The clinicopathological significance and prognostic value of programmed death-ligand 1 in prostate cancer: a meta-analysis of 3133 patients

Background: Programmed death-ligand 1 (PD-L1) is considered an adverse factor predicting poor prognosis in various cancers, but the significance of PD-L1 expression for the prognosis of prostate cancer (PCa) is still unclear. We aimed to investigate the clinicopathological significance and prognostic value of PD-L1 expression in PCa.

Methods: Studies were retrieved from PubMed, Web of Science, Cochrane Library and Embase before March 23, 2020. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were obtained to assess the results. Begg’s test was applied to evaluate publication bias.

Results: Fourteen studies involving 3133 cases were analyzed. The pooled data showed that both PD-L1 protein expression and PD-L1 DNA methylation (mPD-L1) were negatively associated with biochemical recurrence-free survival, with HRs of 1.67 (95% CI = 1.38-2.06, p < 0.001) and 2.23 (95% CI = 1.51-3.29, p < 0.001), respectively. In addition, PD-L1 overexpression was significantly related to advanced tumor stage (OR = 1.40, 95% CI= 1.13-1.75, p = 0.003), positive surgical margin (OR = 1.36, 95% CI = 1.03-1.78, p = 0.028), higher Gleason score (OR = 1.81, 95% CI = 1.35-2.42, p < 0.001) and androgen receptor positivity (OR = 2.20, 95% CI = 1.61-3.01, p < 0.001), while no significant correlation with age (p = 0.122), preoperative PSA (p = 0.796) or nodal status (p = 0.113) was observed.

Conclusions: The study revealed that high expression of PD-L1 was related to unfavorable prognosis and advanced clinicopathological factors in PCa patients.

Exploring the Role of TRIP-Brs in Human Breast Cancer: An Investigation of Expression, Clinicopathological Significance, and Prognosis

TRIP-Brs, a group of transcription factors (TFs) that modulate several mechanisms in higher organisms. However, the novel paradigm to target TRIP-Brs in specific cancer remains to be deciphered. In particular, comprehensive analysis of TRIP-Brs in clinicopathological and patients’ prognosis, especially in breast cancer (BRCA), is being greatly ignored. Therefore, we explored the key roles of TRIP-Br expression, modulatory effects, mutations, immune infiltration, and prognosis in BRCA using multidimensional approaches. We found elevated levels of TRIP-Brs in numerous cancer tissues than normal. Higher expression of TRIP-Br-2/4/5 was shown to be positively associated with lower survival, tumor grade, and malignancy of patients with BRCA. Additionally, higher TRIP-Br-3/4 were also significantly linked with worse/short survival of BRCA patients. TRIP-Br-1/4/5 were significantly overexpressed and enhanced tumorigenesis in large-scale BRCA datasets. The mRNA levels of TRIP-Brs have been also correlated with tumor immune infiltrate in BRCA patients. In addition, TRIP-Brs synergistically play a pivotal role in central carbon metabolism, cancer-associated pathways, cell cycle, and thyroid hormone signaling, which evoke that TRIP-Brs may be a potential target for the therapy of BRCA. Thus, this investigation may lay a foundation for further research on TRIP-Br-mediated management of BRCA.

Pediatric meningioma: a clinicopathologic and molecular study with potential grading implications

Meningiomas are common in adults (~35% of brain tumors) but rare in children, where they exhibit unique clinical, pathological and molecular features compared to adult counterparts. Thus, data generated from adult cohorts may be imperfectly suited to guiding diagnostic, prognostic and treatment decisions for children. We studied 50 meningioma patients ≤18 years with available clinical and pathological data to address the need for data obtained in the pediatric setting. As previously described, we noted a slight bias toward male patients and a higher proportion of spinal tumors compared to adults. Thirty-eight of 50 specimens were further analyzed by next generation sequencing. Loss-of-function mutations in NF2 and chromosome 22 losses were common, but pathogenic variants in other genes (SMARCB1, FUBP1, BRAF, TERT promoter, CHEK2, SMAD and GATA3) were identified in a minority of cases. Copy number variants outside of chromosomes 22 and 1 were infrequent. H3K27 hypomethylation, a useful biomarker in adult tumors, was not found in our cohort. In exploring the correlation between mitotic count and recurrence-free survival, we found a threshold of six mitoses per 10 high powered fields as the optimal cutoff in predicting recurrence-free survival. If independently validated in larger studies, adjusted grading thresholds could enhance the clinical management of pediatric meningiomas.

Comprehensive Analysis of Expression, Clinicopathological Association and Potential Prognostic Significance of RABs in Pancreatic Cancer

RAB proteins (RABs) represent the largest subfamily of Ras-like small GTPases that regulate a wide variety of endosomal membrane transport pathways. Their aberrant expression has been demonstrated in various malignancies and implicated in pathogenesis. Using The Cancer Genome Atlas (TCGA) database, we analyzed the differential expression and clinicopathological association of RAB genes in pancreatic ductal adenocarcinoma (PDAC). Of the 62 RAB genes analyzed, five (RAB3A, RAB26, RAB25, RAB21, and RAB22A) exhibited statistically significant upregulation, while five (RAB6B, RAB8B, RABL2A, RABL2B, and RAB32) were downregulated in PDAC as compared to the normal pancreas. Racially disparate expression was also reported for RAB3A, RAB25, and RAB26. However, no clear trend of altered expression was observed with increasing stage and grade, age, and gender of the patients. PDAC from occasional drinkers had significantly higher expression of RAB21 compared to daily or weekly drinkers, whereas RAB25 expression was significantly higher in social drinkers, compared to occasional ones. The expression of RABL2A was significantly reduced in PDAC from diabetic patients, whereas RAB26 was significantly lower in pancreatitis patients. More importantly, a significant association of high expression of RAB21, RAB22A, and RAB25, and low expression of RAB6B, RABL2A, and RABL2B was observed with poorer survival of PC patients. Together, our study suggests potential diagnostic and prognostic significance of RABs in PDAC, warranting further investigations to define their functional and mechanistic significance.

