Distant metastasis

远处转移
  • 文章类型: Journal Article
    肝细胞癌(HCC),肝癌的主要形式,其特点是高致死率和多因素病因,包括肝炎病毒感染,生活方式因素,和遗传倾向。本研究旨在探讨ZNF208基因多态性对台湾肝癌患者临床病理特征的影响,集中于三个特定的单核苷酸多态性(SNP):rs2188971,rs2188972和rs8105767。我们的队列包括438例HCC患者和1193例对照个体。使用肿瘤/淋巴结/转移(TNM)系统确定临床分期,并收集各种临床指标。我们的分析显示,与对照组相比,肝癌患者的ZNF208表达有统计学意义的增加,表明在HCC进展中的潜在作用。虽然在ZNF208SNP和HCC风险增加之间没有观察到实质性关联,特定的临床特征如远处转移和血管浸润显示与这些SNP显著相关,表明它们对疾病侵袭性的影响。人口统计学分析强调了饮酒和病毒性肝炎标志物等因素在HCC中的重要性。我们的研究强调了遗传对肝癌的影响的复杂性,ZNF208多态性可能影响肿瘤进展和患者预后。
    Hepatocellular carcinoma (HCC), a major form of liver cancer, is characterized by high lethality and a multifactorial etiology that includes hepatitis virus infections, lifestyle factors, and genetic predispositions. This study aimed to explore the impact of ZNF208 gene polymorphisms on the clinicopathological features of Taiwanese HCC patients, focusing on three specific single nucleotide polymorphisms (SNPs): rs2188971, rs2188972, and rs8105767. Our cohort consisted of 438 HCC patients and 1193 control individuals. Clinical staging was determined using the tumor/node/metastasis (TNM) system, and various clinical indicators were collected. Our analysis revealed a statistically significant increase in ZNF208 expression in HCC patients compared to controls, indicating a potential role in HCC progression. Although no substantial association was observed between ZNF208 SNPs and increased HCC risk, specific clinical features such as distant metastasis and vascular invasion showed significant associations with these SNPs, suggesting their influence on disease aggressiveness. Demographic analyses highlighted the importance of factors like alcohol consumption and viral hepatitis markers in HCC. Our study underscores the complexity of genetic influences on HCC, with ZNF208 polymorphisms potentially affecting tumor progression and patient outcomes.
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  • 文章类型: Journal Article
    口腔鳞状细胞癌向骨骼肌的远处转移是极为罕见的实体,并且是患者预后不良的指标。我们介绍了一例口腔舌鳞状细胞癌,其转移到腹直肌,并在原发性根治性手术后9个月临床上出现症状。
    Distant metastasis of oral squamous cell carcinoma to skeletal muscles is an extremely rare entity and is an indicator of poor prognosis for the patient. We present a case of oral tongue squamous cell carcinoma that metastasized to the rectus abdominis muscle and clinically became symptomatic nine months after curative surgery of the primary.
