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Maeshima Y, Kataoka TR, Vandenbon A, Hirata M, Takeuchi Y, Suzuki Y, Fukui Y, Kawashima M, Takada M, Ibi Y, Haga H, Morita S, Toi M, Kawaoka S, Kawaguchi K. Intra-patient spatial comparison of non-metastatic and metastatic lymph nodes reveals a reduction in CD169 + macrophages within metastatic breast cancers. EBioMedicine 2024; 107:105271. [PMID: 39173531 DOI: 10.1016/j.ebiom.2024.105271] [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: 12/20/2023] [Revised: 06/06/2024] [Accepted: 07/25/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Breast cancer cells suppress the host immune system to efficiently invade the lymph nodes; however, the underlying mechanism remains incompletely understood. Here, we aimed to comprehensively characterise the effects of breast cancers on immune cells in the lymph nodes. METHODS We collected non-metastatic and metastatic lymph node samples from 6 patients with breast cancer with lymph node metastasis. We performed bulk transcriptomics, spatial transcriptomics, and imaging mass cytometry to analyse the obtained lymph nodes. Furthermore, we conducted histological analyses against a larger patient cohort (474 slices from 58 patients). FINDINGS The comparison between paired lymph nodes with and without metastasis from the same patients demonstrated that the number of CD169+ lymph node sinus macrophages, an initiator of anti-cancer immunity, was reduced in metastatic lymph nodes (36.7 ± 21.1 vs 7.3 ± 7.0 cells/mm2, p = 0.0087), whereas the numbers of other major immune cell types were unaltered. We also detected that the infiltration of CD169+ macrophages into metastasised cancer tissues differed by section location within tumours, suggesting that CD169+ macrophages were gradually decreased after anti-cancer reactions. Furthermore, CD169+ macrophage elimination was prevalent in major breast cancer subtypes and correlated with breast cancer staging (p = 0.022). INTERPRETATION We concluded that lymph nodes with breast cancer metastases have fewer CD169+ macrophages, which may be detrimental to the activity of anti-cancer immunity. FUNDING JSPS KAKENHI (16H06279, 20H03451, 20H04842, 22H04925, 19K16770, and 21K15530, 24K02236), JSPS Fellows (JP22KJ1822), AMED (JP21ck0106698), JST FOREST (JPMJFR2062), Caravel, Co., Ltd, Japan Foundation for Applied Enzymology, and Sumitomo Pharma Co., Ltd. under SKIPS.
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Affiliation(s)
- Yurina Maeshima
- Department of Breast Surgery, Kyoto University Hospital, Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan; Inter-Organ Communication Research Team, Institute for Frontier Life and Medical Sciences, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tatsuki R Kataoka
- Department of Pathology, Iwate Medical University, Yahaba-cho, Shiwa-gun, Iwate Prefecture 028-3694, Japan
| | - Alexis Vandenbon
- Laboratory of Tissue Homeostasis, Institute for Life and Medical Sciences, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan; Institute for Liberal Arts and Sciences, Kyoto University, Kyoto 606-8507, Japan
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Yasuhide Takeuchi
- Department of Diagnostic Pathology, Kyoto University, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Yutaka Suzuki
- Graduate School of Frontier Science, The University of Tokyo, Chiba 277-8562, Japan
| | - Yukiko Fukui
- Department of Breast Surgery, Kyoto University Hospital, Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Kyoto University Hospital, Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Kyoto University Hospital, Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Yumiko Ibi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital, Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan; Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Shinpei Kawaoka
- Inter-Organ Communication Research Team, Institute for Frontier Life and Medical Sciences, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan; Department of Integrative Bioanalytics, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan.
| | - Kosuke Kawaguchi
- Department of Breast Surgery, Kyoto University Hospital, Graduate School of Medicine, Shogoin Sakyo-ku, Kyoto 606-8507, Japan; Department of Breast Surgery, Breast Center, Mie University, Mie 514-0102, Japan.
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Endo S, Imai H, Shiono A, Hashimoto K, Miura Y, Okazaki S, Abe T, Mouri A, Kaira K, Masubuchi K, Masubuchi T, Kobayashi K, Minato K, Kato S, Kagamu H. The Glasgow Prognostic Score as a Predictor of Survival after Chemoradiotherapy for Limited-Disease Small Cell Lung Cancer. Oncology 2024:1-11. [PMID: 39102792 DOI: 10.1159/000540651] [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: 05/17/2024] [Accepted: 07/26/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Established biomarkers for predicting chemoradiotherapy efficacy for limited-disease small cell lung cancer (LD-SCLC) are lacking. The inflammation-based Glasgow Prognostic Score (GPS), comprising serum C-reactive protein (CRP) and albumin levels, can predict survival in advanced cancer. This study investigated whether metabolic and inflammatory markers, including the GPS, can predict the efficacy of chemoradiotherapy in patients with LD-SCLC. METHODS We retrospectively analyzed 124 patients who underwent chemoradiotherapy for LD-SCLC at two institutions between April 2007 and June 2021, and assessed the prognostic significance of various metabolic and inflammatory markers. The GPS was calculated using the CRP and albumin concentrations, and categorized as follows: 0, CRP <1.0 mg/dL and albumin ≥3.5 mg/dL; 1, elevated CRP or decreased albumin; and 2, CRP ≥1.0 mg/dL and albumin<3.5 mg/dL. Differences in progression-free survival (PFS) and overall survival (OS) were examined using Kaplan-Meier curves and Cox proportional-hazard models. RESULTS The overall response rate was 95.1% (95% confidence interval [CI]: 89.6-97.9%). The median PFS and OS from chemoradiotherapy initiation were 12.6 (95% CI: 9.9-15.4) and 29.0 (95% CI: 24.8-45.5) months, respectively. The GPS demonstrated independent predictive ability for the effectiveness of chemoradiotherapy, wherein favorable scores (GPS 0-1) were significantly correlated with superior PFS and OS compared to unfavorable scores (GPS 2: PFS: 14.8 vs. 6.7 months, p = 0.0001; OS: 35.4 vs. 11.0 months, p < 0.0001). CONCLUSION This preliminary examination revealed that the GPS was significantly associated with PFS and OS in patients undergoing chemoradiotherapy for LD-SCLC, indicating its potential utility in assessing the therapeutic outcomes in LD-SCLC.
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Affiliation(s)
- Satoshi Endo
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Ayako Shiono
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kosuke Hashimoto
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Shohei Okazaki
- Division of Radiation Oncology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Atsuto Mouri
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Ken Masubuchi
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takeshi Masubuchi
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
- Division of Health Evaluation and Promotion, SUBARU Health Insurance Society, Ota Memorial Hospital, Ota, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
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Silva GAD, Oliveira LCD, Wiegert EVM, Calixto-Lima L, Cunha GDC, Peres WAF. Prognostic risk stratification using C-reactive protein, albumin, and associated inflammatory biomarkers in patients with advanced cancer in palliative care. Curr Probl Cancer 2024; 51:101115. [PMID: 38943779 DOI: 10.1016/j.currproblcancer.2024.101115] [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: 04/07/2023] [Revised: 04/10/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE To evaluate the prognostic value of C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), and modified Glasgow Prognostic Score (mGPS) at different thresholds in patients with advanced cancer in palliative care. METHODS Prospective cohort study with patients evaluated at a palliative care unit in Brazil between July 2016 and March 2020. We included patients ≥ 20 years old, both sexes, able to provide the necessary information or accompanied by someone able to do so, and Karnofsky Performance Status ≥ 30 %. The exclusion criteria were the absence of laboratory data and previous diagnosis of autoimmune and infectious diseases. The thresholds analyzed were: CRP < 5 vs. 5-10 vs. > 10 mg/L, albumin < 2.4 vs. 2.4-2.9 vs. 3.0-3.5 vs. > 3.5 g/dL; CAR <1.2 vs. 1.2-2.0 vs. > 2.0, and mGPS equal to 0 vs. 1 vs. 2. Kaplan-Meier curves and Cox regression models (with hazard ratios [HR] and 95% confidence interval [CI]) were used to evaluate prognostic value, and the concordance statistic (C-statistic) was used to evaluate the predictive accuracy of these thresholds to predict death within 90 days. RESULTS A total of 1,877 patients were included. Median overall survival was 51 (19;124) days and decreased in line with the deterioration of the inflammatory biomarkers. According to the Cox regression models, HR increased as the thresholds worsened (CRP: 1.74 [95% CI, 1.50-2.02] to 2.30 [95% CI, 2.00-2.64]; albumin: 1.77 [95% CI, 1.52-2.07] to 2.60 [95% CI, 2.15-3.14]; CAR: 1.47 [95% CI, 1.21-1.77] to 2.35 [95% CI, 2.05-2.69]; mGPS: 1.78 [95% CI, 1.40-2.23] to 1.89 [95% CI, 1.65-2.15]). All the inflammatory biomarkers evaluated showed discriminatory accuracy for predicting death (C-statistic >0.70), with CAR as the best parameter (C-statistic: 0.80). CONCLUSION Our results suggest that CRP, albumin, CAR, and mGPS can be used as clinically meaningful biomarkers to stratify patients with advanced cancer in palliative care according to the severity of these indicators.
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Affiliation(s)
- Geisiane Alves da Silva
- Department of Nutrition and Dietetics, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Wilza Arantes Ferreira Peres
- Department of Nutrition and Dietetics, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Zuo P, Bonate P, Garg A, Matsangou M, Tang M. Population Pharmacokinetic Modeling and Exposure-Response Analysis for the Antibody-Drug Conjugate Enfortumab Vedotin in Locally Advanced or Metastatic Urothelial Carcinoma. Clin Pharmacol Ther 2024. [PMID: 39039635 DOI: 10.1002/cpt.3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/24/2024] [Indexed: 07/24/2024]
Abstract
Enfortumab vedotin is a fully human monoclonal antibody directed to Nectin-4 and conjugated to monomethyl auristatin E (MMAE), approved for treatment of previously treated locally advanced or metastatic urothelial carcinoma (mUC). This population analysis characterized pharmacokinetics of enfortumab vedotin and free (unconjugated) MMAE, identified covariates affecting pharmacokinetics, and evaluated weight-based dosing for enfortumab vedotin. Exposure-response analyses characterized relationships between enfortumab vedotin and free MMAE exposures and efficacy/safety endpoints. Data from 748 patients with locally advanced or mUC in 5 clinical studies were analyzed using nonlinear mixed-effects modeling. Patients received enfortumab vedotin 0.50-1.25 mg/kg every 3 weeks or on days 1, 8, and 15 of a 28-day cycle. Relevant covariates retained in final models were evaluated for clinical relevance to enfortumab vedotin and free MMAE exposures. Although some covariates produced differences in exposure, the magnitude of changes was not clinically meaningful. Simulations indicated weight-based dosing yielded more consistent exposures across body weight groups vs. a hypothetical fixed-dose regimen of enfortumab vedotin 95 mg (calculated for median body weight, 75 kg). Exposure-response analysis showed average enfortumab vedotin concentrations were not a statistically significant predictor of overall survival (hazard ratio 0.91, 95% confidence interval: 0.72-1.14; P = 0.41); all exposure quartiles had a greater median overall survival than chemotherapy (11.0-12.6 vs. 9.0 months). Enfortumab vedotin and free MMAE exposures were statistically significant predictors of grade ≥ 3 treatment-related adverse events (both P < 0.0001). This analysis supports enfortumab vedotin 1.25 mg/kg on days 1, 8, and 15 of a 28-day cycle.
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Affiliation(s)
- Peiying Zuo
- Astellas Pharma, Inc., Northbrook, Illinois, USA
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | - Peter Bonate
- Astellas Pharma, Inc., Northbrook, Illinois, USA
| | - Amit Garg
- Pfizer Inc., South San Francisco, California, USA
| | | | - Mei Tang
- Astellas Pharma, Inc., Northbrook, Illinois, USA
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Usui N, Nakata J, Uehata A, Kojima S, Hisadome H, Ando S, Saitoh M, Inatsu A, Tsuchiya T, Mawatari T, Suzuki Y. Association of Postexercise Vagal Dysfunction With Protein-Energy Wasting and Noncardiovascular Outcomes in Patients Receiving Hemodialysis: A Retrospective Cohort Study. J Ren Nutr 2024; 34:321-329. [PMID: 38000522 DOI: 10.1053/j.jrn.2023.11.005] [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: 06/07/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE Postexercise vagal dysfunction is linked to noncardiovascular mortality in hemodialysis patients, but the mechanism is unknown. This study aimed to determine the association of cardiovagal neuropathy with systemic inflammation, protein-energy wasting, and noncardiovascular hospitalization. METHODS This 2-center retrospective cohort study analyzed data from 280 hemodialysis patients who underwent exercise test. Patients were assessed for heart rate (HR) recovery (bpm) for 1 minute after exercise, a marker of vagal function, and were divided into 3 categories (Low: ≤ 6, Mid: 7-11, High: ≥ 12 bpm). We followed 1-year changes in the systemic inflammation-based prognostic score (Glasgow Prognostic Score [GPS]), body weight, and creatinine generation rate (CGR), an indicator of muscle mass, as well as 2-year hospitalization. RESULTS The HR recovery category was associated with serum C-reactive protein and albumin levels and GPS. After 1 year, the low HR recovery category was associated with worsening in GPS (low, 0 [0-0.5]; mid, 0 [0-1]; high, 0 [0-0]), weight (low, 100.0 [96.1-102.5]; mid, 101.3 [98.9-105.0]; high, 100.5 [98.2-102.9]%), and CGR (low, 97.0 [88.5-111.4]; mid, 110.2 [90.9-124.8]; high, 106.2 [95.5-115.5]%), and the correlations with GPS and CGR remained consistent after adjusting for confounders such as exercise capacity and hospitalization during the follow-up period. There were 117 patients hospitalized. Compared to the high HR recovery category, the mid (hazard ratio: 1.8, 95% confidence interval [CI]: 1.1-3.1, P = .02) and low (hazard ratio: 2.4, 95% CI: 1.5-4.0, P = .001) categories were independently associated with an increased risk of all-cause hospitalization. For noncardiovascular disease hospitalization, the low HR recovery category was independently associated with increased risk of hospitalization (hazard ratio: 2.1, 95% CI: 1.2-3.7, P = .007). CONCLUSIONS Vagal neuropathy in this population can contribute to adverse outcomes associated with systemic inflammation and protein-energy wasting.
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Affiliation(s)
- Naoto Usui
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan; Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
| | - Junichiro Nakata
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
| | - Akimi Uehata
- Division of Cardiology, Kisen Hospital, Tokyo, Japan
| | - Sho Kojima
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | | | - Shuji Ando
- Department of Information Sciences, Tokyo University of Science, Chiba, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | | | | | | | - Yusuke Suzuki
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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Tur-Martínez J, Rodríguez-Santiago J, Osorio J, Miró M, Yarnoz C, Jofra M, Ferret G, Salvador-Roses H, Fernández-Ananín S, Clavell A, Luna A, Aldeano A, Olona C, Hermoso J, Güell-Farré M, Dal Cero M, Gimeno M, Pallarès N, Pera M. Prognostic Relevance of Preoperative Immune, Inflammatory, and Nutritional Biomarkers in Patients Undergoing Gastrectomy for Resectable Gastric Adenocarcinoma: An Observational Multicentre Study. Cancers (Basel) 2024; 16:2188. [PMID: 38927894 PMCID: PMC11201927 DOI: 10.3390/cancers16122188] [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: 05/26/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The aim of this study was to evaluate different preoperative immune, inflammatory, and nutritional scores and their best cut-off values as predictors of poorer overall survival (OS) and disease-free survival (DFS) in patients who underwent curative gastric cancer resection. Methods: This was a retrospective observational multicentre study based on data of the Spanish EURECCA Esophagogastric Cancer Registry. Time-dependent Youden index and log-rank test were used to obtain the best cut-offs of 18 preoperative biomarkers for OS and DFS. An adjusted Cox model with variables selected by bootstrapping was used to identify the best preoperative biomarkers, which were also analysed for every TNM stage. Results: High neutrophil-to-lymphocyte ratio (NLR), high monocyte systemic inflammation index (moSII), and low prognostic nutritional index (PNI) were identified as independent predictors of poor outcome: NLR > 5.91 (HR:1.73; 95%CI [1.23-2.43]), moSII >2027.12 (HR:2.26; 95%CI [1.36-3.78]), and PNI >40.31 (HR:0.75; 95%CI [0.58-0.96]) for 5-year OS and NLR > 6.81 (HR:1.75; 95%CI [1.24-2.45]), moSII > 2027.12 (HR:2.46; 95%CI [1.49-4.04]), and PNI > 40.31 (HR:0.77; 95%CI [0.60,0.97]) for 5-year DFS. These outcomes were maintained in the whole cohort for NLR and moSII (p < 0.05) but not in stage II and for PNI in all tumoral stages. The associations of NLR-PNI and moSII-PNI were also a relevant prognostic factor for OS. Conclusions: High NLR, high moSII (for stages I and III), and low PNI (regardless of tumour stage) were the most promising preoperative biomarkers to predict poor OS and DFS in gastric cancer patients treated with curative intent.
