Utilization of Resources and Overall Outcome in Patients Undergoing Hematopoietic Stem Cell Transplantation Related to Psychosocial Factors as Measured by the Transplant Evaluation Rating Scale (TERS).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3332-3332
Author(s):  
Dawn S. Speckhart ◽  
H.K. Holland ◽  
Scott R. Solomon ◽  
Lawrence E. Morris ◽  
Asad Bashey
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Rating Scale ◽  
Risk Group ◽  
Psychosocial Risk ◽  
Moderate Risk ◽  
Hematopoietic Stem ◽  
Risk Patients ◽  
Transplant Evaluation ◽  
Length Of Hospitalization

Abstract Several studies have begun to examine the relationship between psychosocial variables and outcome in hematopoietic stem cell transplantation (HSCT). Data presented at the 2006 ASH Convention, demonstrated a significant relationship between psychosocial variables, such as those assessed on the Transplant Evaluation Rating Scale (TERS), and objective outcomes, such as length of hospitalization and survival. The 2006 data included 200 consecutive patients (136 autologous, 65 allogeneic) undergoing HSCT. Based on the patient’s TERS score, each patient was stratified into one of two groups (low/moderate risk (n=173) vs. high risk (n=28)) based on their predicted psychosocial risk for problems during transplant. With the addition of 166 patients (Current N=366: 239 autologous, 127 allogeneic) the difference in length of hospitalization between low/moderate risk (10 days) versus high risk (19 days) patients remains significant (p<.02). For allogeneic patients (N=127), there continues to be an improved overall survival in low/moderate risk patients in the first 12 to 18 months following HSCT compared to high risk patients (p = .246). To determine whether similar factors impact utilization of resources in patients undergoing HSCT, we prospectively conducted psychosocial assessments on 112 consecutive allogeneic HSCT patients. An analysis of cost was completed for all patients in both the low/moderate risk group and high risk group. The mean cost differential for high risk patients is noted to be 27% higher than those patients in the low/moderate risk group (p = .122). This trend reinforces earlier data presented and suggests a correlation between pre-transplant psychosocial risk factors and resource utilization in HSCT. Overall Survival Overall Survival

scholarly journals The Psychosocial Transplant Evaluation Rating Scale (TERS) Prospectively Predicts Inferior Overall Survival Outcome for High Risk Scoring Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 207-207 ◽  
Author(s):  
Dawn Speckhart ◽  
Scott R. Solomon ◽  
Xu Zhang ◽  
Lawrence E. Morris ◽  
Asad Bashey ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
High Risk ◽  
Cell Transplantation ◽  
Rating Scale ◽  
Disease Risk ◽  
Psychosocial Risk ◽  
Hematopoietic Stem ◽  
Transplant Evaluation ◽  
The Relationship

Abstract Several studies have begun to examine the relationship between psychosocial variables and outcome in hematopoietic stem cell transplantation (HSCT). Previous studies have also looked at the relationship between the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and disease risk on overall survival in HSCT. Research has shown that disease risk and HCT-CI may have a negative relationship with outcome in HSCT. In this study, psychosocial data was collected prospectively on 437 patients undergoing related and unrelated allogeneic HSCT. All patients were assessed using the Transplant Evaluation Rating Scale (TERS). Based on the patient’s TERS score, each patient was stratified into one of two groups (low/moderate risk (n=371) vs. high risk (n=66)) based on their predicted psychosocial risk for problems during transplant. The 1-year overall survival (OS) for the low/mod risk TERS group versus the high TERS risk group was 78% and 61%, respectively (p=.005). Stratification by CIBMTR disease risk identified 261 patients with low and intermediate risk disease of which 228 had low/mod risk TERS score and 33 had high risk TERS score. The is a significant survival advantage for Low/Mod Risk TERS patients vs. High Risk TERS patients at 100 day, 1 year and overall survival being 97% vs 79% (P=.01), 85% vs 58% (P=.002) and 68% vs 42% (P=.002) with a median follow up of 48 months (graph attached). An adjusted logistic regression analysis showed that psychosocial factors have a significant impact on overall survival despite all patients being required to have 24 hour caregiver support, a pre-transplant psychosocial evaluation and post-transplant psychosocial intervention. The analysis controlled for other variables such as age, gender, performance status, disease risk and transplant type. These results highlight the impact of psychosocial factors on HSCT outcome, as those patients who are expected to do well based on their low/intermediate disease risk may not perform as expected due to psychosocial risk factors. These results suggest the need to perform careful psychosocial assessments on all HSCT patients in order to predict mortality risks for the individual patient and to help the transplant team strategize how to better manage the high risk psychosocial patient. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Psychosocial Factors as Measured by the Transplant Evaluation Rating Scale (TERS) Predict Length of Hospitalization and Transplant Outcomes Following Hematopoietic Stem Cell Transplantation.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 75-75 ◽  
Author(s):  
Dawn S. Speckhart ◽  
Scott R. Solomon
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Rating Scale ◽  
Solid Organ ◽  
Hematopoietic Stem ◽  
Transplant Patients ◽  
Transplant Evaluation ◽  
Length Of Hospitalization

