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Zhou H, Chen J, Liu K, Xu H. Prognostic factors and predictive nomogram models for early death in elderly patients with hepatocellular carcinoma: a population-based study. Front Mol Biosci 2023; 10:1275791. [PMID: 37908229 PMCID: PMC10613697 DOI: 10.3389/fmolb.2023.1275791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023] Open
Abstract
Background: Owing to an aging society, there has been an observed increase in the average age of patients diagnosed with hepatocellular carcinoma (HCC). Consequently, this study is centered on identifying the prognostic factors linked with early death among this elderly demographic diagnosed with HCC. Additionally, our focus extends to developing nomograms capable of predicting such outcomes. Methods: The Surveillance, Epidemiology and End Results (SEER) database underpinned this study, showcasing participants aged 75 and above diagnosed with HCC within the timeframe from 2010 to 2015. These participants were divided randomly, at a 7:3 ratio, into training and validation cohorts. Univariable and multivariable logistic regressions were applied to the training cohort in the identification of prognostic indicators of early death, forming the basis for nomogram development. To measure the efficacy of these nomograms within both cohorts, we resorted to Receiver Operating Characteristic (ROC) curves, along with GiViTI calibration belt and Decision Curve Analysis (DCA). Results: The study involved 1,163 elderly individuals diagnosed with HCC, having reported instances of 397 all-cause early deaths and 356 HCC-specific early deaths. The sample group was divided into two cohorts: a training group consisting of 815 individuals, and a validation cohort, comprised of 348 individuals. Multifactorial analysis identified grade, T-stage, surgery, radiation, chemotherapy, bone and lung metastasis as significant predictors of mortality from all causes. Meanwhile, race, grade, T-stage, surgery, radiation, chemotherapy, and bone metastasis were revealed to be estimative factors for cancer-specific mortality. Subsequently, these factors were used to develop nomograms for prediction. GiViTI calibration belt corroborated the acceptable coherence of the nomograms, DCA confirmed their valuable clinical applicability, and ROC curves evidenced satisfactory discriminative capacity within both training and validation cohorts. Conclusion: The nomograms utilized in this study proved instrumental in detecting early death among elderly individuals afflicted with HCC. This tool could potentially assist physicians in formulating individualized treatment strategies.
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Affiliation(s)
- Hao Zhou
- Department of Hepatobiliary and Pancreatic Surgery II, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Junhong Chen
- Department of Hepatobiliary and Pancreatic Surgery II, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Kai Liu
- Department of Hepatobiliary and Pancreatic Surgery II, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Hongji Xu
- Department of Abdominal Surgery, Guiqian International General Hospital, Guiyang, Guizhou, China
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Chen F, Wu Y, Xu H, Song T, Yan S. Impact of marital status on overall survival in patients with early-stage hepatocellular carcinoma. Sci Rep 2022; 12:19923. [PMID: 36402820 PMCID: PMC9675859 DOI: 10.1038/s41598-022-14120-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
The purpose of the present research was to assess the prognostic impact of marital status in hepatocellular carcinoma (HCC) patients with tumors ≤ 2 cm (stage Ia) based on the data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients who received a histopathologic HCC diagnosis between 2004 and 2016 were recruited. Overall survival (OS) was the major outcome measure. The Cox regression model and the Fine-Gray regression model were used for the purpose of comparing and examining the prognostic value of marital status for OS. The data for a total of 2446 stage Ia HCC patients were extracted from the database. The median overall survival time was 96.0 months, with 5-year and 10-year overall survival rates of 58.2% and 45.8%, respectively. In both the Fine-Gray regression model and Cox regression model, marital status [married vs. unmarried and others, both P < 0.001, hazard ratio (HR) = 1.389 for Cox and HR = 1.378 for Fine-Gray], age at diagnosis, tumor grade, and surgery at the primary site independently served as prognostic indicators associated with OS. In conclusion, positive marital status was independently associated with better OS for stage Ia HCC patients, and its prognostic influence should be validated in the near future.