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Affiliation(s)
- Jaume Tur-Martínez
- Department of Surgery, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Department of Surgery, Complex Hospitalari Universitari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | | | - Javier Osorio
- Department of Surgery, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Mònica Miró
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Concepción Yarnoz
- Department of Surgery, Hospital Universitario de Navarra, Universidad Pública de Navarra, 31008 Pamplona, Spain
| | - Mariona Jofra
- Department of Surgery, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Georgina Ferret
- Department of Surgery, Hospital Universitari Josep Trueta, 17007 Girona, Spain
| | | | - Sonia Fernández-Ananín
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Arantxa Clavell
- Department of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Alexis Luna
- Department of Surgery, Hospital Universitari Parc Taulí de Sabadell, 08208 Sabadell, Spain
| | - Aurora Aldeano
- Department of Surgery, Hospital General de Granollers, 08402 Granollers, Spain
| | - Carles Olona
- Department of Surgery, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Judith Hermoso
- Department of Surgery, Hospital Universitari de Vic, 08500 Vic, Spain
| | - Mercè Güell-Farré
- Department of Surgery, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
- Faculty of Medicine, Universitat de Vic-Universitat Central de Cataluña (UVIC-UCC), 08500 Vic, Spain
- Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Mariagiulia Dal Cero
- Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Natàlia Pallarès
- Biostatistics Support and Research Unit, Germans Trias i Pujol Research Institute and Hospital (IGTP), 08916 Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
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Ohyama Y, Inaba Y, Kubota M, Kanemaru T, Hasegawa K. CT-assessed sarcopenia and prognostic nutritional index are associated with poor prognosis in oral squamous cell carcinoma. Oral Maxillofac Surg 2024; 28:659-666. [PMID: 37935816 DOI: 10.1007/s10006-023-01191-1] [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: 06/10/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Recently, it has been reported that sarcopenia and nutritional evaluation are associated with the prognosis of patients with cancer; however, there are only a few detailed reports on oral cancer. This single-center retrospective study aimed to analyze the relationship between computed tomography (CT)-assessed sarcopenia (CT-SP), immunocompetence, nutritional status, and the prognosis of patients with oral squamous cell carcinoma (OSCC). METHODS This retrospective study included patients who underwent radical therapy with surgery for OSCC between January 2014 and January 2021. Skeletal muscle in the third cervical vertebra (C3) was measured using preoperative cervical CT, and the skeletal muscle index (SMI) was calculated. Nutritional status were investigated using blood tests. The correlation between each parameter and prognosis was analyzed. The primary predictor variables were SMI, ECOG performance status, BMI, and nutritional status. The primary outcome variable was the 5-year overall survival rate (OS) and the secondary outcome variable was 5-year disease-specific survival rate (DSS). RESULTS One hundred sixty-three patients were registered retrospectively. The number of patients with CT-SP was 76 (52%). In the univariate analysis, CT-SP, prognostic nutritional index (PNI), and lymphocyte-monocyte ratio (LMR) were associated with poor prognosis, with statistically significant differences in OS and DSS. In the multivariate analysis, only CT-SP was identified as an independent prognostic factor for DSS. CT-SP was significantly correlated with the PNI. CONCLUSION CT-SP was associated with a significant decrease in survival rate in patients with OSCC. Furthermore, CT-SP was correlated with the PNI.
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Affiliation(s)
- Yoshio Ohyama
- Department of Oral and Maxillofacial Surgery, Shizuoka City Shizuoka Hospital, 10-93, Outemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8690, Japan.
| | - Yoshinori Inaba
- Department of Oral and Maxillofacial Surgery, Shizuoka City Shizuoka Hospital, 10-93, Outemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8690, Japan
| | - Mako Kubota
- Department of Maxillofacial Surgery, Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tomoki Kanemaru
- Department of Maxillofacial Surgery, Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kazuki Hasegawa
- Department of Oral and Maxillofacial Surgery, Shizuoka City Shizuoka Hospital, 10-93, Outemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8690, Japan
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Yule MS, Thompson J, Leesahatsawat K, Sousa MS, Anker SD, Arends J, Balstad TR, Brown LR, Bye A, Dajani O, Fallon M, Hjermstad MJ, Jakobsen G, McDonald J, McGovern J, Roeland EJ, Sayers J, Skipworth RJ, Ottestad IO, Philips I, Simpson MR, Solheim TS, Vagnildhaug OM, McMillan D, Laird BJ, Dolan RD. Biomarker endpoints in cancer cachexia clinical trials: Systematic Review 5 of the cachexia endpoint series. J Cachexia Sarcopenia Muscle 2024; 15:853-867. [PMID: 38783477 PMCID: PMC11154797 DOI: 10.1002/jcsm.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/11/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Regulatory agencies require evidence that endpoints correlate with clinical benefit before they can be used to approve drugs. Biomarkers are often considered surrogate endpoints. In cancer cachexia trials, the measurement of biomarkers features frequently. The aim of this systematic review was to assess the frequency and diversity of biomarker endpoints in cancer cachexia trials. A comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990-2023) was completed. Eligible trials met the following criteria: adults (≥18 years), prospective design, more than 40 participants, use of a cachexia intervention for more than 14 days and use of a biomarker(s) as an endpoint. Biomarkers were defined as any objective measure that was assayed from a body fluid, including scoring systems based on these assays. Routine haematology and biochemistry to monitor intervention toxicity were not considered. Data extraction was performed using Covidence, and reporting followed PRISMA guidance (PROSPERO: CRD42022276710). A total of 5975 studies were assessed, of which 52 trials (total participants = 6522) included biomarkers as endpoints. Most studies (n = 29, 55.7%) included a variety of cancer types. Pharmacological interventions (n = 27, 51.9%) were most evaluated, followed by nutritional interventions (n = 20, 38.4%). Ninety-nine different biomarkers were used across the trials, and of these, 96 were assayed from blood. Albumin (n = 29, 55.8%) was assessed most often, followed by C-reactive protein (n = 22, 42.3%), interleukin-6 (n = 16, 30.8%) and tumour necrosis factor-α (n = 14, 26.9%), the latter being the only biomarker that was used to guide sample size calculations. Biomarkers were explicitly listed as a primary outcome in six trials. In total, 12 biomarkers (12.1% of 99) were used in six trials or more. Insulin-like growth factor binding protein 3 (IGFBP-3) and insulin-like growth factor 1 (IGF-1) levels both increased significantly in all three trials in which they were both used. This corresponded with a primary outcome, lean body mass, and was related to the pharmacological mechanism. Biomarkers were predominately used as exploratory rather than primary endpoints. The most commonly used biomarker, albumin, was limited by its lack of responsiveness to nutritional intervention. For a biomarker to be responsive to change, it must be related to the mechanism of action of the intervention and/or the underlying cachexia process that is modified by the intervention, as seen with IGFBP-3, IGF-1 and anamorelin. To reach regulatory approval as an endpoint, the relationship between the biomarker and clinical benefit must be clarified.
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Affiliation(s)
- Michael S. Yule
- St Columba's HospiceEdinburghUK
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Joshua Thompson
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | - Khachonphat Leesahatsawat
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyAustralia
| | - Stefan D. Anker
- Department of Cardiology (CVK)Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- Institute of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin BerlinBerlinGermany
| | - Jann Arends
- Department of Medicine IMedical Center – University of Freiburg, Faculty of Medicine, University of FreiburgFreiburg im BreisgauGermany
| | - Trude R. Balstad
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Leo R. Brown
- Department of Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Asta Bye
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University Hospital, University of OsloOsloNorway
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet‐Oslo Metropolitan UniversityOsloNorway
| | - Olav Dajani
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University Hospital, University of OsloOsloNorway
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Marie Fallon
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Marianne J. Hjermstad
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University Hospital, University of OsloOsloNorway
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Gunnhild Jakobsen
- Cancer ClinicSt Olavs Hospital, Trondheim University HospitalTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - James McDonald
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Josh McGovern
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | | | - Judith Sayers
- St Columba's HospiceEdinburghUK
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Richard J.E. Skipworth
- Department of Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Inger O. Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Iain Philips
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Melanie R. Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Cancer ClinicSt Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Ola Magne Vagnildhaug
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Cancer ClinicSt Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Donald McMillan
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | - Barry J.A. Laird
- St Columba's HospiceEdinburghUK
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Ross D. Dolan
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
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9
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Saitta C, Afari JA, Patil D, Tanaka H, Yuen KL, Wang L, Cortes J, Liu F, Mahmood M, Matian J, Mansour M, Puri D, Cerrato C, Nguyen MV, Hakimi K, Kobayashi M, Fukuda S, Meagher MF, Fujii Y, Master V, Derweesh IH. Association of Elevated C-Reactive Protein with Worsened Outcomes in Different Histologies of Renal Cortical Tumors: Analysis of the INMARC Registry. Clin Genitourin Cancer 2024; 22:102098. [PMID: 38733897 DOI: 10.1016/j.clgc.2024.102098] [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: 08/28/2023] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND To evaluate relationship between histological subtypes of renal cell carcinoma (RCC) and preoperative c-reactive protein (CRP). PATIENTS AND METHODS We queried the International Marker Consortium for Renal Cancer database for patients affected by RCC. Patients were classified according to their histology: benign tumors, clear cell (cc) RCC, chromophobe (ch) RCC, papillary (p) RCC, and variant histology (vh) RCC; and according to CRP (mg/L): low CRP ≤5 and high CRP >5. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM), recurrence and association between CRP and histology. Multivariable analysis (MVA) via Cox regression and multivariable logistic regression were fitted to elucidate predictors of outcomes. RESULTS Total 3902 patients (high CRP n = 1266) were analyzed; median follow up 51 (IQR 20-91) months. On MVA elevated CRP was an independent risk factor associated with increased risk of ACM in benign tumors (HR 5.98, P < .001), ccRCC (HR 2.69, P < .001), chRCC (HR 3.99, P < .001), pRCC (HR 1.76, P = .009) and vhRCC (HR 2.97, P =.007). MVA for CSM showed CRP as risk factor in ccRCC (HR 2.77, P < .001), chRCC (HR 6.16, P = .003) and pRCC (HR 2.29, P = .011), while in vhRCC was not (P = .27). MVA for recurrence reported CRP as risk factor for ccRCC (HR 1.30, P = .013), while in chRCC (P = .33), pRCC (P = .34) and vhRCC (P = .52) was not. On multivariable logistic regression CRP was a predictor of pRCC (OR 1.003, P = .002), while decreasing CRP was associated with benign tumors (OR 0.994, P = .048). CONCLUSION Elevated CRP was a robust predictor of worsened ACM in all renal cortical neoplasms. While most frequently observed in pRCC patients, elevated CRP was independently associated with worsened CSM in non-vhRCC. Conversely, elevated CRP was least likely to be noted in benign tumors, and elevation in this subgroup of patients should prompt further consideration for surveillance given increased risk of ACM. Further investigation is requisite.
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Affiliation(s)
- Cesare Saitta
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Jonathan A Afari
- Department of Urology, UC San Diego Health System, San Diego, CA
| | | | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kit L Yuen
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Luke Wang
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Julian Cortes
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Franklin Liu
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Mirha Mahmood
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Joshua Matian
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Mariam Mansour
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Dhruv Puri
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Clara Cerrato
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Mimi V Nguyen
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Kevin Hakimi
- Department of Urology, UC San Diego Health System, San Diego, CA
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Viraj Master
- Department of Urology, Emory Medical Center, Atlanta, GA
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10
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Yamamoto Y, Tanaka S, Matsuura K, Yamamoto S, Urano K, Okita J, Kato E, Odagiri T, Deguchi Y. Effectiveness of opioid switching for dyspnea and its predictors in cancer patients: a single-center retrospective observational study. Jpn J Clin Oncol 2024; 54:549-555. [PMID: 38323655 DOI: 10.1093/jjco/hyae008] [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: 11/16/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Morphine is the most used opioid for dyspnea, but other opioids such as oxycodone and fentanyl are increasingly used, and opioid switching to these is sometimes undertaken. No studies have verified the effectiveness of opioid switching for relief of dyspnea. We retrospectively investigated the effectiveness of opioid switching for dyspnea and its predictors. METHODS All patients with opioid switching for dyspnea during hospitalization at Komaki City Hospital from January 2019 to August 2022 were included. Opioid switching was defined as a change to another opioid, and the assessment period for evaluating the effectiveness and adverse events of opioid switching was set as 1 week. Patients with Numeric Rating Scale or Japanese version of the Support Team Assessment Schedule reduction for dyspnea of at least 1, or with clear improvement based on medical records, were considered valid. Mitigating factors for dyspnea were identified using logistic regression analysis. RESULTS Of the 976 patients with opioid switching, 57 patients had opioid switching for relief of dyspnea. Of these, opioid switching was effective in 21 patients (36.8%). In a multivariate analysis, older patients (odds ratio: 5.52, 95% CI: 1.50-20.20, P < 0.01), short prognosis for post-opioid switching (odds ratio: 0.20, 95% CI: 0.04-0.87, P = 0.03) and cachexia (odds ratio: 0.12, 95% CI: 0.02-0.64, P < 0.01) were significantly associated with opioid switching effects for dyspnea. There were no serious adverse events after opioid switching. CONCLUSION This study indicates that opioid switching for dyspnea may have some effect. Furthermore, opioid switching for dyspnea may be more effective in older patients and less effective in terminally ill patients or in those with cachexia.
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Affiliation(s)
| | - Shion Tanaka
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Seiji Yamamoto
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Kimihiko Urano
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Junya Okita
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Eisuke Kato
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
- Department of Palliative Care, Seino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Yuko Deguchi
- Departments of Pharmacy, Komaki City Hospital, Komaki, Aichi, Japan
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11
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Utsunomiya T, Watanabe J, Tokuda K, Ueno Y, Hanaoka J, Yagi S, Tada F, Hiraoka A, Ninomiya T, Ohtani H. C-reactive Protein-to-Albumin Ratio: A Useful Predictor for Biliary Fistula After Hepatectomy. Cureus 2024; 16:e60735. [PMID: 38903332 PMCID: PMC11187723 DOI: 10.7759/cureus.60735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Postoperative bile leakage (POBL) has emerged as a complication following hepatectomy. POBL is associated with an elevated risk of liver failure and surgical death. This study aimed to examine risk factors for POBL in primary hepatocellular carcinoma (HCC) patients. Methods A total of 296 patients who had surgical resection for a preoperative diagnosis of primary HCC from January 2013 to December 2022 at Ehime Prefectural Central Hospital were included in this study. The patients were categorized into two groups based on the presence of POBL. The preoperative, operative, and histopathological findings were analyzed between the two groups. Risk factors were determined using multivariable analysis. Results Regarding preoperative findings, statistically significant differences were observed in white blood cell count, platelet count, C-reactive protein (CRP) level, and CRP-to-Albumin ratio (CAR) between the two groups (p = 0.023, p = 0.025, p = 0.011, and p = 0.012, respectively). As for intraoperative variables, only operation time (p = 0.017) was statistically correlated with the risk of POBL. Regarding pathological variables, there were no statistically significant differences between the two groups. The optimal cut-off value of CAR, as determined by ROC curve analysis, was 0.053. This value had a sensitivity of 80.0% and a specificity of 72.8%. Multivariate logistic regression analysis indicated that CAR ≥ 0.053 (p = 0.030) and operation time ≥ 308 min (p = 0.023) were independent potential markers for POBL after hepatectomy. Conclusion A high CAR level can be an effective predictor for POBL following hepatectomy.
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Affiliation(s)
- Takeshi Utsunomiya
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Jota Watanabe
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Kazunori Tokuda
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Yoshitomo Ueno
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Jun Hanaoka
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Shigehiko Yagi
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Fujimasa Tada
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Atsushi Hiraoka
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Tomoyuki Ninomiya
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Hiromi Ohtani
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
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12
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Boukovala M, Modest DP, Ricard I, Fischer von Weikersthal L, Decker T, Vehling-Kaiser U, Uhlig J, Schenk M, Freiberg-Richter J, Peuser B, Denzlinger C, Peveling Genannt Reddemann C, Graeven U, Schuch G, Schwaner I, Heinrich K, Neumann J, Jung A, Held S, Stintzing S, Heinemann V, Michl M. Evaluation of the inflammation-based modified Glasgow Prognostic Score (mGPS) as a prognostic and predictive biomarker in patients with metastatic colorectal cancer receiving first-line chemotherapy: a post hoc analysis of the randomized phase III XELAVIRI trial (AIO KRK0110). ESMO Open 2024; 9:103374. [PMID: 38744100 PMCID: PMC11108861 DOI: 10.1016/j.esmoop.2024.103374] [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: 12/07/2023] [Revised: 02/29/2024] [Accepted: 03/28/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The inflammation-based modified Glasgow Prognostic Score (mGPS) combines serum levels of C-reactive protein and albumin and was shown to predict survival in advanced cancer. We aimed to elucidate the prognostic impact of mGPS on survival as well as its predictive value when combined with gender in unselected metastatic colorectal cancer (mCRC) patients receiving first-line chemotherapy in the randomized phase III XELAVIRI trial. PATIENTS AND METHODS In XELAVIRI, mCRC patients were treated with either fluoropyrimidine/bevacizumab followed by additional irinotecan at first progression (sequential treatment arm; Arm A) or upfront combination of fluoropyrimidine/bevacizumab/irinotecan (intensive treatment arm; Arm B). In the present post hoc analysis, survival was evaluated with respect to the assorted mGPS categories 0, 1 or 2. Interaction between mGPS and gender was analyzed. RESULTS Out of 421 mCRC patients treated in XELAVIRI, 362 [119 women (32.9%) and 243 men (67.1%)] were assessable. For the entire study population a significant association between mGPS and overall survival (OS) was observed [mGPS = 0: median 28.9 months, 95% confidence interval (CI) 25.9-33.6 months; mGPS = 1: median 21.4 months, 95% CI 17.6-26.1 months; mGPS = 2: median 16.8 months, 95% CI 14.3-21.2 months; P < 0.00001]. Similar results were found when comparing progression-free survival between groups. The effect of mGPS on survival did not depend on the applied treatment regimen (P = 0.21). In female patients, a trend towards longer OS was observed in Arm A versus Arm B, with this effect being clearly more pronounced in the mGPS cohort 0 (41.6 versus 25.5 months; P = 0.056). By contrast, median OS was longer in male patients with an mGPS of 1-2 treated in Arm B versus Arm A (20.8 versus 17.4 months; P = 0.022). CONCLUSION We demonstrate the role of mGPS as an independent predictor of OS regardless of the treatment regimen in mCRC patients receiving first-line treatment. mGPS may help identify gender-specific subgroups that benefit more or less from upfront intensive therapy.