Abstract Although psychological and social factors are recognized as being important in the evaluation of patients for hematopoietic stem cell transplantation (HSCT), no standard approach to psychosocial assessment currently exists. In solid organ transplantation, psychosocial assessments have been integrated into the selection of appropriate candidates, and certain psychosocial variables, such as active substance abuse, have been shown to negatively impact outcomes in solid organ transplant patients. To determine whether similar factors impact outcomes in patients undergoing HSCT, we prospectively conducted psychosocial assessments on 221 consecutive patients (155 autologous, 66 allogeneic) undergoing HSCT. The relationship between psychosocial variables, such as those assessed on the Transplant Evaluation Rating Scale (TERS), and objective outcomes, such as length of hospitalization and survival was evaluated. Based on the patient’s TERS score, each patient was stratified into one of two groups (low/moderate risk (n=187) vs. high risk (n=34)) based on their predicted psychosocial risk for problems during transplant. Although the two groups were similar in regards to known pre-transplant prognostic factors such as age, performance status, disease risk, and transplant type, there was a significant difference in the median length of hospitalization between patients who score low/moderate (10 days) and those who scored high (21.5 days) on the TERS. This difference was significant both for patients receiving autologous (9 vs. 15 days, p&lt;.02) and allogeneic transplants (16 vs. 45 days, p&lt;.001). Furthermore, 2-year overall survival was significantly improved in allogeneic transplant patients who score low/moderate vs. those that scored high on the TERS (72% vs. 46%; p&lt;=.02). These findings suggest a strong correlation between pre-transplant psychosocial risk factors, resource utilization and patient outcome in HSCT. Figure 1. Overall survival following allogeneic stem cell transplantation according to TERS score Figure 1. Overall survival following allogeneic stem cell transplantation according to TERS score

scholarly journals The Transplant Evaluation Rating Scale predicts overall survival after allogeneic hematopoietic stem cell transplantation

2020 ◽  
Vol 4 (19) ◽  
pp. 4812-4821
Author(s):  
Melhem M. Solh ◽  
Dawn Speckhart ◽  
Scott R. Solomon ◽  
Asad Bashey ◽  
Lawrence E. Morris ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Rating Scale ◽  
Disease Risk ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Intermediate Risk ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Transplant Evaluation