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Affiliation(s)
- Fangjie Chen
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang People’s Republic of China ,grid.506977.a0000 0004 1757 7957Department of Nursing, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014 Zhejiang People’s Republic of China
| | - Ying Wu
- grid.506977.a0000 0004 1757 7957Department of Nursing, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014 Zhejiang People’s Republic of China
| | - Hong’en Xu
- grid.506977.a0000 0004 1757 7957Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014 Zhejiang People’s Republic of China
| | - Tao Song
- grid.506977.a0000 0004 1757 7957Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014 Zhejiang People’s Republic of China
| | - Senxiang Yan
- grid.452661.20000 0004 1803 6319Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang People’s Republic of China
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Stereotactic Body Radiation Therapy for the Management of Hepatocellular Carcinoma: Efficacy and Safety. Cancers (Basel) 2022; 14:cancers14163892. [PMID: 36010885 PMCID: PMC9405555 DOI: 10.3390/cancers14163892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary This study aimed to describe treatment efficacy and safety in patients with hepatocellular carcinoma (HCC) undergoing stereotactic body radiation therapy (SBRT). In one of the largest retrospective studies to date, we analyzed the data of 318 patients. The median follow-up period was 70.2 months. The local control rate at 24 and 60 months was 94% (91–97%) and 94% (91–97%), respectively. Relapse-free survival at 12, 24, and 60 months was 62% (55–67%), 29% (23–36%), and 13% (8–19%), respectively. OS at 12, 24, and 60 months was 72% (95%CI 67–77%), 44% (38–50%), and 11% (7–15%), respectively. The outcome is highly related to the natural evolution of the underlying cirrhosis. Child-Pugh score B-C, high BCLC score, portal thrombosis, GTV volume, and higher PTV volume reported on total hepatic volume ratio were significantly associated with OS. SBRT is efficient for the management of HCC with a favorable toxicity profile. Abstract This study aimed to describe patient characteristics, treatment efficacy, and safety in patients with hepatocellular carcinoma (HCC) undergoing stereotactic body radiation therapy (SBRT). We retrospectively analyzed data of 318 patients with 375 HCC treated between June 2007 and December 2018. Efficacy (overall survival [OS], relapse-free survival, and local control) and acute and late toxicities were described. The median follow-up period was 70.2 months. Most patients were treated with 45 Gy in three fractions. The median (range) PTV volume was 90.7 (2.6–1067.6) cc. The local control rate at 24 and 60 months was 94% (91–97%) and 94% (91–97%), respectively. Relapse-free survival at 12, 24, and 60 months was 62% (55–67%), 29% (23–36%), and 13% (8–19%), respectively. OS at 12, 24, and 60 months was 72% (95%CI 67–77%), 44% (38–50%), and 11% (7–15%), respectively. Approximately 51% and 38% experienced acute and late toxicity, respectively. Child-Pugh score B-C, high BCLC score, portal thrombosis, high GTV volume, and higher PTV volume reported on total hepatic volume ratio were significantly associated with OS. SBRT is efficient for the management of HCC with a favorable toxicity profile. The outcome is highly related to the natural evolution of the underlying cirrhosis.
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Zhang H, Du X, Dong H, Xu W, Zhou P, Liu S, Qing X, Zhang Y, Yang M, Zhang Y. Risk factors and predictive nomograms for early death of patients with advanced hepatocellular carcinoma: a large retrospective study based on the SEER database. BMC Gastroenterol 2022; 22:348. [PMID: 35854221 PMCID: PMC9297630 DOI: 10.1186/s12876-022-02424-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a kind of tumor with high invasiveness, and patients with advanced HCC have a higher risk of early death. The aim of the present study was to identify the risk factors of early death in patients with advanced HCC and establish predictive nomograms. METHODS Death that occurred within 3 months of initial diagnosis is defined as early death. Patients diagnosed with stage IV HCC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results database for model establishment and verification. Univariable and multivariable logistic regression analyses were used to identify the risk factors. Predictive nomograms were constructed and an internal validation was performed. Decision curve analysis (DCA) was used to verify the true clinical application value of the models. RESULTS Of 6603 patients (57% age > 60, 81% male, 70% white, 46% married), 21% and 79% had stage IVA and IVB, respectively. On the multivariable analyses, risk factors for early deaths in patients with stage IVA were age, tumor size, histological grade, alpha-fetoprotein (AFP), fibrosis score, tumor stage (T stage), surgery, radiotherapy, and chemotherapy, and that in stage IVB were age, histological grade, AFP, T stage, node stage (N stage), bone metastasis, lung metastasis, surgery, radiotherapy, and chemotherapy. The areas under the curves (AUCs) were 0.830 (95% CI 0.809-0.851) and 0.789 (95% CI 0.768-0.810) in stage IVA and IVB, respectively. Nomograms comprising risk factors with the concordance indexes (C-indexes) were 0.820 (95% CI 0.799-0.841) in stage IVA and 0.785 (95% CI 0.764-0.0.806) in stage IVB for internal validation (Bootstrapping, 1000re-samplings). The calibration plots of the nomograms show that the predicted early death was consistent with the actual value. The results of the DCA analysis show that the nomograms had a good clinical application. CONCLUSION The nomograms can be beneficial for clinicians in identifying the risk factors for early death of patients with advanced HCC and predicting the probability of early death, so as to allow for individualized treatment plans to be accurately selected.
