Utility of the DECAF score for predicting survival of patients with COPD: a meta-analysis of diagnostic accuracy studies.

OBJECTIVE: The DECAF (Dyspnea, Eosinopenia, Consolidation, Acidemia, Atrial Fibrillation) score is a widely used system for predicting the survival of patients with acute aggravation of chronic obstructive pulmonary disease (COPD). Evaluations of the predictive accuracy of DECAF have shown differing results. We performed this meta-analysis to evaluate the DECAF score as a survival predictor in patients with COPD. MATERIALS AND METHODS: We have included the studies examining the accuracy of DECAF scoring system as index test with occurrence of events (mortality and need for invasive/non-invasive ventilation) as reference standards irrespective of the study design employed, type of participants and severity of the condition. We conducted a systematic search for all studies reporting the predictive accuracy of DECAF scores in the databases of PubMed Central, Scopus, Medline, Embase, and Cochrane from inception until September 2020. We have used the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool to evaluate the risk of bias. We used the STATA software "midas" package to perform the meta-analysis. RESULTS: We included 21 studies with 6429 patients. Most studies included were prospective. Most studies were conducted in the United Kingdom. Most studies used a cut-off value of the DECAF score ≥3 to predict the in-hospital or 30-day mortality and need for mechanical ventilation. All the studies used the occurrence of in-hospital/30-day mortality or patient undergoing mechanical ventilation as the reference standards. The pooled sensitivity and specificity of the DECAF score for predicting in-hospital mortality among patients with acute exacerbation of COPD were 74% (95% CI, 67%-79%) and 76% (95% CI, 68%-82%), respectively; and those for the 30-day mortality were 72% (95% CI, 59%-82%) and 83% (95% CI, 67%-93%), respectively. The overall quality of the studies in our meta-analysis was high. We found no significant publication biases as per Deek's test and funnel plot. CONCLUSIONS: This review has certain strengths. It is the first meta-analysis assessing the predictive utility of the DECAF score for in-hospital mortality among patients with AECOPD. Most studies included were of high quality according to the QUADAS-2 tool. Despite these strengths, our review had some limitations. We found a significant between-study variability in our analysis that can limit its value for inferring or interpreting the pooled findings. The predictive accuracy of the scoring system depends on many factors such as the ethnicity of the participants or patients, the timing of the scoring system assessment, and the AECOPD severity. We could not assess the influence of these variables in our study. Despite these shortcomings, our findings provide valuable information and important implications for the clinical practice involving patients with AECOPD. We found that the DECAF score can predict in-hospital and 30-day mortalities with satisfactory sensitivity and specificity.

[A multicenter randomized prospective study of concurrent chemoradiation with 60 Gy versus 50 Gy for inoperable esophageal squamous cell carcinoma].

Objective: To determine whether 60 Gy is superior to standard 50 Gy for definitive concurrent chemoradiation(CCRT) in esophageal squamous cell carcinoma (ESCC) using modern radiation technology in a phase Ⅲ prospective randomized trial. Methods: From April 2013 to May 2017, 331 patients from 22 hospitals who were pathologically confirmed with stage ⅢA-ⅣA ESCC were randomized to 60 Gy or 50 Gy with random number table. Total of 305 patients were analyzed, including 152 in 60 Gy group and 153 in 50 Gy group. The median age was 63 years, 242(79.3%) males and 63(20.7%) females. The median length of primary tumor was 5.6 cm. The clinical characteristics between two groups were comparable. All patients were delivered 2 Gy per fraction, 5 fractions per week. Concurrent weekly chemotherapy with docetaxel (25 mg/m(2)) and cisplatin (25 mg/m(2)) and 2 cycles consolidation chemotherapy with docetaxel (70 mg/m(2)) and cisplatin (25 mg/m(2), d1-3) were administrated. The primary endpoint was local/regional progression-free survival (LRPFS). The data were compared with Pearson chi-square test or Fisher's exact test. Results: At a median follow-up of 27.3 months, the disease progression rate was 37.5% (57/152), 43.8% (67/153) in the high and standard-dose group, respectively (χ(2)=1.251, P=0.263). The 1, 2, 3-year LRPFS rate was 75.4%, 56.8%, 52.1% and 74.2%, 58.4%, 50.1%, respectively (HR: 0.95, 95%CI: 0.69-1.31, P=0.761). The 1, 2, 3-year overall survival rate was 84.1%, 64.8%, 54.1% and 85.4%, 62.9%, 54.0%, respectively (HR: 0.98, 95%CI: 0.71-1.38, P=0.927). The 1, 2, 3-year progression-free survival rate was 70.8%, 54.2%, 48.5% and 65.5%, 51.9%, 45.1%, respectively (HR: 0.93, 95%CI: 0.68-1.26, P=0.621). The incidence rates in toxicities between the two groups were similar except for higher rate of severe pneumonitis in high dose group (χ(2)=11.596, P=0.021). Conclusions: The efficacy in disease control is similar between 60 Gy and 50 Gy using modern radiation technology concurrent with chemotherapy for ESCC. The 50 Gy should be recommended as the regular radiation dose with CCRT for ESCC.