Abstract To evaluate the impact of psychosocial risks on post–hematopoietic stem cell transplantation (HSCT) outcomes, we prospectively conducted psychosocial assessment of 556 consecutive allogeneic HSCT patients who received their first allogeneic transplant at our center between 2003 and 2017. The Transplant Evaluation Rating Scale (TERS) score was prospectively assessed by a psychologist before transplantation, and patients were categorized as low, intermediate, or high risk based on their TERS score. Patients in the high-risk TERS group had significantly longer hospital stays during the first 180 days and 1 year post–allogeneic HSCT compared with the low-risk group (16 vs 13 and 21 vs 16 days; P = .05 and .02, respectively). The survival estimates for low-, intermediate-, and high-risk TERS groups at 3 year were as follows: overall survival (OS), 73%, 60%, and 65%; disease-free survival (DFS), 63%, 55%, and 60%; nonrelapse mortality (NRM), 11%, 20%, and 17%; and relapse, 26%, 25%, and 23%, respectively. In a multivariable analysis, intermediate- and high-risk TERS scores predicted for inferior OS, similar DFS, and higher NRM compared with low-risk TERS score. In a subset analysis of patients with low/intermediate risk per Disease Risk Index, multivariable analysis showed that high- and intermediate-risk TERS scores predicted for significantly worse OS, worse DFS, higher NRM, and similar relapse rates compared with low-risk TERS score. Our findings show that psychosocial factors as measured by TERS score are strong predictors of morbidity and mortality after HSCT among patients with low/intermediate disease risk.

scholarly journals A Novel Autophagy-Related lncRNA Gene Signature to Improve the Prognosis of Patients with Melanoma

2020 ◽  
Author(s):  
Yi Ding ◽  
Tian Li ◽  
Min Li ◽  
Tuersong Tayier ◽  
MeiLin Zhang ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Risk Model ◽  
Risk Group ◽  
Clinical Information ◽  
Low Risk ◽  
Gene Set Enrichment Analysis ◽  
Positive Regulation ◽  
Risk Patients ◽  
Cox Analysis

Abstract Background: Autophagy and long non-coding RNAs (lncRNAs) have been the focus of research on the pathogenesis of melanoma. However, the autophagy network of lncRNAs in melanoma has not been reported. The purpose of this study was to investigate the lncRNA prognostic markers related to melanoma autophagy and predict the prognosis of patients with melanoma.Methods: We downloaded RNA-sequencing data and clinical information of melanoma from The Cancer Genome Atlas. The co-expression of autophagy-related genes (ARGs) and lncRNAs was analyzed. The risk model of autophagy-related lncRNAs was established by univariate and multivariate COX regression analyses, and the best prognostic index was evaluated combined with clinical data. Finally, gene set enrichment analysis was performed on patients in the high- and low-risk groups.Results: According to the results of the univariate COX analysis, only the overexpression of LINC00520 was associated with poor overall survival, unlike HLA-DQB1-AS1, USP30-AS1, AL645929, AL365361, LINC00324, and AC055822. The results of the multivariate COX analysis showed that the overall survival of patients in the high-risk group was shorter than that recorded in the low-risk group (p<0.001). Moreover, in the receiver operating characteristic curve of the risk model we constructed, the area under the curve (AUC) was 0.734, while the AUC of T and N was 0.707 and 0.658, respectively. The Gene Ontology was mainly enriched with the positive regulation of autophagy and the activation of the immune system. The results of the Kyoto Encyclopedia of Genes and Genomes enrichment were mostly related to autophagy, immunity, and melanin metabolism.Conclusion: The positive regulation of autophagy may slow the transition from low-risk patients to high-risk patients in melanoma. Furthermore, compared with clinical information, the autophagy-related lncRNAs risk model may better predict the prognosis of patients with melanoma and provide new treatment ideas.

scholarly journals A four-gene prognostic signature for predicting the overall survival of patients with lung adenocarcinoma

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11911
Author(s):  
Lei Liu ◽  
Huayu He ◽  
Yue Peng ◽  
Zhenlin Yang ◽  
Shugeng Gao
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Lung Adenocarcinoma ◽  
Prognostic Model ◽  
Risk Group ◽  
Gene Signature ◽  
Tnm Staging ◽  
High Risk Group ◽  
Prognostic Signature ◽  
Risk Patients

