后3年、5年无病生存率(disease free survival,DFS)校准图线并与实际观察情况比较。用Bootstrap法进行内部验证,计算一致性指数(C-index)评估模型准确性。分析时间依赖的ROC曲线比较其与第7版美国癌症联合委员会(American Joint Committee On Cancer,AJCC)分期系统(TNM系统)在预测术后的3年、5年的DFS的敏感性和特异性。结果438例CRC患者中233例患者出现转移,其中肝脏转移105例,肺转移57例。COX回归模型分析示肿瘤分化程度,肿瘤TNM分期,癌胚抗原(CEA)水平,糖类抗原19-9(CA19-9)水平,中性粒细胞与淋巴细胞之比(Neutrophil lymphocyte radio,NLR),抑癌基因P53是患者预后的独立影响因素。列线图用于预测生存的C指数为0.678。校正曲线表明预测的3年、5年DFS与实际观察情况高度符合。时间依赖的ROC曲线结果表明,相较于传统AJCC-TNM分期,列线图预后模型在预测术后3年和5年的DFS具有更高的敏感性和特异性。结论列线图可较准确预测个体CRC患者的预后,利于临床工作者对其随访或及时开展对患者有益治疗。     

Establishment of a prognostic model for patients with sepsis based on SOFA: a retrospective cohort study

ObjectiveTo construct a nomogram based on the Sequential Organ Failure Assessment (SOFA) that is more accurate in predicting 30-, 60-, and 90-day mortality risk in patients with sepsis.MethodsData from patients with sepsis were retrospectively collected from the Medical Information Mart for Intensive Care (MIMIC) database. Included patients were randomly divided into training and validation cohorts. Variables were selected using a backward stepwise selection method with Cox regression, then used to construct a prognostic nomogram. The nomogram was compared with the SOFA model using the concordance index (C-index), area under the time-dependent receiver operating characteristics curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting, and decision-curve analysis (DCA).ResultsA total of 5240 patients were included in the study. Patient’s age, SOFA score, metastatic cancer, SpO₂, lactate, body temperature, albumin, and red blood cell distribution width were included in the nomogram. The C-index, AUC, NRI, IDI, and DCA of the nomogram showed that it performs better than the SOFA alone.ConclusionA nomogram was established that performed better than the SOFA in predicting 30-, 60-, and 90-day mortality risk in patients with sepsis.     

Development and validation of a nomogram to predict in-hospital cardiac arrest among patients admitted with acute coronary syndrome

AimThis study aimed to develop and validate a nomogram to recognize in-hospital cardiac arrest (CA) in patients with acute coronary syndrome (ACS).MethodsThis multicenter case-control study reviewed 164 ACS patients who had in-hospital CA and randomly selected 521 ACS patients with no CA experience. We randomly assigned 80% of the participants to a development cohort, 20% of those to an independent validation cohort. The least absolute shrinkage and selection operator (LASSO) regression model was used for data dimension reduction, and multivariable logistic regression analysis was used to develop the CA prediction nomogram. Nomogram performance was assessed with respect to discrimination, calibration, and clinical usefulness.ResultsSeven parameters, including chest pain, Killip class, potassium, BNP, arrhythmia, platelet count, and NEWS, were used to create individualized CA prediction nomograms. The CA prediction nomogram showed good discrimination (C-index of 0.896, 95%CI, 0.865–0.927) and calibration. Application of the CA prediction nomogram in assessments of the validation cohort improved discrimination (C-index of 0.914, 95%CI, 0.873–0.967) and calibration. The results of decision curve analysis demonstrated that the CA prediction nomogram was clinically useful.ConclusionOur study generated a friendly risk score to recognize in-hospital CA with good discrimination and calibration. Further studies need to establish a pathway to guide the application of the risk score in clinical practice.     

