Liver metastases

肝转移
  • 文章类型: Journal Article
    目的:利用原发灶第一引流静脉(FDV)的循环肿瘤细胞(CTC)和其他临床相关参数,构建预测结直肠癌(CRC)患者肝转移的列线图,为临床诊断和治疗提供理论依据。
    方法:收集了343例CRC患者的信息并建立了数据库。多因素分析用于确定结直肠癌肝转移(mCRC)的独立因素,并构建列线图。接收机工作特性曲线(ROC),校准图,和决策曲线分析(DCA)用于评估歧视,与实际风险达成协议,和预测模型的临床实用性,分别。
    结果:有肝转移患者的FDV中CTC水平明显高于无肝转移患者。Logistic多因素分析显示,血管侵犯,T级,癌胚抗原(CEA),CA19-9和CTC可以用作构建列线图的预测因子。列线图在预测mCRC方面表现出良好的判别能力,训练集和验证集的曲线下面积(AUC)值为0.871[95%CI:0.817-0.924)和0.891(95%CI:0.817-0.964),分别。]ThecalibrationcurvesofboththetrainingandvalidationsetshowsthatthemodelwaseffectiveinpredictingtheprobabilityofmCRC.DCA用于评估该预测模型,并显示出良好的净临床效益。
    结论:我们开发并验证了基于FDV中CTC与其他临床参数相结合的列线图模型,以更好地预测mCRC的发生。
    OBJECTIVE: To use circulating tumor cells (CTC) from the first drainage vein (FDV) of the primary lesion and other clinically relevant parameters to construct a nomogram for predicting liver metastasis in colorectal cancer (CRC) patients, and to provide a theoretical basis for clinical diagnosis and treatment.
    METHODS: Information from 343 CRC patients was collected and a database was established. Multivariate logistic analysis was used to identify independent factors for colorectal cancer liver metastasis(mCRC) and nomograms were constructed. Receiver operating characteristic curves(ROC), calibration plots, and decision curve analysis (DCA) were used to assess discrimination, agreement with actual risk, and the clinical utility of the prediction model, respectively.
    RESULTS: CTC levels in FDV were significantly higher in patients with liver metastasis than in those without liver metastasis. Logistic multivariate analysis showed that vascular invasion, T stage, carcinoembryonic antigen (CEA), CA19-9, and CTC could be used as predictors to construct nomograms. The nomograms showed good discriminatory ability in predicting mCRC, with area under the curve (AUC) values of 0.871 [95 % CI: 0.817-0.924) and 0.891 (95 % CI: 0.817-0.964) for the training and validation sets, respectively.] The calibration curves of both the training and validation sets showed that the model was effective in predicting the probability of mCRC. DCA was used to evaluate this predictive model and showed good net clinical benefit.
    CONCLUSIONS: We developed and validated a nomogram model based on the combination of CTC in the FDV with other clinical parameters to better predict the occurrence of mCRC.
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  • 文章类型: Journal Article
    肝转移通常发生在许多实体恶性肿瘤中。随着系统疗法的进步和预期寿命的延长,在寡转移中使用局部疗法的作用正在迅速增加.立体定向放射治疗(SBRT)是一种新兴的精确疗法,在不可切除的肝转移的治疗中越来越频繁地使用。本文就SBRT在肝转移中的作用作一综述。治疗原则,临床结果,毒性,和最佳的患者选择。
    Liver metastases occur commonly in many solid malignancies. With advances in systemic therapies and increased life expectancy, the role of using local therapies in oligo-metastases is rapidly increasing. Stereotactic body radiotherapy (SBRT) is an emerging precision therapy that is being used more frequently in the treatment for unresectable liver metastases. This review focuses on the role of SBRT for liver metastases, principles of treatment, clinical outcomes, toxicity, and optimal patient selection.
