Prognostic

预后
  • 文章类型: Journal Article
    hsa-miR-520a来自位于19q13.42的MIR520A,在各种疾病的发展中具有重要作用,包括不同类型的癌症,反复妊娠丢失,脑缺血/再灌注损伤,和坐骨神经痛.关于癌症,许多研究已经提出了关于这种特定miRNA功能的不同发现。总结一下,已经观察到它在胰腺癌中下调,神经胶质瘤,卵巢癌,宫颈癌,子宫内膜癌,肺癌,和急性髓细胞性白血病.这篇综述的目的是对has-miR-520a在这些疾病中的作用进行全面概述。在每个设置中都特别关注其靶mRNA和所涉及的失调的信号通路。此外,我们旨在总结miR-520a作为恶性肿瘤预后因子的意义.最后,我们进行了全面的计算机内分析,以揭示该miRNA的生物学作用,并为未来的研究工作引入创新概念.
    hsa-miR-520a is derived from MIR520A located at 19q13.42 and has a significant part in the development of various disorders, including different types of cancers, recurrent pregnancy loss, cerebral ischemia/reperfusion injury, and sciatica. In relation to cancer, numerous studies have presented diverse findings regarding the function of this particular miRNA. To summarize, it has been observed to be down-regulated in pancreatic cancer, glioma, ovarian cancer, cervical cancer, uterine corpus endometrial carcinoma, lung cancer, and acute myeloid leukemia. The purpose of this review is to offer an inclusive overview of the role of has-miR-520a in these disorders, with a specific focus on its target mRNAs in each setting and the deregulated signaling pathways involved. Additionally, we aimed to summarize the implication of miR-520a as a prognostic factor in malignancies. Finally, we performed comprehensive in-silico analyses to uncover the biological roles of this miRNA and introducing innovative concepts for future research endeavors.
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  • 文章类型: Journal Article
    目的:本研究旨在探讨表观扩散系数(ADC)和分数阶结石(FROC)特异性参数与预后指标和Kirsten大鼠肉瘤病毒癌基因同源(KRAS)突变状态在直肠癌中的关系。
    方法:回顾性纳入158例直肠癌患者。ADC的直方图测量,扩散系数(D),体素内扩散异质性(β),并估计整个肿瘤体积的微观结构量(μ)。评估直方图测量值与预后指标之间的关系。直方图测量的功效,既单独进行,又联合进行,为了评估不同的KRAS突变状态,我们也进行了评估.使用接受者工作特征(ROC)曲线分析评估均值和中值直方图测量在评估各种KRAS突变状态中的性能。小于0.05的P值被认为是统计学上显著的。
    结果:ADC的直方图测量,D,β,和μ在高-中分化组和低分化组之间存在显着差异,T1-2和T3-4亚组,淋巴结转移(LNM)阴性和LNM阳性亚组,结外延伸(ENE)阴性和ENE阳性亚组,肿瘤沉积(TD)阴性和TD阳性亚组,和淋巴管浸润(LVI)阴性和LVI阳性亚组。Dmean的组合,β均值,和μ均值在评估KRAS突变状态方面实现了最高性能[ROC曲线下面积(AUC)=0.904]。
    结论:当通过直方图评估来自FROC模型的参数作为潜在生物标志物时,在区分直肠癌预后指标和确定KRAS突变状态方面,它们超越了传统的ADC值.
    OBJECTIVE: This study aims to explore the relationship between apparent diffusion coefficient (ADC) and fractional-order calculus (FROC)-specific parameters with prognostic indicators and Kirsten rat sarcoma viral oncogene homologue (KRAS) mutation status in rectal cancer.
    METHODS: One hundred fifty-eight patients with rectal cancer were retrospectively enrolled. Histogram measurements of ADC, diffusion coefficient (D), intravoxel diffusion heterogeneity (β), and a microstructural quantity (μ) were estimated for the whole-tumor volume. The relationships between histogram measurements and prognostic indicators were evaluated. The efficacy of histogram measurements, both conducted singly and in conjunction, for evaluating different KRAS mutation statuses was also assessed. The performance of mean and median histogram measurements in evaluating various KRAS mutation statuses was assessed using Receiver Operating Characteristic (ROC) curve analysis. A p-value of less than 0.05 was considered statistically significant.
