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Connaughton M, Dabagh M. Modeling Physical Forces Experienced by Cancer and Stromal Cells Within Different Organ-Specific Tumor Tissue. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2024; 12:413-434. [PMID: 38765886 PMCID: PMC11100865 DOI: 10.1109/jtehm.2024.3388561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/07/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
Mechanical force exerted on cancer cells by their microenvironment have been reported to drive cells toward invasive phenotypes by altering cells' motility, proliferation, and apoptosis. These mechanical forces include compressive, tensile, hydrostatic, and shear forces. The importance of forces is then hypothesized to be an alteration of cancer cells' and their microenvironment's biophysical properties as the indicator of a tumor's malignancy state. Our objective is to investigate and quantify the correlation between a tumor's malignancy state and forces experienced by the cancer cells and components of the microenvironment. In this study, we have developed a multicomponent, three-dimensional model of tumor tissue consisting of a cancer cell surrounded by fibroblasts and extracellular matrix (ECM). Our results on three different organs including breast, kidney, and pancreas show that: A) the stresses within tumor tissue are impacted by the organ specific ECM's biophysical properties, B) more invasive cancer cells experience higher stresses, C) in pancreas which has a softer ECM (Young modulus of 1.0 kPa) and stiffer cancer cells (Young modulus of 2.4 kPa and 1.7 kPa) than breast and kidney, cancer cells experienced significantly higher stresses, D) cancer cells in contact with ECM experienced higher stresses compared to cells surrounded by fibroblasts but the area of tumor stroma experiencing high stresses has a maximum length of 40 μm when the cancer cell is surrounded by fibroblasts and 12 μm for when the cancer cell is in vicinity of ECM. This study serves as an important first step in understanding of how the stresses experienced by cancer cells, fibroblasts, and ECM are associated with malignancy states of cancer cells in different organs. The quantification of forces exerted on cancer cells by different organ-specific ECM and at different stages of malignancy will help, first to develop theranostic strategies, second to predict accurately which tumors will become highly malignant, and third to establish accurate criteria controlling the progression of cancer cells malignancy. Furthermore, our in silico model of tumor tissue can yield critical, useful information for guiding ex vivo or in vitro experiments, narrowing down variables to be investigated, understanding what factors could be impacting cancer treatments or even biomarkers to be looking for.
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Affiliation(s)
- Morgan Connaughton
- Department of Biomedical EngineeringUniversity of Wisconsin-MilwaukeeMilwaukeeWI53211USA
| | - Mahsa Dabagh
- Department of Biomedical EngineeringUniversity of Wisconsin-MilwaukeeMilwaukeeWI53211USA
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Li M, Zhang J, Zha Y, Li Y, Hu B, Zheng S, Zhou J. A prediction model for xerostomia in locoregionally advanced nasopharyngeal carcinoma patients receiving radical radiotherapy. BMC Oral Health 2022; 22:239. [PMID: 35715856 PMCID: PMC9206362 DOI: 10.1186/s12903-022-02269-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 06/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background This study was to evaluate the predictors of xerostomia and Grade 3 xerostomia in locoregionally advanced nasopharyngeal carcinoma (NPC) patients receiving radical radiotherapy and establish prediction models for xerostomia and Grade 3 xerostomia based on the predictors. Methods Totally, 365 patients with locoregionally advanced NPC who underwent radical radiotherapy were randomly divided into the training set (n = 255) and the testing set (n = 110) at a ratio of 7:3. All variables were included in the least absolute shrinkage and selection operator regression to screen out the potential predictors for xerostomia as well as the Grade 3 xerostomia in locoregionally advanced NPC patients receiving radical radiotherapy. The random forest (RF), a decision tree classifier (DTC), and extreme-gradient boosting (XGB) models were constructed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC) and accuracy were analyzed to evaluate the predictive performance of the models. Results In the RF model for predicting xerostomia, the sensitivity was 1.000 (95%CI 1.000–1.000), the PPV was 0.990 (95%CI 0.975–1.000), the NPV was 1.000 (95%CI 1.000–1.000), the AUC was 0.999 (95%CI 0.997–1.000) and the accuracy was 0.992 (95%CI 0.981–1.000) in the training set. The sensitivity was 0.933 (95%CI 0.880–0.985), the PPV was 0.933 (95%CI 0.880–0.985), and the AUC was 0.915 (95%CI 0.860–0.970) in the testing set. Hypertension, age, total radiotherapy dose, dose at 50% of the left parotid volume, mean dose to right parotid gland, mean dose to oral cavity, and course of induction chemotherapy were important variables associated with the risk of xerostomia in locoregionally advanced NPC patients receiving radical radiotherapy. The AUC of DTC model for predicting xerostomia was 0.769 (95%CI 0.666–0.872) in the testing set. The AUC of the XGB model for predicting xerostomia was 0.834 (0.753–0.916) in the testing set. The RF model showed the good predictive ability with the AUC of 0.986 (95%CI 0.972–1.000) in the training set, and 0.766 (95%CI 0.626–0.905) in the testing set for identifying patients who at high risk of Grade 3 xerostomia in those with high risk of xerostomia. Conclusions An RF model for predicting xerostomia in locoregionally advanced NPC patients receiving radical radiotherapy and an RF model for predicting Grade 3 xerostomia in those with high risk of xerostomia showed good predictive ability.