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Affiliation(s)
- M Boukovala
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München
| | - D P Modest
- Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité-Universitaetsmedizin, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - I Ricard
- Comprehensive Cancer Center, University Hospital, LMU Munich, München
| | | | - T Decker
- Private Oncological Practice, Ravensburg
| | | | - J Uhlig
- Private Oncological Practice, Naunhof
| | - M Schenk
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg
| | | | - B Peuser
- Onkologische Praxis am Diakonissenhaus, Leipzig
| | | | | | - U Graeven
- Kliniken Maria Hilf GmbH, Mönchengladbach
| | - G Schuch
- Hämatologisch-Onkologische Praxis Altona, Hamburg
| | - I Schwaner
- Onkologische Schwerpunktpraxis Kurfürstendamm, Berlin
| | - K Heinrich
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München
| | - J Neumann
- Institute of Pathology, Ludwig-Maximilians-University of Munich
| | - A Jung
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg; Institute of Pathology, Ludwig-Maximilians-University of Munich
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - S Stintzing
- Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité-Universitaetsmedizin, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - M Michl
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München.
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13
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Hirasawa Y, Adachi T, Hashimoto T, Fukuokaya W, Koike Y, Yata Y, Komura K, Uchimoto T, Tsujino T, Nishimura K, Takahara K, Saruta M, Fujita K, Hashimoto M, Uemura H, Shiroki R, Azuma T, Kimura T, Ohno Y. Comparison of the efficacy of enfortumab vedotin between patients with metastatic urothelial carcinoma who were treated with avelumab or pembrolizumab: real-world data from a multi-institutional study in Japan. J Cancer Res Clin Oncol 2024; 150:182. [PMID: 38592548 PMCID: PMC11003883 DOI: 10.1007/s00432-024-05717-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Enfortumab vedotin (EV) is a novel antibody-drug conjugate approved for metastatic urothelial carcinoma (UC) refractory to prior treatment with immune checkpoint inhibitors (ICIs). However, the difference in efficacy of EV after each ICIs and prognostic factors are not well known. We aimed to compare the efficacy of EV in patients with metastatic UC who were treated with avelumab or pembrolizumab and to identify the prognostic factors. METHODS The records of 100 patients with advanced metastatic UC who received EV after the administration of either avelumab or pembrolizumab were retrospectively collected from five academic hospitals in Japan. RESULTS The median follow-up period was 6.7 months. The median overall survival (OS) and progression-free survival (PFS) in the EV after avelumab/pembrolizumab group were not reached/14.7 months (p = 0.17) and 10.4/5.2 months (p = 0.039), respectively. The objective response rates (ORR) were 66.6% and 46.8% in EV after avelumab and EV after pembrolizumab groups, respectively (p = 0.14). Multivariate analysis identified histological variants, liver metastasis, low serum albumin levels, and high serum CRP level as significant poor prognostic factors. The median OS and PFS of cachexia patients with both low serum albumin levels and high serum CRP levels were 6.0 months and 0.93 months, respectively. CONCLUSION PFS was superior in patients treated with EV after avelumab to EV after pembrolizumab. However, OS showed no significant difference between the two groups. Because the prognosis of patients with cachexia is extremely poor, the initiation of EV should be discussed in these patients.
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Affiliation(s)
- Yosuke Hirasawa
- Department of Urology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takahiro Adachi
- Department of Urology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuhei Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Taizo Uchimoto
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takuya Tsujino
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kazuki Nishimura
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita-Health University School of Medicine, Aichi, Japan
| | - Masanobu Saruta
- Department of Urology, Fujita-Health University School of Medicine, Aichi, Japan
| | - Kazutoshi Fujita
- Department of Urology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Mamoru Hashimoto
- Department of Urology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita-Health University School of Medicine, Aichi, Japan
| | - Takashi Azuma
- Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshio Ohno
- Department of Urology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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Shimoyama R, Imamura Y, Uryu K, Mase T, Shiragami M, Fujimura Y, Hayashi M, Ohtaki M, Ohtani K, Shinozaki N, Minami H. Inflammation‑based prognostic markers of metastatic pancreatic cancer using real‑world data in Japan: The Tokushukai REAl‑world Data (TREAD) project. Oncol Lett 2024; 27:136. [PMID: 38357476 PMCID: PMC10865166 DOI: 10.3892/ol.2024.14269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
Inflammation-based prognostic markers based on a combination of blood-based parameters, including the modified Glasgow prognostic score (mGPS), have been associated with clinical outcomes in patients with various types of cancer. The present study aimed to evaluate and compare the accuracy of these previously reported markers in patients with metastatic pancreatic cancer receiving first-line chemotherapy. A total of 846 patients were identified between April 2010 and March 2020 as part of a nationwide real-world study from 46 Tokushukai medical group hospitals in Japan. Blood laboratory data collected within 14 days of starting first-line chemotherapy assessed 17 inflammation-based prognostic markers. Information from patients with no missing data was used to compare the accuracy and performance of the inflammation-based prognostic markers. A total of 487 patients were eligible for this supplemental analysis. The 17 inflammation-based markers demonstrated significant prognostic value. Among them, the concordance rate with overall survival (OS) was highest for mGPS. The median OS time of patients with mGPS 0, 1 and 2 was 8.2, 6.0 and 2.9 months, respectively. Compared with mGPS 0, mGPS 1 and 2 showed hazard ratios of 1.39 (95% confidence interval, 1.07-1.81) and 2.63 (2.00-3.45), respectively. The present real-world data analysis showed that various previously reported inflammation-based markers had significant prognostic value in patients with metastatic pancreatic cancer. Among these markers, the mGPS demonstrated the highest level of accuracy. This trial has been registered in the University Hospital Medical Information Network Clinical Trials Registry as UMIN000050590 on April 1, 2023.
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Affiliation(s)
- Rai Shimoyama
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, Japan
| | - Yoshinori Imamura
- Department of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Kiyoaki Uryu
- Department of Medical Oncology, Yao Tokushukai General Hospital, Osaka 581-0011, Japan
| | - Takahiro Mase
- Department of Breast Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu 503-0015, Japan
| | | | | | - Maki Hayashi
- Mirai Iryo Research Center Inc., Tokyo 102-0074, Japan
| | - Megu Ohtaki
- deCult Co., Ltd., Hatsukaichi, Hiroshima 739-0413, Japan
| | - Keiko Ohtani
- deCult Co., Ltd., Hatsukaichi, Hiroshima 739-0413, Japan
| | - Nobuaki Shinozaki
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa 247-8533, Japan
| | - Hironobu Minami
- Department of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
- Cancer Center, Kobe University Hospital, Kobe, Hyogo 650-0017, Japan
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15
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Geppert J, Rohm M. Cancer cachexia: biomarkers and the influence of age. Mol Oncol 2024. [PMID: 38414161 DOI: 10.1002/1878-0261.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 02/29/2024] Open
Abstract
Cancer cachexia (Ccx) is a complex metabolic condition characterized by pronounced muscle and fat wasting, systemic inflammation, weakness and fatigue. Up to 30% of cancer patients succumb directly to Ccx, yet therapies that effectively address this perturbed metabolic state are rare. In recent decades, several characteristics of Ccx have been established in mice and humans, of which we here highlight adipose tissue dysfunction, muscle wasting and systemic inflammation, as they are directly linked to biomarker discovery. To counteract cachexia pathogenesis as early as possible and mitigate its detrimental impact on anti-cancer treatments, identification and validation of clinically endorsed biomarkers assume paramount importance. Ageing was recently shown to affect both the validity of Ccx biomarkers and Ccx development, but the underlying mechanisms are still unknown. Thus, unravelling the intricate interplay between ageing and Ccx can help to counteract Ccx pathogenesis and tailor diagnostic and treatment strategies to individual needs.
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Affiliation(s)
- Julia Geppert
- Institute for Diabetes and Cancer, Helmholtz Munich, Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Maria Rohm
- Institute for Diabetes and Cancer, Helmholtz Munich, Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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16
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Liu S, Zhao Q, Wang Z, Zhao B, Zhang X. Albumin‑bilirubin grade is an independent prognostic factor for small lung cell cancer. Mol Clin Oncol 2024; 20:12. [PMID: 38213660 PMCID: PMC10777464 DOI: 10.3892/mco.2023.2710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024] Open
Abstract
Albumin-bilirubin (ALBI) grade was first described in 2015 as an indicator of liver dysfunction in patients with hepatocellular carcinoma. ALBI grade has been reported to have prognostic value in several malignancies including non-small cell lung cancer (NSCLC). The present study aimed to explore the prognostic impact of ALBI grade in patients with small cell lung cancer (SCLC). It retrospectively analyzed 135 patients with SCLC treated at Hebei General Hospital between April 2015 and August 2021. Patients were divided into two groups according to the cutoff point of ALBI grade determined by the receiver operating characteristic (ROC) curve: Group 1 with pre-treatment ALBI grade ≤-2.55 for an improved hepatic reserve and group 2 with ALBI grade >-2.55. Kaplan-Meier and Cox regression analysis were performed to assess the potential prognostic factors associated with progression free survival (PFS) and overall survival (OS). Propensity score matching (PSM) was applied to eliminate the influence of confounding factors. PFS and OS (P<0.001) were significantly improved in group 1 compared with in group 2. Multivariate analysis revealed that sex (P=0.024), surgery (P=0.050), lactate dehydrogenase (LDH; P=0.038), chemotherapy (P=0.038) and ALBI grade (P=0.028) are independent risk factors for PFS and that surgery (P=0.013), LDH (P=0.039), chemotherapy (P=0.009) and ALBI grade (P=0.013) are independent risk factors for OS. After PSM, ALBI grade is an independent prognostic factor of PFS (P=0.039) and OS (P=0.007). It was concluded that ALBI grade was an independent prognostic factor in SCLC.
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Affiliation(s)
- Shicheng Liu
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
| | - Qingtao Zhao
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
| | - Zengming Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
- Graduate School, Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Bin Zhao
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Xiaopeng Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050000, P.R. China
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17
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Patel PS, Fragkos K, Keane N, Wilkinson D, Johnson A, Chan D, Roberts B, Neild P, Yalcin M, Allan P, FitzPatrick MEB, Gomez M, Williams S, Kok K, Sharkey L, Swift C, Mehta S, Naghibi M, Mountford C, Forbes A, Rahman F, Di Caro S. Nutritional care pathways in cancer patients with malignant bowel obstruction: A retrospective multi-centre study. Clin Nutr ESPEN 2024; 59:118-125. [PMID: 38220364 DOI: 10.1016/j.clnesp.2023.11.018] [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: 03/02/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Variation in access to parenteral nutrition (PN) in patients with intestinal failure secondary to malignant bowel obstruction (MBO) exists due to differing practice, beliefs and resource access. We aimed to examine differences in nutritional care pathways and outcomes, by referral to nutrition team for PN in patients with MBO. METHODS This is a retrospective cohort study of MBO adults admitted to eight UK hospitals within a year and 1 year follow-up. Demographic, nutritional and medical data were analysed by comparing patients referred (R) or not referred (NR) for PN. Differences between groups were tested by Kruskal-Wallis, Chi-Squared tests and multi-level regression and survival using Cox regression. RESULTS 232 patients with 347 MBO admissions [median 66yr, (IQR: 55-74yrs), 67 % female], 79/232 patients were referred for PN (R group). Underlying primary malignancies of gynaecological and gastrointestinal origin predominated (71 %) and 78 % with metastases. Those in the NR group were found to be older, weigh more on admission, and more likely to be treated conservatively compared to those in the R group. For 123 (35 %) admissions, patients were referred to a nutrition team, and for 204 (59 %) admissions, patients were reviewed by a dietician. Multi-disciplinary team discussion and dietetic contact were more likely to occur in the R group-123/347 admissions (R vs NR group: 27 % vs. 7 %, P = 0.001; 95 % vs 39 %, P < 0.0001). Median admission weight loss was 8 % (IQR: 0 to 14). 43/123 R group admissions received inpatient PN only, with 32 patients discharged or already established on home parenteral nutrition. Overall survival was 150 days (126-232) with no difference between R/NR groups. CONCLUSION In this multi-centre study evaluating nutritional care management of patients with malignant bowel obstruction, only 1 in 3 admissions resulted in a referral to the nutrition team for PN, and just over half were reviewed by a dietician. Further prospective research is required to evaluate possible consequences of these differential care pathways on clinical outcomes and quality of life.
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Affiliation(s)
- Pinal S Patel
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Konstantinos Fragkos
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Niamh Keane
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - David Wilkinson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Amy Johnson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Derek Chan
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Bradley Roberts
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Penny Neild
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Metin Yalcin
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Philip Allan
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael E B FitzPatrick
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael Gomez
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Williams
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Klaartje Kok
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Lisa Sharkey
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Carla Swift
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Shameer Mehta
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Mani Naghibi
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Christopher Mountford
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Alastair Forbes
- Department of Gastroenterology, Norfolk & Norwich University Hospital, Norwich, United Kingdom; University of Tartu, Estonia
| | - Farooq Rahman
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Simona Di Caro
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
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18
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Olgun P, Diker O. Sixth-Week Immune-Nutritional-Inflammatory Biomarkers: Can They Predict Clinical Outcomes in Patients with Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors? Curr Oncol 2023; 30:10539-10549. [PMID: 38132403 PMCID: PMC10742278 DOI: 10.3390/curroncol30120769] [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: 11/05/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND We investigated the relationships between inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Lung Immune Prognostic Index (LIPI), and modified Glasgow prognostic score (mGPS) to determine whether they could predict treatment response to pembrolizumab or nivolumab (immunotherapy) 6 weeks after the start of treatment (post-treatment). METHODS We included all patients with lung cancer treated with immunotherapy. We examined the biomarker trends and explored their associations with progression-free survival (PFS), overall survival (OS), and response rate (RR) at 6 weeks. RESULTS Eighty-three patients were enrolled in the study. The presence of liver metastasis, low post-treatment NLR (<5), low post-treatment PLR (<170), intermediate post-treatment LIPI, and immune-related adverse events were significantly associated with the response. The multivariate analysis revealed that high post-treatment NLRs ≥ 5 (p = 0.004) and PLRs ≥ 170 (p ≤ 0.001) were independent prognostic factors of shorter OS. A good LIPI status was associated with better PFS (p = 0.020) and OS (p = 0.065). Post-treatment mGPS (0-2) was significantly associated with improved PFS (p = 0.009) and OS (p = 0.064). CONCLUSIONS Post-treatment NLR, PLR, LIPI, and mGPS are associated with worse OS and recurrence. These findings should be independently and prospectively validated in further studies.