Background The prognosis of patients for lung adenocarcinoma (LUAD) is known to vary widely; the 5-year overall survival rate is just 63% even for the pathological IA stage. Thus, in order to identify high-risk patients and facilitate clinical decision making, it is vital that we identify new prognostic markers that can be used alongside TNM staging to facilitate risk stratification. Methods We used mRNA expression from The Cancer Genome Atlas (TCGA) cohort to identify a prognostic gene signature and combined this with clinical data to develop a predictive model for the prognosis of patients for lung adenocarcinoma. Kaplan-Meier curves, Lasso regression, and Cox regression, were used to identify specific prognostic genes. The model was assessed via the area under the receiver operating characteristic curve (AUC-ROC) and validated in an independent dataset (GSE50081) from the Gene Expression Omnibus (GEO). Results Our analyses identified a four-gene prognostic signature (CENPH, MYLIP, PITX3, and TRAF3IP3) that was associated with the overall survival of patients with T1-4N0-2M0 in the TCGA dataset. Multivariate regression suggested that the total risk score for the four genes represented an independent prognostic factor for the TCGA and GEO cohorts; the hazard ratio (HR) (high risk group vs low risk group) were 2.34 (p < 0.001) and 2.10 (p = 0.017). Immune infiltration estimations, as determined by an online tool (TIMER2.0) showed that CD4+ T cells were in relative abundance in the high risk group compared to the low risk group in both of the two cohorts (both p < 0.001). We established a composite prognostic model for predicting OS, combined with risk-grouping and clinical factors. The AUCs for 1-, 3-, 5- year OS in the training set were 0.750, 0.737, and 0.719; and were 0.645, 0.766, and 0.725 in the validation set. The calibration curves showed a good match between the predicted probabilities and the actual probabilities. Conclusions We identified a four-gene predictive signature which represents an independent prognostic factor and can be used to identify high-risk patients from different TNM stages of LUAD. A new prognostic model that combines a prognostic gene signature with clinical features exhibited better discriminatory ability for OS than traditional TNM staging.

scholarly journals SPECIFICS OF ANTIHYPERTENSION THERAPY IN HYPERTENSIVES OF VARIOUS CARDIOVASCULAR RISK (BY THE REGISTRY OF CHRONIC NON-COMMUNICABLE DISEASES IN TYUMENSKAYA OBLAST)

2018 ◽  
Vol 17 (3) ◽  
pp. 4-10
Author(s):  
A. Yu. Efanov ◽  
Yu. A. Vyalkina ◽  
Yu. A. Petrova ◽  
Z. M. Safiullina ◽  
O. V. Abaturova ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Risk Level ◽  
Moderate Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High

Aim. To assess the specifics of antihypertension therapy (AHT) in hypertensives of various cardiovascular risk, in the registry of chronic non-communicable diseases in Tyumenskaya oblast.Material and methods. A random sample studied, of 1704 patients with hypertension, inhabitants of Tyumenskaya oblast (region), ascribed to dispensary follow-up. Mean age 62±7,5 y.o. Of those 31,5% (n=537) males. The prevalence and efficacy of AHT assessed according to cardiovascular risk level. The significance was evaluated with the criteria χ2.Results. AHT was characterized by the growth of the frequency of treatment approaches with cardiovascular risk consideration. Regular treatment took 33,9% patients of low and moderate risk vs 41,3% of high and very high (p<0,01). In the male group such tendency also took place. Gender specifics of AHT was characterized by that in the groups of high and very high risk females took medications significantly more commonly than males — 46,6% vs 29,1% in high risk group (p<0,01) and 47,5% vs 30% in very high risk group (p<0,01). With the increase of the risk level, there was decline of treatment efficacy — from 95% in low risk group to 32,5% in very high risk group; 53,1% of the participants were taking monotherapy, 32,9% — two drugs, 14,0% — ≥3 drugs. With the increase of risk grade there is tendency to increase of combinational AHT, however with no significant increase of efficacy. Treatment efficacy in high and very high risk patients comparing to patients with low and moderate risk was significantly lower — 33,1% vs 69,7% (p<0,01), respectively. Statins intake among the high and very high risk patients was 10,6-11,0% males and 7,8% females (p<0,05).Conclusion. AHT in hypertensives in Tymenskaya oblast, under dispensary follow-up, is characterized by insufficient usage of combinational drugs. With the raise of cardiovascular risk there is tendency to higher rate of combinational AHT. However there is no significant increase in efficacy of treatment with the increase of medications number. A very low rate of statins intake is noted. The obtained specifics witness for the necessity to optimize AHT among the high and very high risk patients — inhabitants of Tyumenskya oblast.