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  • 文章类型: Journal Article
    本研究的目的是比较不同淋巴结分期系统的预测价值,并制定预测胰腺导管腺癌(PDAC)远处转移的最佳预后列线图。我们的研究涉及从监测中选择的6364名患者,流行病学,和最终结果(SEER)数据库和来自中国的126名患者。通过单因素和多因素logistic回归分析筛选远处转移的独立危险因素。并对不同淋巴结分期系统进行了基于模型的比较。此外,我们开发了一个列线图,用于使用最佳性能淋巴结分期系统预测远处转移。淋巴结比率(LNR),阳性淋巴结(LODDS)的对数几率,年龄,主站点,grade,肿瘤大小,美国癌症联合委员会(AJCC)第7版T期,和放疗受者状态是PDAC患者远处转移的重要预测因素。具有LODDS的模型比具有LNR的模型更适合。我们基于LODDS和六个临床参数开发了列线图模型。0.753的曲线下面积(AUC)和一致性指数(C指数)表明该模型满足判别标准。Kaplan-Meier曲线显示不同转移风险患者的OS差异显著。与AJCC第8版N期相比,LODDS似乎具有更好的预测PDAC患者远处转移的能力,PLN和LNR分级系统。此外,我们建立了一个预测远处转移的列线图模型.临床医生可以使用该模型来检测远处转移高风险的患者并做出进一步的临床决策。
    The purpose of this study was to compare the predictive value of different lymph node staging systems and to develop an optimal prognostic nomogram for predicting distant metastasis in pancreatic ductal adenocarcinoma (PDAC). Our study involved 6364 patients selected from the Surveillance, Epidemiology, and End Results (SEER) database and 126 patients from China. Independent risk factors for distant metastasis were screened by univariate and multivariate logistic regression analyses, and a model-based comparison of different lymph node staging systems was conducted. Furthermore, we developed a nomogram for predicting distant metastasis using the optimal performance lymph node staging system. The lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), age, primary site, grade, tumor size, American Joint Committee on Cancer (AJCC) 7th Edition T stage, and radiotherapy recipient status were significant predictors of distant metastasis in PDAC patients. The model with the LODDS was a better fit than the model with the LNR. We developed a nomogram model based on LODDS and six clinical parameters. The area under the curve (AUC) and concordance index (C-index) of 0.753 indicated that this model satisfied the discrimination criteria. Kaplan-Meier curves indicate a significant difference in OS among patients with different metastasis risks. LODDS seems to have a superior ability to predict distant metastasis in PDAC patients compared with the AJCC 8th Edition N stage, PLN and LNR staging systems. Moreover, we developed a nomogram model for predicting distant metastasis. Clinicians can use the model to detect patients at high risk of distant metastasis and to make further clinical decisions.
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  • 文章类型: Journal Article
    背景:贫血是被诊断为胃癌的患者公认的危险因素,常伴有不良预后。在这种情况下,及时预测胃癌贫血患者的远处转移风险至关重要。
    方法:收集中山大学附属第一医院胃癌合并术前贫血患者的资料。来自广西医科大学第一附属医院的队列作为外部验证集。根据单变量和多变量逻辑回归分析筛选的危险因素建立列线图。
    结果:共纳入848例术前贫血胃癌患者。幽门梗阻,癌抗原125,T分期,N级,肿瘤大小,术前体重下降是胃癌伴贫血患者远处转移的独立预测因素(p<0.05),在此基础上构建了一个列线图。准确性,通过一致性指数评估列线图的可靠性和临床价值,接收机工作特性曲线,决策曲线分析,显示良好的稳定性和临床预测价值。
    结论:术前贫血胃癌患者,并发幽门梗阻,CA125升高,T和N阶段提前,肿瘤较大,和术前体重减轻,应重视远处转移。
    BACKGROUND: Anemia represents a well-established risk factor for patients diagnosed with gastric cancer, and is often associated with an unfavorable prognosis. In this context, the timely prediction of distant metastasis risk in patients with anemic gastric cancer assumes paramount importance.
    METHODS: Information of gastric cancer patients complicated with preoperative anemia in the First Affiliated Hospital of Sun Yat-sen University was collected. The cohort from the First Affiliated Hospital of Guangxi Medical University was used as an external validation set. A Nomogram was established based on the risk factors screened by univariate and multivariate logistic regression analyses.
    RESULTS: A total of 848 gastric cancer patients with preoperative anemia were enrolled. Pyloric obstruction, carcinoma antigen 125, T stage, N stage, tumor size, and preoperative weight loss were independent predictors of distant metastasis in gastric cancer patients with anemia (p < 0.05), based on which a nomogram was constructed. The accuracy, reliability and clinical value of the nomogram were evaluated by concordance index, receiver operating characteristic curve, decision curve analysis, calibration curve and showed good stability and clinical predictive value.
    CONCLUSIONS: Preoperative anemic gastric cancer patients, complicated with pyloric obstruction, elevated CA125, advanced T and N stage, larger tumor size, and preoperative weight loss, should be paid more attention to distant metastasis.