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  • 文章类型: Journal Article
    目的:本研究的目的是根据接受化疗的转移性胰腺癌的独立预后因素构建有意义的列线图模型。
    方法:本研究为回顾性研究,连续纳入2013年1月至2021年6月的143例患者。利用具有曲线下面积(AUC)的接收器工作特征(ROC)曲线来确定最佳截止值。Kaplan-Meier生存分析,利用单变量和多变量Cox回归分析来确定炎症生物标志物和临床病理特征与生存的相关性。运行R软件以基于独立风险因素构建列线图以可视化生存。使用校准曲线和决策曲线分析(DCA)检查列线图模型。
    结果:全身免疫炎症指数(SII)的最佳临界值为966.71、0.257和2.54,单核细胞与淋巴细胞比率(MLR),通过ROC分析获得中性粒细胞与淋巴细胞比率(NLR)。Cox比例风险模型显示基线SII,饮酒史和转移部位是生存的独立预后指标.我们建立了本研究主要终点的预后列线图。通过校准曲线和DCA评估了列线图的预测潜力和临床疗效。
    结论:我们根据独立的预后因素构建了列线图,这些模型在临床实践中具有良好的应用前景,可帮助临床医生对患者进行个性化管理.
    OBJECTIVE: The purpose of the study is to construct meaningful nomogram models according to the independent prognostic factor for metastatic pancreatic cancer receiving chemotherapy.
    METHODS: This study is retrospective and consecutively included 143 patients from January 2013 to June 2021. The receiver operating characteristic (ROC) curve with the area under the curve (AUC) is utilized to determine the optimal cut-off value. The Kaplan-Meier survival analysis, univariate and multivariable Cox regression analysis are exploited to identify the correlation of inflammatory biomarkers and clinicopathological features with survival. R software are run to construct nomograms based on independent risk factors to visualize survival. Nomogram model is examined using calibration curve and decision curve analysis (DCA).
    RESULTS: The best cut-off values of 966.71, 0.257, and 2.54 for the systemic immunological inflammation index (SII), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) were obtained by ROC analysis. Cox proportional-hazards model revealed that baseline SII, history of drinking and metastasis sites were independent prognostic indices for survival. We established prognostic nomograms for primary endpoints of this study. The nomograms\' predictive potential and clinical efficacy have been evaluated by calibration curves and DCA.
    CONCLUSIONS: We constructed nomograms based on independent prognostic factors, these models have promising applications in clinical practice to assist clinicians in personalizing the management of patients.
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  • 文章类型: Journal Article
    随着抗雄激素治疗的广泛使用,如阿比特龙和恩扎鲁他胺,神经内分泌前列腺癌(NEPC)的发病率正在增加。NEPC是一种致命形式的前列腺癌(PCa),诊断后中位总生存期不到一年。除了在PCa中看到的常见骨转移,NEPC表现出内脏转移的特征,尤其是肝转移,作为临床预后不良的指标。已经确定了驱动PCa神经内分泌可塑性的关键因素,然而,肝转移背后的潜在机制仍不清楚。在这项研究中,我们确定PROX1是PCa神经内分泌可塑性的驱动因素,负责促进肝转移。机械上,抗雄激素治疗减轻PROX1的转录抑制。随后,升高的PROX1水平驱动神经内分泌可塑性和肝脏特异性转录重编程,促进肝转移。此外,PROX1诱导的PCa肝转移依赖于重新编程的脂质代谢,有效减少肝转移形成的破坏。
    With the widespread use of anti-androgen therapy, such as abiraterone and enzalutamide, the incidence of neuroendocrine prostate cancer (NEPC) is increasing. NEPC is a lethal form of prostate cancer (PCa), with a median overall survival of less than one year after diagnosis. In addition to the common bone metastases seen in PCa, NEPC exhibits characteristics of visceral metastases, notably liver metastasis, which serves as an indicator of a poor prognosis clinically. Key factors driving the neuroendocrine plasticity of PCa have been identified, yet the underlying mechanism behind liver metastasis remains unclear. In this study, we identified PROX1 as a driver of neuroendocrine plasticity in PCa, responsible for promoting liver metastases. Mechanistically, anti-androgen therapy alleviates transcriptional inhibition of PROX1. Subsequently, elevated PROX1 levels drive both neuroendocrine plasticity and liver-specific transcriptional reprogramming, promoting liver metastases. Moreover, liver metastases in PCa induced by PROX1 depend on reprogrammed lipid metabolism, a disruption that effectively reduces the formation of liver metastases.
