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Rajendran AT, Vadakkepushpakath AN. Natural Food Components as Biocompatible Carriers: A Novel Approach to Glioblastoma Drug Delivery. Foods 2024; 13:2812. [PMID: 39272576 PMCID: PMC11394703 DOI: 10.3390/foods13172812] [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: 07/08/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 09/15/2024] Open
Abstract
Efficient drug delivery methods are crucial in modern pharmacotherapy to enhance treatment efficacy, minimize adverse effects, and improve patient compliance. Particularly in the context of glioblastoma treatment, there has been a recent surge in interest in using natural dietary components as innovative carriers for drug delivery. These food-derived carriers, known for their safety, biocompatibility, and multifunctional properties, offer significant potential in overcoming the limitations of conventional drug delivery systems. This article thoroughly overviews numerous natural dietary components, such as polysaccharides, proteins, and lipids, used as drug carriers. Their mechanisms of action, applications in different drug delivery systems, and specific benefits in targeting glioblastoma are examined. Additionally, the safety, biocompatibility, and regulatory considerations of employing food components in drug formulations are discussed, highlighting their viability and future prospects in the pharmaceutical field.
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Affiliation(s)
- Arunraj Tharamelveliyil Rajendran
- Department of Pharmaceutics, NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Nitte (Deemed to be University), Mangalore 575018, Karnataka, India
| | - Anoop Narayanan Vadakkepushpakath
- Department of Pharmaceutics, NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Nitte (Deemed to be University), Mangalore 575018, Karnataka, India
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2
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Frailty in Patients Undergoing Surgery for Brain Tumors: A Systematic Review of the Literature. World Neurosurg 2022; 166:268-278.e8. [PMID: 35843574 DOI: 10.1016/j.wneu.2022.07.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Emerging literature suggests that frailty may be an important driver of postoperative outcomes in patients undergoing surgery for brain tumors. We systematically reviewed the literature on frailty in patients with brain tumor with respect to 3 questions: What methods of frailty assessment have been applied to patients with brain tumor? What thresholds have been defined to distinguish between different levels of frailty? What clinical outcomes does frailty predict in patients with brain tumor? METHODS A literature search was conducted using PubMed, Embase, The Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov. Included studies were specific to patients with brain tumor, used a validated instrument to assess frailty, and measured the impact of frailty on postoperative outcomes. RESULTS Of 753 citations, 21 studies met our inclusion criteria. Frailty instruments were studied, in order of frequency reported, including the 5-factor modified frailty index, 11-factor modified frailty index, Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator, and Hopkins Frailty Score. Multiple different conventions and thresholds were reported for distinguishing the levels of frailty. Clinical outcomes associated with frailty included mortality, survival, complications, length of stay, charges, costs, discharge disposition, readmissions, and operative time. CONCLUSIONS Frailty is an increasingly popular concept in patients with brain tumor that is associated with important clinical outcomes. However, the extant literature is largely comprised of retrospective studies with heterogeneous definitions of frailty, thresholds for defining levels of frailty, and patient populations. Further work is needed to understand best practices in assessing frailty in patients with brain tumor and applying these concepts to clinical practice.
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Meng C, Gan L, Li K, Yi F, Peng L, Li J, Li Y. Prognostic nutritional index before surgical treatment may serve as a prognostic biomarker for patients with upper tract urothelial carcinoma: A systematic review and meta-analysis. Front Nutr 2022; 9:972034. [PMID: 36211527 PMCID: PMC9538959 DOI: 10.3389/fnut.2022.972034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis meta-analysis aims to assess whether the prognostic nutritional index (PNI) score before treatment can be an independent biomarker of the prognosis of patients with upper tract urothelial carcinoma (UTUC).Materials and methodsWe systematically search PubMed, Embase, Scopus database, and Cochrane Library, and the search time is up to April 2021. Use STATA 16.0 software for data processing and statistical analysis.ResultsSix studies, including seven cohorts, were eventually included in our meta-analysis. The meta-analysis results showed that low PNI scores are associated with worse OS (HR: 1.92; 95% CI 1.60 to 2.30; P < 0.01), DFS/RFS/PFS (HR: 1.57; 95% CI 1.33 to 1.85; P < 0.01), and CSS/DSS (HR: 1.79; 95% CI 1.49 to 2.16; P < 0.01), which supported the PNI score as an independent prognostic biomarker for survival outcomes. The subgroup analysis and Begg’s test showed that the results were stable.ConclusionBased on current evidence, this meta-analysis proves that the PNI score of UTUC patients before treatment is an independent prognostic biomarker. It performs well on OS, DFS/RFS/PFS, and CSS/DSS. This conclusion needs to be verified by a prospective cohort study with larger sample size and a more rigorous design.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338503], identifier [CRD42022338503].
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Affiliation(s)
- Chunyang Meng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Lijian Gan
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Kangsen Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Fulin Yi
- Department of Anesthesiology, North Sichuan Medical College (University), Nanchong, China
| | - Lei Peng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yunxiang Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China
- *Correspondence: Yunxiang Li,
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Yang C, Lan T, Wang Y, Huang WH, Li SM, Li J, Li FP, Li YR, Wang ZF, Li ZQ. Cumulative Scoring Systems and Nomograms for Predicating Survival in Patients With Glioblastomas: A Study Based on Peripheral Inflammatory Markers. Front Oncol 2022; 12:716295. [PMID: 35719947 PMCID: PMC9198436 DOI: 10.3389/fonc.2022.716295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Inflammation is a hallmark of cancers. The purpose of the present study was to evaluate the prognostic potential of hematological inflammatory markers in glioblastoma multiforme (GBM) patients. The clinical data of 99 patients with lower-grade gliomas and 88 patients with GBMs were retrospectively analyzed. The optimal cutoff values for peripheral markers were determined by X-tile. Kaplan-Meier and Cox proportional hazard regression analyses were performed to identify markers with prognostic significance. Several scoring systems were constructed by combining these prognostic markers. The predictive accuracies of nomograms incorporating these scoring systems were evaluated by Harrell’s concordance index and receiver operating characteristic curve analysis. GBM patients exhibited higher neutrophil counts (p=0.001), neutrophil-to-lymphocyte ratio (NLR) (p<0.001), and platelet-to-lymphocyte ratio (PLR) (p=0.001), as well as lower lymphocyte counts (p=0.023), lymphocyte-to-monocyte ratio (LMR) (p=0.015), and albumin-to-globulin ratio (AGR) (p=0.003) than those with lower-grade gliomas. Multivariate analysis indicated that a high NLR (> 2.0) (Hazard ratio[HR]=2.519, 95% confidence interval (CI): 1.220-5.204, p=0.013), low LMR (< 2.3) (HR=2.268, 95%CI: 1.172-4.386, p=0.015), or low AGR (< 1.7) (HR=2.924, 95%CI: 1.389-6.135, p=0.005) were associated with poor overall survival in GBM patients. The scoring systems of AGR-NLR, AGR-LMR, and LMR-NLR were associated with GBM survival. The nomogram integrating AGR-NLR score had the best efficacy in predicting GBM survival (c-index=0.874). Pretreatment scores of AGR-NLR, AGR-LMR, and LMR-NLR may serve as prognostic factors for GBM patients, and a nomogram integrating AGR-NLR may provide a reliable tool to facilitate personalized preoperative evaluations.
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Affiliation(s)
- Chao Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tian Lan
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yi Wang
- Department of Physiology, Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Wen-Hong Huang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Si-Man Li
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Li
- Department of Physiology, Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Feng-Ping Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yi-Rong Li
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ze-Fen Wang
- Department of Physiology, Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Zhi-Qiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Silahli M, Tekin M. Albumin haemoglobin index: A novel pre-operative marker for predicting mortality and hospital stay in patients under one-year undergoing gastrointestinal surgeries. Afr J Paediatr Surg 2022; 19:89-96. [PMID: 35017378 PMCID: PMC8809471 DOI: 10.4103/ajps.ajps_4_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of this study was to evaluate the mortality and morbidity of infants <1 year of age with intestinal obstruction requiring surgical intervention and to investigate the factors affecting mortality and hospital length of stay in paediatric surgery, including albumin-haemoglobin index. PATIENTS AND METHODS The records of gastrointestinal paediatric surgeries in the past 10 years of patients who were <1-year-old at Baskent University Konya Hospital were obtained from the hospital and retrospectively studied. Patient characteristics, especially the relationship between albumin haemoglobin index (AHI) and hospital duration and mortality, were examined. According to the surgical areas, it also subjected this relationship to further analysed in subgroups. RESULTS There were 144 cases who fulfilled the inclusion criteria. Pre-operative serum AHI was analysed using receiver operating characteristics (ROC) curve analyzes. In the ROC analysis, AHI had a diagnostic value in predicting case discharge rates (area under the curve: 0.755, P = 0.001). When the cut-off point was set at 46.18, the sensitivity of the test was 57.5% and the sensitivity for predicting survival was 84%. In the logistic regression model to estimate survival, the odds ratio of AHI was 1.063 (confidence interval: 1.020-1.108, P = 0.004). In subgroup analyzes, AHI positively predicted survival in the NEC group and in the other group. In a linear regression model analysing the effect of AHI on hospital stay of length, AHI explained 10% of the variance in the hospital stay of length variable and significantly and negatively influenced the hospital length variable (β = -0.319, P = 0.05). In the linear regression model for subgroup analyzes, AHI significantly and negatively predicted hospital length of stay in the NEC and pyloric surgery groups, but positively predicted hospital length of stay in the perforation group. CONCLUSION The AHI can be used as a valuable marker to predict the likelihood of discharge and length of hospital stay in paediatric surgical cases <1-year-old.
