The Prognostic Significance of Pontine-White Matter Score in Primary Central Nervous System Lymphoma Patients.

BACKGROUND: Limited data exist on the significance of PET imaging and quantitative PET parameters in primary central nervous system (CNS) lymphoma due to its relative rarity. This study was conducted to investigate the prognostic value of a novel internal standardization indicator, the pontine-white matter (PW) score, in primary CNS lymphoma patients undergoing post-treatment 18F-FDG PET/CT and PET/MR imaging. METHODS: From January 2014 to December 2022, eligible patients with primary CNS lymphoma who underwent post-treatment PET imaging were enrolled. Using the FDG uptake of the pons and white matter as an internal reference, the PW score was graded based on the metabolism of the post-therapeutic lesion for each patient, and its associations with patients' prognosis were investigated. RESULTS: In total, 41 patients with post-treatment PET/CT and 49 patients with post-treatment PET/MR imaging were enrolled. ROC curve analysis indicated that the PW score possessed robust discriminative ability in distinguishing patients with worse outcomes. Furthermore, a higher PW score was significantly correlated with and identified as an independent prognostic indicator for, worse prognosis in both the PET/CT and PET/MR cohorts. CONCLUSION: The study demonstrated that the PW score was an effective prognostic indicator for identifying post-treatment primary CNS lymphoma patients with worse outcomes.

Application of calcium overload-based ion interference therapy in tumor treatment: strategies, outcomes, and prospects.

Low selectivity and tumor drug resistance are the main hinderances to conventional radiotherapy and chemotherapy against tumor. Ion interference therapy is an innovative anti-tumor strategy that has been recently reported to induce metabolic disorders and inhibit proliferation of tumor cells by reordering bioactive ions within the tumor cells. Calcium cation (Ca2+) are indispensable for all physiological activities of cells. In particular, calcium overload, characterized by the abnormal intracellular Ca2+ accumulation, causes irreversible cell death. Consequently, calcium overload-based ion interference therapy has the potential to overcome resistance to traditional tumor treatment strategies and holds promise for clinical application. In this review, we 1) Summed up the current strategies employed in this therapy; 2) Described the outcome of tumor cell death resulting from this therapy; 3) Discussed its potential application in synergistic therapy with immunotherapy.

Exploring Prognostic Immune Microenvironment-Related Genes in Head and Neck Squamous Cell Carcinoma from the TCGA Database.

Purpose: Head and neck squamous cell carcinoma (HNSCC) has a high rate of local and distant metastases. In tumor tissues, the interaction between tumor cells and the tumor microenvironment (TME) is closely related to cancer development and prognosis. Therefore, screening for TME-related genes in HNSCC is crucial for understanding metastatic patterns. Methods: Our research relied mainly on a novel algorithm called Estimation of STromal and Immune cells in MAlignant Tumors using Expression data (ESTIMATE). Fragments Per Kilobase of exon model per Million mapped fragments (FPKM) data and HNSCC clinical data were obtained from the TCGA database, and the purity of HNSCC tissue and the features of stromal and immune cell infiltration were determined. Furthermore, differentially expressed genes (DEGs) were screened based on immune, stromal, and ESTIMATE scores, and their protein-protein interaction (PPI) networks and ClueGO functions were evaluated. Finally, the expression profiles of DEGs related to immunity in HNSCC were determined. Differential gene expression was verified in the highly invasive oral cancer cell lines (SCC-25, CAL-27, and FaDu) and oral cancer tissues. Results: Our analysis found that both the immune and ESTIMATE scores were significantly associated with the prognosis of HNSCC. Moreover, cross-validation using the Venn algorithm revealed that 433 genes were significantly upregulated, and 394 genes were significantly downregulated. All DEGs were associated with both ESTIMATE and immune scores. The enrichment of cytokine-cytokine receptor interactions and chemokine signaling pathways was observed using pathway enrichment analyses. We initially screened 25 genes after analyzing the key sub-networks of the PPI network. Survival analysis revealed the significance of CCR4, CXCR3, P2RY14, CCR2, CCR8, and CCL19 in relation to survival and their association with immune infiltration-related metastasis in HNSCC. Conclusions: The expression profiles of relevant TME-related genes were screened following stromal and immune cell scoring using ESTIMATE, and DEGs associated with survival were identified. These TME-related gene markers offer valuable utility as both prognostic indicators and markers denoting metastatic traits in HNSCC.