Trends in conditional survival and predictors of late death in neuroblastoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10533-10533
Author(s):  
Hannah Olsen ◽  
Kevin M. Campbell ◽  
Rochelle Bagatell ◽  
Steven G. DuBois
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Primary Site ◽  
Conditional Survival ◽  
Late Death ◽  
High Risk Patients ◽  
Risk Patients ◽  
Over Time

10533 Background: Significant advances in the treatment of neuroblastoma have been made in the past several decades. There are scant data examining how these improvements have changed over time and differentially affected conditional survival among high- and non-high-risk patient groups. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results Database. We analyzed clinical characteristics and survival outcomes for 4717 neuroblastoma patients. Kaplan-Meier methods were used to estimate overall survival (OS) and conditional overall survival (COS) conditioned on having survived 1, 2, or 5 years from diagnosis, with estimates compared between groups using log-rank tests. Results: Five-year OS was 41.46% (95% CI 38.77-44.13) for the high-risk group and 91.13% (95% CI 89.49-92.53) for the non-high-risk group. Both groups saw significant improvements in OS by decade (p<0.001). Five-year COS among 1-year survivors was 52.69% (95% CI 38.77-44.13) for the high-risk group and 96.75% (95% CI 95.57-97.62) for the non-high-risk group. One-year survivors in the high-risk group showed a statistically significant improvement in COS over time. No difference in COS was observed among 5-year high-risk survivors. There were no statistically significant changes in COS over time for 1- and 5-year survivors in the non-high-risk group. In the high-risk and non-high-risk groups, 82% and 32% of late deaths (>5 years from diagnosis) were attributable to cancer, respectively. Statistically significant adverse prognostic factors for late death were age >1 year at diagnosis, metastatic disease, and non-thoracic primary site (p=0.001). Conclusions: Improvements in COS over time have largely benefited high-risk patients, though they are still at higher risk for late death due to cancer when compared to non-high-risk patients. Age, stage, and primary site, but not treatment decade, influence outcomes among 5-year survivors. [Table: see text]

A reclassification of Myelodysplastic Syndrome (MDS) patients of RAEB-1 subgroup according to IPSS-R improves discrimination of high risk patients and better predicts overall Survival. A retrospective analysis of 49 Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4957-4957 ◽  
Author(s):  
Jaroslav Cermak ◽  
Dana Mikulenková ◽  
Jana Brezinova ◽  
Kyra Michalova
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Median Survival ◽  
Risk Group ◽  
Univariate Analysis ◽  
Refractory Anemia ◽  
Term Survival ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High