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  • 文章类型: Comparative Study
    目的:本荟萃分析旨在比较[18F]FDGPET/CT与[18F]FDGPET/MRI在鉴别原发癌患者肝转移方面的诊断效能。
    方法:PubMed,Embase,WebofScience,搜索了Cochrane图书馆,并纳入了评估[18F]FDGPET/CT和[18F]FDGPET/MRI对原发癌肝转移患者诊断效能的研究。我们使用随机效应模型来分析它们的敏感性和特异性。亚组分析和相应的荟萃回归侧重于种族,图像分析,研究设计,并进行了分析方法。CochraneQ和I2统计量用于评估组内和组间异质性。
    结果:这篇meta分析纳入了7篇文章,共343例患者。[18F]FDGPET/CT的灵敏度为0.82(95%CI:0.63-0.96),[18F]FDGPET/MRI为0.91(95%CI:0.82-0.98);两种方法之间没有显着差异(P=0.32)。同样,两种方法均显示相同的特异性:[18F]FDGPET/CT为1.00(95%CI:0.95-1.00),[18F]FDGPET/MRI为1.00(95%CI:0.96-1.00),因此,方法间差异无统计学意义(P=0.41)。此外,亚组分析显示无差异.Meta回归分析显示种族是[18F]FDGPET/CT异质性的潜在来源(P=0.01),而图像分析和造影剂被发现是[18F]FDGPET/MRI异质性的潜在来源(P=0.02)。
    结论:[18F]FDGPET/MRI与[18F]FDGPET/CT在普通人群和亚组中具有相似的敏感性和特异性。[18F]FDGPET/CT可能是更具成本效益的选择。然而,由于纳入的研究数量有限,本荟萃分析的结论是初步的,和进一步的研究是必要的验证。
    OBJECTIVE: This meta-analysis aimed to compare the diagnostic effectiveness of [18F]FDG PET/CT with that of [18F]FDG PET/MRI in terms of identifying liver metastasis in patients with primary cancer.
    METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched, and studies evaluating the diagnostic efficacy of [18F]FDG PET/CT and [18F]FDG PET/MRI in patients with liver metastasis of primary cancer were included. We used a random effects model to analyze their sensitivity and specificity. Subgroup analyses and corresponding meta-regressions focusing on race, image analysis, study design, and analysis methodologies were conducted. Cochrane Q and I2 statistics were used to assess intra-group and inter-group heterogeneity.
    RESULTS: Seven articles with 343 patients were included in this meta-analysis. The sensitivity of [18F]FDG PET/CT was 0.82 (95 % CI: 0.63-0.96), and that of [18F]FDG PET/MRI was 0.91 (95 % CI: 0.82-0.98); there was no significant difference between the two methods (P = 0.32). Similarly, both methods showed equal specificity: 1.00 (95 % CI: 0.95-1.00) for [18F]FDG PET/CT and 1.00 (95 % CI: 0.96-1.00) for [18F]FDG PET/MRI, and thus, there was no significant difference between the methods (P = 0.41). Furthermore, the subgroup analyses revealed no differences. Meta-regression analysis revealed that race was a potential source of heterogeneity for [18F]FDG PET/CT (P = 0.01), while image analysis and contrast agent were found to be potential sources of heterogeneity for [18F]FDG PET/MRI (P = 0.02).
    CONCLUSIONS: [18F]FDG PET/MRI has similar sensitivity and specificity to [18F]FDG PET/CT for detecting liver metastasis of primary cancer in both the general population and in subgroups. [18F]FDG PET/CT may be a more cost-effective option. However, the conclusions of this meta-analysis are tentative due to the limited number of studies included, and further research is necessary for validation.