Study on the Semi-Solid Thixotropic Forging Forming Process for the Low-Carbon Steel Claw Pole.

Low-carbon steel has been popularly applied in numerous applications because of its unique features, such as good plasticity, high strength, great hardness, and excellent toughness. Additionally, the semi-solid thixotropic forging forming method has been widely used in light alloys, due to its advantages of low forming force and high forming quality, whereas its application in ferrous materials is still limited. In this study, the semi-solid thixotropic forging forming process is proposed for producing the low-carbon steel claw pole, with the main stages being radial forging deformation, isothermal treatment, and forging forming. The effect of the area reduction rate on the effective strain from the cross sections of the radial-forged metal bar was studied using numerical simulations. The effect of the isothermal holding process on the microstructures of radial-forged billets was investigated, to obtain the ideal semi-solid microstructures. The microstructure and mechanical properties of low-carbon steel claw poles from the thixotropic forging experiment are presented and discussed. It was found that when the area reduction rate was 67%, the effective strain at the edge of the metal bar exceeded 5.0, while the effective strain at the center was above 1.2, indicating an excellent quality of forging for the bar. The optimization of the process parameters for preparing low-carbon steel semi-solid billets with fine and globular microstructures was achieved with an area reduction rate of 67%, an isothermal temperature of 1500 °C, and a duration time of 15 min. Moreover, the low-carbon steel claw pole fabricated with the optimized operating parameters was found fully filled, with a sharp profile and a flat surface, where the yield strength and tensile strength increased by 88.5% and 79.8%, respectively, compared to the starting materials.

CT-based decision tree model for predicting EGFR mutation status in synchronous multiple primary lung cancers.

Background: The current study aimed to construct a computed tomography (CT)-based decision tree algorithm (DTA) model to predict the epidermal growth factor receptor (EGFR) mutation status in synchronous multiple primary lung cancers (SMPLCs). Methods: The demographic and CT findings of 85 patients with molecular profiling for surgically resected SMPLCs were reviewed retrospectively. Least absolute shrinkage and selection operator (LASSO) regression was used to select the potential predictors of EGFR mutation, and a CT-DTA model was developed. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to assess the performance of this CT-DTA model. Results: The CT-DTA model was applied to predict the EGFR mutant that had ten binary split, of which eight parameters to accurately categorize the lesions as follows: the presence of bubble-like vacuole sign (19.4% importance in the development of the model), presence of air bronchogram sign (17.4% importance), smoking status (15.7% importance), types of the lesions (14.8% importance), histology (12.6% importance), presence of pleural indentation sign (7.6% importance), gender (6.9% importance), and presence of lobulation sign (5.6% importance). The ROC analysis achieved an area under the curve (AUC) of 0.854. Multivariate logistic regression analysis demonstrated that this CT-DTA model was an independent predictor of EGFR mutation (P<0.001). Conclusions: CT-DTA model is a simple tool to predict the status of EGFR mutation in SMPLC patients and could be considered for treatment decision-making.

A Novel Prognostic Score Based on Multiple Quantitative Parameters of Chest CT for Patients with Synchronous Multiple Primary Lung Cancer: Is Solid Component Size a Better Prognostic Indicator?