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Affiliation(s)
- Polat Olgun
- Department of Medical Oncology, Faculty of Medicine, Near East University, 99138 Nicosia, Cyprus;
- Medical Oncology, Dr. Burhan Nalbantoğlu Government Hospital, 99010 Nicosia, Cyprus
| | - Omer Diker
- Department of Medical Oncology, Faculty of Medicine, Near East University, 99138 Nicosia, Cyprus;
- Medical Oncology, Dr. Burhan Nalbantoğlu Government Hospital, 99010 Nicosia, Cyprus
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19
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Guo F, Sun Z, Wang Z, Gao J, Pan J, Zhang Q, Ren S. Nomogram for predicting prolonged postoperative ileus after laparoscopic low anterior resection for rectal cancer. World J Surg Oncol 2023; 21:380. [PMID: 38082330 PMCID: PMC10712154 DOI: 10.1186/s12957-023-03265-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) is a common complication after colorectal surgery that increases patient discomfort, hospital stay, and financial burden. However, predictive tools to assess the risk of PPOI in patients undergoing laparoscopic low anterior resection have not been developed. Thus, the purpose of this study was to develop a nomogram to predict PPOI after laparoscopic low anterior resection for rectal cancer. METHODS A total of 548 consecutive patients who underwent laparoscopic low anterior resection for mid-low rectal cancer at a single tertiary medical center were retrospectively enrolled between January 2019 and January 2023. Univariate and multivariate logistic regression analysis was performed to analyze potential predictors of PPOI. The nomogram was constructed using the filtered variables and internally verified by bootstrap resampling. Model performance was evaluated by receiver operating characteristic curve and calibration curve, and the clinical usefulness was evaluated by the decision curve. RESULTS Among 548 consecutive patients, 72 patients (13.1%) presented with PPOI. Multivariate logistic analysis showed that advantage age, hypoalbuminemia, high surgical difficulty, and postoperative use of opioid analgesic were independent prognostic factors for PPOI. These variables were used to construct the nomogram model to predict PPOI. Internal validation, conducted through bootstrap resampling, confirmed the great discrimination of the nomogram with an area under the curve of 0.738 (95%CI 0.736-0.741). CONCLUSIONS We created a novel nomogram for predicting PPOI after laparoscopic low anterior resection. This nomogram can assist surgeons in identifying patients at a heightened risk of PPOI.
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Affiliation(s)
- Fangliang Guo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Zhiwei Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Zongheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Jianfeng Gao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Jiahao Pan
- Department of General Surgery, Shanghai Changzheng Hospital, Shanghai, 200003, People's Republic of China
| | - Qianshi Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China.
| | - Shuangyi Ren
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China.
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20
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Goodrose-Flores C, Bonn SE, Klasson C, Frankling MH, Lagerros YT, Björkhem-Bergman L. Appetite and its association with mortality in patients with advanced cancer - a Post-hoc Analysis from the Palliative D-study. BMC Palliat Care 2023; 22:159. [PMID: 37880704 PMCID: PMC10601273 DOI: 10.1186/s12904-023-01287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Loss of appetite is a common nutrition symptom in patients with cancer. Understanding the trajectory of appetite could be of clinical use for prognostication in palliative cancer care. Our primary aim was to explore the association between self-assessed appetite and mortality in patients suffering from advanced cancer. Secondary aims included the relation between fatigue, albumin levels and CRP/albumin ratio and mortality. We also aimed to study potential sex-differences in the associations. METHODS Post-hoc analyses were performed using data from the Palliative D-study comprising 530 patients with cancer admitted to palliative care. Appetite and fatigue were assessed with the Edmonton Symptom Assessment System (ESAS). Cox proportional hazards models were used to calculate Hazard ratios (HR) with 95% confidence intervals (CI) for exposures of appetite, fatigue, albumin and CRP/albumin ratio, and time from study inclusion to death or censoring. Analyses were also performed stratified by sex. RESULTS The follow-up time ranged between 7 to 1420 days. Moderate and poor appetite were significantly associated with a higher mortality rate compared to reporting a good appetite; HR 1.44 (95%CI: 1.16-1.79) and HR 1.78 (95%CI: 1.39-2.29), respectively. A higher mortality rate was also seen among participants reporting severe fatigue compared to those reporting no fatigue; HR 1.84 (95%CI:1.43-2.36). Participants with low albumin levels (< 25 g/L) and those in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75-7.63) and HR 2.66 (95%CI:212-3.35), compared to participants with high albumin levels (> 36 g/L) and those in lowest tertile of CRP/albumin ratio. These associations were more pronounced in men than in women. CONCLUSION Poor appetite, severe fatigue, low albumin level and a high CRP/albumin ratio were associated with increased mortality rates among patients with advanced cancer. All these variables might be clinically useful for prognostication in palliative cancer care. TRIAL REGISTRATION Clinicaltrial.gov. Identifier: NCT03038516;31, January 2017.
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Affiliation(s)
- Charlotte Goodrose-Flores
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | - Stephanie E Bonn
- Department of Medicine, Division of Clinical Epidemiology (KEP), Solna, Karolinska Institutet, Stockholm, Sweden
| | - Caritha Klasson
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Maria Helde Frankling
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Thoracic Oncology Center, Theme Cancer, Solna, Stockholm, SE-171 64, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Division of Clinical Epidemiology (KEP), Solna, Karolinska Institutet, Stockholm, Sweden
- Center of Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-122 19, Stockholm, Sweden
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Wang J, Tan S, Xu J, Li S, Yan M, Yang F, Huang Q, Zhang Z, Zhang Y, Han J, Liu H, Zhuang Q, Xi Q, Meng Q, Wu G. Development and application of the Cancer Cachexia Staging Index for the diagnosis and staging of cancer cachexia. Nutrition 2023; 114:112114. [PMID: 37454609 DOI: 10.1016/j.nut.2023.112114] [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: 12/28/2022] [Accepted: 06/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The current tools for evaluating cancer cachexia are either too simple to reflect the far-reaching effects of cachexia or too complicated to be used in daily practice. This study aimed to develop a cancer cachexia staging index (CCSI) that is both practical and comprehensive. METHODS Patients with gastrointestinal cancers were prospectively included in the study. Clinical data including weight change, body composition, systematic inflammation, nutrition, and function status were entered into regression models to determine the best variable combination as well as their respective cutoff values and score distribution in the CCSI. The CCSI's ability to predict outcomes and evaluate the consequences of cachexia for patients were then assessed. RESULTS Clinical information and test results from 10 568 patients were used to develop a CCSI composed of subjective and objective measures. Subjective measures included body mass index-adjusted weight loss grade, rate of weight loss, inflammation (neutrophil-to-lymphocyte ratio and C-reactive protein level), and prealbumin level. Objective measures included appetite status and physical status. Patients were diagnosed and stratified by the total CCSI score into 3 subgroups: no cachexia, mild or moderate cachexia, and severe cachexia. The CCSI grades showed good survival discrimination and were independently predictive of survival in multivariate analysis. Compared with the traditional Fearon criteria for diagnosing cancer cachexia, the CCSI was more accurate in predicting postoperative complications (net reclassification index [NRI], 2.8%; 95% CI, 0.0104-0.0456%), death (NRI, 10.68%; 95% CI, 0.0429-0.1708%), recurrence (NRI, 3.71%; 95% CI, 0.0082-0.0685%), and overall survival (NRI, 8.5%; 95% CI, 0.0219-0.1533%). The CCSI also had better discriminative ability than Fearon criteria in discriminating nutritional status, body composition, and systematic inflammation in patients with or without cachexia. A more detailed evaluation of a randomly selected subgroup (n = 1566) showed that CCSI grades had good discrimination of appetite and food intake status, physical function and muscle strength, symptom burden, and quality of life. CONCLUSIONS The CCSI is a comprehensive and practical evaluation tool for cancer cachexia. It can predict postoperative outcomes and survival. The CCSI stages showed good discrimination when evaluating patients with cancer in terms of nutritional status, physical function, systematic inflammation, body composition, symptom burden, and quality of life.
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Affiliation(s)
- Junjie Wang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahao Xu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuhao Li
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingyue Yan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fan Yang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiuyue Huang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhige Zhang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanni Zhang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Han
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Liu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiulin Zhuang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiulei Xi
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingyang Meng
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guohao Wu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Li F, Ren Y, Fan J, Zhou J. The predictive value of the preoperative albumin-to-fibrinogen ratio for postoperative hospital length of stay in liver cancer patients. Cancer Med 2023; 12:20321-20331. [PMID: 37815011 PMCID: PMC10652297 DOI: 10.1002/cam4.6606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a significant global health burden, with postoperative hospital length of stay (LOS) impacting patient outcomes and healthcare costs. Existing nutritional, inflammatory, and coagulation indices can predict LOS, with particular interest in albumin, fibrinogen, and D-dimer. This study investigates the predictive value of preoperative albumin-to-fibrinogen ratio (AFR) and albumin-to-D-dimer ratio (ADR) for postoperative LOS in HCC patients. METHODS This retrospective study involved 462 adult HCC patients who underwent partial hepatic lesion excision between February 2016 and August 2022. We analyzed demographic and clinical data, including preoperative blood samples, surgical approach, and LOS. The primary outcome measure was LOS, calculated from the date of surgery to the date of hospital discharge. Preoperative AFR and ADR were calculated. The ROC curves determined optimal cutoff points. The Cox proportional hazards model, Kaplan-Meier method, and the log-rank test were used for statistical analysis. RESULTS The study established an optimal AFR cutoff value of 15.474, with a higher AUC value than ADR, indicating superior predictive potential for postoperative LOS. Participants with high-AFR (AFR > 15.474) had a shorter median LOS (13 vs. 15 days, p < 0.001) compared to those with low-AFR (AFR ≤15.474). Multivariate analysis revealed high-AFR (HR: 1.99; p < 0.001) as a positive influence on LOS reduction, whereas Child-Pugh rated as B (HR: 0.49; p < 0.001), laparotomy (HR: 0.37; p < 0.001) and total bilirubin >20.5 μmol/L (HR: 0.58; p < 0.001) negatively impacted LOS reduction. Subgroup analysis confirmed AFR's predictive ability for patients experiencing reduced or prolonged LOS due to Child-Pugh score, surgical methods, and total bilirubin concentrations. Even within normal albumin and fibrinogen levels, patients with high-AFR exhibited a shorter LOS (all p < 0.001). CONCLUSIONS Our findings underscore the value of the AFR as a reliable predictor of LOS in HCC patients. An AFR greater than 15.474 consistently correlated with a shorter LOS, suggesting its potential clinical utility in guiding perioperative management and resource allocation in HCC patients.
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Affiliation(s)
- Fang Li
- Department of Hepatobiliary SurgeryLiaoning Cancer Hospital & Institute, Cancer Hospital of China Medical UniversityShenyangLiaoningChina
| | - Yuetong Ren
- Department of Hepatobiliary SurgeryLiaoning Cancer Hospital & Institute, Cancer Hospital of China Medical UniversityShenyangLiaoningChina
| | - Jiacheng Fan
- Department of Medical Laboratory Technology, Medical SchoolShandong Xiandai UniversityJinanShandongChina
| | - Jin Zhou
- Medical Oncology Department of Gastrointestinal CancerLiaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of TechnologyLiaoningShenyangChina
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Yokota J, Endo R, Takahashi R. Improving physical performance reduces dysphagia via improvement of tongue strength in patients with acute heart failure: a two-wave cross-lagged mediation model analysis. Aging Clin Exp Res 2023; 35:2237-2246. [PMID: 37462898 DOI: 10.1007/s40520-023-02485-w] [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: 05/07/2023] [Accepted: 06/21/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Physical performance improvement through whole-body exercise may have a positive impact on dysphagia via improvement of maximum tongue pressure (MTP). AIMS The present study aimed to quantitatively analyze whether improvement in physical performance reduces dysphagia by improving MTP in patients with acute heart failure (AHF). METHODS A total of 146 patients with AHF and dysphagia were included. Dysphagia was defined as a functional oral intake scale (FOIS) score < 6. The short physical performance battery (SPPB) indexed physical performance. A two-wave cross-lagged mediation model was used to examine whether an improvement in SPPB results improves the FOIS score via an improvement in MTP. The SPPB, MTP, and FOIS scores (T1: baseline, T2: hospital discharge) were included in the model. RESULTS A total of 146 patients were included in the final analysis. The SPPB result at T1 positively affected MTP (β = 0.150, P = 0.030) and the FOIS score (β = 0.249, P = 0.002) at T2. MTP at T1 also positively affected the FOIS score at T2 (β = 0.189, P = 0.026). Furthermore, the SPPB result indirectly affected the FOIS score by affecting the MTP (indirect effect = 0.028; 95% CI = 0.010, 0.078). DISCUSSION This study contributes to the knowledge base regarding the potential of exercise therapy as a new treatment strategy for dysphagia in patients with AHF. CONCLUSION An improvement in SPPB results improved the FOIS score by improving the MTP in patients with AHF.
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Affiliation(s)
- Junichi Yokota
- Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-Cho, Hirosaki, Aomori, 036-8564, Japan.
- Department of Clinical Research, National Hospital Organization Sendai Medical Center, Sendai, Japan.
| | - Ryunosuke Endo
- Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-Cho, Hirosaki, Aomori, 036-8564, Japan
| | - Ren Takahashi
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
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24
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Imai H, Wasamoto S, Tsuda T, Nagai Y, Kishikawa T, Masubuchi K, Osaki T, Miura Y, Umeda Y, Ono A, Minemura H, Yamada Y, Nakagawa J, Kozu Y, Taniguchi H, Ohta H, Kasai T, Kaira K, Kagamu H. Using the neutrophil-to-lymphocyte ratio to predict the outcome of individuals with nonsquamous non-small cell lung cancer receiving pembrolizumab plus platinum and pemetrexed. Thorac Cancer 2023; 14:2567-2578. [PMID: 37469246 PMCID: PMC10481141 DOI: 10.1111/1759-7714.15036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Factors predicting the response to pembrolizumab plus platinum and pemetrexed combination therapy (Pemb-Plt-PEM) in nonsquamous non-small cell lung cancer (non-sq NSCLC) are unclear. We investigated the Glasgow Prognostic (GP) score, neutrophil-to-lymphocyte ratio (NLR), and body mass index (BMI) as predictors of response to initial treatment with combination therapy in individuals with advanced non-sq NSCLC. METHODS We retrospectively reviewed 236 patients who received initial treatment with combination therapy for non-sq NSCLC at 13 institutions between December 2018 and December 2020. The usefulness of the GP score, NLR, and BMI as prognostic indicators was assessed. Cox proportional hazard models and the Kaplan-Meier method were used to compare progression-free survival (PFS) and overall survival (OS). RESULTS The response rate was 51.2% (95% CI: 44.9-57.5%). The median PFS and OS after beginning Pemb-Plt-PEM were 8.8 (95% CI: 7.0-11.9) months and 23.6 (95% CI: 18.7-28.6) months, respectively. The NLR independently predicted the efficacy of Pemb-Plt-PEM-the PFS and OS were more prolonged in individuals with NLR <5 than in those with NLR ≥5 (PFS: 12.8 vs. 5.3 months, p = 0.0002; OS: 29.4 vs. 12.0 months, p < 0.0001). BMI predicted the treatment response-individuals with BMI ≥22.0 kg/m2 had longer OS than did those with BMI < 22.0 kg/m2 (OS: 28.4 vs. 18.4 months, p = 0.0086). CONCLUSIONS The NLR significantly predicted PFS and OS, whereas BMI predicted OS, in individuals who initially received Pemb-Plt-PEM for non-sq NSCLC. These factors might be prognosis predictors in non-sq NSCLC.
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Affiliation(s)
- Hisao Imai
- Department of Respiratory MedicineComprehensive Cancer Center, International Medical Center, Saitama Medical UniversityHidakaSaitamaJapan
- Division of Respiratory MedicineGunma Prefectural Cancer CenterOtaGunmaJapan
| | - Satoshi Wasamoto
- Division of Respiratory MedicineSaku Central Hospital Advanced Care CenterSakuNaganoJapan
| | - Takeshi Tsuda
- Division of Respiratory MedicineToyama Prefectural Central HospitalToyamaToayamaJapan
| | - Yoshiaki Nagai
- Department of Respiratory MedicineJichi Medical University, Saitama Medical CenterSaitamaSaitamaJapan
| | - Takayuki Kishikawa
- Division of Thoracic OncologyTochigi Cancer CenterUtsunomiyaTochigiJapan
| | - Ken Masubuchi
- Division of Respiratory MedicineGunma Prefectural Cancer CenterOtaGunmaJapan
| | - Takashi Osaki
- Division of Respiratory MedicineNational Hospital Organization Shibukawa Medical CenterShibukawaGunmaJapan
| | - Yosuke Miura
- Division of Allergy and Respiratory Medicine, Integrative Centre of Internal MedicineGunma University HospitalMaebashiGunmaJapan
| | - Yukihiro Umeda
- Third Department of Internal MedicineFaculty of Medical Sciences, University of FukuiEiheijiFukuiJapan
| | - Akihiro Ono
- Division of Internal MedicineKiryu Kosei General HospitalKiryuGunmaJapan
| | - Hiroyuki Minemura
- Department of Pulmonary MedicineFukushima Medical UniversityFukushimaFukushimaJapan
| | - Yutaka Yamada
- Division of Respiratory MedicineIbaraki Prefectural Central HospitalKasamaIbarakiJapan
| | - Junichi Nakagawa
- Division of Respiratory MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Yuki Kozu
- Division of Respiratory MedicineSaku Central Hospital Advanced Care CenterSakuNaganoJapan
| | - Hirokazu Taniguchi
- Division of Respiratory MedicineToyama Prefectural Central HospitalToyamaToayamaJapan
| | - Hiromitsu Ohta
- Department of Respiratory MedicineJichi Medical University, Saitama Medical CenterSaitamaSaitamaJapan
| | - Takashi Kasai
- Division of Thoracic OncologyTochigi Cancer CenterUtsunomiyaTochigiJapan
| | - Kyoichi Kaira
- Department of Respiratory MedicineComprehensive Cancer Center, International Medical Center, Saitama Medical UniversityHidakaSaitamaJapan
| | - Hiroshi Kagamu
- Department of Respiratory MedicineComprehensive Cancer Center, International Medical Center, Saitama Medical UniversityHidakaSaitamaJapan
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25
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Tanimura K, Takeda T, Yoshimura A, Honda R, Goda S, Shiotsu S, Fukui M, Chihara Y, Uryu K, Takei S, Katayama Y, Hibino M, Yamada T, Takayama K. Predictive Value of Modified Glasgow Prognostic Score and Persistent Inflammation among Patients with Non-Small Cell Lung Cancer Treated with Durvalumab Consolidation after Chemoradiotherapy: A Multicenter Retrospective Study. Cancers (Basel) 2023; 15:4358. [PMID: 37686634 PMCID: PMC10486354 DOI: 10.3390/cancers15174358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Durvalumab consolidation after chemoradiotherapy (CRT) is a standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, studies on immunological and nutritional markers to predict progression-free survival (PFS) and overall survival (OS) are inadequate. Systemic inflammation causes cancer cachexia and negatively affects immunotherapy efficacy, which also reflects survival outcomes. PATIENTS AND METHODS We retrospectively investigated 126 patients from seven institutes in Japan. RESULTS The modified Glasgow Prognostic Score (mGPS) values, before and after CRT, were the essential predictors among the evaluated indices. A systemic inflammation-based prognostic risk classification was created by combining mGPS values before CRT, and C-reactive protein (CRP) levels after CRT, to distinguish tumor-derived inflammation from CRT-induced inflammation. Patients were classified into high-risk (n = 31) and low-risk (n = 95) groups, and the high-risk group had a significantly shorter median PFS of 7.2 months and an OS of 19.6 months compared with the low-risk group. The hazard ratios for PFS and OS were 2.47 (95% confidence interval [CI]: 1.46-4.19, p < 0.001) and 3.62 (95% CI: 1.79-7.33, p < 0.001), respectively. This association was also observed in the subgroup with programmed cell death ligand 1 expression of ≥50%, but not in the <50% subgroup. Furthermore, durvalumab discontinuation was observed more frequently in the high-risk group than in the low-risk group. CONCLUSION Combining pre-CRT mGPS values with post-CRT CRP levels in patients with locally advanced NSCLC helps to predict the PFS and OS of durvalumab consolidation after CRT.