Critical prognostic value of the log odds of negative lymph nodes/tumor size in rectal cancer patients

BACKGROUNDThe number of negative lymph nodes (NLNs) and tumor size are associated with prognosis in rectal cancer patients undergoing surgical resection. However, little is known about the prognostic significance of the NLN count after adjusting for tumor size.AIMTo assess the prognostic impact of the log odds of NLN/tumor size (LONS) in rectal cancer patients.METHODSData of patients with stage I–III rectal cancer were extracted from the Surveillance, Epidemiology, and End Results Program database. These patients were randomly divided into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were used to determine the prognostic value of the LONS. The optimal cutoff values of LONS were calculated using the "X-tile" program. Stratified analysis of the effect of LONS on cancer-specific survival (CSS) and overall survival (OS) were performed. The Kaplan-Meier method with the log-rank test was used to plot the survival curve and compare the survival data among the different groups.RESULTSIn all, 41080 patients who met the inclusion criteria were randomly divided into a training cohort (n = 28775, 70%) and a validation cohort (n = 12325, 30%). Univariate and multivariate analyses identified the continuous variable LONS as an independent prognostic factor for CSS [training cohort: Hazard ratio (HR) = 0.47, 95% confidence interval (CI): 0.44–0.51, P < 0.001; validation cohort: HR = 0.46, 95%CI: 0.41-0.52, P < 0.001] and OS (training cohort: HR = 0.53, 95%CI: 0.49-0.56, P < 0.001; validation cohort: HR = 0.52, 95%CI: 0.42-0.52, P < 0.001). The X-tile program indicated that the difference in CSS was the most significant for LONS of -0.8, and the cutoff value of -0.4 can further distinguish patients with a better prognosis in the high LONS group. Stratified analysis of the effect of the categorical variable LONS on CSS and OS revealed that LONS was also an independent predictor, independent of pN stage, pT stage, tumor-node-metastasis stage, site, age, sex, the number of examined lymph nodes, race, preoperative radiotherapy and carcinoembryonic antigen level. CONCLUSIONLONS is associated with improved survival of rectal cancer patients independent of other clinicopathological factors.     

Prognostic nomograms for predicting overall survival and cause-specific survival of signet ring cell carcinoma in colorectal cancer patients

BACKGROUNDSignet ring cell carcinoma (SRCC) is an uncommon subtype in colorectal cancer (CRC), with a short survival time. Therefore, it is imperative to establish a useful prognostic model. As a simple visual predictive tool, nomograms combining a quantification of all proven prognostic factors have been widely used for predicting the outcomes of patients with different cancers in recent years. Until now, there has been no nomogram to predict the outcome of CRC patients with SRCC.AIMTo build effective nomograms for predicting overall survival (OS) and cause-specific survival (CSS) of CRC patients with SRCC.METHODSData were extracted from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Multivariate Cox regression analyses were used to identify independent variables for both OS and CSS to construct the nomograms. Performance of the nomograms was assessed by concordance index, calibration curves, and receiver operating characteristic (ROC) curves. ROC curves were also utilized to compare benefits between the nomograms and the tumor-node-metastasis (TNM) staging system. Patients were classified as high-risk, moderate-risk, and low-risk groups using the novel nomograms. Kaplan-Meier curves were plotted to compare survival differences.RESULTSIn total, 1230 patients were included. The concordance index of the nomograms for OS and CSS were 0.737 (95% confidence interval: 0.728-0.747) and 0.758 (95% confidence interval: 0.738-0.778), respectively. The calibration curves and ROC curves demonstrated good predictive accuracy. The 1-, 3-, and 5-year area under the curve values of the nomogram for predicting OS were 0.796, 0.825 and 0.819, in comparison to 0.743, 0.798, and 0.803 for the TNM staging system. In addition, the 1-, 3-, and 5-year area under the curve values of the nomogram for predicting CSS were 0.805, 0.847 and 0.863, in comparison to 0.740, 0.794, and 0.800 for the TNM staging system. Based on the novel nomograms, stratified analysis showed that the 5-year probability of survival in the high-risk, moderate-risk, and low-risk groups was 6.8%, 37.7%, and 67.0% for OS (P < 0.001), as well as 9.6%, 38.5%, and 67.6% for CSS (P < 0.001), respectively.CONCLUSIONConvenient and visual nomograms were built and validated to accurately predict the OS and CSS rates for CRC patients with SRCC, which are superior to the conventional TNM staging system.     

