Prognosis and survival analysis of patients with pancreatic cancer: retrospective experience of a single institution

Background The overall survival of patients with pancreatic cancer is extremely low. Despite multiple large-scale studies, identification of predictors of patient survival remains challenging. This study aimed to investigate the prognostic factors for pancreatic cancer. Methods The clinical data of 625 patients with pancreatic cancer treated at Shengjing Hospital of China Medical University from January 2013 to December 2017 were collected. Results Of 625 patients, 569 were followed from 1 to 75 months. The median overall survival was 9.3 months. The overall 1-, 3-, and 5-year survival rates were 37.8%, 15.1%, and 10.5%, respectively. Cox proportional hazards model indicated that baseline carbohydrate antigen 199 level, neutrophil-lymphocyte ratio, operative procedure, lymph node metastasis, number of distant organ metastasis, and postoperative adjuvant chemotherapy were independent prognostic factors of patients with pancreatic cancer. Baseline carbohydrate antigen 199 level, degree of weight loss, operative procedure, lymph node metastasis, number of distant organ metastasis, and postoperative adjuvant chemotherapy were independent prognostic factors of pancreatic head cancer subgroup. Baseline carbohydrate antigen 199 level, carcinoembryonic antigen level, total bilirubin level, neutrophil-lymphocyte ratio, peripancreatic invasion, number of distant organ metastasis, and postoperative adjuvant chemotherapy were independent prognostic factors of the pancreatic body/tail cancer subgroup. Conclusions Higher carbohydrate antigen 199 levels, neutrophil-lymphocyte ratio, lymph node metastasis and distant organ metastasis predict a poor prognosis in patients with pancreatic cancer. Early detection, early radical surgery and adjuvant chemotherapy are needed to improve prognosis for this deadly disease.

The Efficacy of Radiotherapy in the Treatment of Hepatocellular Carcinoma with Distant Organ Metastasis

Background. Recently, radiotherapy has been used in the treatment of hepatocellular carcinoma (HCC). However, there is no study analyzing the efficacy of radiotherapy in cases of advanced HCC. The objective of this investigation was to determine the efficacy of radiotherapy in patients with HCC invading distant organs. Methods. The data of 2342 patients diagnosed between 2010 and 2015 with HCC invading distant organs were extracted from the SEER database. Propensity score matching (PSM) was used to reduce selection bias. Results. Before PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) in the radiotherapy group (mOS = 5 months, 95% CI: 4.5–5.5; mCSS = 5 months, 95% CI: 4.4–5.6) were longer than those in the nonradiotherapy group (mOS = 3 months, 95% CI: 2.8–3.2; mCSS = 3 months, 95% CI: 2.8–3.2; both P < 0.001 ). After PSM, mOS in the radiotherapy group (5 months, 95% CI: 4.5–5.5) was longer than that in the nonradiotherapy group (3 months, 95% CI: 2.6–3.4; P < 0.001 ), and the mCSS in the radiotherapy group (5 months, 95% CI: 4.4–5.6) was longer than that in the nonradiotherapy group (3 months, 95% CI: 2.6–3.4; P < 0.001 ). Before PSM, the multivariate analysis showed that all-cause and cancer-specific mortality rates were higher in the nonradiotherapy group than in the radiotherapy group. The adjusted Cox regression analysis for subgroups showed that, in the nonradiotherapy group, patients with bone metastases and multiorgan metastases had a worse survival than those in the radiotherapy group. Conclusion. HCC patients with metastases to distant organs obtain survival benefit from radiotherapy, particularly patients with bone metastases and multiorgan metastases.