PD-L1 Expression in Glioblastoma, the Clinical and Prognostic Significance: A Systematic Literature Review and Meta-Analysis

Background: The clinical and prognostic value of programmed death-ligand 1, PD-L1, in glioblastoma remains controversial. The present study aimed to identify the expression of PD-L1 for its prognostic value in glioblastoma.

Methods: A comprehensive literature search was performed using the PubMed and CNKI databases. The overall survival (OS) and disease-free survival (DFS) of GBM was analyzed based on Hazard ratios (HRs) and 95% confidence intervals (CIs). Furthermore, Odds ratios (ORs) and 95% CIs were summarized for clinicopathological parameters. The statistical analysis was using RevMan 5.3 software.

Results: The meta-analysis was performed by using total nine studies including 806 patients who had glioblastoma. The pooled results indicated that PD-L1 expression in tumor tissues was significantly related to a poor OS (HR = 1.63, 95%CI: 1.19–2.24, P = 0.003, random effects model) with heterogeneity (I² = 51%). In subgroup analyses, PD-L1 positivity was significantly associated with a worse OS for patients of American and Asian regions, but not for those of European regions. Moreover, PD-L1 expression implied a trend toward the mutation status of the IDH1 gene [coding the Isocitrate Dehydrogenase (NADP(+))-1 protein] (HR = 9.92, 95%CI: 1.85–53.08, P = 0.007, fixed effects model). However, the prediction overall survival (OS) of the patients showed that PD-L1 expression was independent from other clinicopathological features, such as gender and age.

Conclusions: Our analyses indicated that high expression of PD-L1 in glioblastoma tumor tissues is associated with poor survival of patients, and PD-L1 may act as a prognostic predictor and an effective therapeutic target for glioblastoma.

Clinicopathological Concordance in 2216 Cases of Skin Biopsy over One Year: An Indian Experience

Introduction

To determine the spectrum of diseases and the level of clinicopathological concordance in skin biopsies received over a period of one year.

Methods

A total of 2216 skin biopsy cases received over a period of one year at a tertiary care center were retrospectively analyzed. The cases were further divided into further categories in levels of concordance based on the agreement between the clinical and histopathological diagnosis rendered.

Results

Of the cases, 61.01% showed clinicopathological concordance. Cases with a descriptive pathological diagnosis, not matching the clinical diagnosis, constituted 31.54%, whereas 4.02% of cases had a definitive pathological diagnosis, which was discordant with the clinical differentials; 3.29% biopsies were inadequate.

Conclusion

This study highlights the clinicopathological concordance in all the biopsies received from dermatology. It emphasizes the importance of skin biopsies in arriving at the diagnosis. However, it is a tool that must be used judiciously. Skin biopsies are also pivotal in flagging malignancies that may mimic benign lesions.

The Clinicopathological Risk Factors in Renal Cell Cancer for the Oncological Outcomes Following Nephron-Sparing Surgery: A PRISMA Systematic Review and Meta-Analysis

Background and Objectives: Published data from individual studies present conflicting evidence about the relationship between clinicopathological risk factors and oncological outcomes in renal cell cancer (RCC) following nephron-sparing surgery (NSS). This study was conducted to explore the potential risk factors for RCC progress after NSS. Methods: Studies published in PubMed, Web of Science, and EMBASE were systematically reviewed from inception to March 2019 to determine risk factors for RCC following NSS. The predictive ability of identified predictors was assessed by hazard ratios (HRs) with 95% confidence intervals (CIs). A fixed-effect or random-effect was used to pool the estimates. Subgroup analyses were performed to explore the source of heterogeneity. Results: Seventeen studies including 38,522 patients with RCC were analyzed. The meta-analysis indicated that positive surgical margin (pooled HR = 1.47; 95% CI:1.24-1.73; P < 0.001), higher Fuhrman grade (pooled HR = 1.58; 95% CI:1.10-2.28; P = 0.013), higher pathological stage (pooled HR = 1.72; 95% CI:1.40-2.12; P < 0.001) and large tumor size (pooled HR = 1.09; 95% CI:1.03-1.16; P = 0.003) were significantly associated with recurrence risk. However, age (pooled HR = 1.00; 95% CI: 1.00-1.01; P = 0.257), sex (male vs. female) (pooled HR = 1.04; 95% CI: 0.89-1.21; P = 0.605) and surgical approach (laparoscope vs. open) (pooled HR = 0.80; 95% CI: 0.59-1.07; P = 0.129) had no effect on recurrence after NSS. In addition, we found that positive surgical margin was significantly associated with recurrence-free survival (pooled HR = 1.87; 95% CI: 1.32-2.66; P < 0.001) and overall mortality (pooled HR = 1.15; 95% CI: 1.07-1.23; P < 0.001), as well as large tumor size for recurrence-free survival (pooled HR = 1.18; 95% CI: 1.06-1.30; P = 0.002)and overall mortality (pooled HR = 1.01; 95% CI: 1.00-1.02; P = 0.004). Conclusions: Unfavorable pathological characteristics were distinctly related to worse oncological outcomes in RCC patients following NSS. These results may contribute to proposed prediction models for RCC patients to aid in counseling and risk stratification.