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Affiliation(s)
- Keiko Tanimura
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan; (K.T.); (A.Y.)
| | - Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan; (K.T.); (A.Y.)
| | - Akihiro Yoshimura
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan; (K.T.); (A.Y.)
| | - Ryoichi Honda
- Department of Respiratory Medicine, Asahi General Hospital, Asahi 289-2511, Japan;
| | - Shiho Goda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto 605-0981, Japan; (S.G.); (S.S.)
| | - Shinsuke Shiotsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto 605-0981, Japan; (S.G.); (S.S.)
| | - Mototaka Fukui
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Uji 611-0041, Japan; (M.F.); (Y.C.)
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Uji 611-0041, Japan; (M.F.); (Y.C.)
| | - Kiyoaki Uryu
- Department of Respiratory Medicine, Yao Tokushukai General Hospital, Yao 581-0011, Japan;
| | - Shota Takei
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (Y.K.); (T.Y.); (K.T.)
| | - Yuki Katayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (Y.K.); (T.Y.); (K.T.)
| | - Makoto Hibino
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa 251-0041, Japan;
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (Y.K.); (T.Y.); (K.T.)
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (Y.K.); (T.Y.); (K.T.)
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26
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Nishihara-Kato F, Imai H, Tsuda T, Wasamoto S, Nagai Y, Kishikawa T, Miura Y, Ono A, Yamada Y, Masubuchi K, Osaki T, Nakagawa J, Umeda Y, Minemura H, Kozu Y, Taniguchi H, Ohta H, Kaira K, Kagamu H. Prognostic Potential of the Prognostic Nutritional Index in Non-Small Cell Lung Cancer Patients Receiving Pembrolizumab Combination Therapy with Carboplatin and Paclitaxel/Nab-Paclitaxel. Oncology 2023; 102:30-42. [PMID: 37598676 DOI: 10.1159/000533604] [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: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Pembrolizumab (Pemb) therapy in conjunction with carboplatin and paclitaxel (PTX)/nab-PTX has been efficacious in treating non-small cell lung cancer (NSCLC). However, the response predictors of this combination therapy (Pemb-combination) remain undetermined. We aimed to evaluate whether Glasgow prognostic score (GPS), neutrophil-to-lymphocyte ratio (NLR), body mass index (BMI), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) are potential factors in prognosticating the response to Pemb-combination therapy in advanced NSCLC patients. METHODS We retrospectively recruited 144 NSCLC patients receiving first-line treatment with Pemb-combination therapy from 13 institutions between December 1, 2018, and December 31, 2020. GPS, NLR, BMI, PLR, and PNI were assessed for their efficacy as prognostic indicators. Cox proportional hazard models and the Kaplan-Meier method were used to compare the progression-free survival (PFS) and overall survival (OS) of the patients. RESULTS The treatment exhibited a response rate of 63.1% (95% confidence interval [CI]: 55.0-70.6%). Following Pemb-combination administration, the median PFS and OS were 7.3 (95% CI: 5.3-9.4) and 16.5 (95% CI: 13.9-22.1) months, respectively. Contrary to PNI, NLR, GPS, BMI, and PLR did not display substantially different PFS in univariate analysis. However, multivariate analysis did not identify PNI as an independent prognostic factor for PFS. Furthermore, univariate analysis revealed that GPS, BMI, and PLR exhibited similar values for OS but not NLR and PNI. Patients with PNI ≥45 were predicted to have better OS than those with PNI <45 (OS: 23.4 and 13.9 months, respectively, p = 0.0028). Multivariate analysis did not establish NLR as an independent prognostic factor for OS. CONCLUSION The PNI evidently predicted OS in NSCLC patients treated with Pemb-combination as first-line therapy, thereby validating its efficiency as a prognostic indicator of NSCLC.
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Affiliation(s)
- Fuyumi Nishihara-Kato
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takeshi Tsuda
- Division of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Satoshi Wasamoto
- Division of Respiratory Medicine, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Yoshiaki Nagai
- Department of Respiratory Medicine, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | | | - Yosuke Miura
- Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Akihiro Ono
- Division of Internal Medicine, Kiryu Kosei General Hospital, Kiryu, Japan
| | - Yutaka Yamada
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Ken Masubuchi
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takashi Osaki
- Division of Respiratory Medicine, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Junichi Nakagawa
- Division of Respiratory Medicine, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Yukihiro Umeda
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Kozu
- Division of Respiratory Medicine, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Hirokazu Taniguchi
- Division of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Hiromitsu Ohta
- Department of Respiratory Medicine, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
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27
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Yuruyen M, Polat O, Denizli BO, Cirak M, Polat H. Survival and factors affecting the survival of older adult patients in palliative care. Ir J Med Sci 2023; 192:1561-1567. [PMID: 36261749 DOI: 10.1007/s11845-022-03186-5] [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: 08/01/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Investigate the survival and risk factors that affect the survival of aged patients in a palliative care center (PCC). METHODS A total of 180 inpatients (aged ≥ 65 years) who were admitted to a PCC from January 2018 to March 2020 were included. Information regarding patients' demographic characteristics, chronic diseases, length of hospital stay, nutrition provided at the first hospital stay, pressure wound, pain, and laboratory results were evaluated. RESULTS The patients 50% were women (n = 90). The mean age, mean comorbidity, and mean follow-up duration was 77.6 years, 3.4, and 115 days (median: 29 days), respectively. The mean NRS2002 score of patients was 4.0 ± 1.0 and the risk of malnutrition was 93%. The mortality rate of the patients was 91.7%. The life expectancy of patients without malignancy was higher than those with malignancy (p < 0.001). Enteral nutrition (EN) via percutaneous endoscopic gastrostomy (PEG) was associated with up to two-fold increase in the survival rates of patients with PCC (p = 0.049, HR: 2.029). High neutrophil/lymphocyte ratio (p = 0.002, HR: 1.017) and high ferritin (p = 0.001, HR: 1.000) and C-reactive protein (CRP) levels (p < 0.001, HR: 1.006) were adverse risk factors affecting life expectancy. Malignity reduced the survival rate of aged patients with PCC by 40% (p = 0.008). CONCLUSION EN via PEG was found to be a positive factor affecting survival rates of older adult patients in palliative care, whereas malignity, high neutrophil/lymphocyte ratio, high CRP and ferritin levels, and prolonged hospital stays were negative risk factors.
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Affiliation(s)
- Mehmet Yuruyen
- Department of Internal Medicine, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Palliative Care Center, Istanbul, Turkey
| | - Ozlem Polat
- Department of Family Medicine, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Palliative Care Center, 31147, Bakırkoy, Istanbul, Turkey.
| | - Betul Ondes Denizli
- Department of Family Medicine, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Palliative Care Center, 31147, Bakırkoy, Istanbul, Turkey
| | - Musa Cirak
- Department of Neurosurgery, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Bradley NA, Walter A, Wilson A, Siddiqui T, Roxburgh CSD, McMillan DC, Guthrie GJK. The prognostic value of preoperative systemic inflammation-based scoring in patients undergoing endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2023; 78:362-369.e2. [PMID: 37086821 DOI: 10.1016/j.jvs.2023.04.018] [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: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is a common condition that is predominantly managed in the United Kingdom by endovascular aneurysm repair (EVAR). Activation of the systemic inflammatory response (SIR) appears to offer prognostic value in patients with vascular disease. The present study examines the relationship between the SIR and survival in patients undergoing standard and complex endovascular aneurysm repair (EVAR and fenestrated/branched [F/B]-EVAR). METHODS Consecutive patients undergoing elective EVAR and F/B-EVAR were retrospectively identified from three tertiary vascular centers over a 5-year period. Neutrophil:lymphocyte ratio and modified Glasgow Prognostic Score were calculated from preoperative blood results and combined into the systemic inflammatory grade (SIG). The primary outcome was all-cause mortality during the follow-up period, which was compared between subgroups of SIGs. RESULTS There were 506 patients included in the final study, with a median follow-up of 68.0 months (interquartile range, 27.3 months), and there were 163 deaths during the follow-up period. Mean survival in the SIG 0 vs SIG 1 vs SIG 2 vs SIG 3 vs SIG 4 subgroups was 80.7 months (95% confidence interval [CI], 76.5-85.0 months) vs 78.7 months (95% CI, 72.7-84.7 months) vs 61.0 months (95% CI, 51.1-70.8 months) vs 65.1 months (95% CI, 45.0-85.2 months) vs 54.9 months (95% CI, 34.4-75.3 months) (P < .05). In the entire cohort, age (P < .001), body mass index (P < .05), high creatinine (P < .05), and SIG (P < .05) were associated with survival on univariate analysis, with retained independent association for age (hazard ratio, 1.72; 95% CI, 1.29-2.31; P < .001) and SIG (hazard ratio, 1.20; 95% CI, 1.02-1.40; P < .05) on multivariate analysis. Increasing SIG (area under the curve, 0.68; 95% CI, 0.58-0.78; P < .01) predicted 1-year mortality. CONCLUSIONS Markers of the SIR such the SIG may be used to identify patients at higher risk of adverse outcome in patients undergoing EVAR and F/B-EVAR for abdominal aortic aneurysms. These findings warrant further investigation in large prospective cohort studies.
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Affiliation(s)
- Nicholas A Bradley
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom.
| | - Amy Walter
- Department of Vascular Surgery, NHS Tayside, Dundee, United Kingdom
| | - Alasdair Wilson
- Department of Vascular Surgery, NHS Grampian, Aberdeen, United Kingdom
| | - Tamim Siddiqui
- Department of Vascular Surgery, NHS Lanarkshire, Glasgow, United Kingdom
| | | | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom
| | - Graeme J K Guthrie
- Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom; Department of Vascular Surgery, NHS Tayside, Dundee, United Kingdom
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29
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Hua X, Long ZQ, Wang SF, Xu F, Wang MD, Chen JY, Zhang YL, Ni WQ, Gao YS. Prognostic significance of the novel nutrition-inflammation marker of lymphocyte-C-reactive protein ratio in patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy. Front Nutr 2023; 10:1162280. [PMID: 37545573 PMCID: PMC10399231 DOI: 10.3389/fnut.2023.1162280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Background Recent studies indicate that the novel lymphocyte-C-reactive protein ratio (LCR) is strongly associated with the survival of various tumors, but its prognostic value in nasopharyngeal carcinoma (NPC) is understudied. This study aimed to explore the relationship between LCR and overall survival (OS) in NPC and develop a predictive model. Methods A total of 841 NPC patients who received concurrent chemoradiotherapy (CCRT) between January 2010 and December 2014 were retrospectively enrolled and randomly divided into a training cohort (n = 589) and a validation cohort (n = 252), and 122 patients between January 2015 and March 2015 were included as an additional validation cohort. Univariate and multivariate Cox analyses were performed to identify variables associated with OS and construct a predictive nomogram. The predictive accuracy of the nomogram was evaluated and independently validated. Results The LCR score differentiated NPC patients into two groups with distinct prognoses (HR = 0.53; 95% CI: 0.32-0.89, P = 0.014). Multivariate analysis showed that age, T stage, N stage, EBV-DNA status, and LCR score were independently associated with OS, and a predictive nomogram was developed. The nomogram had a good performance for the prediction of OS [C-index = 0.770 (95% CI: 0.675-0.864)]. and outperformed the traditional staging system [C-index = 0.589 (95% CI: 0.385-0.792)]. The results were internally and additionally validated using independent cohorts. Conclusion The pretreatment LCR could independently predict the overall survival in NPC patients. A novel LCR-based prognostic model of an easy-to-use nomogram was established, and it outperformed the conventional staging system in terms of predictive power. Further external verification remains necessary.
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Affiliation(s)
- Xin Hua
- Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Zhi-Qing Long
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Si-Fen Wang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fei Xu
- Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Meng-Di Wang
- Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Jia-Yi Chen
- Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Yu-Ling Zhang
- Department of Endocrinology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Wei-Qiong Ni
- Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Yun-Sheng Gao
- Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
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McGovern J, Dolan RD, Simmons C, Daly LE, Ryan AM, Power DG, Fallon MT, Laird BJ, McMillan DC. Are CT-Derived Muscle Measurements Prognostic, Independent of Systemic Inflammation, in Good Performance Status Patients with Advanced Cancer? Cancers (Basel) 2023; 15:3497. [PMID: 37444607 DOI: 10.3390/cancers15133497] [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: 04/11/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The present study examined the relationships between CT-derived muscle measurements, systemic inflammation, and survival in advanced cancer patients with good performance status (ECOG-PS 0/1). Data was collected prospectively from patients with advanced cancer undergoing anti-cancer therapy with palliative intent. The CT Sarcopenia score (CT-SS) was calculated by combining the CT-derived skeletal muscle index (SMI) and density (SMD). The systemic inflammatory status was determined using the modified Glasgow Prognostic Score (mGPS). The primary outcome of interest was overall survival (OS). Univariate and multivariate Cox regressions were used for survival analysis. Three hundred and seven patients met the inclusion criteria, out of which 62% (n = 109) were male and 47% (n = 144) were ≥65 years of age, while 38% (n = 118) were CT-SS ≥ 1 and 47% (n = 112) of patients with pre-study blood were inflamed (mGPS ≥ 1). The median survival from entry to the study was 11.1 months (1-68.1). On univariate analysis, cancer type (p < 0.05) and mGPS (p < 0.001) were significantly associated with OS. On multivariate analysis, only mGPS (p < 0.001) remained significantly associated with OS. In patients who were ECOG-PS 0, mGPS was significantly associated with CT-SS (p < 0.05). mGPS may dominate the prognostic value of CT-derived sarcopenia in good-performance-status patients with advanced cancer.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
| | - Ross D Dolan
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
| | - Claribel Simmons
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Louise E Daly
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland
| | - Aoife M Ryan
- Cork Cancer Research Centre, University College Cork, T12 YN60 Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy and Cork University Hospital, T12 DC4A Cork, Ireland
| | - Marie T Fallon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Donald C McMillan
- Academic Unit of Surgery, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK
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Kimura J, Sui K, Tabuchi M, Sakamoto S, Murokawa T, Iwata J, Morita S, Iiyama T, Okabayashi T. Preoperative percent body fat in bioelectrical impedance analysis predicts pancreatic fistula after pancreaticoduodenectomy. Langenbecks Arch Surg 2023; 408:248. [PMID: 37380749 DOI: 10.1007/s00423-023-02998-y] [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: 10/18/2022] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND It is unclear which body composition affects postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. In the present study, we evaluated the relationship between nutritional factors, body composition, and POPF. METHODS This was a prospective observational cohort study. Patients who underwent pancreaticoduodenectomy between March 2018 and July 2021 were included in this study. Preoperative body composition was measured using a bioelectrical impedance analyzer. In addition, the predictive factors for POPF were analyzed using logistic regression model. RESULTS The study included 143 patients. Among these patients, 31 had POPF (POPF group) and 112 did not (non-POPF group) after pancreaticoduodenectomy. For body composition, the percent body fat was significantly higher in the POPF group (26.90 vs 23.48, P = 0.022). Multivariate analysis revealed that alcohol consumption (odds ratio 2.95, P = 0.03), pancreatic duct < 3 mm (odds ratio 3.89, P < 0.01), and percent body fat (odds ratio 1.08, P = 0.01) were significantly independent predictive factors for POPF. When the patients were divided into three groups based on their percent body fat (< 25, 25-35, and ≥ 35), POPF occurred more frequently in the group with ≥ 35 percent body fat (47.1%) than in the < 25 group (15.5%) (P = 0.008). CONCLUSION Predictive factors for POPF related to nutritional status, such as percent body fat, should be considered before proceeding to pancreaticoduodenectomy (ClinicalTrials.gov trial registration no. NCT5257434).