Factors associated with overall survival in early gastric cancer patients who underwent additional surgery after endoscopic submucosal dissection

BACKGROUNDControversy exists about the benefit of additional surgery after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).AIMTo examine risk factors for overall survival (OS) after additional surgery in patients with EGC who initially underwent ESD.METHODSThis was a retrospective analysis of patients with EGC who underwent additional surgery after ESD at the Beijing Friendship Hospital affiliated to Capital Medical University between August 2012 and August 2019. OS was the primary outcome. Lymph node metastasis and residual tumor were secondary outcomes. Logistic regression models and Kaplan-Meier curves were used for further analysis. RESULTSForty-two patients were evaluated, including 35 (83.3%) males and 7(16.7%) females. The mean age was 62 (range, 32-82) years. Male sex [hazard ratio (HR) = 21.906, 95% confidence interval (CI): 3.762-229.250; P = 0.039), T1b invasion (HR = 3.965, 95%CI: 1.109-17.432; P = 0.047), undifferentiated tumor (HR = 9.455, 95%CI: 0.946-29.482; P = 0.049), lymph node metastasis (HR = 2.126, 95%CI: 0.002-13.266; P = 0.031), and residual tumor (HR = 4.275, 95%CI: 1.049-27.420; P = 0.043) were independently associated with OS. The follow-up duration was 4-81 mo (median: 50.7 mo). OS was 77.0 ± 12.1 mo (95%CI: 53.3-100.7 mo). The 3-year and 5-year OS rates were 94.1% and 85%, respectively.CONCLUSIONMale sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor are independently associated with OS in patients with EGC who underwent additional surgery after ESD.     

Nomogram to predict the risk of endoscopic removal failure with forceps/baskets for treating submandibular stones

BACKGROUNDEndoscopic removal with forceps/baskets is favored in treating submandibular stones due to its minimal invasiveness. However, recent studies have found that endoscopic removal failure (ERF) is not unusual, and stones in such cases still need to be removed with other surgical methods. If the risk of ERF can be predicted preoperatively, it could be helpful for surgeons when choosing the appropriate therapy.AIMTo develop a predictive nomogram for the risk of ERF when treating submandibular stones based on their preoperative clinical features. METHODSA total of 180 patients with 211 submandibular stones treated from January 2012 to December 2020 were included in the current study. Based on the preoperative clinical features of the stones, independent risk factors for ERF were identified by logistic regression analysis. The stones were then randomly divided into training and testing sets. A nomogram was constructed to predict the risk of ERF using the training set and then validated using both sets. The predictive performance of the nomogram was assessed by calibration curves and the concordance index (C-index).RESULTSThree independent predictors, location (P = 0.040), transverse diameter (P < 0.001) and longitudinal diameter (P < 0.001) measured on the cone beam computed tomography (CBCT) images of the submandibular stones, were identified and included in the predictive nomogram. Calibration curves of the nomogram showed good agreement between the predicted and observed probabilities in both sets. The C-index in the training set was 0.917 (95%CI, 0.875-0.959) and that in the testing set was 0.925 (95%CI, 0.862-0.989). CONCLUSIONA nomogram based on the location, transverse and longitudinal diameters on CBCT images of submandibular stones showed satisfactory efficacy in predicting the risk of ERF preoperatively when treating submandibular stones.     

Transarterial chemoembolization with pirarubicin-eluting microspheres in patients with unresectable hepatocellular carcinoma: Preliminary results

