Background The intestinal-liver axis is associated with various liver diseases. Here, we verified the role of the gut microbiota and macrophage activation in the progression of pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome (PA-HSOS), and explored the possible mechanisms and new treatment options.
Background: Elderly patients with Intrahepatic Cholangiocarcinoma (ICC) are frequently under-represented in clinical trials, which leads to the unclear management of ICC in elderly patients.This study aimed to describe treatment patterns and establish a reliable nomogram in elderly ICC patients.Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) database, we conducted a retrospective analysis of 1651 elderly patients (≥65 years) diagnosed with ICC between 2004 and 2016.Results: For the whole study population, 29.3% received only chemotherapy, 26.7% no tumor-directed therapy, 19.1% surgery alone, 17.5% radiotherapy, and 7.4% surgery plus chemotherapy.Compared with the age group of 65-74 years, patients aged ≥75 years were less likely to accept treatment.Among patients 66-74 years of age, surgery alone resulted in a median overall survival (OS) of 30 months, surgery combined with chemotherapy 26 months, radiotherapy 17 months, chemotherapy alone 10 months and no therapy 3 months; while among patients ≥75 years of age, the median OS was 21, 25, 14, 9 and 4, respectively.Moreover, independent prognostic indicators including age, gender, grade, tumor size, T stage, N stage, M stage, and treatment were incorporated to construct a nomogram.The C-indexes of the OS nomogram were 0.725 and 0.724 for the training and validation cohorts, respectively.Importantly, the predictive model harbored a better discriminative power than the American Joint Committee on Cancer TNM staging system.Conclusion: Active treatment should not be abandoned among all the elderly patients with ICC.The validated nomogram provided an effective and practical tool to accurately evaluate prognosis and to guide personalized treatment for elderly ICC patients.
Abstract Background: Patients who survived the initial esophagogastric variceal bleeding (EVB) experienced an increased risk of recurrent bleeding and death, but a reliable predictive model is lacking. We aim to develop and validate a model for rebleeding prediction in cirrhotic patients with EVB after modified percutaneous transhepatic variceal embolization (PTVE) with cyanoacrylate. Methods: A total of 122 patients with EVB who underwent PTVE from January 2015 to March 2020 were enrolled in this study . The multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction. The discrimination, calibration and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease (MELD) and Child–Pugh model. Additionally, a risk stratification was developed according to nomogram. Results: Rebleeding within 3 months after PTVE occurred in 32 patients (26.2%). The independent rebleeding indicators included the history of endoscopic therapy, Child–Pugh score, partial splenic embolization and creatinine level. The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities with a concordance index of 0.85 which was confirmed to be 0.83 through bootstrapping validation. The nomogram harbored better discrimination and clinical applicability than the MELD and Child–Pugh model. As shown in the Kaplan-Meier curves, the patients at high risk were significantly associated with the high probability of rebleeding ( P < 0.001). Conclusions: We created a creatinine-based nomogram to predict rebleeding in cirrhotic patients received PTVE, which could help clinicians to discern the high-risk patients to perform more aggressive treatments earlier and formulate intensive follow-up plan for them.
While hepatocellular carcinoma (HCC) represents a highly heterogeneous disease with variable oncogenesis mechanisms and biological features, little is understood about differences in distant metastasis (DM) and prognosis between early-onset and late-onset HCC. This study defined early-onset disease as cancer diagnosed at age younger than 50 years and aimed to present a comprehensive analysis to characterize these disparities based on age.
