scholarly journals Development and Validation of a Prognostic Nomogram to Predict Overall Survival of Elderly Patients with Gastric Cancer

2020 ◽  
Author(s):  
Xingguo Zhou ◽  
Yinlu Ding ◽  
Yu Wang ◽  
Ying Xue ◽  
Yifeng Zang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Elderly Patients ◽  
Receiver Operating Characteristic ◽  
Clinical Utility ◽  
Operating Characteristic ◽  
Term Survival ◽  
Ajcc Stage ◽  
Development And Validation ◽  
Receiver Operating

Abstract Background Gastric cancer (GC) is one of the most common malignant tumors of digestive tract origin in China. The proportion of elderly patients with gastric cancer (GC) gradually increases as the population ages. We aimed to develop a prognostic nomogram for prediction of elderly (≥ 75 years old) GC patients in overall survival (OS). Patients and Methods Patients with GC from 2005 to 2014 were selected from the Surveillance, Epidemiology, and End Result (SEER) database and randomly assigned to development and validation sets. The variables for establishing nomogram were confirmed by univariate and multivariate Cox proportional hazard analysis based on the development set. The predictive accuracy and discriminative ability of the model was evaluated using the receiver operating characteristic (ROC) curve, the concordance index (C-index) and calibration curves, while its clinical utility was assessed using decision curve analysis (DCA) and Kaplan-Meier curve. Results A total of 1445 patients were included in this study. The nomogram was developed including histologic grade, AJCC stage T, N, M and surgery according to the univariate and multivariate cox regression analysis, the area under the time-dependent receiver operating characteristic curve (AUC) and Occam’s Law of Razor. The C-index of the nomogram was higher than the TNM system in the training cohort (0.710 vs 0.652, p < 0.001), which was also confirmed in the validation cohort (0.701 vs 0.643, p < 0.001); and high AUCs were noted in both development and validation sets. The nomogram showed good discrimination and calibration in both development and validation sets. The DCA curves showed that the nomogram had better clinical utility compared to the AJCC stage model. In addition, participants could be divided into three disparate risk groups (low, moderate, high) by the nomogram. Conclusion This study established a prognostic nomogram that improved the performance of the AJCC staging system with incorporation of risk factors to better predict the short-term survival in elderly GC patients.

scholarly journals Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3598
Author(s):  
Ga Hee Kim ◽  
Kee Don Choi ◽  
Yousun Ko ◽  
Taeyong Park ◽  
Kyung Won Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Early Gastric Cancer ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Endoscopic Submucosal Dissection ◽  
Term Survival ◽  
Factors Associated ◽  
Submucosal Dissection

Background/Aim: We investigated the oncologic outcomes in elderly patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) by focusing on the impact of comorbidities, sarcopenia, and nutritional status. Methods: Between 2005 and 2016, 280 patients aged ≥ 80 years with 289 EGCs underwent ESD at a tertiary care center. The short- and long-term survival outcomes were assessed. Cox regression analysis was used to identify factors associated with survival, including clinicopathologic factors and abdominal muscle area measured by computed tomography. Results: The rates of en bloc, R0, and, curative resection were 99.3%, 90.0%, and 69.2%, respectively. The rates of post-ESD bleeding and perforation rates were 2.1% and 3.1%, respectively, and no cases showed significant life-threatening adverse events. Over a median follow-up period of 70.5 months, the 3- and 5-year overall survival (OS) rates were 89.5% and 77.1%, respectively; of the114 patients who died, only four (3.5%) were due to gastric cancer. A total of 173 (61.8%) had sarcopenia, and they had lower rates of 3-year (88.4% vs. 91.4%) and 5-year (73.1% vs. 84.0%; p = 0.046) OS than did those without sarcopenia. In multivariable analyses, prognostic nutritional index (hazard ratio [HR], 0.93; 95% confidence interval [CI]: 0.90–0.98; p = 0.002) and Charlson comorbidity index (HR 1.19; 95% CI: 1.03–1.37; p = 0.018) were significant factors associated with overall survival. Conclusions: ESD was a feasible and safe therapeutic method to use in elderly patients, whose long-term survival was significantly associated with nutritional status and comorbidities. These results suggest the need for a possible extension of the curative criteria for ESD in elderly patients with EGC.

scholarly journals Pan-cancer genomic amplifications underlie a Wnt hyperactivation phenotype associated with stem cell-like features leading to poor prognosis