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  • 文章类型: Journal Article
    由于其稀有性,对于有远处转移的ASCC患者的治疗没有足够的证据.到目前为止,ASCC远处转移的治疗策略不太标准化,需要更加个体化的方法.因此,在远处转移发生后,获取有关治疗结局和预后因素的信息,以确定最佳的治疗策略,从而获得更好的患者结局并预测其预后至关重要.
    在日本进行的多机构队列研究中,我们回顾性评估了58例同时发生远处转移的ASCC患者和28例异时远处转移的ASCC患者。
    当比较有同步远处转移和异时远处转移的ASCC患者的OS时,两组间差异无统计学意义。同步远处转移患者的五年OS率为37.4%,异时远处转移患者为27.6%。在同步远处转移的ASCC患者中,多部位远处转移患者的OS显著低于单部位(HR:4.56,95%CI:1.16~18.00,P<0.0001).此外,在有异时远处转移的ASCC患者中,在多因素分析中,早期复发是预测OS差的独立因素(HR:4.13,95%CI:1.22~13.94,P=0.022).
    有多个部位远处转移的ASCC患者预后较差。此外,在ASCC患者中,早期复发是OS的独立预后因素.
    UNASSIGNED: Due to its rarity, there is insufficient evidence for managing ASCC patients with distant metastasis. Thus far, the therapeutic strategy for distant metastasis of ASCC is less standardized and requires a more individualized approach. Therefore, it is crucial to obtain information regarding treatment outcomes and prognostic factors following the development of distant metastasis to identify optimal care strategies for better patient outcomes and predict their prognosis.
    UNASSIGNED: In the multi-institute cohort study conducted in Japan, we retrospectively assessed 58 ASCC patients with synchronous distant metastasis and 28 ASCC patients with metachronous distant metastasis.
    UNASSIGNED: When comparing the OS between ASCC patients with synchronous distant metastasis and metachronous distant metastasis, there was no statistically significant difference between the two groups. The OS rate at five years was 37.4% for patients with synchronous distant metastasis and 27.6%; for metachronous distant metastasis. In ASCC patients with synchronous distant metastasis, patients with distant metastasis at multiple sites exhibited extremely worse OS than those at single sites (HR: 4.56, 95% CI: 1.16-18.00, P< 0.0001). In addition, in ASCC patients with metachronous distant metastasis, early recurrence was an independent factor for predicting poor OS in the multivariate analysis (HR: 4.13, 95% CI: 1.22-13.94, P = 0.022).
    UNASSIGNED: ASCC patients with distant metastasis at multiple sites were a worse prognosis. In addition, early recurrence was identified as an independent prognostic factor for OS among ASCC patients.
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  • 文章类型: Journal Article
    很少有研究研究原发性肿瘤切除术(PTR)对远处转移的甲状腺髓样癌(DMMTC)患者的影响。这项基于人群的研究旨在评估PTR在DMMTC患者中的应用,确定它的好处,并确定最佳的手术适应症。2010年至2020年期间诊断的DMMTC患者被纳入监测,流行病学,和结束结果(SEER)程序。Logistic回归分析确定了手术决策的驱动因素。倾向得分匹配(PSM),Kaplan-Meier方法,和Cox回归用于比较手术组和非手术组的总生存期(OS)和疾病特异性生存期(DSS).进行亚组分析以确定最佳手术指征。包括238名DMMTC患者,122例(51.3%)患者接受PTR。甲状腺外延伸和N1分期是促进手术决定的独立因素。PSM调整后的生存分析显示,手术组在OS和DSS方面均具有显着的优势。此外,亚组分析表明,除了年龄≥65岁的患者,肿瘤≤20毫米,或具有多个转移位点(>1),其他人显著受益于PTR。PTR显著改善了选定DMMTC患者的预后。其他患者接受PTR的决定应基于对疾病的全面评估,外科医生的经验,和家庭讨论潜在的生存福利。
    Few studies have investigated the impact of primary tumor resection (PTR) on patients with distant metastasis medullary thyroid carcinoma (DMMTC). This population-based study aims to assess the application of PTR in DMMTC patients, ascertain its benefits, and identify optimal surgical indications. DMMTC Patients diagnosed between 2010 and 2020 were included through the Surveillance, Epidemiology, and End Results (SEER) program. Logistic regression analysis identified driving factors of surgical decision-making. Propensity score matching (PSM), Kaplan-Meier method, and Cox regression were utilized to compare overall survival (OS) and disease-specific survival (DSS) between surgical and non-surgical groups. Subgroup analyses were performed to determine optimal surgical indications. Of 238 DMMTC patients included, 122 (51.3%) patients underwent PTR. Extrathyroidal extension and N1 stage emerged as independent factors promoting the surgical decision. PSM-adjusted survival analyses revealed significant advantages in both OS and DSS for the surgical group. Moreover, subgroup analyses indicated that except for patients aged ≥ 65 years, tumors ≤ 20 mm, or with multiple metastasized sites (> 1), the others significantly benefit from PTR. PTR significantly improves prognosis in selected DMMTC patients. The decision to undergo PTR in other patients should be based on a comprehensive assessment of the disease, surgeon\'s experience, and family discussions for potential survival benefits.