    RESULTS: The histogram measurements of ADC, D, β, and μ differed significantly between well-moderately differentiated groups and poorly differentiated groups, T1-2 and T3-4 subgroups, lymph node metastasis (LNM)-negative and LNM-positive subgroups, extranodal extension (ENE)-negative and ENE-positive subgroups, tumor deposit (TD)-negative and TD-positive subgroups, and lymphovascular invasion (LVI)-negative and LVI-positive subgroups. The combination of Dmean, βmean, and μmean achieved the highest performance [The area under the ROC curve (AUC) = 0.904] in evaluating the KRAS mutation status.
    CONCLUSIONS: When assessing parameters from the FROC model as potential biomarkers through histograms, they surpass traditional ADC values in distinguishing prognostic indicators and determining KRAS mutation status in rectal cancer.
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  • 文章类型: Journal Article
    (1)目前,复发和难治性急性髓系白血病(R/RAML)患者的生存预后极差.因此,探索新型药物对提高R/RAML患者预后势在必行。Chidamide的疗效和作用机制,一种新的表观遗传调节药物,在R/RAML的治疗中仍不清楚。
    方法:已通过各种方法(例如细胞凋亡)在各种AML细胞系中探索了Chidamide的作用机制,细胞周期分析,高通量转录组测序,基因沉默,和异种移植模型。
    结果:这里,我们发现西达胺能有效诱导细胞凋亡,G0/G1相阻滞,和线粒体膜电位去极化在R/RAML细胞,包括原代细胞和细胞系。通过RNA-seq分析,我们进一步发现,西达胺在表观遗传学上调节分化相关通路的上调,同时抑制与细胞复制和细胞周期进程相关的通路.值得注意的是,我们的筛选确定NR4A3为关键抑制基因,其通过西达胺的上调导致P21依赖性细胞周期停滞在G0/G1期.
    结论:我们发现了西达本胺治疗复发和难治性急性髓系白血病(R/RAML)的一种新的表观遗传调节机制。
    (1) Currently, the survival prognosis for patients with relapsed and refractory acute myeloid leukemia (R/R AML) is extremely poor. Therefore, the exploration of novel drugs is imperative to enhance the prognosis of patients with R/R AML. The therapeutic efficacy and mechanism of Chidamide, a novel epigenetic regulatory drug, in the treatment of R/R AML remain unclear.
    METHODS: The mechanism of action of Chidamide has been explored in various AML cell lines through various methods such as cell apoptosis, cell cycle analysis, high-throughput transcriptome sequencing, gene silencing, and xenograft models.
    RESULTS: Here, we have discovered that chidamide potently induces apoptosis, G0/G1 phase arrest, and mitochondrial membrane potential depolarization in R/R AML cells, encompassing both primary cells and cell lines. Through RNA-seq analysis, we further revealed that chidamide epigenetically regulates the upregulation of differentiation-related pathways while suppressing those associated with cell replication and cell cycle progression. Notably, our screening identified NR4A3 as a key suppressor gene whose upregulation by chidamide leads to P21-dependent cell cycle arrest in the G0/G1 phase.
    CONCLUSIONS: We have discovered a novel epigenetic regulatory mechanism of chidamide in the treatment of relapsed and refractory acute myeloid leukemia (R/R AML).
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  • 文章类型: Journal Article
    目的:评估当代非肌层浸润性膀胱癌(NMIBC)患者经尿道重复电切术(reTUR)残留肿瘤的预后意义。
    方法:从法国的8个转诊中心对患者进行回顾性分析,意大利和西班牙。该队列包括连续的高风险或极高风险NMIBC患者,他们接受了reTUR和随后的辅助BCG治疗。
    结果:共筛查了440例高危NMIBC患者,29例(6%)在reTUR时升高≥T2,并分析了411例(T1阶段:n=275,67%)。肿瘤残留191例(46%)。在初次TURBT的T1肿瘤患者中,在reTUR的18%中发现了持续性T1肿瘤(n=49/275)。在初次TURBT的高级别Ta肿瘤患者中,在6%的reTUR中发现T1肿瘤(n=9/136)。在多变量逻辑回归分析中,我们发现使用光动力诊断(PDD,p=0.4)或切除类型(常规与恩集团,p=0.6)和残留肿瘤的风险。估计5年复发率和无进展生存率分别为56%和94%,分别。残留肿瘤与较高的复发风险(p<0.001)显着相关,但与进展无关(p=0.11)。只有残留的T1肿瘤与较高的进展风险相关(p<0.001),估计5年无进展生存率为76%。
    结论:ReTUR应该仍然是T1肿瘤的标准,无论是否使用整块切除或PDD,并且在高级别Ta肿瘤中可以安全地省略。reTUR的持续T1肿瘤不应排除这些患者的保守治疗,我们还需要进一步的研究来探索此亚组第三次切除的益处.