Fusion protein tTF-EG3287 induces occlusion of tumor vessels and impairs tumor growth in human colon caner.

The problems including narrow indications, low drug loading, and difficulty in intervention severely affect the clinical efficacy of anti-tumor embolization. Here, we designed a novel tTF-EG3287 protein consisting of the truncated tissue factor (tTF) fused with the bicyclic polypeptide which was encoded by exons 7 and 8 for accurate localization in the tumor vascular endothelial cells (EG3287). This study aims to explore its anti-cancer effect. Gene sequencing was used to verify the fusion gene and SDS-PAGE gel to confirm the optimal induction time and concentration of tTF-EG3287. Nickel affinity chromatography column was used to purify the fusion protein. Confocal microscopy was used to assess the target activity of tTF-EG3287 on colon cancer cells in vitro. Thrombelastography assay was used to identify the pro-coagulant activity of tTF-EG3287. In in vivo experiments, the specific localization of tTF-EG3287 in tumor tissues and the effect of tTF-EG3287 on tumor thrombosis were further detected by in vivo imaging and HE staining, respectively. The tTF-EG3287 fusion protein was efficiently purified by nickel-affinity chromatography column. Moreover, tTF-EG3287 fusion protein showed strong coagulation a ctivity and specific binding ability to the cell surface of colon cancer. In vivo, tTF-EG3287 stably and persistently accumulated in tumor tissues, and specifically induced mixed thrombus formation in tumor vessels, and then impaired tumor growth (tumor inhibition rate=79.2%, p<0.01). Our data prove that the fusion protein tTF-EG3287 could be used as a novel and promising anti-cancer strategy and has great potential value for clinical applications.

Prognostic relevance and therapeutic implications of centromere protein F expression in patients with esophageal squamous cell carcinoma.

Centromere protein F (CENP-F), a cell cycle-regulated centromere protein, has been shown to affect numerous tumorigenic processes. This study aimed to clarify the prognostic significance of CENP-F expression in patients with esophageal squamous cell carcinoma (ESCC). The levels of CENP-F messenger RNA and protein were higher in ESCC cell lines than in the normal tissues. An immunohistochemical analysis of paired tissue specimens showed that the CENP-F expression was higher in tumorous tissues than in the adjacent non-tumorous tissues (P < 0.001). Moreover, there was a significant correlation between CENP-F expression and gender (P = 0.012), clinical stage (P = 0.039), and T classification (P = 0.026). Patients with higher CENP-F expression had shorter overall survival than those with lower CENP-F expression (P = 0.009). Multivariate Cox analysis indicated that CENP-F expression is an independent prognostic factor for overall survival (hazard ratio = 0.582, 95% confidence interval = 0.397-0.804, P = 0.041). Importantly, it was found that zoledronic acid (ZOL) could significantly enhance the chemotherapeutic sensitivity of ESCC cell lines with high CENP-F expression to cisplatin, although ZOL alone only exhibited a minor inhibitory effect to ESCC cells. In summary, these findings demonstrate that CENP-F may serve as a valuable molecular marker for predicting the prognosis of ESCC patients. In addition, the data indicate a potential benefit of combining ZOL with cisplatin in ESCC, suggesting that CENP-F expression may have therapeutic implications.

Ubiquitin D is correlated with colon cancer progression and predicts recurrence for stage II-III disease after curative surgery.

BACKGROUND: Our recent study observed that the expression of ubiquitin D (UBD), a member of ubiquitin-like modifier family, was upregulated in colon cancer parenchymal cells. The present study further investigated the clinical signicance of UBD in colon cancer. METHODS: Using quantitative PCR, tissue microarray (TMA), western blot analysis and immunohistochemical stain, we evaluated UBD mRNA and protein levels in tumour tissues from patients with colon cancer at different stages and in paired adjacent normal epithelium. RESULTS: Immunohistochemical detection of UBD on a TMA containing 203 paired specimens showed that increased cytoplasmic UBD was signicantly associated with depth of cancer invasion, lymph node metastasis, distant metastasis, tumour histologic grade, advanced clinical stage and Ki-67 proliferative index. Patients with UBD-positive tumours had a significantly higher disease recurrence rate and poorer survival than patients with UBD-negative tumours after the radical surgery. Stratification analysis according to tumour stage revealed UBD as an independent predictor for tumour recurrence in patients with stage II and III tumours. CONCLUSION: UBD may contribute to the progression of colon carcinogenesis and function as a novel prognostic indicator of forecasting recurrence of stage II and III patients after curative operations.