2019 ◽  
Author(s):  
Wai Hoong Chang ◽  
Alvina G. Lai
Keyword(s):  
Stem Cells ◽  
Overall Survival ◽  
Cancer Stem Cells ◽  
Receiver Operating Characteristic ◽  
Poor Prognosis ◽  
Operating Characteristic ◽  
Epithelial To Mesenchymal Transition ◽  
Mesenchymal Transition ◽  
Pan Cancer ◽  
Receiver Operating

AbstractCancer stem cells pose significant obstacles to curative treatment contributing to tumor relapse and poor prognosis. They share many signaling pathways with normal stem cells that control cell proliferation, self-renewal and cell fate determination. One of these pathways known as Wnt is frequently implicated in carcinogenesis where Wnt hyperactivation is seen in cancer stem cells. Yet, the role of conserved genomic alterations in Wnt genes driving tumor progression across multiple cancer types remains to be elucidated. In an integrated pan-cancer study involving 21 cancers and 18,484 patients, we identified a core Wnt signature of 16 genes that showed high frequency of somatic amplifications linked to increased transcript expression. The signature successfully predicted overall survival rates in six cancer cohorts (n=3,050): bladder (P=0.011), colon (P=0.013), head and neck (P=0.026), pan-kidney (P<0.0001), clear cell renal cell (P<0.0001) and stomach (P=0.032). Receiver operating characteristic analyses revealed that the performance of the 16-Wnt-gene signature was superior to tumor staging benchmarks in all six cohorts and multivariate Cox regression analyses confirmed that the signature was an independent predictor of overall survival. In bladder and renal cancer, high risk patients as predicted by the Wnt signature had more hypoxic tumors and a combined model uniting tumor hypoxia and Wnt hyperactivation resulted in further increased death risks. Patients with hyperactive Wnt signaling had molecular features associated with stemness and epithelial-to-mesenchymal transition. Our study confirmed that genomic amplification underpinning pan-cancer Wnt hyperactivation and transcriptional changes associated with molecular footprints of cancer stem cells lead to increased death risks.List of AbbreviationsTCGAThe Cancer Genome AtlasKEGGKyoto Encyclopedia of Genes and GenomesGOGene OntologyROCReceiver operating characteristicAUCArea under the curveHRHazard ratioTNMTumor, node and metastasisHIFHypoxia inducible factorTFTranscription factorEMTEpithelial-to-mesenchymal transition

scholarly journals Activities of Daily Living (ADL) Predicts in-hospital Mortality in Geriatric Patients with Community-acquired Pneumonia (CAP)

2020 ◽  
Author(s):  
Yu Kang ◽  
Xiang-Yang Fang ◽  
dong wang ◽  
Xiao-juan Wang
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Receiver Operating Characteristic ◽  
Barthel Index ◽  
Daily Living ◽  
Geriatric Patients ◽  
Operating Characteristic ◽  
Community Acquired Pneumonia ◽  
Increased Risk ◽  
Receiver Operating

Abstract Background: Community-acquired pneumonia (CAP) is an important problem with significant mortality. Activity of daily living (ADL) function decline is associated with increased mortality in elderly patients. We aimed to investigate the prognostic value of ADL at admission on the in-hospital mortality in geriatric patients with pneumonia. Methods: Patients over 65 years old admitted to Beijing Chao-yang hospital due to CAP from June 2012 through June 2020 were retrospectively reviewed by electronic medical records. Risk factors for mortality in pneumonia patients described in literature were included in our study. ADL evaluation at admission was performed by Barthel index (BI). Results: 4880 patients were included, 131 patients (2.7%) died during their admission. 69.5% patients in Dead group had a BI scores < 60. Mean BI score in the Dead group and Alive group were 49.89±30.20 and 81.57±22.14, respectively. Dead group had lower BI scores than Alive group (p＜0.001). A low BI was associated with increased in-hospital mortality. Logistic regression analyses demonstrated that ADL function at admission was significantly and independently associated with the in-hospital mortality, either in younger (age 65-74years) or very elderly (age≥75years) patients. Receiver operating characteristic ( ROC ) curve analysis revealed that BI at admission is an predictor related to in-hospital mortality in elderly patients, The area under the receiver operating characteristic (ROC) curves of BI in predicting in-hospital mortality was 0.81 (with 95% confidence interval: 0.78–0.85).Conclusion: ADL decline is associated with increased risk of in-hospital mortality among elderly patients hospitalized with CAP. ADL function at admission can predict in-hospital mortality in geriatric patients with CAP. Barthel Index (BI) can be used as a simple and convenient method for the assessment of the ADL functional status at admission in geriatric patients with CAP to identify patients at high risk and conducive to clinical decision making.