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Affiliation(s)
- Musa Silahli
- Department of Paediatrics, Konya Training and Application Centre, Baskent University Medical Faculty, Baskent University, Konya, Turkey
| | - Mehmet Tekin
- Department of Paediatrics, Konya Training and Application Centre, Baskent University Medical Faculty, Baskent University, Konya, Turkey
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Liu J, Wu P, Lai S, Song X, Wang M, Wang X, Liu S, Hou H, Zhang Y, Wang J. Clinicopathological and Prognostic Significance of Preoperative Prognostic Nutritional Index in Patients with Upper Urinary Tract Urothelial Carcinoma. Nutr Cancer 2022; 74:2964-2974. [PMID: 35297733 DOI: 10.1080/01635581.2022.2049829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To investigate the prognostic value of preoperative prognostic nutritional index (PNI) to predict oncological outcome and intravesical recurrence (IVR) in upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). This study involved the clinical data of 255 patients with UTUC who had undergone RNU from 2004 to 2019 at our institution. Patients were grouped according to an optimal value of preoperative PNI. Kaplan-Meier analyses and Cox proportional hazards models were used to analyze the associations of preoperative PNI with progression-free survival (PFS), cancer-specific survival (CSS), overall survival (OS), and IVR. Patients with low PNI were more likely to be older, have higher tumor stage, higher eGFR, and multifocal lesions. No significant association was found between PNI and CSS, IVR. In subgroup analysis according to the risk stratification, low PNI was associated with worse PFS, CSS, and OS for patients with higher risk. Multivariate analyses showed that elevated PNI was an independent prognostic indicator for PFS (P = 0.014) and OS (P = 0.048). A low PNI is an independent predictor of PFS and OS in patients with UTUC after RNU. By subgroup analysis, the prognostic value of PNI was limited to patients with higher risk. PNI may become a useful biomarker to predict oncological outcomes in patients with UTUC after RNU.
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Affiliation(s)
- Jianyong Liu
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Pengjie Wu
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Shicong Lai
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xinda Song
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Miao Wang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Shengjie Liu
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, Beijing, People's Republic of China.,National Center of Gerontology, Beijing, People's Republic of China.,Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Beijing Hospital Continence Center, Beijing, People's Republic of China
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Mao W, Wang K, Wu Y, Ni J, Zhang H, Wang Y, Wu Z, Liu R, Geng J, Chen S, Chen M. Prognostic Significance of Modified Advanced Lung Cancer Inflammation Index in Patients With Renal Cell Carcinoma Undergoing Laparoscopic Nephrectomy: A Multi-Institutional, Propensity Score Matching Cohort Study. Front Nutr 2022; 8:781647. [PMID: 35127784 PMCID: PMC8811296 DOI: 10.3389/fnut.2021.781647] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background We conducted a multi-institutional clinical study to assess the prognostic value of the advanced lung cancer inflammatory index (ALI) and modified ALI (mALI) in patients with renal cell carcinoma (RCC). Methods We collected 440 patients who underwent laparoscopic nephrectomy at three centers from 2014 to 2019. ALI was defined as body mass index (BMI) × serum albumin (ALB)/neutrophil-to-lymphocyte ratio (NLR) and mALI as L3 muscle index × ALB/NLR. Kaplan-Meier curves, receiver operating characteristic (ROC) curves and Cox survival analysis were used to assess the effect of ALI and mALI on overall survival (OS). In addition, we performed 1:1 propensity score matching (PSM) for the high mALI and low mALI groups to further explore the impact of mALI on survival in RCC patients. Results The optimal cut-off values for ALI and mALI were 40.6 and 83.0, respectively. Based on the cut-off values, we divided the patients into high ALI and low ALI groups, high mALI and low mALI groups. ALI and mALI were significantly associated with the AJCC stage, Fuhrman grade, T stage, and M stage. Low ALI (p = 0.002) or low mALI (p < 0.001) was associated with poorer prognosis. ROC curves showed that mALI was a better predictor of OS than ALI. Multivariate Cox regression analysis showed that low mALI (aHR = 2.22; 95% CI 1.19–4.13, p = 0.012) was an independent risk factor for OS in RCC patients who underwent nephrectomy, while ALI (aHR = 1.40; 95% CI 0.73–2.66, p = 0.309) was not significantly associated. Furthermore, after PSM analysis, we found that mALI remained an independent risk factor for OS (aHR = 2.88; 95% CI 1.33–6.26, p = 0.007) in patients with RCC. Conclusions For RCC patients undergoing laparoscopic nephrectomy, low ALI and low mALI were associated with poor prognosis, and preoperative mALI can be used as a potential independent prognostic indicator for RCC patients.
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Affiliation(s)
- Weipu Mao
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Keyi Wang
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
| | - Yuan Wu
- Department of Urology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, China
| | - Jinliang Ni
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Houliang Zhang
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yidi Wang
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zonglin Wu
- Department of Urology, Shidong Hospital of Yangpu District, Shanghai, China
| | - Ruiji Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Jiang Geng
- Department of Urology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- Jiang Geng
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Shuqiu Chen
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- *Correspondence: Ming Chen
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Association between postoperative hypoalbuminemia and postoperative pulmonary imaging abnormalities patients undergoing craniotomy for brain tumors: a retrospective cohort study. Sci Rep 2022; 12:64. [PMID: 34996896 PMCID: PMC8742077 DOI: 10.1038/s41598-021-00261-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/07/2021] [Indexed: 01/15/2023] Open
Abstract
Hypoalbuminemia is associated with poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on complications in patients undergoing brain tumor surgery. This retrospective study included 372 consecutive patients who underwent brain tumors surgery from January 2017 to December 2019. The patients were divided into hypoalbuminemia (< 35 g/L) and non-hypoalbuminemia group (≥ 35 g/L) based on postoperative albumin levels. Logistic regression analyses were used to determine risk factors. Of the total 372 patients, 333 (89.5%) developed hypoalbuminemia after surgery. Hypoalbuminemia was associated with operation time (OR 1.011, P < 0.001), preoperative albumin (OR 0.864, P = 0.015) and peroperative globulin (OR 1.192, P = 0.004). Postoperative pulmonary imaging abnormalities had a higher incidence in patients with than without hypoalbuminemia (41.1% vs 23.1%, P = 0.029). The independent predictors of postoperative pulmonary imaging abnormalities were age (OR 1.053, P < 0.001), operation time (OR 1.003, P = 0.013) and lower postoperative albumin (OR 0.946, P = 0.018). Pulmonary imaging abnormalities [OR 19.862 (95% CI 2.546–154.936, P = 0.004)] was a novel independent predictors of postoperative pneumonia. Postoperative hypoalbuminemia has a higher incidence with the increase of operation time, and may be associated with postoperative complications in patients undergoing brain tumor surgery.
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Alan O, Telli TA, Basoğlu T, Arikan R, Demircan NC, Ercelep O, Sakar M, Bozkurt S, Atasoy BM, Dane F, Ziyal Mİ, Yumuk PF. Impact of prognostic nutritional index on survival in recurrent glioblastoma. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:15-21. [PMID: 34998488 DOI: 10.1016/j.neucie.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/16/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Primary brain tumors are relatively rare malignancy, with high-grade gliomas (glioblastoma multiforme and anaplastic gliomas) are the most common types. We aimed to evaluate the prognostic value of Prognostic Nutritional Index (PNI), which is calculated by lymphocyte count and albumin, in recurrent glioblastoma patients treated with systemic treatment. METHODS Data of 64 patients with recurrent glioblastoma who received systemic treatment and followed in our clinic between 2012 and 2018 was retrospectively collected and analyzed. PNI was calculated as: [(10×serum albumin (g/dL))+(0.005×total lymphocyte count)]. Patients were categorized according to the median PNI value. We investigated the prognostic role of PNI groups, and survival outcomes. RESULTS Median value of PNI was 45.7, and median follow-up duration was 9 months (1-68 months). Median overall survival (OS) was 7.9 months (95%CI: 5.5-10.4). Median OS was significantly longer in patients with PNI>45.7 compared to patients with PNI≤45.7 (13.9 months (95%CI: 10.5-17.4), and 4.6 months (95%CI: 2.5-6.8), p<0.001, respectively). In multivariate analysis, PNI was found to be an independent prognostic factor for OS [HR:0.41 (95%CI:0.22-0.74), p=0.03)]. CONCLUSION In our study, the PNI was found to be an independent prognostic biomarker in patients with recurrent glioblastoma, but further prospective trials are necessary to validate its prognostic role.
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Affiliation(s)
- Ozkan Alan
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
| | - Tugba Akın Telli
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Tugba Basoğlu
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Rukiye Arikan
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Nazim Can Demircan
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Ozlem Ercelep
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Sakar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Suheyla Bozkurt
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Beste Melek Atasoy
- Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Faysal Dane
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | | | - Perran Fulden Yumuk
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
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Kim YJ, Oh H, Lee SJ, Kim KM, Kang H, Park CK, Park HP. Prognostic significance of the postoperative prognostic nutritional index in patients with glioblastoma: a retrospective study. BMC Cancer 2021; 21:942. [PMID: 34418999 PMCID: PMC8380354 DOI: 10.1186/s12885-021-08686-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prognostic nutritional index (PNI) reflects immunonutritional status. We evaluated the effects of postoperative PNI and perioperative changes in the PNI on overall survival (OS) in glioblastoma (GBM) patients. METHODS Demographic, laboratory, and clinical data were retrospectively collected from 335 GBM patients. Preoperative and postoperative PNIs were calculated from serum albumin concentration and lymphocyte count, which were measured within 3 weeks before surgery and 1 month after surgery. Patients were classified into high (n = 206) or low (n = 129) postoperative PNI groups according to the postoperative PNI cutoff value and further classified into four groups according to the cutoff values of the preoperative and postoperative PNIs, as follows: Group HH (both high PNIs, n = 92), Group HL (high preoperative and low postoperative PNI, n = 70), Group LH (low preoperative and high postoperative PNI, n = 37), and Group LL (both low PNIs, n = 136). RESULTS The median OS was significantly longer in the high postoperative PNI (PNI ≥ 50.2) group than the low postoperative PNI (PNI < 50.2) group (24.0 vs. 15.0 months, p < 0.001). In multivariate analysis, high postoperative PNI was a significant predictor of OS. OS was significantly longer in Group HH than in Group LL and seemed longer in Group HH than in Group HL and in Group LH than in Group LL. OS was not different between Groups HH and LH or between Groups HL and LL. CONCLUSIONS High postoperative PNI was associated with improved OS and perioperative changes in PNI may provide additional important information for prognostic prediction in GBM patients.