Abstract Abstract 4957 Refractory anemia with excess of bone marrow (BM) blasts up to 10% (RAEB-1) has been generally considered a MDS subgroup with moderate prognosis and most of the patients are not indicated for immediate intensive treatment. In our retrospective study, 27 out of 49 patients with RAEB-1 had intermediate-1 (IM-1) risk and 22 patients were classified as intermediate-2 (IM-2) risk group according to the IPSS. Nevertheless, median survival of untreated patients with RAEB-1. was only 5. 0 months compared to 36. 3 months in untreated patients with ≤ 5% BM blasts at the time of diagnosis (P<0. 0001). After reclassification of patients according to revised IPSS (IPSS-R) only 14 patients remained in the intermediate (IM) risk group and 3 patients were even shifted to the low (L) risk group. On the other hand, 14 patients have fulfilled criteria for high (H) risk group and 18 out of 49 patients (37%) had very high (VH) risk score. Median survival of patients treated with low dose chemotherapy (9. 0 months) or hydroxyurea (8. 8 months) was not significantly different from that in patients who received supportive care only. A significant benefit in median survival was observed after combination chemotherapy (14. 0 months) or after stem cell transplantation (SCT) (17. 0 months). SCT was the only treatment connected with prolonged survival, nevertheless, estimated 5 years overall survival of 31. 2 months was significantly inferior (P=0. 02) to that of transplanted patients not only with ≤ 5% BM blasts (62. 2 months) but also with > 10% BM blasts (55. 6 months). Univariate analysis using Kaplan-Meier curves and log-rank2 test revealed as significant variables affecting overall survival: poor cytogenetics IPSS subgroup (P=0. 001), ECOG > 2 (P=0. 001), IM-2 IPSS risk group (P=0. 001), treatment with SCT (P=0. 003), platelet (PLT) count < 20×109/l (P=0. 004), high or very high IPSS-R risk group (P=0. 01) and age > 60 years (P=0. 03). The most important independent variable for determining overall survival (studied by Cox regression multivariate analysis) was poor cytogenetics according IPSS (P=0. 0001, χ2=52. 623), followed by PLT count < 20×109/l (P=0. 001, χ2= 10. 382), and ECOG > 2 (P=0. 002, χ2= 9. 794). Our data suggest that RAEB-1 represent a poor prognostic MDS subgroup with similar outcome as advanced MDS with > 10% BM blasts. The analysis confirms the usefulness of IPSS-R for prediction of survival and for better discrimination of high risk patients in subgroups of patients with less advanced disease. Moreover, the results of regression analysis justify the high scoring value of cytogenetic abnormalities used in IPSS-R. SCT represents the only treatment enabling a long-term survival of RAEB-1 patients, nevertheless, our results of SCT were inferior to that achieved in patients with advanced MDS. Thus, more extensive clinical trials validating efficiency of hypomethylating agents and other new drugs in the treatment of RAEB-1 patients are needed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Identification of Immune-Related Genes for Establishment of Prognostic Index in Hepatocellular Carcinoma

2021 ◽  
Vol 9 ◽  
Author(s):  
Yinfang Li ◽  
Ling Zou ◽  
Xuejun Liu ◽  
Judong Luo ◽  
Hui Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
High Risk ◽  
Cox Regression ◽  
Risk Group ◽  
Prognostic Index ◽  
Hub Genes ◽  
Cox Regression Analysis ◽  
Risk Patients ◽  
Immune Related Genes

Background: Immune checkpoint inhibitor (ICI) therapy has been proved to be a promising therapy to many types of solid tumors. However, effective biomarker for estimating the response to ICI therapy and prognosis of hepatocellular carcinoma (HCC) patients remains underexplored. The aim of this study is to build a novel immune-related prognostic index based on transcriptomic profiles.Methods: Weighted gene co-expression network analysis (WGCNA) was conducted to identify immune-related hub genes that are differentially expressed in HCC cohorts. Next, univariate Cox regression analysis and least absolute shrinkage and selection operator (LASSO) analysis were used to detect hub genes associated to overall survival (OS). To validate the immune-related prognostic index, univariate and multivariate Cox regression analysis were performed. CIBERSORT and ESTIMATE were used to explore the tumor microenvironment and immune infiltration level.Results: The differential expression analysis detected a total of 148 immune-related genes, among which 25 genes were identified to be markedly related to overall survival in HCC patients. LASSO analysis yielded 10 genes used to construct the immune-related gene prognostic index (IRGPI), by which a risk score is computed to estimate low vs. high risk indicating the response to ICI therapy and prognosis. Further analysis confirmed that this immune-related prognostic index is an effective indicator to immune infiltration level, response to ICI treatment and OS. The IRGPI low-risk patients had better overall survival (OS) than IRGPI high-risk patients on two independent cohorts. Moreover, we found that IRGPI high-risk group was correlated with high TP53 mutation rate, immune-suppressing tumor microenvironment, and these patients acquired less benefit from ICI therapy. In contrast, IRGPI-low risk group was associated with low TP53 and PIK3CA mutation rate, high infiltration of naive B cells and T cells, and these patients gained relatively more benefit from ICI therapy.

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