PurposeTo present the early results of pirarubicin-eluting microsphere transarterial chemoembolization (PE-TACE) for patients with unresectable hepatocellular carcinoma (HCC).Materials and methodsWe retrospectively analyzed 55 consecutive patients with HCC who received PE-TACE between April 1, 2015 and August 30, 2016. The complication rate, tumor response rate, progression-free survival (PFS), and overall survival (OS) were analyzed.ResultsAdverse events were generally mild and included abdominal pain and fever, although a major complication was reported in 1 patient (1.8%). During a median follow-up of 10.0 months (range, 3.0–24.0 months), 14 patients (25.5%) achieved a complete tumor response, 25 (45.5%) had a partial response, 9 (16.4%) showed stable disease, and 7 (12.7%) had disease progression. The 1-month overall response rate was 70.9%, and the local tumor response rate was 89.0%. The 1-month tumor response rate was 100% for Barcelona Clinic Liver Cancer (BCLC) stage A or B disease and 62.8% for BCLC stage C disease. The median PFS was 6.1 months (95% confidence interval [95%CI], 3.4–8.8 months; range, 1.0–24.0 months). The median OS was 11.0 months (95%CI, 7.1–14.9 months; range, 2.0–24.0 months). Kaplan-Meier analysis (log-rank test) found significant differences in OS between patients grouped by tumor number (P = 0.006), tumor size (P = 0.035), and Eastern Cooperative Oncology Group (ECOG) score (P = 0.005). The tumor number (1 vs. ≥2) was the only factor independently associated with OS (hazard ratio [HR], 2.867; 95%CI, 1.330–6.181; P = 0.007).ConclusionsPE-TACE for unresectable HCC may be safe, with favorable tumor response rates and survival time, especially in patients with a single large tumor. Longer follow-up using a larger series is necessary to confirm these preliminary results.     

Clinical significance of signet ring cells in surgical esophageal and esophagogastric junction adenocarcinoma: A systematic review and meta-analysis

BACKGROUNDThe clinical significance of signet ring cells (SRCs) in surgical esophageal and esophagogastric junction adenocarcinoma (EEGJA) remains unclear now.AIMTo explore the association between the presence of SRCs and the clinicopathological and prognostic characteristics in surgical EEGJA patients by combining and analyzing relevant studies.METHODSThe PubMed, Web of Science, and EMBASE electronic databases were searched for the relevant literature up to March 28, 2021. The relative risk (RR) with 95% confidence interval (CI) was calculated to assess the relationship between SRCs and clinicopathological parameters of surgical EEGJA patients, and the hazard ratio (HR) with 95%CI was calculated to explore the impact of SRC on the prognosis. All statistical analyses were conducted with STATA 12.0 software.RESULTSA total of ten articles were included, involving 30322 EEGJA patients. The pooled results indicated that the presence of SRCs was significantly associated with tumor location (RR: 0.76, 95%CI: 0.61-0.96, P = 0.022; I² = 49.4%, P = 0.160) and tumor-node-metastasis stage (RR: 1.30, 95%CI: 1.02-1.65, P = 0.031; I² = 73.1%, P = 0.002). Meanwhile, the presence of SRCs in surgical EEGJA patients predicted a poor overall survival (HR: 1.36, 95%CI: 1.12-1.65, P = 0.002; I² = 85.7%, P < 0.001) and disease-specific survival (HR: 1.86, 95%CI: 1.55-2.25, P < 0.001; I² = 63.1%, P = 0.043). CONCLUSIONThe presence of SRCs is related with advanced tumor stage and poor prognosis and could serve as a reliable and effective parameter for the prediction of postoperative survival and formulation of therapy strategy in EEGJA patients. However, more high-quality studies are still needed to verify the above findings.     

Epidemiological features for primary lymphoma of the female genital tract patients and development of a nomogram to predict survival

BackgroundPrimary lymphoma of the female genital tract (PLFGT) is a sporadic extranodal lymphoma. Its epidemiology and prognosis are not fully recognized. Our study aimed to construct and validate prognostic nomograms for predicting survival for patients with PLFGT.MethodsIncidence rate from 1975 to 2017 and patients with PLFGT from 1975 to 2011 in the Surveillance, Epidemiology and End Results (SEER) database were retrospectively reviewed. The nomograms of overall survival (OS) and disease-specific survival (DSS) were established according to the multivariate Cox regression analyses. The concordance index (C-index) and calibration plots were used to demonstrate its robustness and accuracy.ResultsA total of 617 PLFGT patients were identified. The overall incidence of PLFGT is 0.437/1,000,000 (adjusted to the US standard population in 2000) from 1975 to 2017. Age, histological subtype, Ann Arbor Stage, and therapeutic strategy were identified as independent prognostic factors for OS and DSS by multivariate Cox regression (p < .05). Nomograms to predict 1-, 5-, and 10-year OS and DSS were established. The C-index and calibration plots showed a good discriminative ability and an optimal accuracy of the nomograms. Patients were divided into three risk groups according to the model of OS.ConclusionsThe incidence of PLFGT has increased in the past 40 years, and the nomograms were developed and validated as an individualized tool to predict OS and DSS for all PLFGT patients and DLBCL patients. All patients are divided into three risk groups to assist clinicians to identify patients at high-risk and choose the optimal individualized treatments for patients.