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Affiliation(s)
- Minying Li
- Department of Oncology Radiotherapy, Zhongshan City People's Hospital, No.2 Sunwen Middle Road, Shiqi District, Zhongshan City, 528403, Guangdong, China.
| | - Jingjing Zhang
- Department of Oncology Radiotherapy, Zhongshan City People's Hospital, No.2 Sunwen Middle Road, Shiqi District, Zhongshan City, 528403, Guangdong, China
| | - Yawen Zha
- Department of Oncology Radiotherapy, Zhongshan City People's Hospital, No.2 Sunwen Middle Road, Shiqi District, Zhongshan City, 528403, Guangdong, China
| | - Yani Li
- Department of Oncology Radiotherapy, Zhongshan City People's Hospital, No.2 Sunwen Middle Road, Shiqi District, Zhongshan City, 528403, Guangdong, China
| | - Bingshuang Hu
- Department of Oncology Radiotherapy, Zhongshan City People's Hospital, No.2 Sunwen Middle Road, Shiqi District, Zhongshan City, 528403, Guangdong, China
| | - Siming Zheng
- Department of Oncology Radiotherapy, Zhongshan City People's Hospital, No.2 Sunwen Middle Road, Shiqi District, Zhongshan City, 528403, Guangdong, China
| | - Jiaxiong Zhou
- Department of Oncology Radiotherapy, Zhongshan City People's Hospital, No.2 Sunwen Middle Road, Shiqi District, Zhongshan City, 528403, Guangdong, China
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Connaughton M, Dabagh M. Association of Hypertension and Organ-Specific Cancer: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10061074. [PMID: 35742125 PMCID: PMC9222904 DOI: 10.3390/healthcare10061074] [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: 04/16/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Hypertension and cancer are two of the leading global causes of death. Hypertension, known as chronic high blood pressure, affects approximately 45% of the American population and is a growing condition in other parts of the world, particularly in Asia and Europe. On the other hand, cancer resulted in approximately 10 million deaths in 2020 worldwide. Several studies indicate a coexistence of these two conditions, specifically that hypertension, independently, is associated with an increased risk of cancer. In the present study, we conducted a meta-analysis initially to reveal the prevalence of hypertension and cancer comorbidity and then to assess which organ-specific cancers were associated with hypertension by calculating the summary relative risks (RRs) and 95% confidence intervals (CIs). Our analysis shows that hypertension plays a role in cancer initiation. Our extended analysis on how the hypertension-associated angiogenesis factors are linked to cancer demonstrated that matrix metalloproteinases 2 and 9 appear to be two key factors facilitating cancer in hypertensive patients. This work serves as an important step in the current assessment of hypertension-promoted increased risk of 19 different cancers, particularly kidney, renal cell carcinoma, breast, colorectal, endometrial, and bladder. These findings provide new insight into how to treat and prevent cancer in hypertensive patients.