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  • 文章类型: Journal Article
    长非编码RNA(lncRNA)已成为结直肠癌(CRC)进展的关键调节因子,但它们在结直肠癌肝转移(CRLM)中的作用和潜在机制仍知之甚少。
    为了探索lncRNAs在CRLM中的表达模式和功能,我们使用TCGA数据库分析了CRC组织中lncRNAs的表达谱,并检查了lncRNAs在匹配的正常组织中的表达模式,CRC,和使用临床样本的CRLM组织。我们使用体外和体内试验进一步研究了LINC02257在CRLM中的生物学作用,并在CRLM小鼠模型中验证了其治疗潜力。
    我们的发现表明LINC02257在转移性CRC组织中高表达,其表达与总生存期呈负相关。功能上,LINC02257促进CRC细胞生长,迁移,转移,并在体外抑制细胞凋亡,体内肝转移增强。机械上,LINC02257上调磷酸化c-JunN末端激酶(JNK)以促进CRLM。
    我们的研究表明,LINC02257通过LINC02257/JNK轴在CRC细胞的增殖和转移中起关键作用。靶向该轴可能代表了治疗CRC患者肝转移的有希望的治疗策略。
    UNASSIGNED: Long noncoding RNAs (lncRNAs) have emerged as critical regulators of colorectal cancer (CRC) progression, but their roles and underlying mechanisms in colorectal cancer liver metastases (CRLMs) remain poorly understood.
    UNASSIGNED: To explore the expression patterns and functions of lncRNAs in CRLMs, we analyzed the expression profiles of lncRNAs in CRC tissues using the TCGA database and examined the expression patterns of lncRNAs in matched normal, CRC, and CRLM tissues using clinical samples. We further investigated the biological roles of LINC02257 in CRLM using in vitro and in vivo assays, and verified its therapeutic potential in a mouse model of CRLM.
    UNASSIGNED: Our findings showed that LINC02257 was highly expressed in metastatic CRC tissues and its expression was negatively associated with overall survival. Functionally, LINC02257 promoted CRC cell growth, migration, metastasis, and inhibited cell apoptosis in vitro, and enhanced liver metastasis in vivo. Mechanistically, LINC02257 up-regulated phosphorylated c-Jun N-terminal kinase (JNK) to promote CRLM.
    UNASSIGNED: Our study revealed that LINC02257 played a key role in the proliferation and metastasis of CRC cells through the LINC02257/JNK axis. Targeting this axis may represent a promising therapeutic strategy for the treatment of liver metastases in patients with CRC.
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  • 文章类型: Journal Article
    背景:卵巢透明细胞癌(OCCC)是一种罕见的卵巢癌病理组织学类型,尽管晚期OCCC(III-IV期)的生存率大大低于晚期浆液性卵巢癌(OSC),这是最常见的组织型。这项研究的目的是通过比较OSC和OCCC来识别高风险的OCCC,调查潜在的风险和预后标志物。
    方法:从监测中确定了2009年至2018年诊断为卵巢癌的患者,流行病学,和最终结果(SEER)计划。使用Logistic和Cox回归模型来确定高危OCCC患者的风险和预后因素。使用Kaplan-Meier曲线评估癌症特异性存活(CSS)和总存活(OS)。此外,采用Cox分析建立列线图模型。使用C指数显示性能评估结果,校准图,接收机工作特性(ROC)曲线,和决策曲线分析(DCA)。免疫组织化学方法用于鉴定新靶标(GPC3)的表达。
    结果:在高级OCCC的Cox分析中,年龄(45-65岁),肿瘤数量(患者的原位/恶性肿瘤总数),T3阶段,双侧肿瘤,肝转移可以定义为预后变量。列线图显示出良好的预测能力和临床实用性。与OSC相比,肝转移对OCCC患者的预后有更强的影响.T3阶段,远处淋巴结转移阳性,肺转移是肝转移的危险因素。化疗是晚期OCCC患者的独立预后因素。但对肝转移患者的CSS没有影响(p=0.0656),而在这些患者中,手术与更好的CSS显着相关(p<0.0001)(p=0.0041)。在所有组织切片中检测到GPC3表达,GPC3染色主要见于细胞质和细胞膜。
    结论:晚期OCCC和有肝转移的OCCC是两种高危OCCC。构建的列线图对晚期OCCC患者表现出令人满意的生存预测。GPC3免疫组织化学有望积累临床前证据,以支持将GPC3纳入OCCC靶向治疗。
    BACKGROUND: Ovarian clear cell carcinoma (OCCC) is a rare pathological histotype in ovarian cancer, while the survival rate of advanced OCCC (Stage III-IV) is substantially lower than that of the advanced serous ovarian cancer (OSC), which is the most common histotype. The goal of this study was to identify high-risk OCCC by comparing OSC and OCCC, with investigating potential risk and prognosis markers.
