The Clinical and Prognostic Factors for Biliary Neuroendocrine Neoplasm: A Study Based on the SEER Database

Background: In this study, we aimed at elucidating the postoperative survival and prognostic factors in patients with biliary neuroendocrine neoplasm (NEN).Methods: Cases of biliary system NEN and adenocarcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A propensity score matching (PSM) method was used to adjust baseline differences in clinicopathological characteristics in our analysis. The Kaplan-Meier analysis was carried out for survival analysis. Results：A total of 243 patients with biliary system NEN were enrolled in this study, of which 119 patients’ lesions located in gallbladder, while the others’ located in bile duct. The postoperative overall survival of bile duct NEN is significantly longer than that of gallbladder NEN (P<0.001). For GB-NENs, surgery method (P=0.020) and lymph node metastasis (P=0.018) were identified as independent prognostic factors. In terms of AOV NENs, age (P=0.017) and lymph node metastasis (P=0.006) were identified was independent prognostic factor, while grade (P=0.002) and lymph node metastasis (P=0.036) were identified as independent prognostic factors for EBD NENs. PSM analysis indicated that patients with biliary duct NENs have better postoperative prognosis than biliary duct adenocarcinoma.Conclusions: Patients with NEN have better overall survival than patients with adenocarcinoma. Gallbladder NEN has adverse prognosis than that of biliary tract NEN. Pathological subtype, differentiation, lymph node metastasis, surgery method and lymph node resection could affect postoperative prognosis of gallbladder and biliary tract NEN.

A Prospective Comparison of TL-400 and NICOM for Goal-Directed Fluid Therapy in Gastrointestinal Tumors Surgery

Objective: Goal-directed fluid therapy (GDFT) based on NICOM(CheetahMedical, Vancouver, Washington) was highly associated with improved postoperative prognosis, but has several limitations. T-Line-400(TL-400, TensysMedical, San Diego, California) which is an emerging non-invasive hemodynamic monitor may be applicable for GDFT. Thus, the trial was to determine whether GDFT based on TL-400, when compared to GDFT based on NICOM, would lead to similar outcomes on patients undergoing gastrointestinal tumor resection.Methods: 100 patients who underwent laparoscopic resection of gastrointestinal tumors in Yongchuan Hospital of Chongqing Medical University from October 2020 to May 2021 were randomized into either TL-400 GDFT group (group T) or NICOM GDFT group (group N). The intraoperative fluid volume and the postoperative complications within 30 days were recorded.Results: There were no significantly statistical differences between groups with respect to the total fluid volume (2360 ±282ml vs 2295 ±223ml), the colloid volume (1167±153ml vs 1126±109ml), the crystalloid volume(1193 ±156ml vs 1173±157ml). Both GDFT based on TL-400 and NICOM strategies were equivalent for the first flatus(57.3±7.9 vs 58.5±8.5hours), wound healing time(11.2 ±1.2days vs 10.9±1.1days) and LOS(hospital length of stay) (13.3±1.4days vs 13.1±1.2days). In addition, the TL-400 had less data missing than the NICOM.Conclusion: TL-400 performs similarly to NICOM in guiding GDFT, with no significant differences in perioperative fluid infusion and postoperative prognosis in patients undergoing gastrointestinal tumor resection. Compared with NICOM, TL-400 can avoid the interference of electrocoagulation and can capture more data.Trial registration: This study has been registered on the Chinese Clinical Trial Registry (ChiCTR2100046350) (http://www.chictr.org.cn/index.aspx).