Clinicopathological analysis of 250 cases of pituitary adenoma under the new WHO classification

Pituitary adenomas (PAs) are a common subtype of intracranial tumors. The aim of the present study was to analyse the clinical and pathological features of different types of pituitary adenomas (PAs) according to the 2017 World Health Organisation Endocrine Organ Tumor Classification guidelines. The clinical data of 250 patients with PAs were collected and analysed. Differences in the incidence of invasion, recurrence and apoplexy in patients between high- and low-risk PAs were compared, as were differences in the Ki-67 index between invasive and non-invasive PAs and between recurrent PAs and non-recurrent PAs. Of the 250 cases, 45 cases were diagnosed as somatotroph adenomas, 26 cases as lactotroph adenomas, 1 case as thyrotroph adenoma, 61 cases as corticotroph adenomas, 93 cases as gonadotropin adenomas, 15 cases as null cell adenomas and 9 cases as plurihormonal adenomas. There were 5 types of high-risk pituitary adenoma identified: 17 cases of sparsely granulated somatotroph adenoma, 11 cases of lactotroph adenoma in men, 3 cases of plurihormonal PIT-1 positive adenoma and 42 cases of silent corticotroph adenoma. Crooke's cell adenoma was not identified. High-risk PAs had significantly higher rates of invasion, recurrence and apoplexy compared with that in low-risk types (P<0.001). Invasive PAs had a significantly higher Ki-67 index compared with that in non-invasive PAs (3.5±1.8 vs. 2.8±1.3; P<0.01). Recurrent PAs had a significantly higher Ki-67 index compared with that in non-recurrent PAs (3.9±1.9 vs. 2.8±1.3; P<0.001). According to the 2017 classification criteria, patients most frequently had gonadotrophin cell adenomas, followed by corticotroph adenomas and the proportion of null cell adenomas was reduced. Differences were noted in the proliferation, recurrence and apoplexy characteristics of high-risk PAs and low-risk PAs. The invasion and recurrence of PAs were found to be related to the Ki-67 index.

Correlation of programmed death-ligand 1 expression with gene expression and clinicopathological parameters in Indian patients with non-small cell lung cancer

Objectives:

The aim of this study is to evaluate the incidence of programmed cell death-ligand 1 (PD-L1) expression in non-small cell lung cancer (NSCLC) cases and its correlation with gene mutation and clinicopathological parameters.

Methods:

Samples from NSCLCs patients were studied for PD-L1 expression through immunohistochemistry (IHC) using Rabbit anti-human PDL-1/CD274 Monoclonal Antibody. Genetic mutations were studied using IHC/fluorescence in situ hybridization (FISH) methods (for anaplastic lymphoma kinase [ALK]) or polymerase chain reaction/gene sequencing analysis (for epidermal growth factor receptor [EGFR]). Pearson's correlation coefficient (r) was used for correlation analysis. PD-L1 expression was analyzed for association with clinicopathological features.

Results:

Of the 101 NSCLC cases, PD-L1 expression was observed in 33.66% (34/101) cases; tumor proportion score of <50%: 67.65% (23/34) and ≥50%: 32.35% (11/34) cases. PD-L1 positivity was seen in; males: 35.5%, females: 28%, smokers: 37.7%, cases with brain metastasis: 20%, cases with pleural effusion: 20.8%, and histopathological evaluation (well-differentiated: 21.42%, moderately-differentiated: 13.79%, poorly-differentiated: 36.11%, and adenosquamous disease: 40.9%). Genetic mutation studies revealed PD-L1 positivity in 18.1% cases with EGFR mutation, 50% of ALK-IHC positive cases, and 33.3% ALK-FISH positive cases. No or very weak correlation (r < 0.3) in PD-L1 expression with gene mutations or clinicopathological parameters was observed.

Conclusions:

The study demonstrated PD-L1 expression in ~ 1/3^rd cases of NSCLC patients. No or very weak correlation was observed for PD-L1 expression with genetic mutations and other parameters studied. The presence of gene mutations in PD-L1 expressed samples suggests further investigation on PD-L1 inhibitors in such patients for decisive treatments.

The Promising Signatures of Circulating microRNA-145 in Epithelial Ovarian Cancer Patients

BACKGROUND

Epithelial ovarian cancer continues to be a deleterious threat to women as it is asymptomatic and is typically detected in advanced stages. Cogent non-invasive biomarkers are therefore needed which are effective in apprehending the disease in early stages. Recently, miRNA deregulation has shown a promising magnitude in ovarian cancer tumorigenesis. miRNA-145(miR- 145) is beginning to be understood for its possible role in cancer development and progression. In this study, we identified the clinicopathological hallmarks altered owing to the downexpression of serum miR-145 in EOC.