BACKGROUND: There is no simple and definitive way to predict the prognosis of synchronous multiple primary lung cancer (SMPLC). In this study, we developed a clinical prognostic score for predicting the survival of patients with SMPLC. PATIENTS AND METHODS: This study included 206 patients with SMPLC between 2011 and 2020 at three hospitals. Kaplan-Meier analysis was used to determine the optimal cutoff values for the quantitative chest computed tomography (CT) parameters. Multivariable Cox proportional hazards regression was carried out to identify independent prognostic factors for predicting overall survival (OS) and disease-free survival (DFS). The time-dependent receiver operating characteristic curve was analyzed to evaluate the prognostic performance. RESULTS: A CT-based prognostic score (CTPS) comprising six chest CT parameters was developed. Compared with T stage, CTPS had a higher prediction accuracy for OS and DFS. All C-indices of the model reached a satisfactory level in both the development and validation cohorts. Significant differences in the OS and DFS curves were observed when the patients were stratified into different risk groups. The high-risk group (CTPS of 5-6) had poorer survival than the low-risk group (CTPS of 0-4). CONCLUSIONS: The developed CTPS and the corresponding risk stratification system are valid for predicting the survival of patients with SMPLC.

Burden of liver cancer due to hepatitis C from 1990 to 2019 at the global, regional, and national levels.

Background: Liver cancer due to hepatitis C (LCDHC) is one of the leading causes of cancer-related deaths worldwide, and the burden of LCDHC is increasing. We aimed to report the burden of LCDHC at the global, regional, and national levels in 204 countries from 1990 to 2019, stratified by etiology, sex, age, and Sociodemographic Index. Methods: Data on LCDHC were available from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study 2019. Numbers and age-standardized mortality, incidence, and disability-adjusted life year (DALY) rates per 100,000 population were estimated through a systematic analysis of modeled data from the GBD 2019 study. The trends in the LCDHC burden were assessed using the annual percentage change. Results: Globally, in 2019, there were 152,225 new cases, 141,810 deaths, and 2,878,024 DALYs due to LCDHC. From 1990 to 2019, the number of incidences, mortality, and DALY cases increased by 80.68%, 67.50%, and 37.20%, respectively. However, the age-standardized incidence, mortality, and DALY rate had a decreasing trend during this period. In 2019, the highest age-standardized incidence rates (ASIRs) of LCDHC were found in high-income Asia Pacific, North Africa and the Middle East, and Central Asia. At the regional level, Mongolia, Egypt, and Japan had the three highest ASIRs in 2019. The incidence rates of LCDHC were higher in men and increased with age, with a peak incidence in the 95+ age group for women and the 85-89 age group for men in 2019. A nonlinear association was found between the age-standardized rates of LCDHC and sociodemographic index values at the regional and national levels. Conclusions: Although the age-standardized rates of LCDHC have decreased, the absolute numbers of incident cases, deaths, and DALYs have increased, indicating that LCDHC remains a significant global burden. In addition, the burden of LCDHC varies geographically. Male and older adult/s individuals have a higher burden of LCDHC. Our findings provide insight into the global burden trend of LCDHC. Policymakers should establish appropriate methods to achieve the HCV elimination target by 2030 and reducing the burden of LCDHC.

Downregulation of circLPAR3 inhibits tumor progression and glycolysis by liberating miR-144-3p and upregulating LPCAT1 in oral squamous cell carcinoma.

Background: Increasing evidence demonstrated the important roles of circular RNAs (circRNAs) in human cancer progression, including oral squamous cell carcinoma (OSCC). The study intentions were to explore the role and molecular mechanism of hsa_circ_0004390 (circLPAR3) in OSCC progression. Methods: Expression of circLPAR3 in collected samples and cultured cell lines was detected with real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR). Loss-of-function experiments were performed to determine the effect of circLPAR3 silencing on OSCC cell proliferation, migration, invasion, apoptosis, angiopoiesis, and glycolysis. The sponge function of circLPAR3 was predicted by bioinformatics analysis and validated by the dual-luciferase reporter and RNA pull-down assays. In vivo experiments were conducted to validate the function of circLPAR3. Results: A marked increase in circLPAR3 expression was observed in OSCC samples and cell lines. Furthermore, circLPAR3 could distinguish OSCC samples from paired non-tumor samples, and patients with high circLPAR3 expression had a poor prognosis. Furthermore, circLPAR3 inhibition decreased OSCC growth in xenograft mouse models. Moreover, circLPAR3 silencing repressed cell proliferation, migration, invasion, angiopoiesis, glycolysis, and induced cell apoptosis in OSCC cells in vitro. Mechanically, circLPAR3 sponged miR-144-3p to prohibit the inhibiting effect of miR-144-3p on LPCAT1, thus promoting OSCC progression. Conclusion: CircLPAR3 exerted a tumor-promoting effect on OSCC growth through elevating LPCAT1 expression via functioning as a miR-144-3p sponge. This study supports the possible role of circLPAR3 in the diagnosis, prognosis, and treatment of OSCC.