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Affiliation(s)
- Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Sang Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Kyung-Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Ali H, Harting R, de Vries R, Ali M, Wurdinger T, Best MG. Blood-Based Biomarkers for Glioma in the Context of Gliomagenesis: A Systematic Review. Front Oncol 2021; 11:665235. [PMID: 34150629 PMCID: PMC8211985 DOI: 10.3389/fonc.2021.665235] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gliomas are the most common and aggressive tumors of the central nervous system. A robust and widely used blood-based biomarker for glioma has not yet been identified. In recent years, a plethora of new research on blood-based biomarkers for glial tumors has been published. In this review, we question which molecules, including proteins, nucleic acids, circulating cells, and metabolomics, are most promising blood-based biomarkers for glioma diagnosis, prognosis, monitoring and other purposes, and align them to the seminal processes of cancer. METHODS The Pubmed and Embase databases were systematically searched. Biomarkers were categorized in the identified biomolecules and biosources. Biomarker characteristics were assessed using the area under the curve (AUC), accuracy, sensitivity and/or specificity values and the degree of statistical significance among the assessed clinical groups was reported. RESULTS 7,919 references were identified: 3,596 in PubMed and 4,323 in Embase. Following screening of titles, abstracts and availability of full-text, 262 articles were included in the final systematic review. Panels of multiple biomarkers together consistently reached AUCs >0.8 and accuracies >80% for various purposes but especially for diagnostics. The accuracy of single biomarkers, consisting of only one measurement, was far more variable, but single microRNAs and proteins are generally more promising as compared to other biomarker types. CONCLUSION Panels of microRNAs and proteins are most promising biomarkers, while single biomarkers such as GFAP, IL-10 and individual miRNAs also hold promise. It is possible that panels are more accurate once these are involved in different, complementary cancer-related molecular pathways, because not all pathways may be dysregulated in cancer patients. As biomarkers seem to be increasingly dysregulated in patients with short survival, higher tumor grades and more pathological tumor types, it can be hypothesized that more pathways are dysregulated as the degree of malignancy of the glial tumor increases. Despite, none of the biomarkers found in the literature search seem to be currently ready for clinical implementation, and most of the studies report only preliminary application of the identified biomarkers. Hence, large-scale validation of currently identified and potential novel biomarkers to show clinical utility is warranted.
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Affiliation(s)
- Hamza Ali
- Department of Neurosurgery, Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center and Academic Medical Center, Amsterdam, Netherlands
| | - Romée Harting
- Department of Neurosurgery, Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center and Academic Medical Center, Amsterdam, Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Netherlands
| | - Meedie Ali
- Department of Neurosurgery, Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center and Academic Medical Center, Amsterdam, Netherlands
| | - Thomas Wurdinger
- Department of Neurosurgery, Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center and Academic Medical Center, Amsterdam, Netherlands
| | - Myron G. Best
- Department of Neurosurgery, Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, VU University Medical Center and Academic Medical Center, Amsterdam, Netherlands
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12
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Jia T, Zhang R, Kong F, Zhang Q, Xi Z. The Prognostic Role and Nomogram Establishment of a Novel Prognostic Score Combining with Fibrinogen and Albumin Levels in Patients with WHO Grade II/III Gliomas. Int J Gen Med 2021; 14:2137-2145. [PMID: 34093034 PMCID: PMC8169085 DOI: 10.2147/ijgm.s303733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose World Health Organization (WHO) Grades II and III gliomas [also known as low grade gliomas (LGGs)] displayed different malignant behaviors and survival outcomes compared to Grade IV gliomas. This study aimed to identify the prognostic predictive value of a novel cumulative prognostic score [combined with fibrinogen and albumin levels (FA score)], establish and validate a point-based nomogram in LGG patients. Patients and Methods A total of 91 patients who underwent total glioma resection at Shengjing Hospital of China Medical University between 2011 and 2013 were enrolled to establish a prognostic nomogram. All patients were histologically diagnosed as grades II/III, and never received radiotherapy or chemotherapy before surgery. Data collection included patient characteristics, clinicopathological factors, and preoperative hematology results. The performance of the nomogram was subsequently validated by the concordance index (c-index), calibration curve, and receiver operating characteristic (ROC) curve. Results The FA score was negatively associated with the overall survival (OS) of LGG patients (p < 0.001). The results of multivariate analysis showed that FA score [p = 0.006, HR = 1.92, 95% confidence interval (CI): 1.21–3.05], age (p = 0.002, HR = 3.014, 95% CI:1.52–5.97), and white blood count (p < 0.001, HR = 4.24, 95% CI: 2.08–8.67) were independent prognostic factors for overall survival (OS). The study established a nomogram to predict OS with a c-index of 0.783 (95% CI, 0.72–0.84). Conclusion FA score might be a potential prognostic biomarker for LGG patients, and a reliable point-based nomogram will help clinicians to decide on the best treatment plans.
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Affiliation(s)
- Tianshu Jia
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Rui Zhang
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Fanfei Kong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Qianjiao Zhang
- Pain Department, The People's Hospital of Liaoning Province, Shenyang, People's Republic of China
| | - Zhuo Xi
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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13
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McAleenan A, Kelly C, Spiga F, Kernohan A, Cheng HY, Dawson S, Schmidt L, Robinson T, Brandner S, Faulkner CL, Wragg C, Jefferies S, Howell A, Vale L, Higgins JPT, Kurian KM. Prognostic value of test(s) for O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation for predicting overall survival in people with glioblastoma treated with temozolomide. Cochrane Database Syst Rev 2021; 3:CD013316. [PMID: 33710615 PMCID: PMC8078495 DOI: 10.1002/14651858.cd013316.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Glioblastoma is an aggressive form of brain cancer. Approximately five in 100 people with glioblastoma survive for five years past diagnosis. Glioblastomas that have a particular modification to their DNA (called methylation) in a particular region (the O6-methylguanine-DNA methyltransferase (MGMT) promoter) respond better to treatment with chemotherapy using a drug called temozolomide. OBJECTIVES To determine which method for assessing MGMT methylation status best predicts overall survival in people diagnosed with glioblastoma who are treated with temozolomide. SEARCH METHODS We searched MEDLINE, Embase, BIOSIS, Web of Science Conference Proceedings Citation Index to December 2018, and examined reference lists. For economic evaluation studies, we additionally searched NHS Economic Evaluation Database (EED) up to December 2014. SELECTION CRITERIA Eligible studies were longitudinal (cohort) studies of adults with diagnosed glioblastoma treated with temozolomide with/without radiotherapy/surgery. Studies had to have related MGMT status in tumour tissue (assessed by one or more method) with overall survival and presented results as hazard ratios or with sufficient information (e.g. Kaplan-Meier curves) for us to estimate hazard ratios. We focused mainly on studies comparing two or more methods, and listed brief details of articles that examined a single method of measuring MGMT promoter methylation. We also sought economic evaluations conducted alongside trials, modelling studies and cost analysis. DATA COLLECTION AND ANALYSIS Two review authors independently undertook all steps of the identification and data extraction process for multiple-method studies. We assessed risk of bias and applicability using our own modified and extended version of the QUality In Prognosis Studies (QUIPS) tool. We compared different techniques, exact promoter regions (5'-cytosine-phosphate-guanine-3' (CpG) sites) and thresholds for interpretation within studies by examining hazard ratios. We performed meta-analyses for comparisons of the three most commonly examined methods (immunohistochemistry (IHC), methylation-specific polymerase chain reaction (MSP) and pyrosequencing (PSQ)), with ratios of hazard ratios (RHR), using an imputed value of the correlation between results based on the same individuals. MAIN RESULTS We included 32 independent cohorts involving 3474 people that compared two or more methods. We found evidence that MSP (CpG sites 76 to 80 and 84 to 87) is more prognostic than IHC for MGMT protein at varying thresholds (RHR 1.31, 95% confidence interval (CI) 1.01 to 1.71). We also found evidence that PSQ is more prognostic than IHC for MGMT protein at various thresholds (RHR 1.36, 95% CI 1.01 to 1.84). The data suggest that PSQ (mainly at CpG sites 74 to 78, using various thresholds) is slightly more prognostic than MSP at sites 76 to 80 and 84 to 87 (RHR 1.14, 95% CI 0.87 to 1.48). Many variants of PSQ have been compared, although we did not see any strong and consistent messages from the results. Targeting multiple CpG sites is likely to be more prognostic than targeting just one. In addition, we identified and summarised 190 articles describing a single method for measuring MGMT promoter methylation status. AUTHORS' CONCLUSIONS PSQ and MSP appear more prognostic for overall survival than IHC. Strong evidence is not available to draw conclusions with confidence about the best CpG sites or thresholds for quantitative methods. MSP has been studied mainly for CpG sites 76 to 80 and 84 to 87 and PSQ at CpG sites ranging from 72 to 95. A threshold of 9% for CpG sites 74 to 78 performed better than higher thresholds of 28% or 29% in two of three good-quality studies making such comparisons.
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Affiliation(s)
- Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Kelly
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) , University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire L Faulkner
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Christopher Wragg
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Sarah Jefferies
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Amy Howell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) , University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kathreena M Kurian
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Medical School: Brain Tumour Research Centre, Public Health Sciences, University of Bristol, Bristol, UK
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14
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Alan O, Telli TA, Basoğlu T, Arikan R, Demircan NC, Ercelep O, Sakar M, Bozkurt S, Atasoy BM, Dane F, Ziyal Mİ, Yumuk PF. Impact of prognostic nutritional index on survival in recurrent glioblastoma. Neurocirugia (Astur) 2021; 33:S1130-1473(20)30136-6. [PMID: 33454185 DOI: 10.1016/j.neucir.2020.11.005] [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: 08/18/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary brain tumors are relatively rare malignancy, with high-grade gliomas (glioblastoma multiforme and anaplastic gliomas) are the most common types. We aimed to evaluate the prognostic value of Prognostic Nutritional Index (PNI), which is calculated by lymphocyte count and albumin, in recurrent glioblastoma patients treated with systemic treatment. METHODS Data of 64 patients with recurrent glioblastoma who received systemic treatment and followed in our clinic between 2012 and 2018 was retrospectively collected and analyzed. PNI was calculated as: [(10×serum albumin (g/dL))+(0.005×total lymphocyte count)]. Patients were categorized according to the median PNI value. We investigated the prognostic role of PNI groups, and survival outcomes. RESULTS Median value of PNI was 45.7, and median follow-up duration was 9 months (1-68 months). Median overall survival (OS) was 7.9 months (95%CI: 5.5-10.4). Median OS was significantly longer in patients with PNI>45.7 compared to patients with PNI≤45.7 (13.9 months (95%CI: 10.5-17.4), and 4.6 months (95%CI: 2.5-6.8), p<0.001, respectively). In multivariate analysis, PNI was found to be an independent prognostic factor for OS [HR:0.41 (95%CI:0.22-0.74), p=0.03)]. CONCLUSION In our study, the PNI was found to be an independent prognostic biomarker in patients with recurrent glioblastoma, but further prospective trials are necessary to validate its prognostic role.