    METHODS: Patients diagnosed with ovarian cancer from 2009 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) Program. Logistic and Cox regression models were used to identify risk and prognostic factors in high-risk OCCC patients. Cancer-specific survival (CSS) and overall survival (OS) were assessed using Kaplan-Meier curves. Furthermore, Cox analysis was employed to build a nomogram model. The performance evaluation results were displayed using the C-index, calibration plots, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Immunohistochemically approach was used to identify the expression of the novel target (GPC3).
    RESULTS: In the Cox analysis for advanced OCCC, age (45-65 years), tumor numbers (total number of in situ/malignant tumors for patient), T3-stage, bilateral tumors, and liver metastases could be defined as prognostic variables. Nomogram showed good predictive power and clinical practicality. Compared with OSC, liver metastases had a stronger impact on the prognosis of patients with OCCC. T3-stage, positive distant lymph nodes metastases, and lung metastases were risk factors for developing liver metastases. Chemotherapy was an independent prognostic factor for patient with advanced OCCC, but had no effect on CSS in patients with liver metastases (p = 0.0656), while surgery was significantly related with better CSS in these patients (p < 0.0001) (p = 0.0041). GPC3 expression was detected in all tissue sections, and GPC3 staining was predominantly found in the cytoplasm and membranes.
    CONCLUSIONS: Advanced OCCC and OCCC with liver metastases are two types of high-risk OCCC. The constructed nomogram exhibited a satisfactory survival prediction for patients with advanced OCCC. GPC3 immunohistochemistry is expected to accumulate preclinical evidence to support the inclusion of GPC3 in OCCC targeted therapy.
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  • 文章类型: Journal Article
    尽管免疫检查点抑制剂治疗晚期胸腺癌具有良好的疗效,影响疗效和预后的因素,包括转移部位,仍然不确定。
    我们的研究旨在调查在现实环境中接受免疫治疗的晚期胸腺癌患者的生存决定因素,对临床实践有影响。
    采用不同的免疫治疗方案分析肝转移对晚期胸腺癌患者生存和预后的影响。
    在2015年1月至2023年1月期间,从7家不同的医院收集了接受免疫治疗的晚期胸腺癌患者及其转移部位的数据进行分析。使用Kaplan-Meier方法进行无进展生存期(PFS)和总生存期(OS)分析。Cox分析用于评估影响生存的因素。
    本研究分析了来自7家不同医院的136名晚期胸腺癌患者。所有接受免疫治疗的患者的PFS为6.4个月,而OS是24.0个月。肝和非肝转移患者的客观反应率不同(11.9%对37.2%,p=0.003)。两组的疾病控制率值也不同(47.6%和80.9%,p=0.037)。与非肝转移患者相比,肝转移患者的PFS表现出较差的免疫治疗效果(3.0对8.0个月,p<0.0001)。这两个患者组的OS也有显著差异(16.1和29.1个月,p=0.009)。
    免疫治疗对晚期胸腺癌肝转移患者的疗效较差。
    UNASSIGNED: Although immune checkpoint inhibitor treatment for advanced thymic carcinoma exhibits promising efficacy, factors that affect the efficacy and prognosis, including metastases sites, remain uncertain.
    UNASSIGNED: Our study aimed to investigate the determinants of survival among patients with advanced thymic carcinoma who underwent immunotherapy in real-world settings, with implications for clinical practice.
    UNASSIGNED: Different therapy regimens of immunotherapy were produced to analyze the influence of liver metastases on survival and prognosis for advanced thymic carcinoma patients.
    UNASSIGNED: Data for advanced thymic carcinoma patients receiving immunotherapy and their metastases sites were collected for analysis from seven different hospitals between January 2015 and January 2023. Progression-free survival (PFS) and overall survival (OS) analyses were performed using the Kaplan-Meier method. Cox analysis was used to evaluate factors influencing survival.