METHODS

70 serum samples from histopathologically confirmed EOC patients and 70 controls were collected. Total RNA from serum was isolated by Trizol method, polyadenylated and reverse transcribed into cDNA. Expression level of miR-145 was detected by miRNA qRT-PCR using RNU6B snRNA as reference.

RESULTS

The alliance of miR-145 profiling amongst patients and controls established itself to be conspicuous with a significant p-value (p<0.0001). A positive conglomeration (p=0.04) of miR-145 profiling was manifested with histopathological grade. Receiver Operating Characteristic (ROC) curve highlights the diagnostic potential and makes it imminent with a robust Area Under the curve (AUC). A positive correlation with the ROC curve was also noted for histological grade, FIGO stage, distant metastasis, lymph node status and survival.

CONCLUSION

Our results propose that miR-145 down-regulation might be a possible touchstone for disease progression and be identified as a diagnostic marker and predict disease outcome in EOC patients.

Morphological patterns of anaemia among pregnant women from Sudan

Background

Morphological patterns of anaemia in pregnancy are considered essential for classification, diagnosis and management of patients, especially in regions with high maternal mortality like Sudan.

Objectives

This study evaluated morphological patterns of anaemia among pregnant women in Sudan and morphological differences across characteristics of participants.

Methods

This cross-sectional study was conducted from September 2016 to February 2017. A total of 200 women were selected according to specific criteria. Laboratory tests were performed for complete blood count, blood smears were performed for morphology and vitamin B12, folate and iron levels were measured. Participants were classified as: normochromic normocytic, microcytic hypochromic, macrocytic or dimorphic. Further classification based on haemoglobin levels was also performed.

Results

A total of 116 participants (58%) had a dimorphic pattern, followed by 50 participants (25%) with a microcytic hypochromic pattern, 20 participants (10%) with a macrocytic pattern and 14 participants (7%) with a normochromic normocytic pattern. Participants with the dimorphic pattern also had low levels of iron and folate. The majority of dimorphic participants presented with mild anaemia, whereas the majority of participants with the microcytic hypochromic pattern presented with moderate or severe anaemia. A high percentage of participants in late pregnancy had the dimorphic pattern, and there were significant differences in the degree of anaemia by parity, gestational age and regular intake of haematinic supplements.

Conclusion

The most frequent morphological pattern of anaemia in this study was dimorphic, followed by microcytic hypochromic, macrocytic and normochromic patterns. Morphological patterns appeared to predict types of vitamin and mineral deficiency and the degree of anaemia.

Survival advantage and clinicopathological significance of microRNA-22 in cancers: a meta-analysis

An increasing number of studies revealed that microRNA-22 as a biomarker may play a significant role in the cancer patients' prognosis, but the accurate prognosis value of microRNA-22 remains somewhat controversial. Thus, we comprehensively searched the database and performed this study to explicate the accurate value of microRNA-22 in the cancer patients' prognosis. This meta-analysis revealed that elevated expression of microRNA-22 correlated with good overall survival (OS) and disease-free survival (DFS)/progression-free survival (PFS)/recurrence-free survival (RFS) in cancers, while no significant association was found in metastasis-free survival (MFS)/distant metastasis-free survival (DMFS). Through the subgroup analysis for OS and DFS/PFS/RFS, we found that elevated expression of miR-22 significantly correlated with good prognosis in most subgroups, while it predicted a worse prognosis in nasopharyngeal carcinoma subgroup. And besides that, elevated expression of miR-22 was negatively correlated with TNM stage, lymph node metastasis, distant metastasis and recurrence, while no significant association was found between microRNA-22 expression and T stage, tumor differentiation, and lymphatic invasion. Our meta-analysis demonstrated that elevated expression of microRNA-22 predicted a good OS and DFS/PFS/RFS in cancer patients; meanwhile, its high expression also means earlier TNM stage, and lower likelihoods of lymph node metastasis, of distant metastasis and of recurrence. If we regularly monitor miR-22 expression in cancer patients, it might be useful for us to predict cancer prognosis in future clinical applications.

21-Gene recurrence score influences the chemotherapy decision for patients with breast cancer of different luminal subtypes

Luminal subtypes and the 21-gene recurrence score (RS) are important factors in the decision-making process for adjuvant chemotherapy in patients with hormonal receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. However, their effect on adjuvant chemotherapy decisions in the real world has not been thoroughly investigated, particularly for patients of the luminal A-like subtype with a high RS or the luminal B-like subtype with a low RS. The present study, a total of 772 HR⁺/HER2^- patients who underwent 21-gene testing, were included in a retrospective analysis. The impact of clinicopathological factors and the 21-gene RS on chemotherapy recommendation was analyzed in the whole population and for patients of different luminal subgroups. The results revealed that chemotherapy was highly recommended for patients of younger age, with larger tumor size, node involvement, higher grade, luminal B-like subtype and higher RS. A high RS was identified to be the most important impact factor for chemotherapy recommendation among all patients [odds ratio (OR), 62.54; 95% CI, 25.58-152.92], the luminal A-like group (OR, 435.05; 95% CI, 29.90-6331.06) and the luminal B-like group (OR, 57.20; 95% CI, 22.42-145.96). For patients of the luminal A-like subtype with a high RS or patients of the luminal B-like subtype with low RS, the 21-gene RS was demonstrated to be the most important independent factor for chemotherapy recommendation, with an adjusted OR of 134.52 (95% CI, 10.39-1741.89). In conclusion, luminal subtypes and the 21-gene RS were found to be associated with chemotherapy recommendation for HR⁺/HER2^- patients. For patients with a discordant luminal subtype and 21-gene RS risk, the 21-gene RS score was found to be the most important factor that influences chemotherapy decision, which warrants further clinical evaluation.

