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Ballard DH, Nguyen GK, Atagu N, Camps G, Salter A, Jaswal S, Naeem M, Ludwig DR, Mellnick VM, Peterson LR, Hawkins WG, Fields RC, Luo J, Ippolito JE. Female-specific pancreatic cancer survival from CT imaging of visceral fat implicates glutathione metabolism in solid tumors. Acad Radiol 2023:S1076-6332(23)00630-X. [PMID: 38129228 DOI: 10.1016/j.acra.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
RATIONALE AND OBJECTIVES To identify if body composition, assessed with preoperative CT-based visceral fat ratio quantification as well as tumor metabolic gene expression, predicts sex-dependent overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS This was a retrospective analysis of preoperative CT in 98 male and 107 female patients with PDAC. Relative visceral fat (rVFA; visceral fat normalized to total fat) was measured automatically using software and corrected manually. Median and optimized rVFA thresholds were determined according to published methods. Kaplan Meier and log-rank tests were used to estimate OS. Multivariate models were developed to identify interactions between sex, rVFA, and OS. Unsupervised gene expression analysis of PDAC tumors from The Cancer Genome Atlas (TCGA) was performed to identify metabolic pathways with similar survival patterns to rVFA. RESULTS Optimized preoperative rVFA threshold of 38.9% predicted significantly different OS in females with a median OS of 15 months (above threshold) vs 24 months (below threshold; p = 0.004). No significant threshold was identified in males. This female-specific significance was independent of age, stage, and presence of chronic pancreatitis (p = 0.02). Tumor gene expression analysis identified female-specific stratification from a five-gene signature of glutathione S-transferases. This was observed for PDAC as well as clear cell renal carcinoma and glioblastoma. CONCLUSION CT-based assessments of visceral fat can predict pancreatic cancer OS in females. Glutathione S-transferase expression in tumors predicts female-specific OS in a similar fashion.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Gerard K Nguyen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Norman Atagu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland (N.A.)
| | - Garrett Camps
- Washington University School of Medicine, Washington University School of Medicine, St. Louis, MO (G.C.)
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX (A.S.)
| | - Shama Jaswal
- Department of Radiology, Weill Cornell Medical Center/New York Presbyterian Hopsital, New York, NY (S.J.)
| | - Muhammad Naeem
- Department of Radiology, Emory University School of Medicine, Atlanta, GA (M.N.)
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Linda R Peterson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (L.R.P.)
| | - William G Hawkins
- Department of Surgery, Washington University School of Medicine, St. Louis, MO (W.G.H., R.C.F.)
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, MO (W.G.H., R.C.F.)
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO (J.L.)
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.).
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Gao T, Wang Y. Association between white blood cell count to hemoglobin ratio and risk of in-hospital mortality in patients with lung cancer. BMC Pulm Med 2023; 23:305. [PMID: 37596548 PMCID: PMC10436509 DOI: 10.1186/s12890-023-02600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The objective of this study was to investigate the association between white blood cell count to hemoglobin ratio (WHR) and risk of in-hospital mortality in patients with lung cancer. METHODS In this retrospective cohort study, the medical records of patients with lung cancer were retrieved from the electronic ICU (eICU) Collaborative Research Database between 2014 and 2015. The primary outcome was in-hospital mortality. The secondary outcome was the length of stay in intensive care unit (ICU). The cut-off value for the WHR was calculated by the X-tile software. The Cox model was applied to assess the association between WHR and in-hospital mortality among patients with lung cancer and the linear regression model was used to investigate the association between WHR and length of ICU stay. Subgroup analyses of age (< 65 years or > = 65 years), Acute Physiology and Chronic Health Evaluation (APACHE) score (< 59 or > = 59), gender, ventilation (yes or no), and vasopressor (yes or no) in patients with lung cancer were conducted. RESULTS Of the 768 included patients with lung cancer, 153 patients (19.92%) died in the hospital. The median total follow-up time was 6.88 (4.17, 11.23) days. The optimal cut-off value for WHR was 1.4. ICU lung cancer patients with WHR > = 1.4 had a significantly higher risk of in-hospital mortality [Hazard ratio: (HR): 1.65, 95% confidence interval (CI): 1.15 to 2.38, P = 0.007) and length of stay in ICU (HR: 0.63, 0.01, 95% CI: 1.24 to 0.045, P = 0.045). According to the subgroup analysis, WHR was found to be associated with in-hospital mortality in patients with higher APACHE score (HR: 1.60, 95% CI: 1.06 to 2.41, P = 0.024), in male patients (HR: 1.87, 95% CI: 1.15 to 3.04, P = 0.012), and in patients with the treatment of ventilation (HR: 2.33, 95% CI: 1.49 to 3.64, P < 0.001). CONCLUSION This study suggests the association between WHR and risk of in-hospital mortality in patients with lung cancer and length of stay, which indicates the importance of attention to WHR for patients with lung cancer.
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Affiliation(s)
- Tingting Gao
- Department of Comprehensive Medical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, P.R. China
| | - Yurong Wang
- Department of Clinical Laboratory, Nanjing Jiangbei Hospital Affiliated to Nantong University, 552 Geguan Road, Jiangbei New District, Nanjing, Jiangsu, 210048, P.R. China.
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