Comparative Assessment of Clinical Benefit Using the ESMO-Magnitude of Clinical Benefit Scale Version 1.1 and the ASCO Value Framework Net Health Benefit Score

2019 ◽  
Vol 37 (4) ◽  
pp. 336-349 ◽  
Author(s):  
Nathan I. Cherny ◽  
Elisabeth G.E. de Vries ◽  
Urania Dafni ◽  
Elizabeth Garrett-Mayer ◽  
Shannon E. McKernin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Receiver Operating Characteristic ◽  
Clinical Benefit ◽  
Operating Characteristic ◽  
Health Benefit ◽  
Progression Free Survival ◽  
Characteristic Curves ◽  
Free Survival ◽  
Receiver Operating Characteristic Curves ◽  
Receiver Operating

PURPOSE To better understand the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS v1.1) and the ASCO Value Framework Net Health Benefit score version 2 (ASCO-NHB v2), ESMO and ASCO collaborated to evaluate the concordance between the frameworks when used to assess clinical benefit attributable to new therapies. METHODS The 102 randomized controlled trials in the noncurative setting already evaluated in the field testing of ESMO-MCBS v1.1 were scored using ASCO-NHB v2 by its developers. Measures of agreement between the frameworks were calculated and receiver operating characteristic curves used to define thresholds for the ASCO-NHB v2 corresponding to ESMO-MCBS v1.1 categories. Studies with discordant scoring were identified and evaluated to understand the reasons for discordance. RESULTS The correlation of the 102 pairs of scores for studies in the noncurative setting is estimated to be 0.68 (Spearman’s rank correlation coefficient; overall survival, 0.71; progression-free survival, 0.67). Receiver operating characteristic curves identified thresholds for ASCO-NHB v2 for facilitating comparisons with ESMO-MCBS v1.1 categories. After applying pragmatic threshold scores of 40 or less (ASCO-NHB v2) and 2 or less (ESMO-MCBS v1.1) for low benefit and 45 or greater (ASCO-NHB v2) and 4 to 5 (ESMO-MCBS v1.1) for substantial benefit, 37 discordant studies were identified. Major factors that contributed to discordance were different approaches to evaluation of relative and absolute gain for overall survival and progression-free survival, crediting tail of the curve gains, and assessing toxicity. CONCLUSION The agreement between the frameworks was higher than observed in other studies that sought to compare them. The factors that contributed to discordant scores suggest potential approaches to improve convergence between the scales.

scholarly journals Immunoscore system combining CD8 and PD-1/PD-L1: A novel approach that predicts the clinical outcomes for cervical cancer

2019 ◽  
Vol 35 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Hong Chen ◽  
Bairong Xia ◽  
Tongsen Zheng ◽  
Ge Lou
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Disease Free Survival ◽  
Tnm Staging ◽  
Characteristic Analysis ◽  
Free Survival ◽  
Disease Free ◽  
Receiver Operating

Purpose: Immunoscore was established to evaluate the prognosis of cancer patients. However, the feasibility of Immunoscore for the prognosis of cervical cancer remains unknown. To find other prognostic markers that contribute to immunological importance, immune checkpoint inhibitors targeting programmed cell death protein (PD-1), or its ligand, PD-L1, are of enormous interest. Our purpose is to investigate the expression of CD8 and PD-1/PD-L1 and their potential role in Immunoscore, supplementing the tumor/node/metastasis (TNM) classification of cervical cancer. Methods: Immunoscore was assessed according to the density of PD-1, PD-L1, and CD8 by immunohistochemistry. The association with overall survival and disease-free survival was assessed by the Kaplan–Meier method. To evaluate the effect of Immunoscore, a Cox proportional hazard regression classification was conducted. To compare the prognostic accuracies of Immunoscore and TNM staging, receiver operating characteristic curves were plotted. Results: Patients with PD-L1positive and PD-1high in immune cells had poorer overall survival and disease-free survival; however, PD-L1positive in tumor cells that infiltrated more CD8+ T cells were related to better overall survival and disease-free survival. These immune factors can be independent predictors for prognoses. According to these factors, a new Immunoscore system with priority in predicting prognoses was established. In receiver operating characteristic analysis for predictions of overall survival (the area under curve (AUC) = 0.833 vs. 0.766) and disease-free survival (AUC = 0.861 vs. 0.729), Immunoscore is more accurate than TNM staging. Conclusions: Thus, this Immunoscore system is an accurate predictive marker, which can be an important supplement to TNM staging for cervical cancer.

scholarly journals Receiver Operating Characteristic Prediction for Classification: Performances in Cross-Validation by Example