Albumin-To-Alkaline Phosphatase Ratio as a Novel and Promising Prognostic Biomarker in Patients Undergoing Esophagectomy for Carcinoma: A Propensity Score Matching Study.

BACKGROUND: Albumin-to-alkaline phosphatase ratio (AAPR) has been reported as a novel prognostic predictor for numerous solid tumors. We aimed to assess the prognostic role of preoperative AAPR in surgically resectable esophageal squamous cell carcinoma (ESCC) by a propensity score matching (PSM) analysis with predictive nomograms. METHODS: Our study was conducted in a single-center prospective database between June 2009 and December 2012. Kaplan-Meier analysis was used to distinguish the difference in survival outcomes between patients stratified by an AAPR threshold. Multivariable Cox proportional hazards regression model was finally generated to specify independent prognostic markers for the entire and PSM cohorts. RESULTS: A total of 497 patients with ESCC were included in this study. An AAPR of 0.50 was determined as the optimal cutoff point for prognostic outcome stratification. Patients with AAPR<0.50 had significantly worse overall survival (OS), and progression-free survival (PFS) compared to those with AAPR≥0.50 (Log-rank P<0.001). This significant difference remained stable in the PSM analysis. Multivariable analyses based on the entire and PSM cohorts consistently showed that AAPR<0.50 might be one of the most predominant prognostic factors resulting in unfavorable OS and PFS of ESCC patients undergoing esophagectomy (P<0.001). The nomograms consisting of AAPR and other independent prognostic factors further demonstrated a plausible predictive accuracy of postoperative OS and PFS. CONCLUSION: AAPR can be considered as a simple, convenient and noninvasive biomarker with a significant prognostic effect in surgically resected ESCC.

Discovery of first-in-class inhibitors of ASH1L histone methyltransferase with anti-leukemic activity.

ASH1L histone methyltransferase plays a crucial role in the pathogenesis of different diseases, including acute leukemia. While ASH1L represents an attractive drug target, developing ASH1L inhibitors is challenging, as the catalytic SET domain adapts an inactive conformation with autoinhibitory loop blocking the access to the active site. Here, by applying fragment-based screening followed by medicinal chemistry and a structure-based design, we developed first-in-class small molecule inhibitors of the ASH1L SET domain. The crystal structures of ASH1L-inhibitor complexes reveal compound binding to the autoinhibitory loop region in the SET domain. When tested in MLL leukemia models, our lead compound, AS-99, blocks cell proliferation, induces apoptosis and differentiation, downregulates MLL fusion target genes, and reduces the leukemia burden in vivo. This work validates the ASH1L SET domain as a druggable target and provides a chemical probe to further study the biological functions of ASH1L as well as to develop therapeutic agents.

Gamma-Glutamyl Transpeptidase to Platelet Ratio Is a Novel and Independent Prognostic Marker for Resectable Lung Cancer: A Propensity Score Matching Study.

BACKGROUND: We report this propensity score matching (PSM) analysis to assess prognostic roles of preoperative gamma-glutamyl transpeptidase to platelet ratio (GPR) in video-assisted thoracoscopic (VATS) lobectomy for stage I-II non-small-cell lung cancer (NSCLC). METHODS: The PSM-based study conducted on our single-center prospectively collected database from January 2014 to August 2015 provided Kaplan-Meier survival analyses using the log-rank test to discriminate differences in overall survival (OS) and disease-free survival (DFS) between patients stratified by preoperative GPR. RESULTS: Our study includes 379 patients diagnosed with operable primary stage I-II NSCLC. A GPR value at 0.16 was recognized as the optimal cutoff point for prognostic prediction. Both OS and DFS of patients with GPR ≥0.16 were significantly shortened when compared to those of patients with GPR <0.16. Patients with GPR ≥0.16 had significantly lower 5-year rates of OS and DFS than those of patients with GPR <0.16 (P <0.001). Significant associations between GPR and unfavorable survival still are validated in the PSM analysis. Multivariable Cox regression models on both the entire cohort and the PSM cohort consistently demonstrated that an elevated preoperative GPR could be an independent prognostic marker for both OS and DFS of resectable NSCLC. CONCLUSIONS: GPR may be an effective and noninvasive prognostic biomarker in VATS lobectomy for surgically resectable NSCLC.