Highlights

• The incident of PLFGT and its subtypes were calculated and compared.
• Nomograms were constructed to predict the 1-, 5-, and 10-year OS and DSS.
• Patients are divided into the low-risk, medium-risk, and high-risk according total score of the nomogram.

     

Increased morbidity and mortality of hepatocellular carcinoma patients in lower cost of living areas

BACKGROUNDThe incidence and mortality rates of hepatocellular carcinoma (HCC) are increasing in the United States. However, the increases in different racial and socioeconomic groups have not been homogeneous. Access to healthcare based on socioeconomic status and cost of living index (COLI), especially in HCC management, is under characterized.AIMThe aim was to investigate the relationship between the COLI and tumor characteristics, treatment modalities, and survival of HCC patients in the United States.METHODSA retrospective study of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HCC between 2007 and 2015 using site code C22.0 and the International Classification of Disease for Oncology, 3rd edition (ICD-O-3) codes 8170-8173, and 8175. Cases of fibrolamellar HCC were excluded. Variables collected included demographics, COLI, insurance status, marital status, stage, treatment, tumor size, and survival data. Interquartile ranges for COLI were obtained. Based on the COLI, the study population was separated into four groups: COLI ≤ 901, 902-1044, 1045-1169, ≥ 1070. The χ² test was used to compare categorical variables, and the Kruskal-Wallis test was used to compare continuous variables without normal distributions. Survival was estimated by the Kaplan-Meier method. We defined P < 0.05 as statistically significant.RESULTSWe identified 47,894 patients with HCC. Patients from the highest COLI areas were older (63 vs 61 years of age), more likely to be married (52.8% vs 48.0%), female (23.7% vs 21.1%), and of Asian and Pacific Islander descent (32.7% vs 4.8%). The patients were more likely to have stage I disease (34.2% vs 32.6%), tumor size ≤ 30 mm (27.1% vs 23.1%), received locoregional therapy (11.5% vs 6.1%), and undergone surgical resection (10.7% vs 7.0%) when compared with the lowest quartile. The majority of patients with higher COLIs resided in California, Connecticut, Hawaii, and New Jersey. Patients with lower COLIs were more likely to be uninsured (5.7% vs 3.4%), have stage IV disease (15.2% vs 13%), and have received a liver transplant (6.6% vs 4.4%) compared with patients from with the highest COLI. Median survival increased with COLI from 8 (95%CI: 7-8), to 10 (10-11), 11 (11-12), and 14 (14-15) mo (P < 0.001) among patients with COLIs of ≤ 901, 902-1044, 1045-1169, ≥ 1070, respectively. After stratifying by year, a survival trend was present: 2007-2009, 2010-2012, and 2013-2015.CONCLUSIONOur study suggested that there were racial and socioeconomic disparities in HCC. Patients from lower COLI groups presented with more advanced disease, and increasing COLI was associated with improved median survival. Future studies should examine this further and explore ways to mitigate the differences.     