    OBJECTIVE: To assess prognostic significance of residual tumor at repeat transurethral resection (reTUR) in contemporary non-muscle-invasive bladder cancer (NMIBC) patients.
    METHODS: Patients were identified retrospectively from eight referral centers in France, Italy and Spain. The cohort included consecutive patients with high or very-high risk NMIBC who underwent reTUR and subsequent adjuvant BCG therapy.
    RESULTS: A total of 440 high-risk NMIBC patients were screened, 29 (6%) were upstaged ≥ T2 at reTUR and 411 were analyzed (T1 stage: n = 275, 67%). Residual tumor was found in 191 cases (46%). In patients with T1 tumor on initial TURBT, persistent T1 tumor was found in 18% of reTUR (n = 49/275). In patients with high-grade Ta tumor on initial TURBT, T1 tumor was found in 6% of reTUR (n = 9/136). In multivariable logistic regression analysis, we found no statistical association between the use of photodynamic diagnosis (PDD, p = 0.4) or type of resection (conventional vs. en bloc, p = 0.6) and the risk of residual tumor. The estimated 5-yr recurrence and progression-free survival were 56% and 94%, respectively. Residual tumor was significantly associated with a higher risk of recurrence (p < 0.001) but not progression (p = 0.11). Only residual T1 tumor was associated with a higher risk of progression (p < 0.001) with an estimated 5-yr progression-free survival rate of 76%.
    CONCLUSIONS: ReTUR should remain a standard for T1 tumors, irrespective of the use of en bloc resection or PDD and could be safely omitted in high-grade Ta tumors. Persistent T1 tumor at reTUR should not exclude these patients from conservative management, and further studies are needed to explore the benefit of a third resection in this subgroup.
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  • 文章类型: Journal Article
    虚弱与肝硬化肝功能失代偿和死亡率增加有关。我们研究的目的是确定一种新的扫描评分,可预测虚弱及其对肝硬化的影响。
    本研究包括51例肝硬化患者。我们使用虚弱量表风险评估评分来识别虚弱的患者。在计算机断层扫描(CT)切片上分析L3水平不同肌肉的密度和面积。调节至高度和密度比(L3-SMDHR)的L3骨骼肌面积定义为L3肌壁*高度/密度。
    L3-SMHDR在虚弱患者和ChildB/C评分患者中明显更高。虚弱与L3-SMHDR相关。虚弱和L3-SMHDR与肝脏相关事件(LRE)相关。我们通过使用ROC设定L3-SMHDR的敏感性和特异性的最合适的截止值:男性5.4和女性4.7。男性患者的AUROC评分为0.784,女性患者为0.975。脆弱和L3-SMHDR之间的Kappa评分为0.752,一致性百分比为87.5%,显示出实质性的协议。这个比率与划分类别的敏感度为100%,特异性为76%,阳性预测值为79.3%,阴性预测值为100%。具有高L3-SMHDR的患者具有显著较低的生存时间和较高的LRE发生率。
    L3-SMHDR是通过使用可测量和可重复的变量来识别肝硬化中的虚弱的新指标。它可以作为肝硬化患者虚弱的预后因素。
    UNASSIGNED: Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis.
    UNASSIGNED: This study included 51 patients with cirrhosis. We used the frailty scale risk assessment score to identify frail patients. The density and area of different muscles at L3 level were analyzed on computed tomography (CT) sections. The L3 skeletal muscle area adjusted to height and density ratio (L3-SMDHR) was defined as L3 muscle wall*height/density.