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Huang S, Tan X, Feng P, Gong S, He Q, Zhu X, Liu N, Li Y. Prognostic Implication of Metabolic Syndrome in Patients with Nasopharyngeal Carcinoma: A Large Institution-Based Cohort Study from an Endemic Area. Cancer Manag Res 2022; 13:9355-9366. [PMID: 34992461 PMCID: PMC8713719 DOI: 10.2147/cmar.s336578] [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: 08/28/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022] Open
Abstract
Objective Metabolic syndrome has been identified as a prognostic predictor in multiple cancers. This study aimed to evaluate the impact of metabolic syndrome on the clinical outcome of patients with nasopharyngeal carcinoma (NPC) and its mechanism. Methods A cohort of 2003 NPC patients with a median follow-up time of 96.3 months (range: 4.1–120.0 months) were enrolled in this analysis. Kaplan–Meier curves and the Log rank test were used to determine the differences in progression-free survival (PFS), cancer specific survival (CSS) and overall survival (OS). Univariate and multivariable analyses were used to identify independent prognostic predictors. Untargeted metabolomics (LC-HRMS) was used to detect the serum metabolic profiles of 10 well-matched patients with or without metabolic syndrome. Differential metabolite-based enrichment analysis and pathway analysis were performed to identify the potential mechanism of metabolic syndrome in NPC. Results A total of 171/2003 (8.5%) patients were diagnosed with metabolic syndrome, and these patients tended to be male (P < 0.001) and older (P = 0.003). Patients with metabolic syndrome had poorer PFS (P = 0.011), CSS (P = 0.003) and OS (P = 0.001) than those without metabolic syndrome. Univariate and multivariable analyses showed that metabolic syndrome was a statistically significant and independent predictor for PFS (HR: 1.34, 95% CI: 1.03–1.75, P = 0.032), CSS (HR: 1.53, 95% CI: 1.12–2.08, P = 0.008), and OS (HR: 1.50, 95% CI: 1.13–2.00, P = 0.006). The serum metabolic profile of patients with metabolic syndrome was distinct from that of patients without metabolic syndrome. A total of 319 differential metabolites [log2(FC)>1 or log2 (FC)<-1] were identified and were significantly involved in D-glutamine and D-glutamate metabolism, and valine, leucine and isoleucine biosynthesis. Conclusion Metabolic syndrome can serve as a prognostic predictor and guide a more personalized therapy for NPC patients.
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Affiliation(s)
- Shengyan Huang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Xirong Tan
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Ping Feng
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, People's Republic of China
| | - Sha Gong
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Qingmei He
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Xunhua Zhu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Na Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Yingqing Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
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Li X, Chen H, Zhao F, Zheng Y, Pang H, Xiang L. Development of a Radiotherapy Localisation Computed Tomography-Based Radiomic Model for Predicting Survival in Patients With Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy Following Induction Chemotherapy. Cancer Control 2022; 29:10732748221076820. [PMID: 35271403 PMCID: PMC8918969 DOI: 10.1177/10732748221076820] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Our purpose is to develop a model combining radiomic features of radiotherapy localisation computed tomography and clinical characteristics that can be used to estimate overall survival in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy following induction chemotherapy. METHODS We recruited 145 patients with pathologically confirmed nasopharyngeal carcinoma between February 2012 and April 2015. In total, 851 radiomic features were extracted from radiotherapy localisation computed tomography images for the gross tumour volume of the nasopharynx and the gross tumour volume of neck metastatic lymph nodes. The least absolute shrinkage and selection operator algorithm was applied to select radiomics features, build the model and calculate the Rad-score. The patients were divided into high- and low-risk groups based on their Rad-scores. A nomogram for estimating overall survival based on both radiomic and clinical features was generated using multivariate Cox regression hazard models. Prediction reliability was evaluated using Harrell's concordance index. RESULTS In total, seven radiomic features and one clinical characteristic were extracted for survival analysis, and the combination of radiomic and clinical features was a better predictor of overall survival (concordance index = .849 [confidence interval: .782-.916]) than radiomic features (concordance index = .793 [confidence interval: .697-.890]) or clinical characteristics (concordance index = .661 [confidence interval: .673-.849]) alone. CONCLUSION Our results show that a nomogram combining radiomic features of radiotherapy localisation computed tomography and clinical characteristics can predict overall survival in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy following induction chemotherapy more effectively than radiomic features or clinical characteristics alone.