Background: Surgery has been the primary treatment in patients with localized gastrointestinal stromal tumors (GISTs) for many decades, whereas it remains controversial regarding the efficacy of primary tumor resection for metastatic GISTs treated with chemotherapy, and likewise it is unclear who would benefit from the surgical resection. Methods: GISTs patients with distant metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of surgery on survival. Results: In total, of 455 patients with metastatic GISTs, 235 patients (51.6%) underwent primary tumor resection and 220 patients (48.4%) did not. Median survival of patients in resection group was 72 (95% CI: 62.90-81.10) months versus 40 (95% CI: 29.53-50.47) months for those in non-resection group (p<0.001). Similarly, surgery in conjunction with chemotherapy led to a favorable impact on survival than chemotherapy alone (OS: 72 vs. 40 months, p<0.001; CSS: 74 vs. 44 months, p<0.001). Multivariable analysis showed that both OS ((HR: 0.581, 95% CI: 0.386-0.874, p=0.009) and CSS (HR: 0.663, 95% CI: 0.439-0.912, p=0.042) were dramatically improved in patients with surgical removal of primary site, as well as primary tumor size between 5-10 cm, while increasing age was predictive of poorer survival. Stratified analysis revealed that patients with tumor locations in the stomach demonstrated a prolonged survival after surgery, with no significant differential surgical effect between the stomach and small intestine.. Conclusions: Our study preliminarily suggests that carefully selected patients with metastatic GISTs might prolong survival after treatment of surgery, especially those with a primary tumor between 5-10 cm and a tumor located in the stomach.
Abstract We aimed to explore factors associated with prognosis in patients with metastatic small bowel adenocarcinoma (SBA) as well as to develop and validate nomograms to predict overall survival (OS) and cancer-specific survival (CSS). Relevant information of patients diagnosed between 2004 and 2016 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms for predicting 1- and 3-year OS and CSS were established with potential risk factors screened from multivariate cox regression analysis. The discrimination and accuracy of the nomograms were assessed by concordance index (C-index), calibration plots, and the area under receiver operating characteristic curve (AUC). In total, 373 SBA patients with M1 category were enrolled. Multivariate analysis revealed that age, size and grade of primary tumor, primary tumor surgery, and chemotherapy were significant variables associated with OS and CSS. The C-index values of the nomogram for OS were 0.715 and 0.687 in the training and validation cohorts, respectively. For CSS, it was 0.711 and 0.690, respectively. Through AUC, decision curve analysis (DCA) and calibration plots, the nomograms displayed satisfactory prognostic predicted ability and clinical application both in the OS and CSS. Our models could be served as a reliable tool for prognostic evaluation of patients with metastatic SBA, which are favorable in facilitating individualized survival predictions and clinical decision-making.
Dermatomyositis (DM) is an autoimmune disease characterized by chronic muscle inflammation and weakness. Patients with DM are at an increased risk of thromboembolic events (TEs). This study aimed to investigate the prevalence of TEs in DM and to identify the independent predictors. A total of 543 patients hospitalized for DM within the past 10 years were analyzed retrospectively and compared with patients with DM with and without TEs for demographic, clinical, and laboratory characteristics. The independent predictors were analyzed using multivariate logistic regression analysis. The diagnostic performance was calculated by a receiver operating curve (ROC). Twenty-two (4.1%) patients with DM had TEs, including 12 (54.5%) with venous thromboembolism and 10 (45.5%) with arterial thromboembolism. Multivariate logistic regression analysis demonstrated that glucocorticoid therapy (odds ratio (OR)=0.003, 95% confidence interval (CI) 0.00-0.03, P<0.001) was a protective factor for the patients with DM developing TEs, whereas increased D-Dimer (OR=1.885, 95% CI 1.21-2.95, P=0.006) was a risk factor. The combined ROC analysis of glucocorticoid therapy and D-Dimer indicated high diagnostic values in distinguishing patients with both DM and TEs from patients without TEs, with 86.4% sensitivity, 98.9% specificity, and 0.983 area under the ROC curve (95% CI 0.962-1.000, P<0.001). Patients with DM who have never received glucocorticoid therapy and have increased D-Dimer (>1.3 mg/L fibrinogen equivalent units) should be screened for TEs.