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Affiliation(s)
- Jiro Kimura
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi City, Kochi, 781-8555, Japan
| | - Kenta Sui
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi City, Kochi, 781-8555, Japan
| | - Motoyasu Tabuchi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi City, Kochi, 781-8555, Japan
| | - Shinya Sakamoto
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi City, Kochi, 781-8555, Japan
| | - Takahiro Murokawa
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi City, Kochi, 781-8555, Japan
| | - Jun Iwata
- Department of Diagnostic Pathology, Kochi Health Sciences Center, Kochi City, Kochi, Japan
| | - Sojiro Morita
- Department of Radiology, Kochi Health Sciences Center, Kochi City, Kochi, Japan
| | - Tastuo Iiyama
- Department of Biostatistics, National Center for Global Health and Medicine, Shinjuku City, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi City, Kochi, 781-8555, Japan.
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Yilmaz S, Aykota MR, Ozgen U, Birsen O, Simsek S, Kabay B. Might simple peripheral blood parameters be an early indicator in the prediction of severity and morbidity of cholecystitis? Ann Surg Treat Res 2023; 104:332-338. [PMID: 37337601 PMCID: PMC10277177 DOI: 10.4174/astr.2023.104.6.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/06/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose The aim of this study is to examine the effectiveness of the neutrophil-lymphocyte ratio (NLR) and CRP/albumin ratio (CAR) in evaluating disease severity and predicting clinical outcomes in patients diagnosed with acute cholecystitis (AC). Methods A total of 186 patients with AC were evaluated retrospectively. NLR, CAR, Mannheim Peritonitis Index (MPI), and P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scores were compared with AC severity grade. Results The rates of the grade 1 patients (group 1) and the grade 2-3 patients (group 2) were 57.5% (n = 107) and 42.5% (n = 79) according to the disease severity according to Tokyo Guidelines criteria (TG) 18/TG13, respectively. The morbidity rates determined in groups 1 and 2 were 26.7% (n = 28) and 51.9% (n = 41), respectively. No mortality was found in group 1, whereas the mortality rate in group 2 was 6.3% (n = 5). According to multivariate analysis, CAR (odds ratio [OR], 1.234; P < 0.001) and MPI (OR, 1.175; P = 0.001) were found to be associated with moderate-severe disease while CAR (OR, 1.109; P = 0.035) and P-POSSUM morbidity (OR, 1.063; P = 0.007) variables were found to be associated with the presence of morbidity. Conclusion We have demonstrated that CAR can be used in predicting severity of AC and that CAR is an alternative simple parameter of P-POSSUM morbidity score in prediction of morbidity in these cases. In addition to other assessment methods, these scores can provide valuable and complementary information in assessment of disease severity and prognosis in AC.
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Affiliation(s)
- Sevda Yilmaz
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Muhammed Rasid Aykota
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Utku Ozgen
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Onur Birsen
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Selda Simsek
- Department of Medical Biology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Burhan Kabay
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Ma LX, Wang Y, Espin-Garcia O, Allen MJ, Jang GH, Zhang A, Dodd A, Ramotar S, Hutchinson S, Tehfe M, Ramjeesingh R, Biagi J, Wilson JM, Notta F, Fischer SE, Zogopoulos G, Gallinger S, Grant RC, Khokha R, Chan N, Grünwald BT, Knox JJ, O'Kane GM. Systemic inflammatory prognostic scores in advanced pancreatic adenocarcinoma. Br J Cancer 2023; 128:1916-1921. [PMID: 36927977 PMCID: PMC10147590 DOI: 10.1038/s41416-023-02214-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Systemic inflammatory scores may aid prognostication and patient selection for trials. We compared five scores in advanced pancreatic adenocarcinoma (PDAC). METHODS Unresectable/metastatic PDAC patients enrolled in the Comprehensive Molecular Characterisation of Advanced Pancreatic Ductal Adenocarcinoma for Better Treatment Selection trial (NCT02750657) were included. Patients had pre-treatment biopsies for whole genome and RNA sequencing. CD8 immunohistochemistry was available in a subset. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, Prognostic Nutritional Index, Gustave Roussy Immune Score (GRIm-S), and Memorial Sloan Kettering Prognostic Score (MPS) were calculated. Overall survival (OS) was estimated using Kaplan-Meier methods. Associations between inflammatory scores, clinical/genomic characteristics, and OS were analysed. RESULTS We analysed 263 patients. High-risk NLR, GRIm-S and MPS were poorly prognostic. The GRIm-S had the highest predictive ability: median OS 6.4 vs. 10 months for high risk vs. low-risk (P < 0.001); HR 2.26 (P < 0.001). ECOG ≥ 1, the basal-like subtype, and low-HRDetect were additional poor prognostic factors (P < 0.01). Inflammatory scores did not associate with RNA-based classifiers or homologous recombination repair deficiency genotypes. High-risk MPS (P = 0.04) and GRIm-S (P = 0.02) patients had lower median CD8 + tumour-infiltrating lymphocytes. CONCLUSIONS Inflammatory scores incorporating NLR have prognostic value in advanced PDAC. Understanding immunophenotypes of poor-risk patients and using these scores in trials will advance the field.
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Affiliation(s)
- Lucy X Ma
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Yifan Wang
- Research Institute of the McGill University Health Centre; Rosalind and Morris Goodman Cancer Institute, McGill University; Department of Surgery, McGill University, Montreal, QC, Canada
| | - Osvaldo Espin-Garcia
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Dalla Lana School of Public Health & Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Biostatistics, University Health Network, Toronto, ON, Canada
| | - Michael J Allen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gun Ho Jang
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Amy Zhang
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Anna Dodd
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Stephanie Ramotar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shawn Hutchinson
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mustapha Tehfe
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Ravi Ramjeesingh
- QEII Health Sciences Centre, Division of Medical Oncology, Dalhousie University, Halifax, NS, Canada
| | | | - Julie M Wilson
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Faiyaz Notta
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sandra E Fischer
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - George Zogopoulos
- Research Institute of the McGill University Health Centre; Rosalind and Morris Goodman Cancer Institute, McGill University; Department of Surgery, McGill University, Montreal, QC, Canada
| | - Steven Gallinger
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada
- Hepatobiliary/Pancreatic Surgical Oncology Program, University Health Network, Toronto, ON, Canada
| | - Robert C Grant
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Rama Khokha
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nathan Chan
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Barbara T Grünwald
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer J Knox
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Grainne M O'Kane
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. grainne.o'
- PanCuRx Ontario Institute for Cancer Research, Toronto, ON, Canada. grainne.o'
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Akazawa Y, Igawa S, Yamada K, Yamamoto H, Yagami Y, Kaizuka N, Manaka H, Kasajima M, Nakahara Y, Sato T, Mitsufuji H, Yokoba M, Kubota M, Sasaki J, Naoki K. The Glasgow Prognostic Score Predicts Survival in Patients with Advanced Non-Small Cell Lung Cancer Harboring Sensitive Epidermal Growth Factor Receptor Mutations Who Are Treated with Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors. Oncology 2023; 101:685-694. [PMID: 37166346 PMCID: PMC10614514 DOI: 10.1159/000530809] [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: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) with sensitive EGFR mutations. The Glasgow prognostic score (GPS) is an inflammation-assessing score based on C-reactive protein and albumin concentrations. Information regarding the association between the GPS and EGFR-TKI treatment effectiveness is limited; hence, we investigated whether the GPS can predict the response of NSCLC to EGFR-TKIs. METHODS We evaluated 340 patients with NSCLC harboring sensitive EGFR mutations who received EGFR-TKI monotherapy between March 2009 and July 2021. The Kaplan-Meier method and Cox proportional hazards models were used to assess progression-free survival (PFS) and overall survival (OS). RESULTS After a median follow-up of 26.6 months, patients with a GPS of 0, 1, and 2 had PFS of 15.7, 10.0, and 6.3 months, respectively, and OS of 40.1, 25.8, and 14.4 months, respectively; patients with a GPS of 0 had significantly better PFS and OS than those with a GPS of 1 (p = 0.03, p = 0.001, respectively) or 2 (p < 0.001, p < 0.001, respectively). Multivariate analysis identified poor performance status, stage 4 at diagnosis, type of EGFR-TKI (gefitinib/erlotinib vs. afatinib), and GPS = 2 as predictors of a short PFS. Meanwhile, poor performance status, gefitinib/erlotinib administration, and GPS = 2 were predictors of a short OS. CONCLUSION The GPS predicted the survival of NSCLC patients harboring sensitive EGFR mutations who were undergoing EGFR-TKI treatment. The GPS might be ideal for routine use in clinical practice, given that it is an easily calculated parameter.
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Affiliation(s)
- Yuki Akazawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kaori Yamada
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroki Yamamoto
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuri Yagami
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuki Kaizuka
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroya Manaka
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takashi Sato
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Masanori Yokoba
- School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Masaru Kubota
- School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Rocha BMM, Dolan RD, Paiva CE, McGovern J, Paiva BSR, Preto DD, McMillan DC, Maia YCP, Laird BJ. Inflammation and Performance Status: The Cornerstones of Prognosis in Advanced Cancer. J Pain Symptom Manage 2023; 65:348-357. [PMID: 36493981 DOI: 10.1016/j.jpainsymman.2022.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT In advanced cancer, although performance status (PS), systemic inflammatory response and nutritional status are known to have prognostic value, geographical variations and sociodemographic indexes may also impact survival. OBJECTIVES This study compares validated prognostic factors in two international cohorts and establishes a prognostic framework for treatment. METHODS Two international biobanks of patients (n=1.518) with advanced cancer were analyzed. Prognostic factors (Eastern Cooperative Oncology Group Performance Status [ECOG-PS], body mass index [BMI] and modified Glasgow Prognostic Score [mGPS]) were assessed. The relationship between these and survival was examined using Kaplan-Meier and Cox regression methods. RESULTS According to multivariate analysis, in the European cohort the most highly predictive factors were BMI <20 kg/m2 (hazard ratio [HR] 1.644), BMI 20-21.9 kg/m2 (HR 1.347), ECOG-PS (HR 1.597-11.992) and mGPS (HR 1.843-2.365). In the Brazilian cohort, the most highly predictive factors were ECOG-PS (HR 1.678-8.938) and mGPS (HR 2.103-2.837). Considering gastrointestinal cancers in particular (n=551), the survival rate at 3 months in both cohorts together ranged from 93% (mGPS 0, PS 0-1) to 0% (mGPS 2, PS 4), and from 81% (mGPS 0, BMI >28 kg/m2) to 44% (mGPS 2, BMI <20 kg/m2). CONCLUSION The established prognostic factors that were compared had similar prognostic capacity in both cohorts. A high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer survival of patients with advanced cancer in the prospective European and Brazilian cohorts.
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Affiliation(s)
- Bruna M M Rocha
- Nutrition and Molecular Biology Research Group (B.M.M.R., Y.C.P.M.), School of Medicine, Federal University of Uberlandia, Minas Gerais, Uberlandia, Brazil
| | - Ross D Dolan
- Academic Unit of Surgery (R.D.D., J.M.G., D.C.M.M.), School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Carlos E Paiva
- Palliative Care and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P., D.D.P.), Pio XII Foundation, Barretos Cancer Hospital, São Paulo, Barretos, Brazil
| | - Josh McGovern
- Academic Unit of Surgery (R.D.D., J.M.G., D.C.M.M.), School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Bianca S R Paiva
- Palliative Care and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P., D.D.P.), Pio XII Foundation, Barretos Cancer Hospital, São Paulo, Barretos, Brazil
| | - Daniel D Preto
- Palliative Care and Quality of Life Research Group (GPQual) (C.E.P., B.S.R.P., D.D.P.), Pio XII Foundation, Barretos Cancer Hospital, São Paulo, Barretos, Brazil
| | - Donald C McMillan
- Academic Unit of Surgery (R.D.D., J.M.G., D.C.M.M.), School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Yara C P Maia
- Nutrition and Molecular Biology Research Group (B.M.M.R., Y.C.P.M.), School of Medicine, Federal University of Uberlandia, Minas Gerais, Uberlandia, Brazil.
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh (B.J.L.), Edinburgh, Scotland, United Kingdom
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Toya Y, Shimada T, Hamada K, Watanabe K, Nakamura J, Fukushi D, Hatta W, Shinkai H, Ito H, Matsuhashi T, Fujimori S, Iwai W, Hanabata N, Shiroki T, Sasaki Y, Fujishima Y, Tsuji T, Yorozu H, Yoshimura T, Horikawa Y, Takahashi Y, Takahashi H, Kondo Y, Fujiwara T, Mizugai H, Gonai T, Tatsuta T, Onochi K, Kudara N, Abe K, Ohira T, Horikawa Y, Ishihata R, Hikichi T, Satoh K, Takahashi F, Masamune A, Iijima K, Fukuda S, Matsumoto T. Prediction model of 3-year survival after endoscopic submucosal dissection for early gastric cancer in elderly patients aged ≥ 85 years: EGC-2 model. J Cancer Res Clin Oncol 2023; 149:1521-1530. [PMID: 35546359 DOI: 10.1007/s00432-022-04024-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Little is known about the prognostic factors for survival after endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer (EGC). The aim of this study is to determine prognostic factors and a prediction model of 3-year survival after ESD for EGC in patients aged ≥ 85 years. METHODS We retrospectively evaluated the clinical outcomes of 740 patients with EGC aged ≥ 85 years, who were treated by ESD at 30 institutions in Japan. Overall survival (OS) and disease-specific survival (DSS) were calculated with the Kaplan-Meier method. Prediction models for 3-year OS after ESD were estimated using the Cox proportional hazards model based on Uno's C-statistics. RESULTS During the follow-up period, 309 patients died of any cause and 10 patients died of gastric cancer. OS and DSS after 3 years were 82.7% and 99.2%, respectively. No significant differences in OS were found among curability categories. The Cox proportional hazards model revealed the geriatric nutritional risk index (GNRI) and the Charlson comorbidity index (CCI) to be predictors of 3-year survival. We established a final model (EGC-2 model) expressed by GNRI - (2.2×CCI) with a cutoff value of 96. The overall survival rate was significantly lower in the model value < 96 group than in the model value ≥ 96 group (P < 0.001). CONCLUSIONS The prediction model using GNRI and CCI will be useful to support decision-making for the treatment of EGC in elderly patients aged ≥ 85 years.