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Affiliation(s)
- Ozkan Alan
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
| | - Tugba Akın Telli
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Tugba Basoğlu
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Rukiye Arikan
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Nazim Can Demircan
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Ozlem Ercelep
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Sakar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Suheyla Bozkurt
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Beste Melek Atasoy
- Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Faysal Dane
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | | | - Perran Fulden Yumuk
- Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
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15
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Huq S, Khalafallah AM, Botros D, Oliveira LAP, White T, Dux H, Jimenez AE, Mukherjee D. The Prognostic Impact of Nutritional Status on Postoperative Outcomes in Glioblastoma. World Neurosurg 2020; 146:e865-e875. [PMID: 33197633 DOI: 10.1016/j.wneu.2020.11.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The clinical impact and optimal method of assessing nutritional status (NS) have not been rigorously examined in glioblastoma. We investigated the relationship between NS and postoperative survival (PS) in glioblastoma using 4 nutritional indices and identified which index best modeled PS. METHODS NS was retrospectively assessed for patients with glioblastoma undergoing surgery at our institution from 2007 to 2019 using the albumin level, albumin/globulin ratio (AGR), nutritional risk index (NRI), and prognostic nutritional index (PNI). Optimal cut points for each index were identified using maximally selected rank statistics and previously established criteria. The predictive value of each index on PS was determined using Cox proportional hazards models adjusted for prognostic variables. The best-performing model was identified using the Akaike Information Criterion. RESULTS Our analysis included 242 patients (64% male) with a mean age of 57.6 years, Karnofsky Performance Status of 77.6, 5-factor modified frailty index of 0.59, albumin level of 4.2 g/dL, AGR of 1.9, NRI of 105.6, and PNI of 47.4. Median PS after index and repeat surgery was 12.7 and 7.8 months, respectively. On multivariable analysis, low albumin level (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.52-2.89; P < 0.001), mild NRI (HR, 1.61; 95% CI, 1.04-2.49; P = 0.032), moderate/severe NRI (HR, 2.51; 95% CI, 1.64-3.85; P < 0.001), and low PNI (HR, 2.51; 95% CI, 1.78-3.53; P < 0.001), but not low AGR (HR, 1.17; 95% CI, 0.89-1.54; P = 0.270), predicted decreased PS. PNI had the lowest Akaike Information Criterion. CONCLUSIONS NS predicts PS in glioblastoma. PNI may provide the best model for assessing NS. NS is an important modifiable aspect of brain tumor management that warrants increased attention.
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Affiliation(s)
- Sakibul Huq
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adham M Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Botros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leonardo A P Oliveira
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Taija White
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hayden Dux
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adrian E Jimenez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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16
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Hu C, Chen K, Tang X. Prognostic value of preoperative controlling nutritional status in patients with glioblastoma. Clin Neurol Neurosurg 2020; 198:106129. [DOI: 10.1016/j.clineuro.2020.106129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/10/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022]
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17
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Yang C, Wen HB, Zhao YH, Huang WH, Wang ZF, Li ZQ. Systemic Inflammatory Indicators as Prognosticators in Glioblastoma Patients: A Comprehensive Meta-Analysis. Front Neurol 2020; 11:580101. [PMID: 33117267 PMCID: PMC7575748 DOI: 10.3389/fneur.2020.580101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Inflammation plays an important role in tumorigenesis. Previous studies have reported the prognostic value of several peripheral inflammatory markers in glioma patients, including the neutrophil-to-lymphocyte ratio (NLR). However, it still remains unclear whether inflammatory markers can independently predict the prognosis of glioblastoma (GBM) patients. The present study aims to explore the prognostic value of systemic inflammatory markers, including neutrophils, lymphocytes, platelets, the NLR, and the platelet-to-lymphocyte ratio (PLR), in patients with GBM. Methods: A comprehensive systemic search and review was performed using the PubMed, EMBASE, and Cochrane Library databases to identify all the relevant literature (published before June 30, 2020) that evaluated the association between any of these inflammatory markers and survival in GBM. Results: There were 2 (634 patients), 3 (723 patients), 2 (237 patients), 8 (1,225 patients), and 3 (505 patients) studies examining the correlation of survival with neutrophils, lymphocytes, platelets, the NLR, and the PLR, respectively. An elevated NLR and elevated neutrophil and platelet counts were associated with worse overall survival (OS) in GBM patients (NLR: hazard ratio [HR] = 1.63, 95% confidence interval [CI]: 1.23–2.15, p = 0.0007; neutrophil count: HR = 1.46, 95% CI:1.16–1.83, p = 0.001; platelet count: HR = 1.58, 95% CI: 1.42–1.77, p < 0.00001). However, there was no significant association between the PLR or the absolute lymphocyte count and OS in GBM patients. Conclusion: The NLR and the absolute neutrophil and platelet counts may be valuable and convenient peripheral inflammatory markers to evaluate the prognosis of GBM patients. Further prospective studies are needed to verify its reliability.
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Affiliation(s)
- Chao Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hong-Bin Wen
- Department of Neurology, Xiangyang Central Hospital, Xiangyang, China
| | - Yu-Hang Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen-Hong Huang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ze-Fen Wang
- Department of Physiology, School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Zhi-Qiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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18
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Liu M, Wang L. Prognostic significance of preoperative serum albumin, albumin-to-globulin ratio, and prognostic nutritional index for patients with glioma: A meta-analysis. Medicine (Baltimore) 2020; 99:e20927. [PMID: 32629692 PMCID: PMC7337547 DOI: 10.1097/md.0000000000020927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The serum albumin, albumin-to-globulin ratio (AGR), and prognostic nutritional index (PNI) have been recommended to represent the nutritional and inflammatory status. Thus, they may be potential prognostic biomarkers for cancer. However, contradictory results were reported in different studies on glioma. The goal of this study was to perform a meta-analysis to re-evaluate their prognostic potential for glioma. METHODS Databases of PubMed, EMBASE, and Cochrane Library were systematically searched to enroll all the studies investigating the prognostic significance of albumin, AGR, and PNI for glioma. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using STATA 13.0 software to indicate the intensity of association. RESULTS Eleven studies with 2928 cases were included. Overall meta-analysis showed that the prognostic values of albumin, AGR, and PNI were limited for glioma (P > .05). However, subgroup analysis demonstrated a high preoperative serum albumin was significantly related with excellent OS of patients with GBM (HR = 0.95, 95% CI: 0.91-0.99, P = .018), while high PNI (HR = 0.56, 95% CI: 0.43-0.73, P < .001) and AGR (HR = 0.57, 95% CI: 0.34-0.96, P = .034) may be a protective factor of favorable OS for patients with high-grade gliomas. Furthermore, integration of all studies with multivariate analysis and clear cut-off also proved reduced preoperative serum albumin, AGR, and PNI were predictors of poor prognosis for patients with gliomas. CONCLUSION Preoperative serum albumin, AGR, and PNI may represent promising biomarkers to predict the prognosis in patients with glioma, especially for high-grade.
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19
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Prognostic Value of C-Reactive Protein to Albumin Ratio in Glioblastoma Multiforme Patients Treated with Concurrent Radiotherapy and Temozolomide. Int J Inflam 2020; 2020:6947382. [PMID: 32566124 PMCID: PMC7298277 DOI: 10.1155/2020/6947382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/25/2020] [Indexed: 12/31/2022] Open
Abstract
Objective We investigated the prognostic impact of C-reactive protein to albumin ratio (CRP/Alb) on the survival outcomes of newly diagnosed glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (TMZ). Methods The pretreatment CRP and Alb records of GBM patients who underwent RT and concurrent plus adjuvant TMZ were retrospectively analyzed. The CRP/Alb was calculated by dividing serum CRP level by serum Alb level obtained prior to RT. The availability of significant cutoff value for CRP/Alb that interacts with survival was assessed with the receiver-operating characteristic (ROC) curve analysis. The primary endpoint was the association between the CRP/Alb and the overall survival (OS). Results A total of 153 patients were analyzed. At a median follow-up of 14.7 months, median and 5-year OS rates were 16.2 months (95% CI: 12.5–19.7) and 9.5%, respectively, for the entire cohort. The ROC curve analysis identified a significant cutoff value at 0.75 point (area under the curve: 74.9%; sensitivity: 70.9%; specificity: 67.7%; P < 0.001) for CRP/Alb that interacts with OS and grouped the patients into two: CRP/Alb <0.75 (n = 61) and ≥0.75 (n = 92), respectively. Survival comparisons revealed that the CRP/Alb <0.75 was associated with a significantly superior median (22.5 versus 15.7 months; P < 0.001) and 5-year (20% versus 0%) rates than the CRP/Alb ≥0.75, which retained its independent significance in multivariate analysis (P < 0.001). Conclusion Present results suggested the pretreatment CRP/Alb as a significant and independent inflammation-based index which can be utilized for further prognostic lamination of GBM patients.
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Alan O, Telli TA, Basoğlu T, Arikan R, Demircan NC, Ercelep O, Bozkurt S, Atasoy BM, Dane F, Yumuk PF. Prognostic value of modified Glasgow prognostic score in recurrent high-grade glial tumors treated with systemic treatment. Clin Neurol Neurosurg 2020; 196:105976. [PMID: 32531614 DOI: 10.1016/j.clineuro.2020.105976] [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: 03/14/2020] [Revised: 05/03/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Malignant high-grade gliomas are the most common and aggressive type of primary brain tumor. We aimed to evaluate the prognostic value of modified Glasgow Prognostic Score (mGPS), which is combination of C-reactive protein (CRP) and albumin, in recurrent high-grade glioma patients treated with systemic treatment. PATIENTS AND METHODS Data of 85 patients with recurrent high-grade glioma who received systemic treatment and followed in our clinic between 2012 and 2018 was retrospectively collected and analyzed. Patients were grouped according to mGPS criteria: mGPS-0: CRP < 10 mg/L and albumin >3.5 g/dL; mGPS-1: CRP < 10 mg/L and albumin <3.5 g/dL or CRP > 10 mg/L and albumin >3.5 g/dL; and mGPS-2: CRP > 10 mg/L and albumin <3.5 mg/L. We investigated the prognostic role of mGPS groups, mutations and survival outcomes. RESULTS There were 42 (49.4 %), 25 (29.6 %), and 18 (21 %) patients in mGPS-0, mGPS-1, and mGPS-2 groups, respectively. Median follow-up duration was 10 months (1-70 months). Median OS was 8.1 months. According to mGPS-0, -1 and -2; median OS was 13.8 months, 7.3 months and 3.6 months respectively (p = 0.003). mGPS, ATRX and IDH-1 mutation status, and ECOG PS were found to be independent prognostic factors for OS. CONCLUSION In our study, mGPS was found to be an independent prognostic factor in patients with recurrent high-grade gliomas. If validated, mGPS can be used as an objective, easily calculated, cheap, and readily available prognostic model in routine practice.