食管鳞状细胞癌患者根治术后生存预测模型的建立与验证:一项多中心真实世界队列研究

  目的  建立并验证食管鳞状细胞癌患者根治术后生存预后预测模型与风险分级标准,为术后最优辅助治疗方案的确定提供真实世界证据。  方法  分别收集2011年5月31日至2018年7月31日在河南省安阳市肿瘤医院(安阳中心)和2009年8月1日至2018年12月31日在广东省汕头大学医学院附属肿瘤医院(汕头中心)连续就诊的食管鳞状细胞癌患者的临床数据和生存随访数据。以安阳中心数据集为建模集,采用基于多因素Cox比例风险回归逐步后退法和AIC准则(Akaike information criterion)的“两步法”构建总生存预测模型。通过Bootstrap重抽样1 000次对模型进行内部统计验证,在汕头中心数据集进行外部验证。根据列线图得分构建预后风险分级标准。  结果  建模队列和验证队列分别纳入4 171例和1 895例食管鳞状细胞癌患者。模型由年龄、性别、肿瘤原发位置、T分期、N分期、淋巴结清扫数、肿瘤大小、辅助治疗方案和术前血红蛋白水平9个变量组成。其中,N分期与辅助治疗方案存在显著交互作用(P＜0.001),即与单纯手术相比,N+期患者可能从辅助治疗中获益,但辅助治疗无法改善N0期患者的预后。建模队列的模型一致性指数(C-index)为0.728 (95% CI: 0.713~0.742),经Bootstrap内部验证后为0.722 (95% CI: 0.711~0.739),验证队列的模型C-index为0.679 (95% CI: 0.662~0.697)。校准图提示模型预测生存率与观测生存率一致性良好。在两个队列中模型准确性均显著高于第7版AJCC(American Joint Committee on Cancer)TNM分期系统(P＜0.05)。此外,在各TNM分期内部,该模型仍可实现理想的预后风险分层效果。  结论  本研究为我国食管鳞状细胞癌患者根治术后总生存提供了个体化预测模型,并揭示N分期可能是制订食管鳞状细胞癌患者术后辅助治疗方案的重要决定因素。     

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。     

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery

ObjectivesThis study aimed to develop a nomogram for predicting the risk of pressure injury (PI) in adult patients undergoing abdominal surgery and validate its effectiveness among these patients.MethodsThis study retrospectively included 11,247 adult patients, who underwent abdominal surgery and postoperative supervision in ICU, in a tertiary care hospital in western China between January 2017 and December 2020. All datasets were extracted from the patient’s medical records and randomly divided into the training cohort (8,997) and the validation cohort (2,250) by 8:2. The univariable logistic regression was used to select potentially relevant features. Then, multivariable logistic regression was also conducted and utilized to establish the nomogram. The nomogram was compared with the Braden scale for predicting PI in the validation cohort through the area under the curve (AUC) of the receiver operator characteristic (ROC) curve, Hosmer-Lemeshow (H-L) test, and decision curve analysis (DCA).Results873 (7.8%) patients suffered PIs. Logistic regression analysis showed that time of operation, weight, type of operation, albumin, and Braden scale score were independent risk factors for PI. A nomogram integrating five selected characteristics was constructed. The AUC of the ROC curve for the nomogram was 0.831, with a specificity of 85.2% and sensitivity of 63.7%. The AUC of the ROC curve for the Braden scale was 0.567, with a specificity of only 33.0%. The P-values of the H-L test were 0.45 (nomogram) and 0.22 (Braden scale), both indicating good calibration. The DCA also displayed that the nomogram had better predictive validity.ConclusionCompared with the Braden scale, the nomogram showed a better predictive performance. This nomogram is informative and has the potential to better guide caregivers for risk stratification and prevention of PI, although it requires further validation.     

Circulating immune parameters-based nomogram for predicting malignancy in laryngeal neoplasm

BACKGROUNDMalignancy prediction remains important to preoperative diagnosis and postoperative follow-up in laryngeal neoplasm.AIMTo evaluate the circulating immune population and develop a nomogram for prediction of malignancy in patients with laryngeal neoplasm.METHODSA primary cohort of 156 patients was divided into laryngeal benign lesion, premalignant lesion and malignant lesion groups. Peripheral blood from patients was measured by blood routine test and flow cytometry. A nomogram was developed and applied to a validation cohort containing 55 consecutive patients.RESULTSAge, gender and seven circulating immune parameters exhibited significant differences between laryngeal benign lesion and premalignant lesion. The nomogram incorporated predictors, including gender, age, smoke index, proportions of monocytes, CD8+ T cells, CD4+ T cells, B cells and CD4/CD8+ T cell ratio. It showed good discrimination between laryngeal premalignant lesion and malignant lesion, with a C-index of 0.844 for the primary cohort. Application of this nomogram in the validation cohort (C-index, 0.804) still had good discrimination and good calibration. Decision curve analysis revealed that the nomogram was clinically useful.CONCLUSIONThis novel nomogram, incorporating both clinical risk factors and circulating immune parameters, could be appropriately applied in preoperative individualized prediction of malignancy in patients with laryngeal neoplasm.