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Affiliation(s)
- Haidong Zhang
- Medical School, Southeast University, Nanjing, China
| | - Xuanlong Du
- Medical School, Southeast University, Nanjing, China
| | - Hui Dong
- Medical School, Southeast University, Nanjing, China
| | - Wenjing Xu
- Medical School, Southeast University, Nanjing, China
| | | | - Shiwei Liu
- Medical School, Southeast University, Nanjing, China
| | - Xin Qing
- Medical School, Southeast University, Nanjing, China
| | - Yu Zhang
- Medical School, Southeast University, Nanjing, China
| | - Meng Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yewei Zhang
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Wang H, Liu C, Meng Z, Zhou W, Chen T, Zhang K, Wu A. Real-world study for identifying the predictive factors of surgical intervention and the value of magnetic resonance imaging in patients with low back pain. Quant Imaging Med Surg 2022; 12:1830-1843. [PMID: 35284262 PMCID: PMC8899926 DOI: 10.21037/qims-21-584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/04/2021] [Indexed: 09/18/2023]
Abstract
BACKGROUND Low back pain (LBP) is a prevalent disease and can be disabling. Currently, many patients with LBP with or without radiculopathy commonly undergo magnetic resonance imaging (MRI) for diagnosis and therapeutic assessment, yet the final intervention is mainly centered around nonoperative treatment. This study's aim was to identify the predictive factors of surgical treatment and the value of MRI in patients with LBP with or without radiculopathy. METHODS The study included a training cohort that consisted of 461 patients with MRI from January 2014 to December 2018. Demographic characteristics and MRI findings were collected from our medical records. We developed and validated 2 nomograms to predict the possibility of receiving surgical treatment in LBP patients, based on multivariable logistic regression analysis. The performance of the 2 nomograms was assessed in terms of their calibration, discrimination, and clinical usefulness. An independent validation cohort containing 163 patients was comparatively analyzed. RESULTS The baseline model incorporated 6 clinicopathological variables, while the MRI model consisted of 9 variables including several MRI findings. Internal validation revealed the good performance of the 2 nomograms in discrimination and calibration, with a concordance index (C-index) of 0.799 (95% CI: 0.743-0.855) for the baseline model and 0.834 (95% CI: 0.783-0.884) for the MRI model, which showed that the addition of MRI findings to the nomogram failed to achieve better prognostic value (Z statistic =-1.509; P=0.131). Application of the 2 models in the validation cohort also showed good discrimination (baseline model: C-index 0.75, 95% CI: 0.671-0.829; MRI model: C-index 0.777, 95% CI: 0.696-0.857) and calibration. No significant predictive benefit was found in the MRI model in the validation cohort (Z statistic =-0.588; P=0.557). CONCLUSIONS This study showed that clinical demographic characteristics provide good prognostic value to determine whether LBP patients with or without radiculopathy require surgical treatment. The addition of MRI findings yielded no significantly incremental prognostic value.