MicroRNAs: Emerging oncogenic and tumor-suppressive regulators, biomarkers and therapeutic targets in lung cancer.

Lung cancer is one of the most common solid tumors worldwide and the leading cause of cancer-related deaths, causing a devastating impact on human health. The clinical prognosis of lung cancer is usually restricted by delayed diagnosis and resistance to anticancer therapies. MicroRNAs, a range of small endogenous noncoding RNAs 22 nucleotides in length, have emerged as one of the most important players in cancer initiation and progression in recent decades. Current evidence reveals pivotal roles of microRNAs in regulating cell proliferation, migration, invasion and metastasis in lung cancer. An increasing number of preclinical and clinical studies have also explored the potential of microRNAs as promising biomarkers and new therapeutic targets for lung cancer. The current review summarizes the most recent progress on the functional mechanisms of microRNAs involved in lung cancer development and progression and further discusses the clinical application of miRNAs as putative therapeutic targets for molecular diagnosis and prognostic prediction in lung cancer.

Systemic Inflammation Score as a Novel Prognostic Indicator for Patients Undergoing Video-Assisted Thoracoscopic Surgery Lobectomy for Non-Small-Cell Lung Cancer.

BACKGROUND: To evaluate the prognostic significance of systemic inflammation score (SIS) for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancers (NSCLCs). Methods: This retrospective cohort study was conducted on the prospectively maintained database in our institution during the study period. Preoperative SIS comprising serum albumin (sALB) and lymphocyte-to-monocyte ratio (LMR) was graded into 0, 1 and 2. Survival analysis was performed to distinguish differences in postoperative survival between three groups of SIS. Finally, multivariate Cox proportional hazards regression analyses were conducted to determine independent prognostic factors. Results: There were 390 patients with operable NSCLCs included. We applied sALB at 40 g/L and our median LMR at 3.91 as the cutoffs for modified SIS scoring criteria. Both overall survival (OS) and disease-free survival (DFS) were significantly shortened in a step-wise fashion with each 1-point increase in SIS (Log-rank p < .001). There was a significant step-wise decline in both OS and DFS rates in proportion to SIS (p < .001). No difference was found in postoperative complications between three groups of SIS. Multivariate analyses finally demonstrated that both SIS = 1 and SIS = 2 could be independent prognostic factors for unfavorable OS and DFS of NSCLCs. Conclusions: SIS can serve as a novel risk stratification tool to refine the prognostic prediction for surgical NSCLCs.

Naples Prognostic Score as a novel prognostic prediction tool in video-assisted thoracoscopic surgery for early-stage lung cancer: a propensity score matching study.

BACKGROUNDS: The Naples Prognostic Score (NPS) emerges as a novel prognostic scoring system in surgical oncology. We aim to assess the prognostic significance of preoperative NPS in patients undergoing completely video-assisted thoracoscopic surgery (VATS) lobectomy for early-stage non-small cell lung cancer (NSCLC) by propensity score matching (PSM) analysis. METHODS: The present study was conducted on our single-center prospectively maintained database between January 2014 and December 2015. A Kaplan-Meier survival analysis using the log-rank test was used to distinguish differences in both overall survival (OS) and disease-free survival (DFS) between the patients stratified by preoperative NPS. Finally, multivariable Cox-proportional hazards regression analysis and PSM analysis were carried out to determine the independent prognostic factors for both OS and DFS. RESULTS: There were 457 patients with operable primary stage I-II NSCLC included. Per 1-point increase in NPS was found to be significantly associated with unfavorable OS and DFS of NSCLC. Both OS and DFS were significantly shortened along with each number increase in the NPS group, showing a step-wise fashion. Such strong correlations between preoperative NPS and survival outcomes still remained validated after PSM analysis. In addition, NPS held the best discriminatory power for predicting both OS and DFS when compared to the other peripheral biomarkers. Multivariable analyses on the entire cohort and the PSM cohort demonstrated that preoperative NPS could be an independent prognostic indicator for both OS and DFS. CONCLUSIONS: The NPS scoring system can serve as a novel risk stratification tool to refine prognostic prediction after VATS lobectomy for surgically resected NSCLC.