Combined Evaluation of Expression of CXCR4 and Nrf2 as Prognostic Factor for Patients with Gastric Carcinoma

BACKGROUND

CXC Chemokine Receptor 4 (CXCR4) and NFE-related factor 2 (Nrf2) have been observed implicated with cell malignant behavior of human cancers.

AIMS

In this study, we detected their expression in gastric carcinoma (GC) tissue specimens and related the result with clinicopathological data and patient survival.

METHODS

120 GC and compared normal tissue specimens were processed to analyse the expression of CXCR4 and Nrf2. We found that the expression of CXCR4 and Nrf2 was dramatically increased in GC tissues when compared to the distant non-cancer tissues (P<0.05). CXCR4 overexpression was associated with the depth of invasion (P= 0.006), Histological grade (P=0.018), TNMstage (P= 0.021), lymph node metastasis (P < 0.001) and distant metastasis (P=0.026), whereas overexpression of Nrf2 protein was significantly associated with tumor size (P=0.045), Histological grade (P=0.026), TNMstage (P= 0.020), lymph node metastases (P < 0.001) and distant metastasis (P=0.008). Furthermore, we observed a significant co-expression of CXCR4 and Nrf2 expression in GC specimens.

RESULTS

In the survival part, we found that GC patients with CXCR4+ and Nrf2+ had worse outcomes. The significant prognostic indicators are age, tumor size, histological grade, TNMstage, CXCR4, Nrf2, and coexpression of CXCR4 and Nrf2 in GC patients. Multivariate analysis showed that TNMstage and CXCR4+/Nrf2+ expression were risk factors. Above all we come to the conclusion that the expression of CXCR4 might partly be regulated by the level of Nrf2 and both positive expressions suggest poor prognosis of GC patients.

The Correlation of Clinicopathological Features With the Status of Surgical Margins in Renal Cell Cancer Patients Following Nephron-Sparing Surgery: A Systematic Review and Meta-Analysis

Objectives: The aim of this study was to evaluate the correlation of various clinicopathological variables with positive surgical margins (PSMs) in renal cell cancer (RCC) patients after nephron-sparing surgery (NSS). Methods: A systematic search of PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure (CNKI) was performed to identify studies that compared PSMs with negative surgical margins (NSMs) and were published up to December 2018. Outcomes of interest included perioperative and postoperative variables, and the data were pooled by odds ratios (ORs)/standard mean differences (SMD) with 95% confidence intervals (CIs) to evaluate the strength of such associations. STATA 12.0 software was used for all statistical analyses. Results: Based on the inclusion and exclusion criteria, 13 studies including 47,499 patients with RCC were analyzed. The results showed that higher Furhman grade (pooled OR = 1.25; 95% CI: 1.14-1.37; P < 0.001), higher pathological stage (pooled OR = 2.67; 95% CI: 2.05-3.50; P < 0.001), non-clear cell RCC (non-ccRCC) histology (pooled OR = 0.78; 95% CI: 0.72-0.84; P < 0.001), and non-white race (pooled OR = 0.90; 95% CI: 0.82-0.99; P = 0.026) were significantly associated with high risk of PSMs. However, age (pooled SMD = 0.09; 95% CI: -0.01-0.20; P = 0.078), gender (female vs. male) (pooled OR = 1.04; 95% CI: 0.96-1.12; P = 0.377), tumor laterality (left vs. right) (pooled OR = 1.09; 95% CI: 0.84-1.42; P = 0.501), tumor focality (unifocal vs. multifocal) (pooled OR = 0.67; 95% CI: 0.23-1.90; P = 0.445), tumor size (pooled SMD = 0.03; 95% CI: -0.10-0.15; P = 0.685), and surgical approach (open vs. non-open) (pooled OR = 0.94; 95% CI: 0.62-1.42; P = 0.763) had no relationship with PSMs. Sensitivity analysis showed that all models were stable, and no publication bias was observed in our study. Conclusions: The present findings demonstrate that the presence of PSMs was associated with higher Furhman grade and higher pathological stage. Additionally, non-white patients with non-ccRCC histology had a high risk of PSMs after NSS. Further multicenter and long-term follow-up studies are required to verify these findings.

Loss of Beclin1 Expression and Nrf2 Overexpression are Associated with Poor Survival of Patients with Non-Small Cell Lung Cancer

BACKGROUND

Nrf2 pathway and autophagy are abnormally activated in response to cellular stress in various types of human cancers. In this study, we selected Beclin1 as an enter point to discuss the relationship between Nrf2 pathway and autophagy, and defined their associations with clinic pathological features and survival of the patients.

METHOD

NSCLC specimens were processed for immunohistochemical and qRT-PCR to analyses the expression of Beclin1 and Nrf2. Kaplan-Meier method and log-rank test were used in the survival data.