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Affiliation(s)
- Hui Wang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, China
| | - Chang Liu
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Zhou Meng
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Wenxian Zhou
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, China
| | - Tao Chen
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, China
| | - Kai Zhang
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopedic Implants, Shanghai, China
| | - Aimin Wu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, China
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A scoring model predicting overall survival for hepatocellular carcinoma patients who receive surgery and chemotherapy. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03224-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Su TS, Li LQ, Liang SX, Xiang BD, Li JX, Ye JZ, Li LQ. A Prospective Study of Liver Regeneration After Radiotherapy Based on a New (Su'S) Target Area Delineation. Front Oncol 2021; 11:680303. [PMID: 34513671 PMCID: PMC8426619 DOI: 10.3389/fonc.2021.680303] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022] Open
Abstract
Background In this study, we designed a new (Su’S) target area delineation to protect the normal liver during liver regeneration and prospectively evaluate liver regeneration after radiotherapy, as well as to explore the clinical factors of liver regeneration and established a model and nomogram. Methods Thirty patients treated with preoperative downstaging radiotherapy were prospectively included in the training cohort, and 21 patients treated with postoperative adjuvant radiotherapy were included in the validation cohort. The cut-off points of each optimal predictor were obtained using receiver-operating characteristic analysis. A model and nomogram for liver regeneration after radiotherapy were developed and validated. Results After radiotherapy, 12 (40%) and 13 (61.9%) patients in the training and validation cohorts experienced liver regeneration, respectively. The risk stratification model based on the cutoffs of standard residual liver volume spared from at least 20 Gy (SVs20 = 303.4 mL/m2) and alanine aminotransferase (ALT=43 u/L) was able to effectively discriminate the probability of liver regeneration. The model and nomogram of liver regeneration based on SVs20 and ALT showed good prediction performance (AUC=0.759) in the training cohort and performed well (AUC=0.808) in the validation cohort. Conclusions SVs20 and ALT were optimal predictors of liver regeneration. This model may be beneficial to the constraints of the normal liver outside the radiotherapy-targeted areas.
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Affiliation(s)
- Ting-Shi Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Li-Qing Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Shi-Xiong Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jian-Xu Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jia-Zhou Ye
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
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Chen L, Guo X, Chen S, Ren Y, Sun T, Yang F, Zheng C. Comparison of the efficacy of pre-surgery and post-surgery radiotherapy in the treatment of hepatocellular carcinoma: a population-based study. Am J Transl Res 2021; 13:360-371. [PMID: 33527030 PMCID: PMC7847525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Radiotherapy has been widely used in the treatment of hepatocellular carcinoma (HCC). However, whether the patients should receive radiotherapy before or after surgical treatment has not been studied. The objective of the study was to compare the efficacy of the treatment in HCC patients who received pre-surgery and post-surgery radiotherapy. METHODS Data from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patients with surgery combined with radiotherapy were included into the study. The outcome measures were overall survival (OS) and cancer-specific survival (CSS). Propensity score matching (PSM) was used to reduce selection bias. RESULTS Before PSM, the median OS (mOS: 82 months) and median CSS (mCSS: NA) in the pre-surgery group were longer than in the post-surgery group (mOS: 21 months; mCSS: 20 months; P<0.001 for both). After PSM, the mOS and mCSS in the pre-surgery group were longer than in the post-surgery group (mOS: 45 vs. 26 months, P=0.011; mCSS: 60 vs. 26 months, P=0.003). The subgroup analysis documented that patients with single tumor, liver resection, and American Joint Committee on Cancer (AJCC) stage I and II had longer mOS and mCSS if they received pre-surgery rather than post-surgery radiotherapy (all P<0.05). Multivariate regression analysis showed patients with post-surgery radiotherapy had a higher risk of mortality than patients with post-surgery radiotherapy. CONCLUSION HCC patients with single tumor, AJCC stage I and II, or with liver resection who received pre-surgery radiotherapy have better survival benefits than patients receiving post-surgery radiotherapy, particularly if internal radiotherapy was used.