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Affiliation(s)
- Xiaoyue Li
- Department of Oncology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Han Chen
- Department of Oncology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Feipeng Zhao
- Department of Otolaryngology-Head and Neck Surgery, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yun Zheng
- Department of Oncology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li Xiang
- Department of Oncology, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Yin WJ, Chen DP, Wang MY, Zheng L, Dong EL, Liu JQ, Qi B. Prognostic value of hypertension in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1313. [PMID: 34532450 PMCID: PMC8422106 DOI: 10.21037/atm-21-3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022]
Abstract
Background The prognostic value of hypertension remains unknown in nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). In this study, we aimed to develop hypertension as a prognostic signature for improving the clinical outcome of non-metastatic NPC patients treated with IMRT. Methods A clinical cohort, comprising 1,057 patients with non-metastatic, histologically proven, NPC who were treated with IMRT were retrospectively reviewed. Associations between hypertension and overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were estimated by Cox regression. A subgroup analysis of the relationship between hypertension grade and NPC prognosis was also conducted. Results Among the 1057 patients, 94 (8.9%) had hypertension. Significant differences were observed between patients with hypertension and patients without hypertension in relation to OS (66.6% vs. 85.4%; P<0.0001), PFS (60.8% vs. 76.3%; P=0.001), LRRFS (85.3% vs. 90.5%; P=0.024), and DMFS (77.4% vs. 85.1%; P=0.048), and patients without hypertension had greater treatment success rates. The Cox analysis showed that hypertension was an independent unfavorable prognostic factor for OS [hazards ratio (HR), 2.056; P=0.001], PFS (HR, 1.716; P=0.005), and DMFS (HR, 1.658; P=0.049). The patients with more severe levels of hypertension had worse OS and LRRFS. Specifically, the 5-year OS and LRRFS for grades 1, 2, and 3 were 70.6%, 64.3%, and 62.4% (P=0.712), and 89.5%, 86.4%, and 76.1% (P=0.376), respectively. Conclusions Hypertension is an independent adverse prognostic factor in NPC patients treated with IMRT. The question of whether the severity of hypertension affects prognosis needs to be further verified by large sample data.
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Affiliation(s)
- Wen-Jing Yin
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Dong-Ping Chen
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Meng-Yao Wang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Lu Zheng
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - En-Lai Dong
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Jin-Quan Liu
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Bin Qi
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
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Chen A, Li Z, He Y, Chen F, Chen L. Effect of the number of control points on the plan quality of intensity-modulated radiotherapy for nasopharyngeal carcinoma. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1954802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Along Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou China
| | - Zhenghuan Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou China
| | - Yadi He
- School of Biomedical Engineering, South Medical University, Guangzhou China
| | - Fei Chen
- School of Biomedical Engineering, Xinhua College of Sun Yat-sen University, Guangzhou China
| | - Li Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou China
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Hypertension predicts a poor prognosis in patients with esophageal squamous cell carcinoma. Oncotarget 2018; 9:14068-14076. [PMID: 29581827 PMCID: PMC5865653 DOI: 10.18632/oncotarget.23774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/21/2017] [Indexed: 12/23/2022] Open
Abstract
Background We investigated the relationship between the preoperative hypertension and prognosis of esophageal squamous cell cancer (ESCC) patients who had underwent esophagectomy. Results We detected 52% patients with hypertension, including 317 patients with newly diagnosed hypertension and 194 patients with history of hypertension. Compared with patients of normal blood pressure, all patients with hypertension and newly diagnosed hypertension were observed to have worse overall and ESCC-specific survival outcome (p < 0.05). After adjusted in multivariate Cox regression analysis, hypertension (HR: 1.343, 95% CI: 1.064, 1.695; HR: 1.315, 95% CI: 1.039, 1.664) and newly diagnosed hypertension (HR: 1.414, 95% CI: 1.095, 1.826; HR: 1.420, 95% CI: 1.098, 1.836) were inversely associated with overall and ESCC-specific survival outcome, respectively. While no association was found between history of hypertension and overall or ESCC-specific survival outcome (HR: 1.229, 95% CI: 0.892, 1.694; HR: 1.132, 95% CI: 0.812, 1.578). Conclusions Hypertension was an independent risk factor and resulted in inferior prognosis for ESCC patients who had underwent esophagectomy. Methods A total of 982 ESCC patients who had underwent esophagectomy from August 2010 to December 2015 were enrolled in our study with a follow up of 6 years. The Kaplan-Meier method and log-rank test were respectively used to calculate and compare survival rate, and Cox proportional hazards regression model was applied to identify independent prognostic factors.
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