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  • 文章类型: Case Reports
    背景:食管癌(EC)占美国所有诊断癌症的1%。这在世界其他地区更为常见。如果有远处转移,相对存活率为6%。没有针对EC的标准化筛选方法。病例介绍:我们报道了一个为期四年的食管癌病例,一种P53阳性突变,伴有心肌和骨骼肌的非典型远处转移。患者接受了多模式治疗,包括免疫疗法,这可能是延长生存期的一个因素。结论:远处转移通常在死后看到,随着生存期的延长,我们能够在死前找到这种独特的转移。尽管有负面扫描的历史,患者的ctDNA(循环肿瘤DNA)保持阳性,在这种情况下,这是一个更好的复发预测指标。未来的研究需要建立具有成本效益的筛查方法和标准化治疗。
    Background: Esophageal cancer (EC) comprises 1% of all diagnosed cancers in the USA. It is more common in other parts of the world. If there is distant metastasis, the relative survival rate is 6%. There are no standardized screening methods for EC. Case Presentation: We reported a four-year case of esophageal cancer, a P53-positive mutation with atypical distant metastasis to the cardiac and skeletal muscles. The patient was managed with multimodal therapy, including immunotherapy, which could have been a factor in prolonged survival. Conclusions: Distant metastases are typically seen postmortem, and with prolonged survival, we are able to find such unique metastases antemortem. Despite a history of negative scans, the patient\'s ctDNA (circulating tumor DNA) remained positive, which was a better predictor of recurrence in this case. Future research is required to establish cost-effective screening methods and standardized treatments.
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  • 文章类型: Journal Article
    间变性甲状腺癌(ATC)具有高度侵袭性,容易发生远处转移(DM),预后很差.本研究旨在构建ATC合并DM患者的准确生存预测模型,为综合评估和治疗规划提供参考。
    我们从SEER数据库中提取了2004年至2019年间诊断为DM的ATC患者的数据,以7:3的比例将它们随机分为训练集和验证集。对训练集依次进行单变量和多变量Cox回归分析,以确定总生存期(OS)的独立预后因素,并构建3个月的列线图。6个月,根据所有确定的独立预后因素,ATC糖尿病患者的8个月OS。接收机工作特性(ROC)曲线分析,决策曲线分析(DCA)曲线分析,和校准曲线分别绘制在训练集和验证集上,以证明模型的性能。此外,根据风险评分将患者分为高危组和低危组,和Kaplan-Meier(KM)生存曲线用于说明两组之间的生存差异。
    本研究共纳入322例患者。单变量和多变量Cox回归分析确定了ATCDM患者OS的5个独立预后因素:手术,肿瘤大小,年龄,化疗,和放射治疗。3个月的列线图,6个月,并根据这些因素建立了8个月的OS。训练集AUC值(3个月AUC:0.767,6个月AUC:0.789,8个月AUC:0.795)和验证集AUC值(3个月AUC:0.753,6个月AUC:0.798,8个月AUC:0.806)以及校准曲线展示了模型的优异适用性和准确性。此外,DCA曲线表明该模型具有显著的临床净获益.KM曲线还证实了该模型对患者OS的出色分层能力。
    本研究中开发的列线图准确预测ATCDM患者的OS。它可以帮助临床医生为这些患者制定适当的治疗策略。
    UNASSIGNED: Anaplastic thyroid cancer (ATC) is highly invasive, prone to distant metastasis (DM), and has a very poor prognosis. This study aims to construct an accurate survival prediction model for ATC patients with DM, providing reference for comprehensive assessment and treatment planning.