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Affiliation(s)
- Ozkan Alan
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
| | - Tugba Akın Telli
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Tugba Basoğlu
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Rukiye Arikan
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nazim Can Demircan
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ozlem Ercelep
- Department of Medical Oncology, Pendik Education and Research Hospital, Marmara University, Istanbul, Turkey
| | - Suheyla Bozkurt
- Department of Pathology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Beste Melek Atasoy
- Department of Radiation Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Faysal Dane
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Yalikun K, Tuersun T, Abudula M, Tiheiran M, Fu Q, Yisireyili D, Zhou Q. Serum albumin levels and serum albumin-globulin ratio are associated with poor prognosis in glioblastoma. Transl Cancer Res 2020; 9:1594-1603. [PMID: 35117507 PMCID: PMC8798444 DOI: 10.21037/tcr.2020.01.57] [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: 10/29/2019] [Accepted: 01/03/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Serum albumin levels (ALB) and albumin-globulin ratio (AGR) are reliable and convenient markers of the nutritional status and inflammation of human body, and ALB has been identified as a prognostic factor in the patients of glioblastoma (GBM). However, no literature has reported the prediction value of AGR for GBM. METHODS In this study we evaluate the serum ALB and AGR levels for GBM. A total of 126 patients with GBM who underwent surgical resection in our institution between 2013 and 2017 were analyzed retrospectively. Clinical information was obtained from electronic medical records. Multiple logistic regression and Cox proportional hazards models were used to assess the prediction value of preoperative ALB and AGR for GBM. RESULTS Preoperative ALB (HR 0.342, 95% CI, 0.123-0.954, P=0.040) and postoperative adjuvant therapy (HR 0.042, 95% CI, 0.005-0.330, P=0.003) were significantly related to progression-free survival (PFS). Cox regression analysis showed the significance of adjuvant therapy (HR 3.579, 95% CI, 2.236-5.729, P<0.001). Preoperative AGR (HR 0.280, 95% CI, 0.103-0.763, P=0.013) and adjuvant therapy (HR 0.156, 95% CI, 0.047-0.513, P=0.002) were showed significance, and Cox regression analysis showed preoperative AGR (HR 1.810, 95% CI, 1.095-2.992, P=0.021) and adjuvant therapy (HR 4.702, 95% CI, 2.841-7.782, P<0.001) were independent predictors of overall survival (OS). CONCLUSIONS The ALB and AGR had significant predictive values for the prognosis of GBM; postoperative adjuvant treatment is also an independent predictor for the prognosis of GBM patients.
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Affiliation(s)
- Kugeluke Yalikun
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Tuerhong Tuersun
- Department of Intensive Care Unit, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Maiaitituersun Abudula
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Maijudan Tiheiran
- Department of Imaging, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Qiang Fu
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Dilimulati Yisireyili
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Qingjiu Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
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Wang DP, Kang K, Lin Q, Hai J. Prognostic Significance of Preoperative Systemic Cellular Inflammatory Markers in Gliomas: A Systematic Review and Meta-Analysis. Clin Transl Sci 2019; 13:179-188. [PMID: 31550075 PMCID: PMC6951460 DOI: 10.1111/cts.12700] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
Glioma is the most common malignant brain tumor and has high lethality. This tumor generated a robust inflammatory response that results in the deterioration of the disease. However, the prognostic role of systemic cellular inflammatory indicators in gliomas remains controversial. This meta‐analysis aimed to assess the prognostic significance of preoperative neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), red cell distribution width (RDW), and prognostic nutritional index (PNI) in patients with gliomas. Databases of PubMed, EMBASE, Web of Science, and The Cochrane Library were systematically searched for all studies published up to January 2019. Study screening and data extraction followed established Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The Newcastle–Ottawa Scale was used to assess the quality of studies. Eighteen studies containing 3,261 patients were included. The analyses showed an increased NLR or RDW was found to be an independent predictor of worse survival in patients with gliomas (hazard ratio (HR): 1.38; 95% confidence interval (CI): 1.09–1.74; P = 0.008; and HR: 1.40; 95% CI: 1.13–1.74; P = 0.002, respectively). Furthermore, a higher PNI indicates a better overall survival (OS; HR: 0.57; 95% CI: 0.42–0.77; P = 0.0002). For the evaluation of PLR and LMR, none of these variables correlated with OS (P = 0.91 and P = 0.21, respectively). Our meta‐analysis indicates the NLR, RDW, and PNI rather than PLR and LMR are the independent index for predicting the OS of gliomas. Pre‐operative NLR, RDW, and PNI can help to evaluate disease progression, optimize treatment, and follow‐up in patients with gliomas.
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Affiliation(s)
- Da-Peng Wang
- Department of Neurosurgery, Tong Ji Hospital, Tong Ji University School of Medicine, Shanghai, China
| | - Kai Kang
- Department of Research and Surveillance Evaluation, Shanghai Center for Health Promotion, Shanghai, China
| | - Qi Lin
- Department of Pharmacy, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Hai
- Department of Neurosurgery, Tong Ji Hospital, Tong Ji University School of Medicine, Shanghai, China
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Prognostic Value of Pretreatment Serum Transthyretin Level in Patients with Gastrointestinal Cancers. DISEASE MARKERS 2019; 2019:7142065. [PMID: 31275452 PMCID: PMC6589268 DOI: 10.1155/2019/7142065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/18/2019] [Indexed: 01/19/2023]
Abstract
Background Many studies have shown the link between the pretreatment serum transthyretin and prognosis in gastrointestinal (GI) cancers. However, based on the conclusion, the initial findings were inconsistent. Hence, this meta-analysis was performed to identify the prognostic values of the pretreatment serum transthyretin in GI cancers. Methods Previous studies published before November 2018 were collected from a comprehensive literature search of several databases. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were applied in the assessment of the intensity of associations. Also, the publication bias and the robustness of merged data were assessed. All statistical analyses were undertaken using STATA/SE 14.1. Results The combined data indicated that the pretreatment serum transthyretin level was related to the prognosis in GI cancers. The group with reduced pretreatment transthyretin had a significantly worse overall survival (OS) (HR = 1.71, 95% CI: 1.37-2.05). The subgroup analysis for OS further showed the predictive value of transthyretin. In addition, the low serum transthyretin level could be an unfavorable factor for recurrence-free survival (RFS) or progression-free survival (PFS) (HR = 1.66, 95% CI: 1.14-2.18) in GI cancers. Conclusion The low pretreatment serum transthyretin level implies an unfavorable prognosis for patients with GI cancers. The monitoring of pretreatment transthyretin level could contribute to the risk stratification and individualized therapy in GI cancers.
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Prognostic nutritional index as a prognostic marker in glioblastoma: Data from a cohort of 282 Italian patients. J Neurol Sci 2019; 400:175-179. [PMID: 30974322 DOI: 10.1016/j.jns.2019.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/06/2019] [Accepted: 04/01/2019] [Indexed: 01/06/2023]
Abstract
Preoperative prognostic nutritional index (PNI) is linked to the clinical outcome of patients with malignant tumours, however few studies have investigated its utility in predicting outcome in glioblastoma multiforme (GBM). We performed a retrospective study on adult patients with GBM in order to evaluate the impact of PNI on overall survival (OS), after adjusting for known prognostic factor (age, extent of surgery, Karnofsky performance status, radiochemotherapy). This is an Italian, multicentre, retrospective, cohort study. The patient's cohort includes 282 individuals with a newly diagnosed GBM followed in 3 Lombardia Hospitals In all cases the diagnosis was supported by histological data. Patient's information including sex, age at onset, Karnofsky performance status (KPS), extension of surgical resection (EOR), adjuvant treatment, antiepileptic treatment, serum variables and survival data were collected. Univariate and multivariate analysis did not reveal an association between PNI and overall survival in our series of GBM patients. PNI is a controversial marker for prognosis in GBM patients and further prospective studies are necessary to elucidate its role.
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Routine Blood Tests Do Not Predict Survival in Patients with Glioblastoma-Multivariable Analysis of 497 Patients. World Neurosurg 2019; 126:e1081-e1091. [PMID: 30880204 DOI: 10.1016/j.wneu.2019.03.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Multiple reports have attributed a prognostic value to routine blood tests results for patients with glioblastoma. However, these studies have reported conflicting results and have often had small sample sizes. We sought to validate the prognostic value of the described tests in an independent glioblastoma patient population. METHODS We performed a retrospective single-center multivariable analysis of 497 patients with glioblastoma who had postoperatively undergone radiotherapy and/or chemotherapy to identify the prognostic value for median overall survival of hemoglobin, white blood cell, monocyte, neutrophil, leukocyte, and platelet counts, neutrophil/lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate, activated partial thromboplastin time, prothrombin time, and lactate dehydrogenase. We also evaluated known prognostic factors for survival such as patient age, intervention type, IDH1 status, Karnofsky clinical performance status, and postoperative treatment modality. RESULTS In a multivariable model, after correcting for multiple testing bias, biopsy alone (hazard ratio, 0.35; 95% confidence interval, 0.26-0.49; false discovery rate-adjusted P < 0.001) and monotherapy after surgery (hazard ratio, 0.46; 95% confidence interval, 0.33-0.66; false discovery rate-adjusted P < 0.001) remained significantly associated with worse median overall survival. Patient age and Karnofsky performance status score ≥70 did not significantly influence survival in the multivariable model. No routine blood test included in the multivariable analysis was significantly associated with survival. CONCLUSIONS In the present study, hemoglobin, white blood cell, monocyte, neutrophil, leukocyte, and platelet counts, neutrophil/lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate, activated partial thromboplastin time, prothrombin time, and lactate dehydrogenase levels did not independently predict for overall survival in patients with glioblastoma.