Background Probiotics has been reported as an effective supplement for Helicobacter pylori eradication. However, knowledge of their comparative efficacy is still lacking. Aim In this study, we used network meta-analysis of current probiotics supplement used in standard triple therapy to assess and rank their comparative effectiveness. Methods All randomized controlled trials from three main databases (PubMed, Embase and Cochrane Library) up to April 2022 were collected and filtered to meet our criterion. We used Bayesian network meta-analysis to evaluate the eligible randomized controlled trials and gave a rank for the efficiency and incidence of side effects of each probiotics supplement. The ranking probability for each therapy was assessed by means of surfaces under cumulative ranking values. Subgroup analysis was conducted to evaluate other possible influencing factors. Results 34 eligible randomized controlled trials entered the following meta-analysis, including 9,004 patients randomized to 10 kinds of therapies. Result showed that most probiotics added therapies had better outcomes than triple therapy, among which Bifidobacterium-Lactobacillus and Bifidobacterium-Lactobacillus-Saccharomyces adjuvant therapy could obtain comprehensive benefit with high eradication rate (78.3% and 88.2% respectively), and cause few side effects. Combination of different probiotics, adding probiotics before or after triple therapy and longer duration of probiotics can improve therapeutic effect in H.pylori infected individuals. Conclusion For triple therapy of H.pylori infection, adding probiotics can increase eradication rate and bring protective effect. Considering the overall influence, Bifidobacterium-Lactobacillus or Bifidobacterium-Lactobacillus-Saccharomyces therapy can be a better choice in improving H.pylori eradication process.
Abstract Background: Data on the management and outcome of gastrointestinal stromal tumors (GISTs) in elderlypatients are scant due to their poor representation in clinical trials. Methods: In total, 1379 elderly patients (≥65 years) histologically confirmed GIST between2010 and 2016 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Results: As a result,surgery alone was the predominant treatment used in both age groups. Patients aged ≥75 years who underwent surgery alone had a median survival of 69 months, chemotherapy alone 51 months, surgery plus chemotherapy 60 months, and no therapy 51 months. While among patients aged 65-74 years, the median OS was not reached (NR), 49, 83, and NR, separately. Besides, C-indexes for the OS nomogram in the training set and validation set were0.771 and 0.761, respectively. Of importance, the predictive model displayed a comparable result to the 8th American Joint Committee on Cancer TNM staging system (p＜0.05), demonstrating improved model discrimination. Conclusions: For elderly patients with GISTs, surgery alone or surgery plus chemotherapy seemed feasible and effective, conferring potential survival benefits even in very elderly patients. Moreover, this simple-to-use nomogram may assist clinicians in treatment decision-making and effectively predict 3- and 5-year survival.
Purpose: To explore the tumor response and propose a nomogram-based prognostic stratification for hepatocellular carcinoma (HCC) after drug-eluting beads transarterial chemoembolization (DEB-TACE). Patients and Methods: From the database of two centers, patients who received DEB-TACE as an initial treatment were enrolled and divided into the training and validation sets. The tumor response after DEB-TACE was estimated according to the Modified Response Evaluation Criteria in Solid Tumors. Using the independent survival predictors in the training set, a nomogram was constructed and validated internally and externally by measuring concordance index (C-index) and calibration. A prognostic stratification based on the nomogram was established. Results: A total of 335 patients met the inclusion criteria for the study. Alkaline phosphatase level, tumor maximum diameter, tumor capsule and portal vein invasion were interrelated with the achievement of complete release after DEB-TACE. Alpha-fetoprotein level, Child-Pugh class, tumor maximum diameter, tumor number, tumor extent and portal vein invasion were integrated into the nomogram. The nomogram demonstrated good calibration and discrimination, with C-indexes of 0.735 and 0.854 and higher area under the curve (AUC) than BCLC and CNLC staging systems in the internal and external validation sets. The prognostic stratification classified patients into three different risk groups, which had significant differences in survival, complete release and objective response rate between any two groups ( P < 0.05). Conclusion: The nomogram-based prognostic stratification has a good distinction and may help to identify the patients benefiting from DEB-TACE. Keywords: hepatocellular carcinoma, drug-eluting beads, nomogram, prediction, transarterial chemoembolization
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