Prognostic Values of B7-H3, B7-H4, and HHLA2 Expression in Human Pancreatic Cancer Tissues Based on mIHC and Spatial Distribution Analysis

Background: Pancreatic cancer (PC) is one of the most malignant cancers and its 5-year survival rate remains poor. Although immunotherapy has achieved certain therapeutic efficacy in some clinical trials, such treatment still shows low responsiveness and overall remission rate. Therefore, it is urgently necessary to dissect the tumor microenvironment and optimize the immunotherapeutic strategies against this malignancy.Methods: Using the multi-color immunohistochemistry, we investigated the expressions of B7-H3, B7-H4, HHLA2, CD8, and CD68 in 63 cases of PC tissues with the tissue microarray. Moreover, we analyzed immunolocalization features, prognostic values of this immune contexture, and clinical associations.Results: The expressions of B7-H3, B7-H4, and HHLA2 could be detected in cytokeratin (CK)+ tumor cells, CD68+macrophages, and even stromal cells. Higher expression of B7-H3 in tumor cells could predict a better survival of the PC patients. A positive correlation was found between the expressions of B7-H3 and HHLA2 in tumor cells, while there was a negative correlation between the expressions of B7-H4 and HHLA2 in tumor cells. A positive correlation was found between the expressions of B7-H3 and B7-H4 or HHLA2 in tumor-associated macrophages (TAMs), but not B7-H4 and HHLA2. Tumor-infiltrating CD8+T cells in combination with CD68+TAMs could serve as an important predictor for the postoperative prognosis of PC patients. Higher expression of B7-H3, or HHLA2 in CD68+TAMs could serve as an important predictor for poorer prognosis of PC patients. Patients with B7-H3lowB7-H4low, B7-H3lowHHLA2low, or B7-H4lowHHLA2low on CD68+TAMs could have a better postoperative prognosis compared with the other sub-populations in the combinational analysis.Conclusions: Taken together, our study indicated variable expressions and prognostic values of B7-H3, B7-H4, and HHLA2, in human PC tissues, and distinctively demonstrated that these immunosuppressive co-stimulators expressed by CD68+TAMs could be used as important bio-markers for the prognostic prediction of PC patients. Moreover, these results supported that the evaluation of these markers could be used as essential candidate targets for immunotherapy against PC.

Association of Serum Anti-PCSK9 Antibody Levels with Favorable Postoperative Prognosis in Esophageal Cancer

BackgroundEsophageal cancer often appears as postoperative metastasis or recurrence after radical surgery. Although we had previously reported that serum programmed cell death ligand 1 (PD-L1) level correlated with the prognosis of esophageal cancer, further novel biomarkers are required for more precise prediction of the prognosis. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is associated with the cholesterol metabolism. But there was no report of relationship between serum PCSK9 antibody and cancer. Therefore, we investigated whether anti-PCSK9 antibodies could be a novel biomarker for solid cancer.MethodsSerum levels of anti-PCSK9 antibodies and antigens in patients with solid cancer were analyzed using amplified luminescence proximity homogeneous assay-linked immunosorbent assay (AlphaLISA). The reactivity of serum antibodies against recombinant PCSK9 protein was investigated by Western blotting, and the expression of PCSK9 antigens in esophageal cancer tissues was examined by immunohistochemical staining.ResultsAlphaLISA showed that serum anti-PCSK9 antibody (s-PCSK9-Ab) levels were significantly higher in patients with esophageal cancer, gastric cancer, colorectal cancer, lung cancer, and breast cancer than in healthy donors, and patients with esophageal cancer had the highest levels. The presence of serum antibody in patients was confirmed by Western blotting. There was no apparent correlation between s-PCSK9-Ab and PCSK9 antigen levels. Immunohistochemical staining demonstrated the expression of PCSK9 antigen in both the cytoplasm and nuclear compartments of esophageal squamous cell carcinoma tissue but not in normal tissue. Compared with patients with low s-PCSK9-Ab levels, those with high s-PCSK9-Ab levels had a favorable postoperative prognosis after radical surgery for esophageal cancer. In the multivariate analysis, tumor depth and s-PCSK9-Ab level were identified as independent prognostic factors. In the univariate analysis of clinicopathological features, high PCSK9 antibody levels were not associated with sex, age, location, tumor depth, lymph node status, squamous cell carcinoma antigen, or p53-Ab, whereas they correlated significantly with PD-L1 levels, which were associated with unfavorable prognosis. Correlation between s-PCSK9-Ab and PD-L1 levels was also confirmed in the logistic regression analysis; therefore, low s-PCSK9-Ab levels could discriminate another poor prognosis group other than high-PD-L1 group.ConclusionsPatients with solid cancer had higher s-PCSK9-Ab levels than healthy donors. High s-PCSK9-Ab levels indicated better prognosis for overall survival after surgery in patients with esophageal cancer.