RESULTS

Beclin1 protein level was found to be significantly associated with more advanced TNM stage (P = 0.035), lymph node metastasis (P = 0.017) and distant metastasis (P = 0.005). The expression of Nrf2 protein was associated with larger tumor size (P = 0.032), more advanced TNM stage (P = 0.011), lymph node metastasis (P = 0.045) and distant metastasis (P = 0.013). Beside there was a strong inverse relationship between Beclin1 and Nrf2 expression in the NSCLC tissues. Distant metastasis, Beclin1, Nrf2, and Beclin1-/Nrf2+ expression was conformed to be independent prognostic factors of patients.

CONCLUSION

Both Nrf2 overexpression and Beclin1 lower-expression are independent indicators of a poor prognosis in NSCLC patients.

Hematologic and Biochemical Reference Interval Development and the Effect of Age, Sex, Season, and Location on Hematologic Analyte Concentrations in Critically Endangered Yangtze Finless Porpoise (Neophocaena asiaeorientalis ssp. asiaeorientalis)

In this study, references intervals for 49 clinicopathological parameters were established for the critically endangered Yangtze finless porpoise (YFP) (Neophocaena phocaenoides asiaorientalis). Both from the wild (Poyang Lake) and seminatural (Tian-E-Zhou Oxbow) populations, individual blood samples from 188 animals were collected from 2009 to 2017 and from 2002 to 2015, respectively. For reference interval determination, we used a non-parametric bootstrap-based procedure to determine the 95th percentiles and the associated 90% confidence interval for each analyte. Our results indicated a need to partition the analyte concentrations by sex, age group, or pregnancy; however, we did not find a need to partition results by location. We then used a linear mixed model to determine if evidence existed for mean differences between location with sex and season as covariates and age group as the clustered random variable on mean hematological parameters in the YFP. We found that 88% of the analytes were significantly different between locations. Within the covariates, sex and season showed 31 and 69% significant difference in mean distributions, respectively. Additionally, age group provided a significant source of variation in 25% of the analytes. In summary, our finding suggests that analytes should be grouped according to sex, age, and reproductive status (non-pregnant and non-lactating, pregnant and lactating). Furthermore, we have provided the first set of reference intervals for 49 clinicopathological parameters that could provide guidelines for the initial evaluation of individuals during health assessments.

MYH9 overexpression correlates with clinicopathological parameters and poor prognosis of epithelial ovarian cancer

The aim of the present study was to investigate the expression of myosin 9 (MYH9) in epithelial ovarian cancer and to explore its correlation with the clinicopathological parameters and prognosis of epithelial ovarian cancer (EOC). A total of 265 cases of paraffin-embedded ovarian cancer tissues and 41 paratumor tissues which had been pathologically confirmed at the Memorial Hospital of Sun Yat-sen University from 2009 to 2017 were included in the present study. MYH9 expression was investigated with immunohistochemistry using a polyclonal antibody specific for MYH9. MYH9 expression is associated with disease progression free and overall survival in epithelial ovarian cancer patients; and the expression of MYH9 is associated with International Federation of Gynecology and Obstetrics stage, lymph node metastasis, intraperitoneal metastasis, survival status (at last follow-up), intraperitoneal recurrence, residual tumor size and ascites with tumor cells. Moreover, in a multivariate model MYH9 overexpression was an independent predictor of poor survival in epithelial ovarian cancer. MYH9 may be a candidate that plays a oncogenic role in epithelial ovarian cancer. MYH9 is a useful independent prognostic marker in epithelial ovarian cancer, and it may provide a candidate target therapy treatment of ovarian cancer in the future.

Clinicopathological factors associated with BRAF-V600E mutation in colorectal serrated adenomas

Serrated adenomas are genetically heterogeneous, and the histological classification into sessile serrated (SSA) adenoma and traditional serrated adenoma (TSA) does not reflect the molecular landscape. The objective of this study was to assess clinical or pathological factors associated with BRAF-V600E mutation in serrated adenomas. Systematic review and meta-analysis was performed by searching electronic databases from January 2011 to January 2019 for studies assessing the association of BRAF-V600E mutation with clinical or pathological features of serrated adenomas. Odds ratio (OR) was calculated for each factor; a P-value <0.05 was considered significant. Forty studies assessing 3511 serrated adenomas (2375 SSAs and 1136 TSAs) were included. BRAF-V600E mutation was significantly associated with proximal localisation (OR = 2.71; P < 0.00001) and CIMP-H status (OR = 4.81; P < 0.0001) in both SSA and TSA, with polyp size <10 mm (OR = 0.41; P = 0.02) in TSA, and with endoscopic pit pattern II-O (OR = 13.11; P < 0.00001) and expression of MUC5A5 (OR = 4.43; P = 0.003) and MUC6 (OR = 2.28; P < 0.05) in SSA. Conversely, BRAF mutation was not associated with age <70 years (OR = 1.63; P = 0.34), age <60 years (OR = 0.86; P = 0.79), female sex (OR = 0.77; P = 0.12), flat morphology (OR = 1.52; P = 0.16), presence of any dysplasia (OR = 1.01; P = 0.59), serrated dysplasia (OR = 1.23; P = 0.72) and invasive cancer (OR = 0.67; P = 0.32), nuclear β-catenin expression (OR = 0.73; P = 0.21) and p53 overexpression (OR = 1.24; P = 0.82). In conclusion, BRAF-V600E mutation is associated with proximal localisation and CIMP-H status in both SSA and TSA, with size <10 mm only in TSA, and with expression of MUC5A5 and MUC6 and endoscopic pit pattern II-O at least in SSA. In serrated adenomas, BRAF-V600E mutation does not seem to be associated with age and sex, with the prevalence of dysplasia and cancer and with the morphology of the dysplastic component.