Mathematics ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. 1741
Author(s):  
Andra Ciocan ◽  
Nadim Al Hajjar ◽  
Florin Graur ◽  
Valentin C. Oprea ◽  
Răzvan A. Ciocan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Receiver Operating Characteristic ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Cross Validation ◽  
Full Model ◽  
Classification Models ◽  
The Stability ◽  
Development And Validation ◽  
Receiver Operating

The stability of receiver operating characteristic in context of random split used in development and validation sets, as compared to the full models for three inflammatory ratios (neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR) and platelet-to-lymphocyte (PLR) ratio) evaluated as predictors for metastasis in patients with colorectal cancer, was investigated. Data belonging to patients admitted with the diagnosis of colorectal cancer from January 2014 until September 2019 in a single hospital were used. There were 1688 patients eligible for the study, 418 in the metastatic stage. All investigated inflammatory ratios proved to be significant classification models on both the full models and on cross-validations (AUCs > 0.05). High variability of the cut-off values was observed in the unrestricted and restricted split (full models: 4.255 for NLR, 2.745 for dNLR and 255.56 for PLR; random splits: cut-off from 3.215 to 5.905 for NLR, from 2.625 to 3.575 for dNLR and from 134.67 to 335.9 for PLR), but with no effect on the models characteristics or performances. The investigated biomarkes proved limited value as predictors for metastasis (AUCs < 0.8), with largely sensitivity and specificity (from 33.3% to 79.2% for the full model and 29.1% to 82.7% in the restricted splits). Our results showed that a simple random split of observations, weighting or not the patients with and whithout metastasis, in a ROC analysis assures the performances similar to the full model, if at least 70% of the available population is included in the study.

scholarly journals Circ_0002232 Acts as a Potential Biomarker for AML and Reveals a Potential ceRNA Network of Circ_0002232/miR-92a-3p/PTEN

2020 ◽  
Author(s):  
zhaoqun Deng ◽  
Xiao-yu Su ◽  
Xin Zhu ◽  
Qian Zhao ◽  
Jin-ming Ke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Interaction Network ◽  
Interaction Prediction ◽  
Cerna Network ◽  
Operating Characteristic Curve ◽  
Receiver Operating

Abstract Background: PTEN, known as a classical tumor suppressor, has been reported to be down-expressed in acute myeloid leukemia (AML) and affected the progression of AML patients. CircRNAs, an emerging type of non-coding RNAs, could act as competing endogenous RNAs (ceRNAs) and has been reported to regulate the expression of PTEN through sponging miRNA in many solid tumors. But there are rarely studies focused on the role of circ-PTEN in AML. Our research was aimed to investigate the expression level of circ_0002232, one of circular RNAs of PTEN, reveal the clinical significance and potential ceRNA interaction network in AML of it.Methods: Circ_0002232 expression in 117 AML patients and 48 controls was detected by using Real-time quantitative PCR. The diagnostic value of circ_0002232 expression was evaluated by receiver operating characteristic curve. Kaplan-Meier curves were used to analyse the impact of circ_0002232 for overall survival. CeRNA network of circ_0002232 was predicted by using interaction prediction websites.Results: Compared with controls, circ_0002232 was notably low-expressed in AML (P<0.001). According to the result of receiver operating characteristic curve, circ_0002232 expression could distinguish AML patients from controls (P<0.001). There were significant differences in patients’ age (P=0.002), FAB classifications (P=0.025), white blood cell count (P=0.034) and platelet count (P=0.047) between low-expressed circ_0002232 group and high-expressed circ_00022332 group. Moreover, there was a positive correlation between circ_0002232 expression and patients’ age (Pearson r=0.256, P=0.0053). Interestingly, we found that patients in low-expressed circ_0002232 group had better overall survival both in whole AML (P=0.019) and non-APL AML (P=0.044). Remarkably, the expression of circ_0002232 was positively correlated with PTEN (Pearson r=0.769, P<0.001). Furthermore, there was a negative correlation in AML between circ_0002232 and miR-92a-3p (Pearson r=-0.262, P=0.032), miR-92a-3p and PTEN (Pearson r=-0.358, P=0.019). Interaction prediction websites revealed that circ_0002232 might regulate the expression of PTEN through sponging miR-92a-3p and affect the process of AML.Conclusions: Circ_0002232, one of circRNAs of PTEN, was remarkably down-regulated in AML and could act as a promising biomarker for the diagnosis of AML. In addition, there might be a potential ceRNA interaction network of circ_0002232/miR-92a-3p/PTEN in AML.