    UNASSIGNED: The L3-SMHDR is significantly higher in frail patients and in patients with Child B/C scores. Frailty was correlated with L3-SMHDR. Frailty and L3- SMHDR were correlated with liver-related events (LRE). We set the most appropriate cut-offs of L3-SMHDR for both sensitivity and specificity by using the ROC: 5.4 for males and 4.7 for females. The AUROC score was 0.784 for male and 0.975 for female patients. The Kappa score between frailty and L3-SMHDR was 0.752, with a percentage of agreement of 87.5%, showing a substantial agreement. This ratio with the divided categories has a sensitivity of 100%, a specificity of 76%, a positive predictive value of 79.3% and a negative predictive value of 100%. Patients with high L3-SMHDR have significantly lower survival time and a higher incidence of LRE.
    UNASSIGNED: The L3-SMHDR is a new index for identifying frailty in cirrhosis by using measurable and reproducible variables. It can be used as a prognostic factor for frailty in patients with cirrhosis.
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  • 文章类型: Journal Article
    随着应用于体液分子生物标志物研究的尖端技术不断发展,这些生物标志物的临床应用改善。各种形式的循环分子生物标志物已被描述,包括无细胞DNA(cfDNA),循环肿瘤细胞(CTC),和无细胞microRNAs(cfmiRs),尽管它们的适用性仍然存在未解决的问题,特异性,灵敏度,和再现性。证明cfmiR在多种癌症中的临床效用和重要性的转化研究已经显著增加。这篇综述旨在总结cfmiRs领域近5年的转化癌研究及其在诊断中的潜在临床应用。预后,监测疾病复发或治疗反应,重点是实体瘤。PubMed用于文献检索,遵循严格的基于肿瘤类型的研究排除标准,患者样本量,和临床应用。共有136项关于cfmiRs在不同实体瘤中的研究被确定,并根据肿瘤类型进行划分。器官部位,找到的cfmiR的数量,方法论,和分析的生物流体类型。这篇全面的综述强调了cfmiRs的临床应用,并总结了需要更多研究和验证的服务不足的领域。
    As cutting-edge technologies applied for the study of body fluid molecular biomarkers are continuously evolving, clinical applications of these biomarkers improve. Diverse forms of circulating molecular biomarkers have been described, including cell-free DNA (cfDNA), circulating tumor cells (CTCs), and cell-free microRNAs (cfmiRs), although unresolved issues remain in their applicability, specificity, sensitivity, and reproducibility. Translational studies demonstrating the clinical utility and importance of cfmiRs in multiple cancers have significantly increased. This review aims to summarize the last 5 years of translational cancer research in the field of cfmiRs and their potential clinical applications to diagnosis, prognosis, and monitoring disease recurrence or treatment responses with a focus on solid tumors. PubMed was utilized for the literature search, following rigorous exclusion criteria for studies based on tumor types, patient sample size, and clinical applications. A total of 136 studies on cfmiRs in different solid tumors were identified and divided based on tumor types, organ sites, number of cfmiRs found, methodology, and types of biofluids analyzed. This comprehensive review emphasizes clinical applications of cfmiRs and summarizes underserved areas where more research and validations are needed.
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  • 文章类型: Journal Article
    肥厚型心肌病(HCM)是猫常见的心脏病,以左心室壁局部或弥漫性肥大为特征,具有不确定的病因和异质的自然史。几种类型的节律紊乱通常与疾病有关。本研究对现有文献进行了全面回顾,为了评估心电图和动态心电图监测在猫肥厚型心肌病治疗中的诊断和预后有效性。讨论的主要主题将包括有关HCM及其与心律失常的联系的一般信息。我们将探讨目前文献中关于Holter监测的节律紊乱,以及用于Holter监测的技术。此外,本综述将涵盖经典心电图(ECG)及其诊断效用.预后指标和抗心律失常治疗也将详细讨论。研究结果强调了了解猫科动物HCM心律失常对准确诊断的重要性。风险评估,和治疗干预。ECG和Holter监测可能为管理猫科动物HCM提供有价值的见解。
    Hypertrophic cardiomyopathy (HCM) is a common heart disease in cats, characterized by regional or diffuse hypertrophy of the left ventricular walls, with an uncertain etiology and heterogenous natural history. Several types of rhythm disturbances are often associated with the disease. This study conducts a comprehensive review of the current literature, in order to evaluate the diagnostic and prognostic effectiveness of electrocardiography and Holter monitoring in the management of feline hypertrophic cardiomyopathy. The main subjects of discussion will include general information about HCM and its connection to arrhythmias. We will explore the rhythm disturbances documented in the current literature on Holter monitoring, as well as the techniques used for Holter monitoring. Additionally, the review will cover classical electrocardiography (ECG) and its diagnostic utility. Prognostic indicators and anti-arrhythmic therapy will also be discussed in detail. The findings highlight the importance of understanding arrhythmias in feline HCM for accurate diagnosis, risk assessment, and therapeutic intervention. ECG and Holter monitoring may offer valuable insights into managing feline HCM.