Sarcopenia and Charlson Comorbidity Index are Risk Factors for Short-Term Postoperative Prognosis of Elderly Patients with Gastrointestinal Tumor: A Retrospective Study

Background Sarcopenia is one of the most common syndromes in the older adults. Gastrointestinal tumor is a malignant disease with high incidence. This study aimed to investigate the risk factors of sarcopenia in older adults with gastrointestinal tumor, the prognostic indicators of and short-term outcomes after resection for gastrointestinal tumor, and to explore the relationship between sarcopenia and short-term postoperative prognosis.Method A total of 247 older patients with gastrointestinal tumors who underwent radical resection in 2019 were included in this study. Relevant indexes were calculated using L3 slice image of computed tomography (CT) to evaluate sarcopenia. Short-term postoperative complications and length of stay were considered as short-term outcome of this study.Results Advanced age, lower higher body mass index (BMI), lower hemoglobin, having history of abdominal surgery and higher visceral fat index (VFI) were risk factors of sarcopenia, while higher BMI and lower subcutaneous fat index (SFI) were protective factors of sarcopenia. Further multivariate logistic regression analysis showed that having history of abdominal surgery, advanced age and lower BMI were independent risk factors. Sarcopenia and higher Charlson comorbidity index were independent risk factors of short-term postoperative complications in the elderly with gastrointestinal tumor. Higher Charlson comorbidity index gave rise to longer length of stay.ConclusionsSarcopenia and higher Charlson comorbidity index predict poor short-term prognosis of older patients undergoing gastrointestinal tumor resection.

Combined prognostic nutritional index and albumin-bilirubin grade to predict the postoperative prognosis of HBV-associated hepatocellular carcinoma patients

This study aims to evaluate the predictive value of the prognostic nutritional index (PNI) and albumin-bilirubin grade (ALBI) for the postoperative prognosis of hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC) patients undergoing radical hepatectomy (RH). Besides, we seek to identify novel prognosis indicators for HBV-HCC patients. Between April 2009 and March 2015, this work enrolled 868 patients diagnosed with HBV-HCC and undergoing RH in the Liver Surgery Department, West China Hospital, Sichuan University (WCHSU). The basic information, laboratory examination indicators, pathological reports, and follow-up data of patients were included. SPSS 22.0 statistical software was used for statistical data analyses. Platelet (PLT), alpha-fetoprotein (AFP), maximum diameter (max-D), number of tumors (Number), degree of differentiation (DD), Microvascular invasion situation (MVI), satellite focus situation (SF), PNI, and ALBI were the independent risk factors for both overall survival (OS) and disease-free survival (DFS) of HBV-HCC patients undergoing RH. Taking PNI = 46 and ALBI = − 2.80 as cut-off values, the OS and DFS of the PNI-high group were significantly higher than those of the PNI-low group. Meanwhile, the OS and DFS of the ALBI-low group were significantly higher than those of the ALBI-high group; the OS and DFS of the PNI-high + ALBI-low group were significantly higher than those of the PNI-low + ALBI-high group. Xie prognostic index (XPI) was the independent risk factor for both OS and DFS of HBV-HCC patients undergoing RH. The OS and DFS of the XPI-high group were significantly higher than those of the XPI-low group. This paper reveals that preoperative PNI and ALBI can predict the OS and DFS of HBV-HCC patients undergoing RH. Their impact on the prognosis of HBV-HCC patients is insignificant, however, it cannot be ignored. XPI can precisely predict the prognosis of HBV-HCC patients undergoing RH, nonetheless, its effect requires additional research for validation.