    UNASSIGNED: The present study analyzed 136 advanced thymic carcinoma patients from seven different hospitals.The PFS for all patients receiving immunotherapy was 6.4 months, while the OS was 24.0 months. The objective response rate was different for patients with liver and non-liver metastases (11.9% versus 37.2%, p = 0.003). The disease control rate values were also different between the two groups (47.6% versus 80.9%, p = 0.037). The PFS for patients with liver metastases demonstrated poor immunotherapy efficacy compared to patients with non-liver metastases (3.0 versus 8.0 months, p < 0.0001). The OS was also significantly different between these two patient groups (16.1 versus 29.1 months, p = 0.009).
    UNASSIGNED: Immunotherapy had poor efficacy in advanced thymic carcinoma patients with liver metastases.
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  • 文章类型: Journal Article
    背景:肝转移(LM)是导致胃癌(GC)患者预后不良的主要因素。这项研究的目的是分析GCLM患者的重要预后风险因素,并建立可靠的列线图模型,可以准确预测个体化预后。从而增强评估患者预后的能力。
    目的:分析GCLM的预后危险因素,建立可靠的列线图模型,准确预测个体化预后,从而增强患者预后评估。
    方法:对与GCLM(III型)有关的临床数据进行回顾性分析,2010年1月至2018年1月入住解放军总医院多个中心的普外科。数据集以2:1的比例分为开发队列和验证队列。在发展队列中,我们利用单变量和多变量Cox回归分析来确定与GCLM患者总生存期相关的独立危险因素.随后,我们基于这些发现建立了预测模型,并使用接收器操作员特征曲线分析评估了其性能,校正曲线,和临床决策曲线。创建了一个列线图来直观地表示预测模型,然后使用验证队列进行外部验证。
    结果:本研究共纳入372例患者,包括发展队列中的248名个体和验证队列中的124名个体。根据Cox分析结果,我们的最终预测模型包含五个独立的危险因素,包括白蛋白水平,原发肿瘤大小,肝外转移的存在,手术治疗现状,和化疗。1-,3-,和5年的“曲线下面积”值在发展队列中分别为0.753、0.859和0.909;而在验证队列中,它们分别为0.772、0.848和0.923。此外,校正曲线显示观测值与实际值之间具有优异的一致性.最后,决策曲线分析曲线显示临床净获益显著.
    结论:我们的研究确定了GCLM的重要预后风险因素,并建立了可靠的列线图模型,在评估患者预后时显示出有希望的预测准确性和潜在的临床益处。
    BACKGROUND: Liver metastases (LM) is the primary factor contributing to unfavorable outcomes in patients diagnosed with gastric cancer (GC). The objective of this study is to analyze significant prognostic risk factors for patients with GCLM and develop a reliable nomogram model that can accurately predict individualized prognosis, thereby enhancing the ability to evaluate patient outcomes.
    OBJECTIVE: To analyze prognostic risk factors for GCLM and develop a reliable nomogram model to accurately predict individualized prognosis, thereby enhancing patient outcome assessment.
    METHODS: Retrospective analysis was conducted on clinical data pertaining to GCLM (type III), admitted to the Department of General Surgery across multiple centers of the Chinese PLA General Hospital from January 2010 to January 2018. The dataset was divided into a development cohort and validation cohort in a ratio of 2:1. In the development cohort, we utilized univariate and multivariate Cox regression analyses to identify independent risk factors associated with overall survival in GCLM patients. Subsequently, we established a prediction model based on these findings and evaluated its performance using receiver operator characteristic curve analysis, calibration curves, and clinical decision curves. A nomogram was created to visually represent the prediction model, which was then externally validated using the validation cohort.
    RESULTS: A total of 372 patients were included in this study, comprising 248 individuals in the development cohort and 124 individuals in the validation cohort. Based on Cox analysis results, our final prediction model incorporated five independent risk factors including albumin levels, primary tumor size, presence of extrahepatic metastases, surgical treatment status, and chemotherapy administration. The 1-, 3-, and 5-years Area Under the Curve values in the development cohort are 0.753, 0.859, and 0.909, respectively; whereas in the validation cohort, they are observed to be 0.772, 0.848, and 0.923. Furthermore, the calibration curves demonstrated excellent consistency between observed values and actual values. Finally, the decision curve analysis curve indicated substantial net clinical benefit.