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Affiliation(s)
- Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 1-1-1, Yahaba, 028-3694, Japan.
| | - Tomohiro Shimada
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Ko Watanabe
- Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Daisuke Fukushi
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirohiko Shinkai
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Hirotaka Ito
- Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shusei Fujimori
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan
| | - Wataru Iwai
- Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan
| | - Norihiro Hanabata
- Division of Endoscopy, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Takeharu Shiroki
- Department of Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yuukou Fujishima
- Division of Gastroenterology, Noshiro Kosei Medical Center, Noshiro, Japan
| | - Tsuyotoshi Tsuji
- Department of Gastroenterology, Akita City Hospital, Akita, Japan
| | - Haruka Yorozu
- Digestive Disease Center, Akita Red Cross Hospital, Akita, Japan
| | | | - Yohei Horikawa
- Department of Gastroenterology, Hiraka General Hospital, Yokote, Japan
| | - Yasushi Takahashi
- Department of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hiroshi Takahashi
- Department of Gastroenterology, Iwate Prefectural Ninohe Hospital, Ninohe, Japan
| | - Yutaka Kondo
- Division of Gastroenterology, Tohoku Rosai Hospital, Sendai, Japan
| | - Takao Fujiwara
- Department of Gastroenterology, Japanese Red Cross Morioka Hospital, Morioka, Japan
| | - Hisata Mizugai
- Department of Gastroenterology, Hachinohe Red Cross Hospital, Hachinohe, Japan
| | - Takahiro Gonai
- Department of Gastroenterology, Iwate Prefectural Kuji Hospital, Kuji, Japan
| | - Tetsuya Tatsuta
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kengo Onochi
- Department of Gastroenterology, Omagari Kosei Medical Center, Daisen, Japan
| | - Norihiko Kudara
- Department of Internal Medicine and Gastroenterology, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Keinosuke Abe
- Department of Gastroenterology, Iwate Prefectural Miyako Hospital, Miyako, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan
| | - Ryoichi Ishihata
- Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Kennichi Satoh
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Fumiaki Takahashi
- Division of Medical Engineering, Department of Information Science, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 1-1-1, Yahaba, 028-3694, Japan
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Aadal L, Holst M, Rasmussen HH, Nielsen JF, Odgaard L. Malnutrition in Patients With Moderate to Severe Acquired Brain Injury: Prevalence During 4 Weeks of Subacute Rehabilitation. J Neurosci Nurs 2023; 55:38-44. [PMID: 36749958 DOI: 10.1097/jnn.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT BACKGROUND: Malnutrition is associated with high rates of complication, longer hospital stays, and increased morbidity and mortality. Malnutrition defined as undernutrition is common in patients with acquired brain injury (ABI); however, estimates vary remarkably. This study aimed to describe malnutrition at admission and after 4 weeks of subacute inpatient neurorehabilitation in patients with ABI using the new global consensus definition of malnutrition. METHODS: One hundred thirty-three patients with moderate to severe ABI consecutively admitted to a specialized neurorehabilitation hospital within a period of 4 months were screened for inclusion, of which 92 were included. Malnutrition was defined as at least 1 phenotypic criterion (weight loss, low body mass index, low muscle mass) and at least 1 etiologic criterion (reduced food intake, inflammation). Malnutrition on admission and after 4 weeks was compared using the McNemar test. RESULTS: The proportion of patients with malnutrition at admission was 42%, with more men (46%) than women (36%) fulfilling the criteria for malnutrition. The most frequent phenotypic and etiologic criteria were weight loss (56%) and inflammation (74%), respectively. During the 4 weeks of rehabilitation, the proportion of male patients fulfilling the individual criteria "weight loss" (difference, -21.4%) and "inflammation" (difference, -18.9%) decreased significantly; "low muscle mass" decreased borderline significant (difference, -8.9%), whereas "low body mass index" did not change. The proportion of female patients fulfilling individual criteria for malnutrition was stable or increased nonsignificantly. CONCLUSION: Malnutrition was common at admission to neurorehabilitation in patients with moderate to severe ABI, with more men than women fulfilling the criteria for malnutrition. The nutritional status improved after 4 weeks of rehabilitation in male patients, whereas it was largely unchanged in female patients. The results provide the basis for monitoring high-quality nutritional nursing care.
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Lactate dehydrogenase: relationship with the diagnostic GLIM criterion for cachexia in patients with advanced cancer. Br J Cancer 2023; 128:760-765. [PMID: 36517550 PMCID: PMC9977728 DOI: 10.1038/s41416-022-02099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although suggestive of dysregulated metabolism, the relationship between serum LDH level, phenotypic/aetiologic diagnostic Global Leadership Initiative on Malnutrition (GLIM) criteria and survival in patients with advanced cancer has yet to examined. METHODS Prospectively collected data from patients with advanced cancer, undergoing anti-cancer therapy with palliative intent, across nine sites in the UK and Ireland between 2011-2016, was retrospectively analysed. LDH values were grouped as <250/250-500/>500 Units/L. Relationships were examined using χ2 test for linear-by-linear association and binary logistics regression analysis. RESULTS A total of 436 patients met the inclusion criteria. 46% (n = 200) were male and 59% (n = 259) were ≥65 years of age. The median serum LDH was 394 Units/L and 33.5% (n = 146) had an LDH > 500 Units/L. LDH was significantly associated with ECOG-PS (p < 0.001), NLR (p < 0.05), mGPS (p < 0.05) and 3-month survival (p < 0.001). LDH was significantly associated with 3-month survival independent of weight loss (p < 0.01), BMI (p < 0.05), skeletal muscle mass (p < 0.01), metastatic disease (p < 0.05), NLR (p < 0.05) and mGPS (p < 0.01). DISCUSSION LDH was associated with performance status, systemic inflammation and survival in patients with advanced cancer. LDH measurement may be considered as an aetiologic criteria and become a potential therapeutic target in the treatment of cancer cachexia.
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Kang L, Liu X, Ji W, Zheng K, Li Y, Song Y, He H, Wang X, Yang T, Guan M, Zhu G, Gao Y, Guan Y, Wang L, Li W. Association of Neutrophil-to-Lymphocyte Ratio with Nutrition in Patients with Various Types of Malignant Tumors: A Multicenter Cross-Sectional Study. J Inflamm Res 2023; 16:1419-1429. [PMID: 37006808 PMCID: PMC10064873 DOI: 10.2147/jir.s401189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Aim Neutrophil-to-lymphocyte ratio (NLR) is an index of systemic inflammation. This study is to clarify the role of NLR in body functional status, nutritional risk and nutritional status in the course of tumor. Methods A multi-center cross-sectional study of patients with various types of malignant tumors was accrued from the whole country. There were 21,457 patients with completed clinical data, biochemical indicators, physical examination, the Patient-Generated Subjective Global Assessment (PG-SGA) and Nutrition Risk Screening 2002 (NRS2002) survey. Logistic regression analysis was used to figure out the influencing factors of NLR, and four models were established to evaluate the influence of NLR on body functions, nutritional risks and nutritional status. Results Male patients, TNM stage IV, total bilirubin, hypertension and coronary atherosclerotic heart disease (CAHD) were independent predictors of NLR >2.5. BMI, digestive systemic tumors and triglyceride negatively affect NLR in multivariable logistic regression. NLR was an independent predictor of Karnofsky Performance Scale (KPS), fat store deficit in all degrees, moderate and severe muscle deficit, mild fluid retention and PG-SGA grade. Conclusion Male patients and those with hypertension and CAHD are prone to systemic inflammation. Systemic inflammation significantly degrades body function status and nutritional status, increases nutritional risk and influences fat and muscle metabolism in patients with malignant tumor. Improving the intervenable indicators such as elevating albumin and pre-albumin, decreasing total bilirubin and enhancing nutrition support are imperative. Obesity and triglyceride behave like anti-systemic inflammation, which is misleading due to reverse causation in the course of malignancy.
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Affiliation(s)
- Lihua Kang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Xiangliang Liu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Wei Ji
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Kaiwen Zheng
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Yuguang Li
- College of Instrumentation and Electrical Engineering, Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Yanqiu Song
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Hua He
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Xiaomeng Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Tingting Yang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Meng Guan
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Ge Zhu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Yangyang Gao
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Yanjie Guan
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Lei Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Wei Li
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
- Correspondence: Wei Li, Cancer Center, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, People’s Republic of China, Tel +86-13756661267, Email
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Systemic Inflammation/Nutritional Status Scores Are Prognostic but Not Predictive in Metastatic Non-Small-Cell Lung Cancer Treated with First-Line Immune Checkpoint Inhibitors. Int J Mol Sci 2023; 24:ijms24043618. [PMID: 36835030 PMCID: PMC9966997 DOI: 10.3390/ijms24043618] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
Biomarkers of systemic inflammation/nutritional status have been associated with outcomes in advanced-stage non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). However, most of them were not tested in cohorts of patients treated with ICIs in combination with chemotherapy (CT) (ICI + CT) or with CT alone, making it impossible to discriminate a predictive from a prognostic effect. We conducted a single-center retrospective study to search for associations between various baseline biomarkers/scores that reflected the systemic inflammation/nutritional status (Lung Immune Prognostic Index, Modified Lung Immune Prognostic Index, Scottish Inflammatory Prognostic Score, Advanced Lung Cancer Inflammation Index, EPSILoN, Prognostic Nutritional Index, Systemic Immune-Inflammation Index, Gustave Roussy Immune Score, Royal Marsden Hospital Prognostic Score, Lung Immuno-oncology Prognostic Score 3, Lung Immuno-oncology Prognostic Score 4, score published by Holtzman et al., and Glasgow Prognostic Score) and outcomes in metastatic NSCLC treated in a first-line setting either with ICI in monotherapy (cohort 1; n = 75), ICI + CT (cohort 2; n = 56), or CT alone (cohort 3; n = 221). In the three cohorts, the biomarkers/scores were moderately associated with overall survival (OS) and progression-free survival (PFS). Their prognostic performance was relatively poor, with a maximum c-index of 0.66. None of them was specific to ICIs and could help to choose the best treatment modality. The systemic inflammation/nutritional status, associated with outcomes independently of the treatment, is therefore prognostic but not predictive in metastatic NSCLC.
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Calixto-Lima L, Wiegert EVM, Oliveira LCD, Chaves GV, Bezerra FF, Avesani CM. The association between low skeletal muscle mass and low skeletal muscle radiodensity with functional impairment, systemic inflammation, and reduced survival in patients with incurable cancer. JPEN J Parenter Enteral Nutr 2023; 47:265-275. [PMID: 36325962 DOI: 10.1002/jpen.2460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/06/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS Factors associated with the concomitant occurrence of low muscle mass and low muscle radiodensity are unclear. This study investigated whether different skeletal muscle phenotypes are associated with functional impairment, serum inflammatory markers, and survival in patients with incurable cancer. METHODS Three hundred and twenty-six patients (median age, 60 years; 67.5% female) who had abdominal or pelvic computed tomography (CT) scans up to 30 days before the initial assessment were enrolled in the study. CT images were used for the assessment of skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD). Optimal stratification analysis was used to derive cohort-specific cutoff points to define SMI and SMD groups with a higher risk for mortality (SMI, males <45.0 cm2 /m2 and females <44.0 cm2 /m2 ; SMD, males <34 Hounsfield units [HU] and females <30 HU). Based on these cutoffs, participants were classified into four phenotypes: low-risk SMI + low-risk SMD, high-risk SMI + low-risk SMD, low-risk SMI + high-risk SMD, and high-risk SMI + high-risk SMD. RESULTS Phenotypes with high-risk SMI or high-risk SMD, especially when combined, were associated with low handgrip strength, poor performance status, higher C-reactive protein, and lower serum albumin levels. The phenotypes with high-risk SMD, regardless of low-risk SMI (hazard ratio [HR], 1.74; 95% CI, 1.05-2.88) or high-risk SMI (HR, 1.99; 95% CI, 1.29-3.05) were associated with higher 90 days' mortality risk. CONCLUSION In patients with incurable cancer, phenotype groups with high-risk SMI and high-risk SMD, particularly when combined, were associated with worse functional impairment and inflammation. Moreover, high-risk SMD was associated with increased mortality risk.
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Affiliation(s)
- Larissa Calixto-Lima
- National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil.,Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | | | | | - Carla Maria Avesani
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Department of Clinical Science, Technology and Intervention, Division of Renal Medicine and Baxter Novum, Karolinska Institute, Stockholm, Sweden
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Costa T, Nogueiro J, Ribeiro D, Viegas P, Santos-Sousa H. Impact of serum albumin concentration and neutrophil-lymphocyte ratio score on gastric cancer prognosis. Langenbecks Arch Surg 2023; 408:57. [PMID: 36689025 DOI: 10.1007/s00423-023-02799-3] [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: 09/12/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION/AIM Serum albumin concentration (COA) and neutrophil-lymphocyte ratio (NLR) could reflect immunological and nutritional status. We aim to evaluate the impact of COA-NLR score on the prognosis of gastric cancer (GC). MATERIAL AND METHODS We perform a retrospective analysis on a database of 637 GC cases, between January 2010 and December 2017. In 396 patients, the inclusion criteria for this study were met (non-resectional or palliative surgery were excluded). Analytic data was only available in 203 patients. COA-NLR score was defined as follows: COA under 35 g/L and NLR value of 2.585 or higher, score 2; one of these conditions, score 1; and neither, score 0. RESULTS In our population (n = 203), 87 patients were classified as score 0, 82 as score 1 and 34 as score 2. COA-NLR score was significantly associated with DFS (HR 1.674; CI 95% 1.115-2.513; p = 0.013) and with OS (HR 2.072; CI 95% 1.531-2.805; p < 0.001). Kaplan-Meier curve analysis (log rank test) revealed that a higher score of COA-NLR predicted a worse OS (p < 0.001) and DFS (p = 0.03). COA-NLR was an independent prognostic factor for OS when adjusted to pStage and age (adjusted HR 1.566; CI 95% 1.145-2.143; p = 0.005). CONCLUSIONS Preoperative COA-NLR score was significantly associated with worse OS and DFS and, in this way, with worse prognosis on GC patients submitted to curative-intent resectional surgery.
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Affiliation(s)
- Teresa Costa
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Surgery Department, Guarda Local Health Unit, Guarda, Portugal.
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Daniel Ribeiro
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Viegas
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
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Wasamoto S, Imai H, Tsuda T, Nagai Y, Minemura H, Yamada Y, Umeda Y, Kishikawa T, Shiono A, Kozu Y, Shiihara J, Yamaguchi O, Mouri A, Kaira K, Kanazawa K, Taniguchi H, Kaburagi T, Minato K, Kagamu H. Pretreatment glasgow prognostic score predicts survival among patients administered first-line atezolizumab plus carboplatin and etoposide for small cell lung cancer. Front Oncol 2023; 12:1080729. [PMID: 36741711 PMCID: PMC9895374 DOI: 10.3389/fonc.2022.1080729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background There are no established predictive biomarkers for the effectiveness of first-line atezolizumab plus carboplatin and etoposide therapy in patients with small-cell lung cancer (SCLC). Therefore, the current study aimed to investigate whether the Glasgow prognostic score (GPS), neutrophil-to-lymphocyte ratio (NLR), and body mass index (BMI) can predict the effectiveness of first-line atezolizumab plus carboplatin and etoposide therapy in patients with extensive-disease SCLC. Methods We reviewed data from 84 patients who received first-line atezolizumab plus carboplatin and etoposide therapy for SCLC at nine Japanese institutions between August 2019 and May 2021. Further, we evaluated the prognostic value of the GPS, NLR, and BMI. The Kaplan-Meier and Cox proportional hazard models were used to examine differences in progression-free survival (PFS) and overall survival (OS). Moreover, the GPS, NLR, and BMI consisted of C-reactive protein and albumin concentrations, neutrophil and lymphocyte counts, and body weight and height, respectively. Results The response rate was 72.6% (95% confidence interval: 63.0-82.1%). The median PFS and OS from the initiation of treatment were 5.4 (95% CI: 4.9-5.9) months and 15.4 (95% CI: 11.4-16.8) months, respectively. The GPS independently predicted the effectiveness of first-line atezolizumab plus carboplatin and etoposide treatment, as a favorable GPS (GPS 0-1) was correlated with significantly better PFS and OS rates compared to a poor GPS (GPS 2) (PFS: 5.8 vs. 3.8 months, p = 0.0005; OS: 16.5 vs. 8.4 months, p<0.0001). Conclusions This is the first analysis to evaluate the association between the GPS, NLR, and BMI and the treatment effectiveness of survival among patients receiving first-line atezolizumab plus carboplatin and etoposide therapy for SCLC. Among patients receiving this treatment for SCLC, GPS was significantly associated with the PFS and OS rates, suggesting that GPS might be useful for evaluating therapeutic outcomes in these patients.
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Affiliation(s)
- Satoshi Wasamoto
- Division of Respiratory Medicine, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan,Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Gunma, Japan,*Correspondence: Hisao Imai,
| | - Takeshi Tsuda
- Division of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Yoshiaki Nagai
- Department of Respiratory Medicine, Jichi Medical University, Saitama Medical Center, Saitama, Saitama, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yutaka Yamada
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Yukihiro Umeda
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Takayuki Kishikawa
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Ayako Shiono
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Yuki Kozu
- Division of Respiratory Medicine, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan
| | - Jun Shiihara
- Department of Respiratory Medicine, Jichi Medical University, Saitama Medical Center, Saitama, Saitama, Japan
| | - Ou Yamaguchi
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Atsuto Mouri
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hirokazu Taniguchi
- Division of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Takayuki Kaburagi
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Gunma, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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Ota M, Komeda K, Iida H, Ueno M, Kosaka H, Nomi T, Tanaka S, Nakai T, Hokutou D, Matsumoto M, Hirokawa F, Lee SW, Kaibori M, Kubo S. The Prognostic Value of Preoperative Serum Markers and Risk Classification in Patients with Hepatocellular Carcinoma. Ann Surg Oncol 2023; 30:2807-2815. [PMID: 36641514 DOI: 10.1245/s10434-022-13007-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/10/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Complex hepatocellular carcinoma (HCC) prognostic biomarkers have been reported in various studies. We aimed to establish biomarkers that could predict prognosis, and formulate a simple classification using non-invasive preoperative blood test data. METHODS We retrospectively identified 305 patients for a discovery cohort who had undergone HCC-related hepatectomy at four Japanese university hospitals between January 1, 2011 and December 31, 2013. Preoperative blood test parameter optimal cut-off values were determined using receiver operating characteristic curve analysis. Cox uni- and multivariate analyses were used to determine independent prognostic factors. Risk classifications were established using classification and regression tree (CART) analysis. Validation was performed with 267 patients from three other hospitals. RESULTS In multivariate analysis, α-fetoprotein (AFP, p < 0.001), protein induced by vitamin K absence or antagonist-II (PIVKA-II, p = 0.006), and C-reactive protein (CRP, p < 0.001) were independent prognostic factors for overall survival (OS). AFP (p = 0.007), total bilirubin (p = 0.001), and CRP (p = 0.003) were independent recurrent risk factors for recurrence-free survival (RFS). CART analysis results formed OS (CRP, AFP, and albumin) and RFS (PIVKA-II, CRP, and total bilirubin) decision trees, based on machine learning using preoperative serum markers, with three risk classifications. Five-year OS (low risk, 80.0%; moderate risk, 56.3%; high risk, 25.2%; p < 0.001) and RFS (low risk, 43.4%; moderate risk, 30.8%; high risk, 16.6%; p < 0.001) risks differed significantly. These classifications also stratified OS and RFS risk in the validation cohort. CONCLUSION Three simple risk classifications using preoperative non-invasive prognostic factors could predict prognosis.