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Chen L, Cai BB, Zhou CJ, Hou XQ, Hu SP, Fang G, Chen WC, Li LH, Yang WJ. A sample model established by S-index predicting overall survival after curative resection of primary hepatocellular carcinoma. Cancer Manag Res 2019; 11:693-703. [PMID: 30679923 PMCID: PMC6338126 DOI: 10.2147/cmar.s193593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Prognostic prediction after curative resection of primary hepatocellular carcinoma (PHCC) remains an arduous task. The S-index calculated from γ-glutamyl transpeptidase, albumin, and platelets is reported to predict the severity of liver fibrosis. We constructed a nomogram for predicting the survival probability of PHCC based on a new indicator, the S-index, combined with other routine clinical parameters. Patients and methods We selected 490 patients with PHCC postradical surgery at the First Affiliated Hospital of Wenzhou Medical University between January 2007 and January 2014. The subjects were randomly allocated into the training cohort and the validation cohort in the ratio 7:3 by the digital method. Important variables screened by univariate analysis were included in multivariate analysis to obtain independent risk factors for predicting the prognosis of PHCC. The construction of the nomogram was based on Cox proportional hazard regression models. The concordance index (C-index) was used in the nomogram for evaluating the model performance for prognosis. We drew time-dependent receiver operating characteristic curves to compare our model with other staging systems. Results The nomogram based on six independent risk factors after multivariate analyses had good predictive power after radical surgery of PHCC. In the training and validation groups, the C-index of the nomogram was highly consistent for evaluating survival from PHCC. Compared with the traditional scoring system, the areas under time-dependent receiver operating characteristic curves were 0.7382, 0.7293, and 0.7520 for 1-, 3-, and 5-year overall survival, respectively. In summary, the nomogram showed excellent results in terms of prognosis of PHCC. Conclusion Based on the S-index and the other clinical indicators, we developed a precise nomogram that predicts the survival probability of patients with PHCC after radical surgery. This tool can provide effective information for surgeons and patients.
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Affiliation(s)
- Lei Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China,
| | - Bin-Bin Cai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China,
| | - Chao-Jun Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China,
| | - Xiang-Qing Hou
- Department of Statistics, School of Public Health and Management, Wenzhou Medical University, Zhejiang, Wenzhou, China
| | - Si-Pin Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China,
| | - Guan Fang
- Department of Colorectal Anus Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China
| | - Wen-Chao Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China,
| | - Lin-Hui Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China,
| | - Wen-Jun Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China,
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Qi F, Zhou X, Wang Y, Wang Y, Wang Y, Zhang Q, Cong R, Yang J, Song N. Pre-treatment prognostic nutritional index may serve as a potential biomarker in urinary cancers: a systematic review and meta-analysis. Cancer Cell Int 2018; 18:207. [PMID: 30564063 PMCID: PMC6296044 DOI: 10.1186/s12935-018-0708-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022] Open
Abstract
Background To investigate the potential prognostic role of pre-treatment prognostic nutritional index (PNI) in urinary cancers. Methods Relevant articles were searched comprehensively from PubMed, Embase and Web of Science, up to November 2018. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted to evaluate their associations. Result A total of 12 related articles including 6561 patients were ultimately enrolled. Our results indicated that a relatively lower level of pre-treatment PNI was associated with decreased OS, CSS/DSS and DFS/RFS/PFS (pooled HR = 1.68, 95% CI 1.45–1.95; pooled HR = 1.57, 95% CI 1.33–1.86; pooled HR = 1.75, 95% CI 1.53–1.99, respectively). Subsequent stratified analysis by cancer type for OS showed that PNI could also be a predictor no matter in renal cell cancer (RCC) or bladder cancer (BC) (pooled HR = 1.65, 95% CI 1.37–1.97 and pooled HR = 1.67, 95% CI 1.20–2.33). Similar results could be found in DFS/RFS/PFS (RCC: HR = 1.81, 95% CI 1.54–2.13 and BC: HR = 1.68, 95% CI 1.32–2.12) and in CSS/DSS (RCC: HR = 1.50, 95% CI 1.23–1.82 and upper tract urothelial carcinoma: HR = 1.61, 95% CI 1.13–2.28). As for the treatment subgroup, a relatively lower level of PNI could also be a positive predictor for OS (surgery: HR = 1.64, 95% CI 1.40–1.93; target therapy: HR = 1.88, 95% CI 1.34–2.63) and DFS/RFS/PFS (surgery: HR = 1.69, 95% CI 1.47–1.95; target therapy: HR = 2.14, 95% CI 1.50–3.05). Conclusion The outcomes of us shed light on that elevated pre-treatment PNI was positively associated with OS, CSS/DSS and DFS/RFS/PFS, indicating that it could be an independent prognostic factor in urinary cancers.
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Affiliation(s)
- Feng Qi
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Xiang Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Yi Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Yamin Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Yichun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Qijie Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Rong Cong
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Jie Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210009 China
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The prognostic value of C-reactive protein/albumin ratio in nasopharyngeal carcinoma: a meta-analysis. Biosci Rep 2018; 38:BSR20180686. [PMID: 30352836 PMCID: PMC6239271 DOI: 10.1042/bsr20180686] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/08/2018] [Accepted: 10/14/2018] [Indexed: 12/26/2022] Open
Abstract
The C-reactive protein/albumin ratio (CRP/Alb ratio) has been reported to have promising prognostic value in several cancers. The current meta-analysis was conducted to better define the prognostic value of CRP/Alb ratio in patients with nasopharyngeal carcinoma (NPC). The Web of Science, Embase, Cochrane Library databases, and PubMed were searched up to 25 February 2018 for the information on CRP/Alb ratio and outcomes of NPC. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were used to evaluate the association between CRP/Alb ratio and survival outcomes in NPC. A total of five studies with 5533 patients with NPC were included. Pooled results showed that high CRP/Alb ratio was associated with poor overall survival (OS) (HR = 1.51, 95% CI: 1.30-1.75, P<0.001) and poor distant metastasis-free survival (DMFS) (HR = 1.23, 95% CI: 1.07-1.43, P=0.005). Subgroup analyses showed that patients with higher CRP/Alb ratio have worse OS in NPC. In conclusion, elevated CRP/Alb ratio was associated with worse prognosis in patients with NPC.
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Abstract
Preoperative prognostic nutritional index (PNI) has been proven to be associated with clinical outcomes in patients with malignancies. However, data regarding the role of PNI in human glioblastomas (GBMs) is lacking. We, therefore, aimed to investigate the association between PNI and clinical parameters and survival in GBM patients.This retrospective analysis included 300 GBM patients who were surgically treated at our institute from 2008 to 2017. PNI was calculated as albumin (g/L) + 5×total lymphocyte count (10/L). SPSS 22.0, GraphPad Prism 5, and X tile were the primary tools used for data analysis, figuring drawing, and calculating optimal cutoffs, respectively.Mean albumin value, lymphocyte count, and PNI were 42.13 ± 4.43 g/L, 1.73 ± 0.71 × 10/L, and 50.80 ± 6.01, respectively. PNI was increased in patients aged ≤60 years and in men. Moreover, PNI ≥44 was associated with improved overall survival in younger patients and women. PNI was not associated with isocitric dehydrogenase (IDH)-1 mutations or predicted survival in GBM patients without such mutations. Univariate analysis showed that a high preoperative Karnofsky performance score, gross total resection, completed chemoradiotherapy, IDH-1 mutations, and higher PNI levels were associated with favorable outcomes. Multivariate analysis showed that only completed chemoradiotherapy and IDH-1 mutations were independent prognostic factors.Our results indicated that PNI is associated with age and sex in GBM patients but fails to provide independent prognostic values.
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Affiliation(s)
| | - Kun Yao
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, China
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Zheng SH, Huang JL, Chen M, Wang BL, Ou QS, Huang SY. Diagnostic value of preoperative inflammatory markers in patients with glioma: a multicenter cohort study. J Neurosurg 2018; 129:583-592. [DOI: 10.3171/2017.3.jns161648] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVEGlioma is the most common form of brain tumor and has high lethality. The authors of this study aimed to elucidate the efficiency of preoperative inflammatory markers, including neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and prognostic nutritional index (PNI), and their paired combinations as tools for the preoperative diagnosis of glioma, with particular interest in its most aggressive form, glioblastoma (GBM).METHODSThe medical records of patients newly diagnosed with glioma, acoustic neuroma, meningioma, or nonlesional epilepsy at 3 hospitals between January 2011 and February 2016 were collected and retrospectively analyzed. The values of NLR, dNLR, PLR, LMR, and PNI were compared among patients suffering from glioma, acoustic neuroma, meningioma, and nonlesional epilepsy and healthy controls by using nonparametric tests. Correlations between NLR, dNLR, PLR, LMR, PNI, and tumor grade were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic significance of NLR, dNLR, PLR, LMR, PNI, and their paired combinations for glioma, particularly GBM.RESULTSA total of 750 patients with glioma (Grade I, 81 patients; Grade II, 208 patients; Grade III, 169 patients; Grade IV [GBM], 292 patients), 44 with acoustic neuroma, 271 with meningioma, 102 with nonlesional epilepsy, and 682 healthy controls were included in this study. Compared with healthy controls and patients with acoustic neuroma, meningioma, or nonlesional epilepsy, the patients with glioma had higher values of preoperative NLR and dNLR as well as lower values of LMR and PNI, whereas PLR was higher in glioma patients than in healthy controls and patients with nonlesional epilepsy. Subgroup analysis revealed a positive correlation between NLR, dNLR, PLR, and tumor grade but a negative correlation between LMR, PNI, and tumor grade in glioma. For glioma diagnosis, the area under the curve (AUC) obtained from the ROC curve was 0.722 (0.697–0.747) for NLR, 0.696 (0.670–0.722) for dNLR, 0.576 (0.549–0.604) for PLR, 0.760 (0.738–0.783) for LMR, and 0.672 (0.646–0.698) for PNI. The best diagnostic performance was obtained with the combination of NLR+LMR and dNLR+LMR, with AUCs of 0.777 and 0.778, respectively. Additionally, NLR (AUC 0.860, 95% CI 0.832–0.887), dNLR (0.840, 0.810–0.869), PLR (0.678, 0.641–0.715), LMR (0.837, 0.811–0.863), and PNI (0.740, 0.706–0.773) had significant predictive value for GBM compared with healthy controls and other disease groups. As compared with the Grade I–III glioma patients, the GBM patients had an AUC of 0.811 (95% CI 0.778–0.844) for NLR, 0.797 (0.763–0.832) for dNLR, 0.662 (0.622–0.702) for PLR, 0.743 (0.707–0.779) for LMR, and 0.661(0.622–0.701) for PNI. For the paired combinations, NLR+LMR demonstrated the highest accuracy.CONCLUSIONSThe NLR+LMR combination was revealed as a noninvasive biomarker with relatively high sensitivity and specificity for glioma diagnosis, the differential diagnosis of glioma from acoustic neuroma and meningioma, GBM diagnosis, and the differential diagnosis of GBM from low-grade glioma.