    UNASSIGNED: We extracted data of ATC patients with DM diagnosed between 2004 and 2019 from the SEER database, randomly dividing them into a training set and a validation set in a ratio of 7:3. Univariate and multivariate Cox regression analyses were sequentially performed on the training set to identify independent prognostic factors for overall survival (OS) and construct nomograms for 3-month, 6-month, and 8-month OS for ATC patients with DM based on all identified independent prognostic factors. Receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA) curve analysis, and calibration curves were separately plotted on the training and validation sets to demonstrate the model\'s performance. Furthermore, patients were stratified into high- and low-risk groups based on their risk scores, and the Kaplan-Meier (KM) survival curves were used to illustrate the survival differences between the two groups.
    UNASSIGNED: A total of 322 patients were included in this study. Univariate and multivariate Cox regression analyses identified five independent prognostic factors for OS in ATC patients with DM: surgery, tumor size, age, chemotherapy, and radiotherapy. Nomograms for 3-month, 6-month, and 8-month OS were established based on these factors. The training set AUC values (3-month AUC: 0.767, 6-month AUC: 0.789, 8-month AUC: 0.795) and validation set AUC values (3-month AUC: 0.753, 6-month AUC: 0.798, 8-month AUC: 0.806) as well as the calibration curves demonstrated excellent applicability and accuracy of the model. Additionally, the DCA curves indicated substantial clinical net benefit of the model. The KM curves also confirmed the model\'s excellent stratification ability for patient OS.
    UNASSIGNED: The nomogram developed in this study accurately predicts OS for ATC patients with DM. It can assist clinicians in formulating appropriate treatment strategies for these patients.
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  • 文章类型: Journal Article
    背景:远处转移(DM)的发展是鼻咽癌(NPC)治疗过程中的主要问题。然而,研究表明,在同步放化疗的基础上,晚期NPC患者的远程控制和生存率得到改善.因此,准确预测鼻咽癌患者的转移至关重要.
    目的:使用详细的磁共振成像(MRI)报告建立鼻咽癌转移的预测模型。
    方法:这项回顾性研究包括792例非远处转移性鼻咽癌患者。从详细的MRI报告中获得了总共469个成像变量。将数据分层并随机分成训练集(50%)和测试集。建立了梯度增强树(GBT)模型,并将其用于选择预测DM的变量。建立了包含所有变量的完整模型和包含前五个变量的简化模型。通过曲线下面积(AUC)评估模型性能。
    结果:在792名患者中,94例随访期间出现DM。转移性宫颈淋巴结的数量(30.9%),肿瘤侵犯鼻腔后半部(9.7%),咽部两侧(6.2%),输卵管圆环(3.3%),咽旁间隙单侧(2.7%)是预测DM的前五名贡献者,基于它们在GBT模型中的相对重要性。全模型的测试AUC为0.75(95%置信区间[CI]:0.69-0.82)。还原模型的测试AUC为0.75(95CI:0.68-0.82)。对于整个数据集,完整模型(AUC=0.76,95CI:0.72-0.82)和简化模型(AUC=0.76,95CI:0.71-0.81)优于肿瘤淋巴结分期系统(AUC=0.67,95CI:0.61-0.73).