The Prognostic and Clinicopathological Roles of PD-L1 Expression in Colorectal Cancer: A Systematic Review and Meta-Analysis

Background: Studies evaluating the prognostic significance of programmed death-ligand 1 (PD-L1) expression in colorectal cancer (CRC) are limited and remain controversial. This meta-analysis was conducted in order to evaluate the clinicopathological and prognostic significance of PD-L1 expression in CRC patients.

Methods: A comprehensive search was performed against the Medline/PubMed, Embase, Cochrane Library, Web of Science (WoS) and Scopus databases. Data were extracted with name of the first author, year of publication, country of origin, tumor type, number of cases, staining method, cut-off values, PD-L1 positive expression, clinicopathological parameters, outcome, and quality assessment score, and statistical analysis was conducted using Review Manager Version 5.3 (Revman the Cochrane Collaboration; Oxford, England) and STATA version 14 (Stata Corporation; College Station, TX, USA).

Results: Ten studies were included in this meta-analysis, in which the pooled hazard ratio (HR) showed that PD-L1 expression in tumor cells was significantly associated with a poor overall survival (HR = 1.50, 95% CI 1.05–2.13, P = 0.03). The pooled HR for disease-free survival (DFS) indicated that PD-L1 expression was significantly associated with shorter DFS (HR = 2.57, 95% CI 1.40–4.75, P = 0.002). The pooled odds ratios (ORs) showed that PD-L1 expression was associated with poor differentiation (OR = 3.47, 95% CI 1.37–8.77, P = 0.008) and right colon cancer (OR = 2.38, 95% CI 1.57–3.60, P < 0.0001). However, the expression of PD-L1 was independent of gender, age, tumor size, tumor stage, lymph node metastasis, and tumor-node metastasis stage.

Conclusion: This meta-analysis indicated that a high level of PD-L1 expression might be a biomarker for a poor prognosis in CRC patients. This information may be helpful for clinicians to stratify CRC patients for anti-PD-1/PD-L1 therapy, particularly patients with microsatellite instability high (MSI-H).

lncRNA small nucleolar RNA host gene 20 predicts poor prognosis in glioma and promotes cell proliferation by silencing P21

Background

In multiple cancers, long non-coding RNA small nucleolar RNA host gene 20 (lncRNA SNHG20) is generally dysregulated. In the present study, both the biological role and clinicopathological value of lncRNA SNHG20 in glioma are explored.

Methods

Real-time PCR was employed to determine lncRNA SNHG20 expression in glioma patients. The prognostic role of expression of lncRNA SNHG20 was evaluated in a retrospective cohort study. In addition, the association between lncRNA SNHG20 expression and the clinicopathological features of glioma patients, such as tumor recurrence, survival status, follow-up time, WHO grade, resection extent, tumor location, Karnofsky performance scale score, cystic change, tumor size, gender and age, was discussed. By constructing and transfecting siRNAs that targeted lncRNA SNHG20 into the glioma U87 cells, the effects of lncRNA SNHG20 on the proliferation and cell cycle of U87 cells were assessed through cell counting kit-8, colony formation and cell cycle assays, respectively. In addition, Western blot and real-time PCR measured the expression levels of P21 and CCNA1 in U87 cells after being transfected with SNHG20 siRNA.

Results

Our results suggested the high expression of lncRNA SNHG20 in human glioma tissues compared with normal brain tissues, which was related to recurrence-free survival and poor overall survival in glioma patients. According to the existing retrospective cohort study, high lncRNA SNHG20 expression was associated with tumor size, extent of resection, WHO grade, follow-up time, survival status and recurrence. Besides, knocking down the expression of lncRNA SNHG20 could inhibit the proliferation and colony formation abilities of glioma U87 cells through cell cycle arrest. Consequently, the expression of CCNA1 was inhibited, and the expression of P21 was up-regulated in U87 cells.

Conclusion

A high lncRNA SNHG20 expression level predicts the poor prognosis for glioma patients. Moreover, lncRNA SNHG20 can promote glioma proliferation through silencing P21 and thus lncRNA SNHG20 is an independent potential prognostic biomarker for glioma patients.

Ultrasonography is valuable in evaluation of papillary thyroid microcarcinoma based on 5 mm tumor size

Introduction

Fine-needle aspiration was once done in suspected malignant thyroid nodules more than 5 mm in diameter. Five millimeter has been applied in many studies as the cut off tumor size in recent years. In this study, we would like to analyze the clinicopathological and ultrasonographic features of papillary thyroid microcarcinoma (PTMC) ≤5 mm and >5 mm with the aim of finding out the diagnostic value of ultrasonography.

Subjects and Methods

A total of 291 patients from January 2012 to October 2014 who underwent an ultrasound examination and were postoperatively diagnosed as PTMC were enrolled in the study. The patients were divided into Group A (≤5 mm) and Group B (>5 mm, ≤10 mm) based on diameter. The clinicopathological and ultrasonographic features of the two groups were statistically analyzed.