Gustave Roussy Immune Score based on a three-category risk assessment scale serves as a novel and effective prognostic indicator for surgically resectable early-stage non-small-cell lung cancer: A propensity score matching retrospective cohort study.

BACKGROUNDS: The Gustave Roussy Immune score (GRIm-Score) emerges as a novel prognostic scoring system for patient selection in phase I trials testing targeted immunotherapy for advanced-stage cancer. We tried to assess potential prognostic roles of preoperative GRIm-Score in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for stage I-II non-small-cell lung cancer (NSCLC) by propensity score-matching (PSM) analysis. METHODS: This PSM-based analysis was performed on our single-center prospectively-maintained database between January 2014 and October 2015. A Kaplan-Meier survival analysis using the log-rank test was used to distinguish differences in both overall survival (OS) and disease-free survival (DFS) between the patients stratified by preoperative GRIm-Score. Multivariable Cox-proportional hazards regression analysis and PSM analysis were both carried out to determine the final independent prognostic parameters. RESULTS: There were 405 patients with surgically resectable stage I-II NSCLC included. Both OS and DFS were significantly shortened along with each number increase in the GRIm-Score group, showing a step-wise fashion. Such strong correlations between preoperative GRIm-Score estimated by a modified 3-category risk scale and survival outcomes still remained validated after PSM analysis. In addition, this GRIm-Score held the superior discriminatory power for predicting both OS and DFS to the other peripheral blood biomarkers. Multivariable analyses on the entire cohort and the PSM cohort demonstrated that GRIm-Score based on a 3-category risk assessment scale could be independently predictive of both OS and DFS. CONCLUSIONS: The GRIm-Score tool can also serve as an effective and noninvasive marker to optimize prognostic prediction for surgically resectable stage I-II NSCLC.

Is liposomal bupivacaine superior to standard bupivacaine for pain control following minimally invasive thoracic surgery?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether regional liposomal bupivacaine was superior to standard bupivacaine for pain control following minimally invasive thoracic surgery. Altogether 70 papers were found using the reported search, of which 5 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two of the five available studies showed a significant reduction of early narcotic consumption with the regional analgesia using liposomal bupivacaine, one showed a significantly reduced usage of opioid medication during postoperative hour 24-36 among the patients receiving liposomal bupivacaine, and 2 showed no difference in cumulative opioid consumption between the 2 regional analgesia groups. In addition, there was no associated difference in the pain severity scores or the length of hospitalization.

Serum uric acid to lymphocyte ratio: A novel prognostic biomarker for surgically resected early-stage lung cancer. A propensity score matching analysis.