Pulmonary metastasis of transmissible venereal tumour in a dog: a case report

The transmissible venereal tumour (TVT) is one of the most frequent neoplasias in dogs. This tumour has specific characteristics, and it is exclusively of canines. Its transmission occurs through viable neoplastic cell transplantation when in contact with mucosa or unhealthy skin and rarely metastasise. This paper aims to report a rare presentation of pulmonary metastasis of widespread transmissible venereal tumours in a Blue Heeler dog. The patient was cachectic, dyspnoeic, and dehydrated and had multiple skin and pharynx nodulations. The cytology of all cutaneous nodulations showed round vacuolated cells with large eccentric nuclei and loose chromatin, which is compatible with TVT’s microscopic characteristics. Owing to the clinical evolution and reserved prognosis, the patient was euthanized. Necroscopy revealed a mass in the right pulmonary caudal lobe. The mass showed the same histopathologic characteristic of the others: not encapsulated infiltrative neoplastic proliferation of round vacuolated cells. The atypical manifestation of cutaneous metastasis and mainly pulmonary metastasis, in this case, denote the importance of TVT inclusion as a differential in cutaneous neoplasia, even if they show distant organ metastasis. Therefore, it emphasised the importance of cytology and histology in the diagnosis of nodular affections.

3D-printing magnesium–polycaprolactone loaded with melatonin inhibits the development of osteosarcoma by regulating cell-in-cell structures

Melatonin has been proposed as a potent anticarcinogen presents a short half-life for osteosarcoma (OS). Cell-in-cell (CIC) structures play a role in the development of malignant tumors by changing the tumor cell energy metabolism. This study developed a melatonin-loaded 3D printed magnesium–polycaprolactone (Mg–PCL) scaffold and investigated its effect and molecular mechanism on CIC in OS. Mg–PCL scaffold was prepared by 3D-printing and its characteristic was determined. The effect and molecular mechanism of Mg–PCL scaffold as well as melatonin-loaded Mg–PCL on OS growth and progression were investigated in vivo and in vitro. We found that melatonin receptor 1 (MT1) and CIC expressions were increased in OS tissues and cells. Melatonin treatment inhibit the key CIC pathway, Rho/ROCK, through the cAMP/PKA signaling pathway, interfering with the mitochondrial physiology of OS cells, and thus playing an anti-invasion and anti-metastasis role in OS. The Mg–PCL–MT could significantly inhibit distant organ metastasis of OS in the in vivo model. Our results showed that melatonin-loaded Mg–PCL scaffolds inhibited the proliferation, invasion and metastasis of OS cells through the CIC pathway. The Mg–PCL–MT could be a potential therapeutics for OS.

Prognosis classification of breast cancer with distant lymph node metastasis IIIc or M1 category

Background: In the American Joint Commission on Cancer (AJCC) staging manual, ipsilateral supraclavicular lymph node metastases (ISLM) were defined as N3c, while contralateral supraclavicular and subclavian lymph node, contralateral internal mammary lymph node, contralateral axillary lymph node, and cervical lymph node as distant lymph nodes metastasis (DLM) were classified as M1, stage IV. Herein, we used the information recorded in the Surveillance, Epidemiology, and End Results (SEER) database to compare patients' overall survival with DLM, ISLM, and distant organ metastasis. Methods: A total of 376 patients with ISLM, 562 patients with DLM, 5,069 patients with IIIc stage breast cancer, and 7,540 patients with distant organ metastasis from the SEER database (2004-2016) were included in the present study. R package was used to perform the Kaplan–Meier survival analysis among these four groups, and propensity score weighting (PSW) was used to minimize the differences in clinicopathological characteristics among groupsResults: After PSW, the median survival of ISLM, DLM, IIIc stage, and distant organ metastasis was 42 months, 50 months, 55 months, and 31months, respectively. DLM achieved significantly better overall survival than distant organ metastasis (p<0.001, HR=0.646, 95%CI:0.561-0.737), while there was no significant difference in long-term survival between DLM and ISLM (p=0.467, HR=0.915, 95%CI:0.719-1.163) or DLM and IIIc stage (p=0.959, HR=0.995, 95%CI:0.837-1.183). Surgery (p<0.001, HR=0.502, 95%CI:0.375-0.674) and chemotherapy (p=0.007, HR=0.701, 95%CI:0.527-0.932) could significantly improve the OS for patients with DLM. When compared with chemotherapy alone, a combination of chemotherapy, surgery, and radiotherapy could achieve better survival, with the increased median survival from 26 months to 82 months (p<0.001, HR=0.366, 95%CI:0.253-0.529).Conclusion: The prognosis of breast cancer patients with DLM was similar to ISLM and IIIc stage, but much better than that of patients with distant organ metastasis. Also, combined-modality therapy significantly improved long-term survival. Consequently, it seems more reasonable to classify DLM as IIIc category instead of M1.