    CONCLUSIONS: Our study identified significant prognostic risk factors for GCLM and developed a reliable nomogram model, demonstrating promising predictive accuracy and potential clinical benefit in evaluating patient outcomes.
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  • 文章类型: Journal Article
    目的:探讨serplulimab联合化疗对食管鳞癌肝转移患者的疗效。
    方法:对ASTRUM-007研究进行了事后探索性分析,重点关注肝转移状态与临床结局之间的关联。对电子数据库进行了系统的文献检索,以确定合格的随机对照试验进行荟萃分析。根据肝转移进行PFS的风险比(HRs)的研究水平汇总分析。
    结果:对ASTRUM-007的事后分析表明,尽管在两个治疗组中,肝转移患者与非肝转移患者相比预后较差(serplulimab加化疗组:中位PFS,5.7vs.6.6个月,HR1.57[95%CI,1.15-2.13];中位OS,13.7vs.15.3个月,HR1.48[95%CI,1.09-1.98];安慰剂加化疗组:中位PFS,4.3vs.5.5个月,HR1.58[95%CI,1.01-2.39];中位OS,10.3vs.11.2个月,HR1.32[95%CI,0.84-2.00]),在这项研究中,在肝转移患者(PFS的HR:0.60;95%CI,0.37-0.97;OS的HR:0.68;95%CI,0.43-1.11)和非肝转移患者(PFS的HR:0.62;95%CI,0.49-0.80;OS的HR:0.69-95%,相似的CI,0.55)中观察到了serplups联合化疗和PFS三项随机对照试验纳入荟萃分析。汇集的HR表明,与单独的化疗相比,添加抗PD-1抗体显着改善了PFS,无论肝转移状态如何。
    结论:这项研究表明,肝转移的存在是一个不良的预后因素,但不影响ESCC患者在化疗中增加PD-1阻断所带来的PFS和OS的改善。这些患者生存的预测性生物标志物值得进一步研究。
    OBJECTIVE: To explore the efficacy of serplulimab plus chemotherapy in esophageal squamous cell carcinoma (ESCC) patients with liver metastases.
    METHODS: A post hoc exploratory analysis of ASTRUM-007 study was performed, focusing on the association between the liver metastases status and the clinical outcomes. A systematic literature search of electronic databases was conducted to identify eligible randomized controlled trials for the meta-analysis. Study-level pooled analyses of hazard ratios (HRs) for PFS according to liver metastases were performed.
    RESULTS: The post hoc analysis of ASTRUM-007 showed that although patients with liver metastases had a worse prognosis comparing with the non-liver metastases patients in both treatment arms (serplulimab plus chemotherapy arm: median PFS, 5.7 vs. 6.6 months, HR 1.57 [95% CI, 1.15-2.13]; median OS, 13.7 vs. 15.3 months, HR 1.48 [95% CI, 1.09-1.98]; placebo plus chemotherapy arm: median PFS, 4.3 vs. 5.5 months, HR 1.58 [95% CI, 1.01-2.39]; median OS, 10.3 vs. 11.2 months, HR 1.32 [95% CI, 0.84-2.00]), OS and PFS benefits derived from serplulimab plus chemotherapy versus placebo plus chemotherapy in this study were observed in both patients with liver metastases (HR of PFS: 0.60; 95% CI, 0.37-0.97; HR of OS: 0.68; 95% CI, 0.43-1.11) and the non-liver metastases patients (HR of PFS: 0.62; 95% CI, 0.49-0.80; HR of OS: 0.69; 95% CI, 0.55-0.87) with similar magnitude. Three randomized controlled trials were included in the meta-analysis. Pooled HRs demonstrated that the addition of anti-PD-1 antibodies significantly improved PFS compared to chemotherapy alone regardless of liver metastases status.
    CONCLUSIONS: This study reveals that the presence of liver metastases is a poor prognostic factor but does not affect the improvements in both PFS and OS brought by adding PD-1 blockade to chemotherapy in ESCC patients. Predictive biomarkers for survival in these patients warrant further investigation.
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