    结论:GBT模型在预测鼻咽癌转移方面优于肿瘤淋巴结分期系统。转移性宫颈淋巴结的数量被确定为主要贡献变量。
    BACKGROUND: Development of distant metastasis (DM) is a major concern during treatment of nasopharyngeal carcinoma (NPC). However, studies have demonstrated improved distant control and survival in patients with advanced NPC with the addition of chemotherapy to concomitant chemoradiotherapy. Therefore, precise prediction of metastasis in patients with NPC is crucial.
    OBJECTIVE: To develop a predictive model for metastasis in NPC using detailed magnetic resonance imaging (MRI) reports.
    METHODS: This retrospective study included 792 patients with non-distant metastatic NPC. A total of 469 imaging variables were obtained from detailed MRI reports. Data were stratified and randomly split into training (50%) and testing sets. Gradient boosting tree (GBT) models were built and used to select variables for predicting DM. A full model comprising all variables and a reduced model with the top-five variables were built. Model performance was assessed by area under the curve (AUC).
    RESULTS: Among the 792 patients, 94 developed DM during follow-up. The number of metastatic cervical nodes (30.9%), tumor invasion in the posterior half of the nasal cavity (9.7%), two sides of the pharyngeal recess (6.2%), tubal torus (3.3%), and single side of the parapharyngeal space (2.7%) were the top-five contributors for predicting DM, based on their relative importance in GBT models. The testing AUC of the full model was 0.75 (95% confidence interval [CI]: 0.69-0.82). The testing AUC of the reduced model was 0.75 (95%CI: 0.68-0.82). For the whole dataset, the full (AUC = 0.76, 95%CI: 0.72-0.82) and reduced models (AUC = 0.76, 95%CI: 0.71-0.81) outperformed the tumor node-staging system (AUC = 0.67, 95%CI: 0.61-0.73).
    CONCLUSIONS: The GBT model outperformed the tumor node-staging system in predicting metastasis in NPC. The number of metastatic cervical nodes was identified as the principal contributing variable.
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  • 文章类型: Journal Article
    在这项研究中,我们的目的是探讨中性粒细胞与淋巴细胞比率(NLR)之间的关系,血小板与淋巴细胞比率(PLR),全身免疫炎症指数(SII),淋巴细胞与单核细胞比率(LMR)和预后营养指数(PNI)与胃癌远处转移的关系,并建立了筛选远处转移患者的有效列线图。共纳入1281例胃癌住院患者,分为训练集和验证集。单变量,采用Lasso回归和多因素Logistic回归分析确定远处转移的危险因素。然后将独立预测因子纳入列线图模型。通过受试者工作特征(ROC)曲线评估列线图的预测性能和临床实用性,校准曲线和决策曲线分析。多因素Logistic回归分析确定D-二聚体,CA199、CA125、NLR和PNI为独立预测因子。基于这些因素的列线图曲线下面积在训练队列中为0.838,在验证队列中为0.811。校准图和决策曲线表明列线图在训练和验证队列中具有良好的预测性能和临床实用性。因此,我们的列线图可能是临床医生筛查有远处转移的胃癌患者的重要工具.
    In this study, We aim to explore the association between the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI) and distant metastasis of gastric cancer and develop an efficient nomogram for screening patients with distant metastasis. A total of 1281 inpatients with gastric cancer were enrolled and divided into the training and validation set.Univariate, Lasso regression and Multivariate Logistic Regression Analysis was used to identify the risk factors of distant metastasis. The independent predictive factors were then enrolled in the nomogram model. The nomogram\'s predictive perform and clinical practicality was evaluated by receiver operating characteristics (ROC) curves, calibration curves and decision curve analysis. Multivariate Logistic Regression Analysis identified D-dimer, CA199, CA125, NLR and PNI as independent predictive factors. The area under the curve of our nomogram based on these factors was 0.838 in the training cohort and 0.811 in the validation cohort. The calibration plots and decision curves demonstrated the nomogram\'s good predictive performance and clinical practicality in both training and validation cohort. Therefore,our nomogram could be an important tool for clinicians in screening gastric cancer patients with distant metastasis.
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