The efficacy of current-used risk factors for metastasis and the effectiveness of additional surgical resection in pT1b esophageal squamous cell carcinoma after endoscopic resection: A multi-institutional retrospective study in China

Purpose ER-treated patients with pT1b ESCC were strongly recommended to receive additional treatments, mainly radical surgical resection (SR). In view of high morbidity and mortality of additional SR treatment, this recommendation remained open to debate. Herein, our research aimed to access the efficacy of current risk predictors for metastasis based on the histological findings in ER specimens, and the effectiveness of additional SR. Methods We conducted a retrospective study of ER-treated pT1b ESCC patients with (n = 42) and without (n = 124) additional SR from 2007 to 2018 in China. Lymph node metastasis & distant organ metastasis (LNM&DOM) reflecting the overall metastasis risk of ESCC after ER treatment were used. The relationships between clinicopathological parameters and metastasis were assessed. And Overall survival(OS) and progression-free survival (PFS) were also analyzed. Results Patients with submucosal invasion depth (SMI) ≥ 200µm didn't demonstrate significant difference in LNM&DOM and survival, as compared with those with SMI < 200µm.In ER alone group, patients with vertical margin(VM) (+) showed worse PFS than those with VM(-) (p = 0.008).More strikingly, for patients in low-risk group who had LVI(-) and VM(-), ER + SR didn't significantly prolong their PFS(p = 0.120) but significantly shorter their OS (p < 0.010) as compared with ER alone treatment. Conclusions SMI ≥ 200µm isn’t a sensitive and predictive indicator for both LNM&DOM and survival for patients with ER treatment. More strikingly, additional SR is not an optimal therapeutic selection for ER-treated pT1b ESCC in low-risk group who had LVI(-) and VM(-).

Establishment and Evaluation of a Nomogram For Prediction of Peritoneal Metastasis in Gastric Cancer

Background Peritoneal metastasis is a critical way of metastasis for gastric cancer, patients with which tend to have poor prognosis. Laparoscopy or laparotomy is still major approach to diagnose peritoneal metastasis presently. This study was aimed to explore the factors affecting peritoneal metastasis of gastric cancer and establish a nomogram to predict that preoperatively. Methods 1002 gastric cancer patients who underwent surgery without distant organ metastasis was collected in the study. The nomogram was built with variables selected by univariate logistical regression and LASSO, and evaluated with internal and external validation ROC curve.Results Three factors including carbohydrate antigen 125, carbohydrate antigen 242 and serosal invasion or not of primary tumor were enrolled in the nomogram. The AUC value was0.922 (95%CI 0.897~0.947) in internal validation and 0.934 (95%CI 0.852~1.000) in external validation. Conclusions This study developed a nomogram with risk factors easily accessible before surgery in patients with gastric cancer, which can predict the probability of peritoneal metastasis well and would be helpful for clinicians to make appropriate therapy strategies.

Combination of Mitochondrial Targeting Doxorubicin with Bcl-2 Function Converting Peptide NuBCP-9 for Synergistic Breast Cancer Metastasis Inhibition

Distant organ metastasis is the main cause of death in breast cancer patients. Evidences have shown that mitochondria also play a crucial role in tumor metastasis, except for as apoptosis...