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Affiliation(s)
- Shi-hao Zheng
- 1Department of Neurosurgery, Fujian Provincial Hospital
| | - Jin-lan Huang
- 2Department of Clinical Laboratory, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
- 4Laboratory Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Ming Chen
- 3Department of Neurosurgery, Xin Hua Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai; and
| | - Bing-long Wang
- 2Department of Clinical Laboratory, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Qi-shui Ou
- 2Department of Clinical Laboratory, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
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Liu W, Qdaisat A, Yeung J, Lopez G, Weinberg J, Zhou S, Cohen L, Bruera E, Yeung SCJ. The Association Between Common Clinical Characteristics and Postoperative Morbidity and Overall Survival in Patients with Glioblastoma. Oncologist 2018; 24:529-536. [PMID: 30049883 DOI: 10.1634/theoncologist.2018-0056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/08/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The impact of noncancerous factors on the morbidity and mortality of glioblastoma multiforme (GBM) has not been well studied. Using a large surgical cohort, we examined the association between multiple clinical characteristics and postoperative morbidities and survival in patients with GBM. MATERIALS AND METHODS The study included 404 consecutive GBM patients who underwent initial tumor resection at MD Anderson Cancer Center between January 1, 2010, and December 31, 2014. Data about clinical characteristics, treatments, and postoperative complications were collected. The associations between clinical parameters and postoperative complications and survival were analyzed. RESULTS Charlson Comorbidity Index was positively related to a higher incidence of postoperative total (odds ratio [OR] = 1.20; p = .002) and neurological (OR = 1.18; p = .011) complications. Preoperative systolic blood pressure (SBp) over 140 mmHg was associated with a higher incidence of postoperative intracranial hemorrhage (OR = 4.42; p = .039) and longer hospital stay (OR = 2.48; p = .015). Greater postoperative fluctuation of SBp (OR = 1.14; p = .025) and blood glucose (mmol/L; OR = 1.48; p = .023) were related to a higher incidence of neurological complications, whereas higher postoperative blood glucose (OR = 0.64; p < .001) was related to a lower incidence. Long-term lower SBp (<124 mmHg; hazard ratio [HR] = 1.47; p = .010) and higher blood glucose (HR = 1.12; p < .001) were associated with shorter survival. Long-term serum albumin level (g/dL; HR = 0.32; p < .001) was positively associated with survival. CONCLUSION Short-term SBp and blood glucose levels and fluctuations are associated with postoperative complications in GBM patients. Their long-term optimization may impact survival of these patients. Future clinical trials are needed to confirm the benefit of optimizing medical comorbidities on GBM patients' outcomes. IMPLICATIONS FOR PRACTICE Glioblastoma multiforme (GBM) is one of the most feared cancer diagnoses because of its limited survival and treatment. This study revealed significant associations of noncancerous factors on the morbidity and mortality of GBM. The complexity of medical comorbidities, as well as short-term postoperative levels and fluctuations of blood pressure and blood glucose, was associated with postoperative complications, but not overall survival. However, long-term levels of these common clinical parameters were significantly associated with survival. Optimization of medical conditions may be critical for reducing the morbidity and mortality of GBM patients. Future clinical trials are needed to validate the observed associations in an independent cohort.
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Affiliation(s)
- Wenli Liu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wang PF, Meng Z, Song HW, Yao K, Duan ZJ, Li SW, Yan CX. Higher Plasma Fibrinogen Levels are Associated with Malignant Phenotype and Worse Survival in Patients with Glioblastomas. J Cancer 2018; 9:2024-2029. [PMID: 29896287 PMCID: PMC5995933 DOI: 10.7150/jca.24714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/05/2018] [Indexed: 12/17/2022] Open
Abstract
Preoperative plasma fibrinogen levels were associated with poor clinical outcomes in malignancies. There were few data about the prognostic value of plasma fibrinogen in glioblastomas (GBMs). The objective of our study was to investigate the association between fibrinogen and patients' clinicopathological factors and overall survival (OS). From 2008 to 2016, 315 patients with GBMs who had a surgical treatment at our institute, were retrospectively involved in this study. IDH (isocitrate dehydrogenase) mutations and ATRX (alpha thalassemia/mental retardation syndrome X-linked) loss were detected with IHC (Immunohistochemistry). The preoperative plasma fibrinogen levels ranged from 1.00 to 5.22 g/L, with a mean of were 2.57 g/L. There were increased levels of plasma fibrinogen in patients aged ≥ 65 years, secondary GBMs, IDH mutation (p = 0.033) and ATRX loss (p = 0.040). Moreover, the plasma fibrinogen level was the highest in the subtype of IDH-1R132H wildtype - ATRX expression, which showed a shorter OS compared to the group of IDH-1R132H mut and IDH-1R132H wildtype - ATRX loss (p = 0.001, log-rank test). ROC curves for fibrinogen and IDH-1R132H wildtype - ATRX expression was also plotted, and indicated a potential diagnostic value of fibrinogen in molecular pathology. Univariate analysis found that younger age, higher KPS (Karnofsky Performance Score), gross total resection, complete chemoradiotherapy, IDH-1R132H mutations and lower levels of fibrinogen were associated with favorable outcomes. Multivariate analysis proved that chemoradiotherapy, IDH-1R132H and fibrinogen were independent prognostic factors. In conclusion, plasma fibrinogen could predict clinical outcome and molecular subtype in GBMs.
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Affiliation(s)
- Peng-Fei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, China
| | - Zhe Meng
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, China
| | - Hong-Wang Song
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, China
| | - Kun Yao
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, China
| | - Ze-Jun Duan
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, China
| | - Shou-Wei Li
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, China
| | - Chang-Xiang Yan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, China
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Prognostic value of the Glasgow Prognostic Score for glioblastoma multiforme patients treated with radiotherapy and temozolomide. J Neurooncol 2018; 139:411-419. [PMID: 29696530 DOI: 10.1007/s11060-018-2879-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/22/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION To evaluate the prognostic value of the Glasgow Prognostic Score (GPS), the combination of C-reactive protein (CRP) and albumin, in glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (GPS). METHODS Data of newly diagnosed GBM patients treated with partial brain RT and concurrent and adjuvant TMZ were retrospectively analyzed. The patients were grouped into three according to the GPS criteria: GPS-0: CRP < 10 mg/L and albumin > 35 g/L; GPS-1: CRP < 10 mg/L and albumin < 35 g/L or CRP > 10 mg/L and albumin > 35 g/L; and GPS-2: CRP > 10 mg/L and albumin < 35 g/L. Primary end-point was the association between the GPS groups and the overall survival (OS) outcomes. RESULTS A total of 142 patients were analyzed (median age: 58 years, 66.2% male). There were 64 (45.1%), 40 (28.2%), and 38 (26.7%) patients in GPS-0, GPS-1, and GPS-2 groups, respectively. At median 15.7 months follow-up, the respective median and 5-year OS rates for the whole cohort were 16.2 months (95% CI 12.7-19.7) and 9.5%. In multivariate analyses GPS grouping emerged independently associated with the median OS (P < 0.001) in addition to the extent of surgery (P = 0.032), Karnofsky performance status (P = 0.009), and the Radiation Therapy Oncology Group recursive partitioning analysis (RTOG RPA) classification (P < 0.001). The GPS grouping and the RTOG RPA classification were found to be strongly correlated in prognostic stratification of GBM patients (correlation coefficient: 0.42; P < 0.001). CONCLUSIONS The GPS appeared to be useful in prognostic stratification of GBM patients into three groups with significantly different survival durations resembling the RTOG RPA classification.
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Huang SY, Odisio BC, Sabir SH, Ensor JE, Niekamp AS, Huynh TT, Kroll M, Gupta S. Development of a predictive model for 6 month survival in patients with venous thromboembolism and solid malignancy requiring IVC filter placement. J Thromb Thrombolysis 2018; 44:30-37. [PMID: 28315167 DOI: 10.1007/s11239-017-1493-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Our purpose was to develop a predictive model for short-term survival (i.e. <6 months) following inferior vena cava filter placement in patients with venous thromboembolism (VTE) and solid malignancy. METHODS Clinical and laboratory parameters were retrospectively reviewed for patients with solid malignancy who received a filter between January 2009 and December 2011 at a tertiary care cancer center. Multivariate Cox proportional hazards modeling was used to assess variables associated with 6 month survival following filter placement in patients with VTE and solid malignancy. Significant variables were used to generate a predictive model. RESULTS 397 patients with solid malignancy received a filter during the study period. Three variables were associated with 6 month survival: (1) serum albumin [hazard ratio (HR) 0.496, P < 0.0001], (2) recent or planned surgery (<30 days) (HR 0.409, P < 0.0001), (3) TNM staging (stage 1 or 2 vs. stage 4, HR 0.177, P = 0.0001; stage 3 vs. stage 4, HR 0.367, P = 0.0002). These variables were used to develop a predictive model to estimate 6 month survival with an area under the receiver operating characteristic curve of 0.815, sensitivity of 0.782, and specificity of 0.715. CONCLUSIONS Six month survival in patients with VTE and solid malignancy requiring filter placement can be predicted from three patient variables. Our predictive model could be used to help physicians decide whether a permanent or retrievable filter may be more appropriate as well as to assess the risks and benefits for filter retrieval within the context of survival longevity in patients with cancer.
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Affiliation(s)
- Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Sharjeel H Sabir
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Joe E Ensor
- The Methodist Hospital Cancer Center, Methodist Hospital Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
| | - Andrew S Niekamp
- The University of Texas Health Science Center at Houston, 7000 Fannin Suite 1200, Houston, TX, 77030, USA
| | - Tam T Huynh
- Department of Vascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Michael Kroll
- Department of Benign Hematology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
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Mantzorou M, Koutelidakis A, Theocharis S, Giaginis C. Clinical Value of Nutritional Status in Cancer: What is its Impact and how it Affects Disease Progression and Prognosis? Nutr Cancer 2017; 69:1151-1176. [PMID: 29083236 DOI: 10.1080/01635581.2017.1367947] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Malnutrition is a common finding in cancer patients, which can affect disease progression and survival. This review aims to critically summarize the prognostic role of nutritional status, from Body Mass Index (BMI) and weight loss to nutrition screening tools and biochemical indices, in cancer patients. According to the currently available data, Prognostic Nutritional Index (PNI) was a significant prognostic factor of patients' survival, both in univariate and multivariate analyses. Pre-operative albumin was also correlated with worse outcomes, being an independent prognostic factor of survival in several studies. BMI was also well-studied, with contradictory results. Although, lower BMI was found to be an independent prognostic factor of shorter survival in some studies, in others it did not have an impact on survival. In this aspect, this review highlights the significant prognostic role of nutritional status in the disease progression and survival of cancer patients. Further, good-quality prospective studies are needed in order to draw precise conclusions on the prognostic role of specific nutritional assessment tools, and biochemical indices associated with the nutritional status in more cancer types, such as liver, breast and prostate cancer, and hematological malignancies.