scholarly journals RGB Pixel Brightness Characteristics of Linked Color Imaging in Early Gastric Cancer: A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Xue Sun ◽  
Li Zhao
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Receiver Operating Characteristic ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Color Imaging ◽  
Linked Color Imaging ◽  
Pixel Brightness ◽  
Receiver Operating

Background and Aims. Linked color imaging (LCI) helps screen and diagnose for early gastric cancer by color contrast in different mucosa. RGB (red, green, and blue) pixel brightness quantifies colors, which is relatively objective. Limited studies have combined LCI images with RGB to help screen for early gastric cancer (EGC). We aimed to evaluate the RGB pixel brightness characteristics of EGC and noncancer areas in LCI images. Methods. We retrospectively reviewed early gastric cancer (EGC) patients and LCI images. All pictures were evaluated by at least two endoscopic physicians. RGB pixel brightness analysis of LCI images was performed in MATLAB software to compare the cancer with noncancer areas. Receiver operating characteristic (ROC) curve was analyzed for sensitivity, specificity, cut-off, and area under the curve (AUC). Results. Overall, 38 early gastric cancer patients were enrolled with 38 LCI images. Pixel brightness of red, green, and blue in cancer was remarkably higher than those in noncancer areas (190.24±37.10 vs. 160.00±40.35, p<0.001; 117.96±33.91 vs. 105.33±30.01, p=0.039; 114.36±34.88 vs. 90.93±30.14, p<0.001, respectively). Helicobacter plyori (Hp) infection was not relevant to RGB distribution of EGC. Whether the score of Kyoto Classification of Gastritis (KCG) is ≥4 or <4, the pixel brightness of red, green, and blue was not disturbed in both cancer and noncancer (p>0.05). Receiver operating characteristic (ROC) curve for differentiating cancer from noncancer was calculated. The maximum area under the curve (AUC) was 0.767 in B/G, with a sensitivity of 0.605, a specificity of 0.921, and a cut-off of 0.97. Conclusions. RGB pixel brightness was useful and more objective in distinguishing early gastric cancer for LCI images.

Übereinstimmung von klinischer Diagnose, strukturierten Interviews und Selbstbeurteilungsfragebögen bei Depression im Kindes- und Jugendalter

2012 ◽  
Vol 40 (6) ◽  
pp. 405-414 ◽  
Author(s):  
Kathrin Dolle ◽  
Gerd Schulte-Körne ◽  
Nikolaus von Hofacker ◽  
Yonca Izat ◽  
Antje-Kathrin Allgaier
Keyword(s):  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Kinder Und Jugendliche ◽  
Prädiktive Werte ◽  
Receiver Operating

Fragestellung: Die vorliegende Studie untersucht die Übereinstimmung von strukturierten Kind- und Elterninterviews sowie dem klinischen Urteil bei der Diagnostik depressiver Episoden im Kindes- und Jugendalter. Zudem prüft sie, ob sich die Treffsicherheit und die optimalen Cut-off-Werte von Selbstbeurteilungsfragebögen in Referenz zu diesen verschiedenen Beurteilerperspektiven unterscheiden. Methodik: Mit 81 Kindern (9–12 Jahre) und 88 Jugendlichen (13–16 Jahre), die sich in kinder- und jugendpsychiatrischen Kliniken oder Praxen vorstellten, und ihren Eltern wurden strukturierte Kinder-DIPS-Interviews durchgeführt. Die Kinder füllten das Depressions-Inventar für Kinder und Jugendliche (DIKJ) aus, die Jugendlichen die Allgemeine Depressions-Skala in der Kurzform (ADS-K). Übereinstimmungen wurden mittels Kappa-Koeffizienten ermittelt. Optimale Cut-off-Werte, Sensitivität, Spezifität sowie positive und negative prädiktive Werte wurden anhand von Receiver operating characteristic (ROC) Kurven bestimmt. Ergebnisse: Die Interviews stimmten untereinander sowie mit dem klinischen Urteil niedrig bis mäßig überein. Depressive Episoden wurden häufiger nach klinischem Urteil als in den Interviews festgestellt. Cut-off-Werte und Validitätsmaße der Selbstbeurteilungsfragebögen variierten je nach Referenzstandard mit den schlechtesten Ergebnissen für das klinische Urteil. Schlussfolgerungen: Klinische Beurteiler könnten durch den Einsatz von strukturierten Interviews profitieren. Strategien für den Umgang mit diskrepanten Kind- und Elternangaben sollten empirisch geprüft und detailliert beschrieben werden.

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