Results

In total, 291 thyroid tumors were analyzed in 291 patients. In patients who were identified with multiple tumors, the largest nodule in size was used for analysis. PTMC >5 mm in diameter were found with a higher incidence of lymph node metastasis and advanced tumor-node-metastasis (TNM) Stage (III/IV) with a significant difference, also with a larger part of multiple tumors compared to PTMC <5 mm. Of all the ultrasonographic features studied, calcification and peripheral halo were more significantly correlated with PTMC >5 mm. The presence of vascularity and blood supply were both associated with the tumor size.

Conclusion

Larger tumor size of PTMC is more likely to involve in lymph node metastasis and advanced TNM stage. Correlation of tumor size with calcification, peripheral halo, vascularity, and blood supply do exist in PTMC. Ultrasound is of great value in the evaluation of PTMC.

Considering the downregulation of Tpm1.6 and Tpm1.7 in squamous cell carcinoma of esophagus as a potent biomarker

AIM

Squamous cell carcinoma of esophagus (SCCE) is an aggressive disease with a poor prognosis. Tropomyosins attach to actin microfilaments, providing its stability. Nonmuscle cells express Tpm isoforms such as Tpm1.6 and Tpm1.7 which are involved in cytoskeleton functional properties regulation.

MATERIALS & METHODS

The expression of Tpm1.6 and Tpm1.7 was analyzed in SCCE tissues and its association with clinicopathological parameters and survival of patients was assessed.

RESULTS

Tpm1.6 and Tpm1.7, besides TPM1 mRNA decreased considerably in SCCE tissues relative to normal esophageal tissues (p < 0.001). TPM1 downregulation level was significantly associated with the degree of tumor differentiation (p = 0.017).

CONCLUSION

Tpm1.6 and Tpm1.7 suppression play a crucial role in esophagus tumorigenesis and could be associated with SCCE poor prognosis.

Prognostic and clinicopathological value of SIRT3 expression in various cancers: a systematic review and meta-analysis

Background

Several studies have explored the prognostic value of sirtuin 3 (SIRT3) in various cancers, but obtained inconsistent results. The current systematic review and meta-analysis was conducted to investigate the association between SIRT3 expression and prognosis in various cancers.

Methods

PubMed, Embase, Web of Science and the Cochrane Library were comprehensively retrieved by the end of September 29, 2017. All the relevant studies were checked and included in the meta-analysis if they met the inclusion criteria.

Results

A total of 17 studies involving 2,865 patients were included in the systematic review and meta-analysis. The results indicated that SIRT3 expression was not significantly associated with overall survival (OS) (hazard ratio [HR]=0.87, 95% CI=0.59–1.29, P=0.50) and disease-free survival (HR=0.87, 95% CI=0.57–1.31, P=0.50) in total various cancers. However, significant relationship between SIRT3 expression and OS in specific cancers was detected, including chronic lymphocytic leukemia (CLL) (HR=0.48, 95% CI=0.26–0.89, P=0.019), hepatocellular carcinoma (HCC) (HR=0.56, 95% CI=0.42–0.74, P<0.001), pancreatic carcinoma (PC) (HR=0.55, 95% CI=0.30–1.00, P=0.049), renal cell carcinoma (RCC) (HR=0.13, 95% CI=0.02–0.98, P=0.048), breast cancer (BC) (HR=2.53, 95% CI=1.83–3.67, P<0.001), colon cancer (CC) (HR=1.87, 95% CI=1.12–3.26, P=0.022) and non-small-cell lung cancer (NSCLC) (HR=2.20, 95% CI=1.38–3.50, P=0.001). Moreover, SIRT3 expression was obviously associated with tumor size (odds ratio [OR]=1.41, 95% CI=1.02–1.94, P=0.04), tumor differentiation (OR=1.52, 95% CI=1.08–2.16, P=0.02) and clinical stage (OR=2.07, 95% CI=1.23–3.46, P=0.01) in HCC.

Conclusion

SIRT3 was distinctly related to the OS in specific cancers. SIRT3 was an unfavorable prognostic factor in BC, CC and NSCLC; however, it was also a favorable prognostic factor in CLL, HCC, PC and RCC, especially in HCC.

High Frequency of Bone Marrow Involvement in Intravascular Large B-Cell Lymphoma

Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma. Thirteen cases of IVLBCL with a median age of 56 years were analyzed retrospectively. Nonspecific symptoms such as fever and hepatosplenomegaly were the most common manifestations, and the bone marrow was usually involved in 8/13 (61.5%) cases. All tumors expressed CD20, and 12/13 (92.3%) of the tumors exhibited a nongerminal center phenotype by Hans algorithm. CD5 was expressed in 3/12 (25%) of the tumors. MYC was negative in all cases, and BCL2 was positive in 10/12 (83.3%) cases. Cytogenetic analysis revealed 5 cases that did not have rearrangements in either the MYC or the BCL2 gene. No association with Epstein-Barr virus was found. Seven of 11 patients received chemotherapy. The median survival time was 6 months. Patients with hemophagocytic syndrome had poor prognoses. Our study demonstrates that IVLBCL has a poor clinical outcome with a high frequency of bone marrow involvement and that the MYC gene may not play an important role in the poor prognosis of IVLBCL.