BACKGROUNDS: This study aims to evaluate the prognostic impact of serum uric acid to lymphocyte ratio (ULR) in video-assisted thoracoscopic surgery (VATS) lobectomy for early-stage non-small-cell lung cancer (NSCLC) through a propensity score-matching (PSM) analysis. METHODS: This study was carried out based on a prospectively-maintained database in our institution between January 2014 and July 2015. Survival analysis using a log-rank test was performed to distinguish the differences in both overall survival (OS) and disease-free survival (DFS) between the patients stratified according to an optimal cut-point of ULR. Finally, multivariable Cox proportional hazards regression analysis and PSM analysis were conducted to identify the prognostic factors of NSCLC. RESULTS: There were 335 patients with surgically resected primary stage I-II NSCLC included. An ULR at 3.83 was found to be the optimal cut-point regarding postoperative survival. Both OS and DFS of the patients with ULR > 3.83 were significantly shortened compared to those of the patient with ULR ≤ 3.83. Patients with ULR > 3.83 had significantly lower rates of OS and DFS until the last follow-up date than those of patients with ULR ≤ 3.83. These differences still remained significant after PSM analysis. Multivariate analyses for the entire cohort finally demonstrated that an elevated ULR could independently predict both unfavorable OS and DFS of surgically resected stage I-II NSCLC. CONCLUSIONS: ULR can be considered as a novel risk stratification tool to refine prognostic prediction for operable early-stage NSCLC.

Novel systemic inflammation response index to predict prognosis after thoracoscopic lung cancer surgery: a propensity score-matching study.

BACKGROUND: Our propensity score-matching (PSM) study evaluated the prognostic significance of systemic inflammation response index (SIRI) for patients undergoing video-assisted thoracoscopic surgery lobectomy for non-small-cell lung cancer (NSCLC). METHODS: This study was conducted on prospectively maintained database in our institution between December 2013 and March 2015. Pre-operative SIRI was calculated by peripheral monocyte × neutrophil/lymphocyte counts. Survival analysis was performed to distinguish differences in post-operative survival between patients stratified by an optimum cut-off of SIRI. Multivariable Cox proportional hazards regression models were established to determine independent prognostic factors. RESULTS: There were 390 patients with resected NSCLC included. A SIRI of 0.99 was identified as the optimum cut-off regarding to post-operative survival. Both overall survival (OS) and disease-free survival (DFS) in patients with SIRI >0.99 were significantly shortened than those in patient with SIRI ≤0.99. Patients with SIRI >0.99 had significantly lower rates of OS and DFS compared to those patients with SIRI ≤0.99. These differences still remained significant after subgroup analyses and PSM analyses. Multivariable analyses on the entire cohort and the PSM cohort commonly demonstrated that high pre-operative SIRI could be an independent prognostic factor for unfavourable OS and DFS of NSCLC. CONCLUSIONS: SIRI serves as a novel risk stratification tool to refine prognostic prediction for surgically resected NSCLC. SIRI may help surgeons to screen high-surgical-risk patients and formulate individualized treatment schemes.

Systemic inflammation score: a novel risk stratification tool for postoperative outcomes after video-assisted thoracoscopic surgery lobectomy for early-stage non-small-cell lung cancer.

OBJECTIVES: To evaluate whether the systemic inflammation score (SIS) could predict postoperative outcomes for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for early-stage non-small-cell lung cancer (NSCLC). METHODS: This retrospective study was conducted on the prospectively maintained database in our institution between January 2016 and December 2017. Preoperative SIS comprising serum albumin (sALB) and lymphocyte-to-monocyte ratio (LMR) was graded into 0, 1 and 2, and then utilized to distinguish patients at high surgical risks. Multivariable logistic-regression analysis was conducted to determine independent risk factors for postoperative outcomes. RESULTS: There were 1,025 patients with TNM-stage I-II NSCLC included, with an overall morbidity rate of 31.1% and mortality rate of 0.3%. We applied the sALB at 40 g/L and the median LMR of our series at 4.42 as dichotomized cutoffs for modified SIS scoring criteria. Both minor and major morbidity rates in patients with SIS=2 were significantly higher than those in patients with SIS=0 and with SIS=1 (P<0.001). No difference was found in overall morbidity rate between patients with SIS=1 and with SIS=0 (P=0.20). No significant difference was found in the mortality rate between these 3 groups. Patients with SIS=2 had the highest probability to experience most of individual complications. Finally, multivariable logistic-regression analysis suggested that preoperative SIS=2 could independently predict the morbidity risks following VATS lobectomy (OR=1.73; 95% CI=1.11-2.71; P=0.016). CONCLUSIONS: The SIS scoring system can be employed as a simplified, effective and routinely operated risk stratification tool in patients undergoing VATS lobectomy.