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Affiliation(s)
- Masato Ota
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
| | - Koji Komeda
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Shiga, Shiga, Japan
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hisashi Kosaka
- Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takeo Nomi
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan.,Department of Surgery, Uji-Tokusyukai Medical Center, Uji, Kyoto, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University of Graduate School of Medicine, Osaka, Osaka, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, Higashiosaka, Osaka, Japan
| | - Daisuke Hokutou
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Masataka Matsumoto
- Department of Surgery, Faculty of Medicine, Kindai University, Higashiosaka, Osaka, Japan
| | - Fumitoshi Hirokawa
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University of Graduate School of Medicine, Osaka, Osaka, Japan
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Dewi EU, Nursalam, Mahmudah, Yunitasari E. The effect of peer support psychoeducation based on experiential learning on self-care demands among breast cancer patients with post-chemotherapy. J Public Health Res 2023; 12:22799036221146901. [PMID: 36643605 PMCID: PMC9834624 DOI: 10.1177/22799036221146901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Breast cancer patients with post-chemotherapy had self-care deficit problems. The patient is unable to perform activities of daily living which can decrease the quality of life. One of the factors that affected self-care deficit among breast cancer patients was inadequate information. This study aimed to determine the effects of peer support psychoeducation based on experiential learning on the self-care demand. Design and methods This study used a quasi-experimental design with pretest and posttest. The independent variable of the study was the application of peer support psychoeducation based on experiential learning and the dependent variable was the self-care demand. The inclusion criteria in this study were breast cancer patients with post-chemotherapy. The exclusion criteria in this study were patients who were unconscious. We selected the experimental and control group randomly. The total sample in this study was 60 people, 30 respondents for the experiment group and 30 respondents for the control group. Peer support psychoeducation based on experiential learning was developed from Wauchope's psychoeducational theory, Orem's self-care, and David Kolb's experiential learning. We used a self-report questionnaire to measure self-care demand. Data were analyzed using Wilcoxon signed rank and Mann-Whitney U tests. Results Peer support psychoeducation based on experiential learning has a significant effect on self-care demand, namely ADL (p = 0.002), pain management (p = 0.002), nutritional management (p = 0.000), and rest and sleep (p = 0.000). Conclusion Psychoeducation based on experiential learning was recommended for nursing care or physician to increase self-care demand.
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Affiliation(s)
- Erika Untari Dewi
- Faculty of Public Health, Universitas
Airlangga, Surabaya, Indonesia,William Booth Health Science College in
Surabaya, East Java, Indonesia
| | - Nursalam
- Faculty of Nursing, Universitas
Airlangga, Surabaya, Indonesia,Nursalam, Faculty of Nursing, Universitas
Airlangga, Surabaya, 60115, Indonesia.
| | - Mahmudah
- Faculty of Public Health, Universitas
Airlangga, Surabaya, Indonesia
| | - Esti Yunitasari
- Faculty of Nursing, Universitas
Airlangga, Surabaya, Indonesia
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46
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Li Y, Fan X, Yu Q, Zhai H, Mi J, Lu R, Jiang G, Wu K. Higher aorta dose increased neutrophil-to-lymphocyte ratio resulting in poorer outcomes in stage II-III non-small cell lung cancer. Thorac Cancer 2023; 14:555-562. [PMID: 36604971 PMCID: PMC9968602 DOI: 10.1111/1759-7714.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study focused on the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the dose of organs at risk in patients with stage II-III non-small cell lung cancer (NSCLC) receiving intensity-modulated radiotherapy. METHODS The clinical characteristics and dosimetric parameters of 372 patients were collected retrospectively. A high NLR was defined as that ≥1.525. Survival analysis was conducted using the Kaplan-Meier and Cox regression analysis. Least absolute shrinkage and selection operator (LASSO) analysis was conducted to select appropriate dosimetric parameters. The risk factors of NLR were evaluated using univariate and multivariate logistic regression analyses. RESULTS Patients with a high NLR had poorer progression-free survival (PFS) (p = 0.011) and overall survival (OS) (p = 0.061). A low NLR (<1.525) predicted better PFS (hazard ratio [HR] 0.676, 95% confidence interval [CI]: 0.508-0.900, p = 0.007) and OS (HR 0.664, 95% CI: 0.490-0.901, p = 0.009). The aorta dose differed between the low and high NLR groups (all <0.1) in the univariate analysis. An aorta V10 was confirmed as a significant risk factor for a high NLR (odds ratio [OR] 1.029, 95% CI: 1.011-1.048, p = 0.002). Receiving chemotherapy before (OR 0.428, 95% CI: 0.225-0.813, p = 0.010) and during (OR 0.491, 95% CI: 0.296-0.815, p = 0.006) radiotherapy were predictive factors of a low NLR. CONCLUSION The aorta dose was significantly associated with a high NLR. Patients with stage II-III NSCLC with a high NLR had poorer prognosis. Receiving chemotherapy before and/or during radiotherapy predicted a low NLR.
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Affiliation(s)
- Yaqi Li
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghaiChina,Shanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Proton and Heavy Ion Center, Fudan University Cancer HospitalShanghaiChina,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina,Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Shanghai Clinical Research Center for Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Shanghai Key Laboratory of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Xingwen Fan
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Shanghai Clinical Research Center for Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Shanghai Key Laboratory of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Qi Yu
- Department of Clinical LaboratoryFudan University Shanghai Cancer CenterShanghaiChina
| | - Haoyang Zhai
- Department of Medical PhysicsFudan University Shanghai Cancer CenterShanghaiChina
| | - Jing Mi
- Department of Medical PhysicsFudan University Shanghai Cancer CenterShanghaiChina
| | - Renquan Lu
- Department of Clinical LaboratoryFudan University Shanghai Cancer CenterShanghaiChina
| | - Guoliang Jiang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghaiChina,Shanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Proton and Heavy Ion Center, Fudan University Cancer HospitalShanghaiChina,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina,Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Shanghai Clinical Research Center for Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Shanghai Key Laboratory of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Kailiang Wu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghaiChina,Shanghai Key Laboratory of Radiation Oncology (20dz2261000)Shanghai Proton and Heavy Ion Center, Fudan University Cancer HospitalShanghaiChina,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation TherapyShanghaiChina,Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Shanghai Clinical Research Center for Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina,Shanghai Key Laboratory of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
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Yamamichi G, Kato T, Yumiba S, Tomiyama E, Koh Y, Nakano K, Matsushita M, Hayashi Y, Ishizuya Y, Watabe T, Hatano K, Kawashima A, Ujike T, Ono Y, Takada T, Takada S, Imamura R, Nonomura N, Uemura M. Diagnostic and prognostic significance of tartrate-resistant acid phosphatase type 5b in newly diagnosed prostate cancer with bone metastasis: A real-world multi-institutional study. Int J Urol 2023; 30:70-76. [PMID: 36305578 PMCID: PMC10092858 DOI: 10.1111/iju.15063] [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: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Approximately, 90% of men with advanced prostate cancer will develop bone metastasis. However, there have been few reports about noninvasive biomarker to detect and predict clinical outcome of bone metastasis (BM) in prostate cancer patients. METHODS We examined 1127 patients who underwent prostate biopsy from August 2012 to June 2017. We also investigated bone turnover markers such as bone-specific alkaline phosphatase, type I collagen cross-linked N-terminal telopeptide, C-terminal pyridinoline cross-linked telopeptide of type I collagen, and tartrate-resistant acid phosphatase type 5b (TRACP 5b). RESULTS A total of 282 patients were diagnosed as prostate cancer with complete clinical data, and 34 patients with bone metastasis. Multivariate analysis revealed C-terminal pyridinoline cross-linked telopeptide of type I collagen, tartrate-resistant acid phosphatase type 5b, and prostate-specific antigen (PSA) were independent biomarkers in detection of BM (p < 0.05, respectively). Furthermore, we developed predictive model formula based on tartrate-resistant acid phosphatase type 5b and PSA, for which the area under the curve was 0.95. In patients with bone metastasis, multivariate cox proportional hazards analysis revealed that this model was significantly associated with poor clinical outcome of cancer-specific survival (p < 0.05). In validation cohort with 137 patients, we also confirmed the utility of this model for diagnosis of BM (the area under the curve = 0.95). CONCLUSIONS Our developed formula of tartrate-resistant acid phosphatase type 5b in accordance with PSA may serve as the useful tool in diagnosis and prediction of clinical outcome for prostate cancer with bone metastasis.
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Affiliation(s)
- Gaku Yamamichi
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoru Yumiba
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eisuke Tomiyama
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Koh
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Nakano
- Department of Urology, Osaka Police Hospital, Osaka, Japan
| | - Makoto Matsushita
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yujiro Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yu Ishizuya
- Department of Urology, Higashiosaka City Medical Center, Osaka, Japan
| | - Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Hatano
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ono
- Department of Urology, Higashiosaka City Medical Center, Osaka, Japan
| | | | - Shingo Takada
- Department of Urology, Osaka Police Hospital, Osaka, Japan
| | - Ryoichi Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
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48
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Tanaka T, Yoshida T, Masuda K, Takeyasu Y, Shinno Y, Matsumoto Y, Okuma Y, Goto Y, Horinouchi H, Yamamoto N, Ohe Y. Prognostic role of modified Glasgow Prognostic score in elderly non-small cell lung cancer patients treated with anti-PD-1 antibodies. Respir Investig 2023; 61:74-81. [PMID: 36460585 DOI: 10.1016/j.resinv.2022.10.003] [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: 08/09/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to investigate whether the immunosenescence-related score is a critical prognostic predictor of anti-programmed cell death protein 1 (PD-1) axis inhibitors in elderly patients with advanced non-small cell lung cancer (NSCLC). METHODS We reviewed 51 patients with advanced NSCLC aged ≥75 years, who were treated with nivolumab or pembrolizumab at the National Cancer Center Hospital between December 2015 and April 2019. Factors such as modified Glasgow prognostic score (mGPS), Neutrophil-to-lymphocyte ratio (NLR), and Charlson comorbidity index (CCI) were used to assess immunosenescence. RESULTS The objective response rate (ORR) and disease control rate (DCR) of all patients were 25.4% (95% confidence interval [CI]: 14.3-39.6) and 52.9% (95% CI: 38.5-67.1), respectively. High mGPS (score of 2) was associated with low DCR compared to low mGPS (score of 0-1) (26.0% vs. 54.0%, p = 0.03). However, none of these scores were significantly related to the ORR. High mGPS was significantly linked to shorter median progression-free survival (mPFS) (4.2 mos. vs. 12.7 mos, p < 0.01), and median overall survival (mOS) (4.8 mos. vs. 28.1 mos, p = 0.03). However, neither CCI nor NLR was associated with prognosis. Multivariate regression analysis identified high mGPS as a significant prognostic factor for mOS (hazard ratio, HR: 0.31 [95% CI: 0.13-0.71], p < 0.01). CONCLUSIONS High mGPS scores significantly impaired DCR, mPFS, and mOS in patients with advanced NSCLC treated with anti-PD-1 antibodies.
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Affiliation(s)
- Tomohiro Tanaka
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Medical & Dental Hospital, Niigata, Japan; Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Tatsuya Yoshida
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Masuda
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Takeyasu
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Shinno
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Xie H, Wei L, Liu M, Liang Y, Yuan G, Gao S, Wang Q, Lin X, Tang S, Gan J. Prognostic significance of preoperative prognostic immune and nutritional index in patients with stage I-III colorectal cancer. BMC Cancer 2022; 22:1316. [PMID: 36522702 PMCID: PMC9756500 DOI: 10.1186/s12885-022-10405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To explore the value of preoperative prognostic immune and nutritional index (PINI) in predicting postoperative complications and long-term outcomes in patients with stage I-III colorectal cancer (CRC). METHODS Restricted cubic splines were used to assess the relationship between PINI and survival in patients with CRC. The Kaplan-Meier method and log-rank test were used to plot the survival curves. The Cox proportional hazards model was used to evaluate independent prognostic predictors in patients with CRC. A logistic regression analysis was performed to identify independent predictors of postoperative complications. The least absolute shrinkage and selection operator (LASSO) logistic regression algorithm was used for feature screening. RESULTS An evident positive dose-response relationship between PINI and survival in patients with CRC was identified. Compared with patients with a high PINI, those with a low PINI had worse disease-free survival (DFS) (47.9% vs. 66.9%, p < 0.001) and overall survival (OS) (49.7% vs. 70.2%, p < 0.001). The Cox proportional hazards model revealed that PINI was independently associated with DFS (hazard ratio [HR], 0.823; 95% confidence interval [CI], 0.754-0.898; p < 0.001) and OS (HR, 0.833; 95% CI, 0.761-0.912; p < 0.001) in patients with CRC. In the logistic regression analysis, PINI was an independent factor affecting postoperative complications in patients with CRC (odds ratio, 0.710; 95%CI: 0.610-0.810, p < 0.001). The LASSO logistic regression algorithm was used to screen for effective prognostic variables. Finally, we constructed PINI-based nomograms to predict postoperative 1-5-year PFS, and OS in patients with CRC. CONCLUSION PINI is an effective biomarker for predicting postoperative complications, DFS, and OS in patients with stage I-III CRC.
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Affiliation(s)
- Hailun Xie
- grid.412594.f0000 0004 1757 2961Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021 P.R. China ,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China
| | - Lishuang Wei
- grid.256607.00000 0004 1798 2653Department of Geriatric Respiratory Disease Ward, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi P.R. China
| | - Mingxiang Liu
- grid.412594.f0000 0004 1757 2961Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021 P.R. China ,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China
| | - Yanren Liang
- grid.412594.f0000 0004 1757 2961Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021 P.R. China ,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China
| | - Guanghui Yuan
- grid.412594.f0000 0004 1757 2961Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021 P.R. China ,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China
| | - Shunhui Gao
- grid.412594.f0000 0004 1757 2961Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021 P.R. China ,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China
| | - Qiwen Wang
- grid.412594.f0000 0004 1757 2961Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021 P.R. China ,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China
| | - Xin Lin
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China ,grid.256607.00000 0004 1798 2653Grade 2018, Department of Clinical Medicine, Guangxi Medical University, Nanning, Guangxi P.R. China
| | - Shuangyi Tang
- grid.412594.f0000 0004 1757 2961Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi 530021 Nanning, P.R. China
| | - Jialiang Gan
- grid.412594.f0000 0004 1757 2961Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021 P.R. China ,Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi P.R. China
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50
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Mie T, Sasaki T, Okamoto T, Takeda T, Mori C, Furukawa T, Kasuga A, Matsuyama M, Ozaka M, Sasahira N. Treatment outcomes of nanoliposomal irinotecan as second-line chemotherapy after gemcitabine and nab-paclitaxel in metastatic and recurrent pancreatic cancer. Jpn J Clin Oncol 2022; 52:1399-1407. [PMID: 36111430 DOI: 10.1093/jjco/hyac145] [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: 07/21/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To compare the treatment outcomes of nanoliposomal-irinotecan (nal-IRI) plus fluorouracil and leucovorin (5-FU/LV) and modified FOLFIRINOX (mFFX) as second-line treatment after gemcitabine with nab-paclitaxel (GnP) for metastatic and recurrent pancreatic cancer. METHODS We retrospectively analyzed consecutive patients with metastatic or recurrent pancreatic cancer treated with nal-IRI plus 5-FU/LV or mFFX after first-line GnP treatment between March 2014 and October 2021 in our hospital. Patient characteristics, treatment outcomes and adverse events were extracted for comparison. RESULTS Two hundred sixteen patients were included (nal-IRI plus 5-FU/LV/mFFX: 50/166). Patients in the nal-IRI plus 5-FU/LV group were older, had poorer ECOG PS, and a higher rate of peritoneal metastasis than those in the mFFX group. Median overall survival was 9.5 and 9.8 months (P = 0.97), respectively, and the median progression-free survival was 4.5 vs 4.8 months (P = 0.61), respectively. Anorexia, fatigue and peripheral neuropathy were more common in the mFFX group, but there was no difference in grade 3/4 adverse events between the two groups. CONCLUSIONS There was no significant difference in efficacy between nal-IRI plus 5-FU/LV and mFFX after GnP. Nal-IRI plus 5-FU/LV appears to be a viable alternative to mFFX as second-line treatment after GnP.
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Affiliation(s)
- Takafumi Mie
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Okamoto
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Takeda
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Chinatsu Mori
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takaaki Furukawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Kasuga
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masato Matsuyama
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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