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Affiliation(s)
- Lei Chen
- The Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
- Hubei Province Key Laboratory of Molecular ImagingWuhan 430022, China
- The Department of Interventional Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
| | - Xiaopeng Guo
- The Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
- Hubei Province Key Laboratory of Molecular ImagingWuhan 430022, China
- The Department of Interventional Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
| | - Shi Chen
- The Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
- Hubei Province Key Laboratory of Molecular ImagingWuhan 430022, China
| | - Yanqiao Ren
- The Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
- Hubei Province Key Laboratory of Molecular ImagingWuhan 430022, China
- The Department of Interventional Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
| | - Tao Sun
- The Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
- Hubei Province Key Laboratory of Molecular ImagingWuhan 430022, China
- The Department of Interventional Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
| | - Fan Yang
- The Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
- Hubei Province Key Laboratory of Molecular ImagingWuhan 430022, China
| | - Chuansheng Zheng
- The Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
- Hubei Province Key Laboratory of Molecular ImagingWuhan 430022, China
- The Department of Interventional Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, China
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Wang R, Liu Y, Sun H, Wang T, Li C, Fan J, Wang Z. Estradiol is significantly associated with prognosis in non-surgical liver cancer patients: from bench to bedside. Aging (Albany NY) 2021; 13:3483-3500. [PMID: 33428602 PMCID: PMC7906196 DOI: 10.18632/aging.202280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
There are rarely systematic studies to analyze the prognostic factors among non-surgical liver cancer patients. Whether there is a gender difference in the survival of non-surgical liver cancer patients and what may cause this difference is still unclear. A total of 12,312 non-surgical liver cancer patients were enrolled in this study. Age, race, sex, grade, tumor TNM stage, marital status, tumor size, and histological type were independent risk factors in liver cancer and were confirmed in the validation cohort. Before menopause, females demonstrated a better mean survival probability than males (39.4±1.4 vs. 32.7±0.8 months, respectively; p<0.001), and continued in post-menopause. The results of differentially expressed genes (DEGs) and KEGG pathway analysis showed that there were significant differences in steroid hormone biosynthesis between male and female liver cancer patients. In vitro experiments revealed that estradiol inhibited the proliferation of hepatocellular cancer cell lines and increased apoptosis, but estrone exerted no effect. In conclusion, gender differences in prognosis among non-surgical liver cancer patients were confirmed and attributable primarily to estradiol.
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Affiliation(s)
- Rangrang Wang
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Liu
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongze Sun
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Wang
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Changcan Li
- Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junwei Fan
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaowen Wang
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Chen Q, Wang S, Lang JH. Development and validation of Nomograms for predicting overall survival and Cancer-specific survival in patients with ovarian clear cell carcinoma. J Ovarian Res 2020; 13:123. [PMID: 33069259 PMCID: PMC7568829 DOI: 10.1186/s13048-020-00727-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ovarian clear cell carcinoma (OCCC) is a rare histologic type of ovarian cancer. There is a lack of an efficient prognostic predictive tool for OCCC in clinical work. This study aimed to construct and validate nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) in patients with OCCC. METHODS Data of patients with primary diagnosed OCCC in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016 was extracted. Prognostic factors were evaluated with LASSO Cox regression and multivariate Cox regression analysis, which were applied to construct nomograms. The performance of the nomogram models was assessed by the concordance index (C-index), calibration plots, decision curve analysis (DCA) and risk subgroup classification. The Kaplan-Meier curves were plotted to compare survival outcomes between subgroups. RESULTS A total of 1541 patients from SEER registries were randomly divided into a training cohort (n = 1079) and a validation cohort (n = 462). Age, laterality, stage, lymph node (LN) dissected, organ metastasis and chemotherapy were independently and significantly associated with OS, while laterality, stage, LN dissected, organ metastasis and chemotherapy were independent risk factors for CSS. Nomograms were developed for the prediction of 3- and 5-year OS and CSS. The C-indexes for OS and CSS were 0.802[95% confidence interval (CI) 0.773-0.831] and 0.802 (0.769-0.835), respectively, in the training cohort, while 0.746 (0.691-0.801) and 0.770 (0.721-0.819), respectively, in the validation cohort. Calibration plots illustrated favorable consistency between the nomogram predicted and actual survival. C-index and DCA curves also indicated better performance of nomogram than the AJCC staging system. Significant differences were observed in the survival curves of different risk subgroups. CONCLUSIONS We have constructed predictive nomograms and a risk classification system to evaluate the OS and CSS of OCCC patients. They were validated to be of satisfactory predictive value, and could aid in future clinical practice.
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Affiliation(s)
- Qian Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 ShuaiFuYuan, Wangfujing, DongCheng District, Beijing, 100730 P.R. China
| | - Shu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 ShuaiFuYuan, Wangfujing, DongCheng District, Beijing, 100730 P.R. China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 ShuaiFuYuan, Wangfujing, DongCheng District, Beijing, 100730 P.R. China
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