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Affiliation(s)
- Maria Mantzorou
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
| | - Antonios Koutelidakis
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
| | - Stamatios Theocharis
- b First Department of Pathology , Medical School, University of Athens , Athens , Greece
| | - Constantinos Giaginis
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
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Aoki Y, Aoki M, Yamada K. Leukocyte Telomere Length and Serum Levels of High-Molecular-Weight Adiponectin and Dehydroepiandrosterone-Sulfate Could Reflect Distinct Aspects of Longevity in Japanese Centenarians. Gerontol Geriatr Med 2017; 3:2333721417696672. [PMID: 28540339 PMCID: PMC5433671 DOI: 10.1177/2333721417696672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 11/17/2022] Open
Abstract
Leukocyte telomere length and serum levels of high-molecular-weight adiponectin and dehydroepiandrosterone-sulfate (DHEA-S) were assessed in association with nutrition and performance status (PS) in Japanese centenarians. Twenty-three centenarians (five men, 18 women) were classified according to their PS 1 (nearly fully ambulatory, n = 2), 2 (in bed less than 50% of daytime, n = 10), 3 (in bed greater than 50%, n = 6), and 4 (completely bedridden, n = 5). Leukocyte telomere length was determined by the hybridization protection assay, and the adiponectin and DHEA-S levels were measured by chemiluminescent enzyme immunoassay. Among variables of PS, body mass index (BMI), albumin, adiponectin, DHEA-S, and telomere length, there were significant correlations between PS and albumin (r = −.694, p < .01), between telomere length and BMI (r = .522, p < .05), between adiponectin and BMI (r = −.574, p < .01), and between DHEA-S and albumin (r = .530, p < .01). When excluding two cancer-bearing centenarians with short telomere, telomere length significantly correlated with PS (r = −.632, p < .01). It was indicated that the short leukocyte telomere was associated with poor PS and cancer development and that the adiponectin or DHEA-S was associated with adiposity or nutritional status. Despite a small number of subjects, these biomarkers seemed to reflect distinct aspects of longevity in Japanese centenarians.
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Affiliation(s)
- Yuji Aoki
- Matsumoto Hospital, Matsumoto, Japan
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Post-translational modifications of FDA-approved plasma biomarkers in glioblastoma samples. PLoS One 2017; 12:e0177427. [PMID: 28493947 PMCID: PMC5426747 DOI: 10.1371/journal.pone.0177427] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/27/2017] [Indexed: 01/08/2023] Open
Abstract
Liquid chromatography-tandem mass spectrometry was used to analyze plasma proteins of volunteers (control) and patients with glioblastoma multiform (GBM). A database search was pre-set with a variable post-translational modification (PTM): phosphorylation, acetylation or ubiquitination. There were no significant differences between the control and the GBM groups regarding the number of protein identifications, sequence coverage or number of PTMs. However, in GBM plasma, we unambiguously observed a decreased fraction in post-translationally modified peptides identified with high quality. The disease-specific PTM patterns were extracted and mapped to the set of FDA-approved plasma protein markers. Decreases of 46% and 24% in the number of acetylated and ubiquitinated peptides, respectively, were observed in the GBM samples. Significance of capturing disease-associated patterns of protein modifications was envisaged.
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Higher N stage and serum ferritin, but lower serum albumin levels are associated with distant metastasis and poor survival in patients with nasopharyngeal carcinoma following intensity-modulated radiotherapy. Oncotarget 2017; 8:73177-73186. [PMID: 29069861 PMCID: PMC5641204 DOI: 10.18632/oncotarget.17418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 03/29/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate the potential risk factors for distant metastasis of nasopharyngeal carcinoma in Chinese patients following standard intensity-modulated radiotherapy and chemotherapy. Methods The potential risk factors for distant metastasis in 622 patients with newly-diagnosed primary nasopharyngeal carcinoma following standard radiotherapy and chemotherapy were evaluated retrospectively by stratification, univariate and multivariate analyses. The 5-year overall survival, distant metastasis-free survival, local recurrence-free survival and progression-free survival rates were determined. Results Univariate and multivariate analyses indicated that N2-3 stage, serum ferritin > 300 μg/L and serum albumin < 42 g/L were independent risk factors for distant metastasis of nasopharyngeal carcinoma (P < 0.001, P = 0.013, P = 0.002, respectively). A risk prediction model was developed as follows: 1) low-risk group: 0-1 risk factor; and 2) high-risk group: 2-3 risk factors. Compared with low-risk group, the high-risk group had significantly lower 5-year distant metastasis-free survival (76.4% vs. 89.6%, P < 0.001), overall survival (76% vs. 85.9%,P < 0.001), local recurrence-free survival (88% vs. 92.4%, P = 0.029) and progression-free survival rates (68.2% vs. 83.7%, P < 0.001). In the high-risk group, patients with three risk factors had the lowest distant metastasis-free survival rate (P = 0.036). Conclusions Combination of higher N stage, serum ferritin and lower serum albumin levels may be valuable for predicting distant metastasis of nasopharyngeal carcinoma patients following standard intensity-modulated radiotherapy and chemotherapy.
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Zhou XW, Dong H, Yang Y, Luo JW, Wang X, Liu YH, Mao Q. Significance of the prognostic nutritional index in patients with glioblastoma: A retrospective study. Clin Neurol Neurosurg 2016; 151:86-91. [DOI: 10.1016/j.clineuro.2016.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/12/2016] [Accepted: 10/21/2016] [Indexed: 12/22/2022]
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Chen Z, Shao Y, Wang K, Cao W, Xiong Y, Wu R, Luo S, Xu X, He X. Prognostic role of pretreatment serum albumin in renal cell carcinoma: a systematic review and meta-analysis. Onco Targets Ther 2016; 9:6701-6710. [PMID: 27822073 PMCID: PMC5094571 DOI: 10.2147/ott.s108469] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Recently, many studies have shown that pretreatment serum albumin can be closely linked to the prognosis of cancer patients, including those with renal cell carcinoma (RCC). However, not all studies have reached the same conclusion. We therefore conducted a systematic review and meta-analysis to evaluate the prognostic value of pretreatment serum albumin in RCC patients. A total of 17 studies involving 6,447 patients were included in our meta-analysis. Our results indicated that a lower pretreatment serum albumin level yielded a worse overall survival (hazard ratio [HR]=2.46, 95% confidence interval [CI] 1.92–3.13), cancer-specific survival (HR=2.22, 95% CI 1.87–2.64), and relapse-free survival/progression-free survival (HR=1.75, 95% CI 1.28–2.38). Generally, these findings were particularly pronounced when stratified by tumor type, analysis type, cut-off value, and HR-obtaining method. In conclusion, a decreased pretreatment serum albumin level implies a poor prognosis for RCC patients, and can be monitored for risk stratification and individualized treatment in RCC patients.
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Affiliation(s)
- Zhen Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Yingjie Shao
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Kun Wang
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Wei Cao
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Yulong Xiong
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Rongzu Wu
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Shicheng Luo
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Xianlin Xu
- Department of Urology, Sir Run Run Shaw Hospital, Third Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University
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Helmersson-Karlqvist J, Flodin M, Havelka AM, Xu XY, Larsson A. The Roche Immunoturbidimetric Albumin Method on Cobas c 501 Gives Higher Values Than the Abbott and Roche BCP Methods When Analyzing Patient Plasma Samples. J Clin Lab Anal 2016; 30:677-81. [PMID: 27169354 DOI: 10.1002/jcla.21921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/09/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Serum/plasma albumin is an important and widely used laboratory marker and it is important that we measure albumin correctly without bias. We had indications that the immunoturbidimetric method on Cobas c 501 and the bromocresol purple (BCP) method on Architect 16000 differed, so we decided to study these methods more closely. METHOD A total of 1,951 patient requests with albumin measured with both the Architect BCP and Cobas immunoturbidimetric methods were extracted from the laboratory system. A comparison with fresh plasma samples was also performed that included immunoturbidimetric and BCP methods on Cobas c 501 and analysis of the international protein calibrator ERM-DA470k/IFCC. RESULTS The median difference between the Abbott BCP and Roche immunoturbidimetric methods was 3.3 g/l and the Roche method overestimated ERM-DA470k/IFCC by 2.2 g/l. The Roche immunoturbidimetric method gave higher values than the Roche BCP method: y = 1.111x - 0.739, R² = 0.971. CONCLUSION The Roche immunoturbidimetric albumin method gives clearly higher values than the Abbott and Roche BCP methods when analyzing fresh patient samples. The differences between the two methods were similar at normal and low albumin levels.
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Affiliation(s)
| | - Mats Flodin
- Department of Medical Sciences, Clinical Chemistry, University Hospital, Uppsala, Sweden
| | | | - Xiao Yan Xu
- Department of Medical Sciences, Clinical Chemistry, University Hospital, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, University Hospital, Uppsala, Sweden.
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Pretreatment neutrophil-to-lymphocyte ratio predicts prognosis in patients with metastatic renal cell carcinoma receiving targeted therapy. Int J Clin Oncol 2015; 21:373-378. [PMID: 26335242 DOI: 10.1007/s10147-015-0894-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 08/16/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is associated with clinical outcomes of various cancers. This study aimed to evaluate whether pretreatment NLR can be used as a prognostic factor in patients with metastatic renal cell carcinoma (mRCC) receiving targeted therapy. METHODS In this single-center retrospective study, the Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) of 373 mRCC patients receiving targeted therapy. The survival outcomes of patients with high (≥ 2.2) and low (< 2.2) pretreatment NLRs were compared by log-rank test, and Cox proportional hazard regression model was used to compare OS and PFS between groups. RESULTS The overall median PFS and OS times for all 373 patients were 18.4 and 34.3 months, respectively. Patients with high NLRs had significantly shorter median OS (28.8 vs 410 months, P = 0.005) and PFS (15.4 vs 23.9 months, P = 0.001) than those with low NLRs. After adjusting for confounding variables, each unit increase of NLR was associated with a 40 % increase in mortality (hazard ratio [HR] 1.391; 95 % confidence interval [CI] 1.022-1.894; P = 0.036). High NLR was also an independent predictor of poor PFS (HR 1.544; 95 % CI 1.166-2.045; P = 0.002). CONCLUSION Pretreatment NLR may be an independent prognostic factor for mRCC patients who are receiving targeted therapy.
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