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  • 文章类型: Journal Article
    背景:癌相关成纤维细胞(CAF)在结直肠癌(CRC)的进展中起着至关重要的作用。然而,CAF亚群轨迹分化对CRC的影响尚不清楚.
    方法:在本研究中,我们首先使用批量和整合的单细胞测序数据探索CAFs亚群的轨迹差异,然后基于CAFs亚群的轨迹差异基因对CRC样本进行一致性聚类。随后,我们利用生物信息学分析了CRC亚型的异质性.最后,我们使用机器学习构建了相关的预后特征,并使用空间转录组数据进行了验证.
    结果:基于CAFs亚群轨迹分化的差异基因,在这项研究中,我们确定了两种CRC亚型(C1和C2).与C1相比,C2的预后较差,较高的免疫逃避微环境和高CAF特性。C1主要与代谢有关,而C2主要与细胞转移和免疫调节有关。通过结合10种机器学习算法的101种组合,我们开发了基于C2特征基因的高CAF风险特征(HCAFRS).HCAFRS是CRC的独立预后因素,当结合临床参数时,可显著预测CRC患者的总生存期。HCAFRS与上皮间质转化密切相关,血管生成,和缺氧。此外,HCAFRS的风险评分主要来自CAFs,并在空间转录组数据中得到验证.
    结论:结论:HCAFRS有可能作为CRC的一个有希望的预后指标,改善CRC患者的生活质量。
    BACKGROUND: Cancer-associated fibroblasts (CAFs) play a crucial role in the progression of colorectal cancer (CRC). However, the impact of CAF subpopulation trajectory differentiation on CRC remains unclear.
    METHODS: In this study, we first explored the trajectory differences of CAFs subpopulations using bulk and integrated single-cell sequencing data, and then performed consensus clustering of CRC samples based on the trajectory differential genes of CAFs subpopulations. Subsequently, we analyzed the heterogeneity of CRC subtypes using bioinformatics. Finally, we constructed relevant prognostic signature using machine learning and validated them using spatial transcriptomic data.
    RESULTS: Based on the differential genes of CAFs subpopulation trajectory differentiation, we identified two CRC subtypes (C1 and C2) in this study. Compared to C1, C2 exhibited worse prognosis, higher immune evasion microenvironment and high CAF characteristics. C1 was primarily associated with metabolism, while C2 was primarily associated with cell metastasis and immune regulation. By combining 101 combinations of 10 machine learning algorithms, we developed a High-CAF risk signatures (HCAFRS) based on the C2 characteristic gene. HCAFRS was an independent prognostic factor for CRC and, when combined with clinical parameters, significantly predicted the overall survival of CRC patients. HCAFRS was closely associated with epithelial-mesenchymal transition, angiogenesis, and hypoxia. Furthermore, the risk score of HCAFRS was mainly derived from CAFs and was validated in the spatial transcriptomic data.
    CONCLUSIONS: In conclusion, HCAFRS has the potential to serve as a promising prognostic indicator for CRC, improving the quality of life for CRC patients.
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  • 文章类型: Journal Article
    引言胃癌是一个重要的全球主要健康问题,特别是在亚洲。近年来,全世界已经诊断出大量新病例,导致大量死亡。这种疾病在这些病例中往往表现得更积极,引发了关于预后和生存结果的争论。尽管如此,研究表明,当肿瘤完全手术切除时,生存率显着提高。材料和方法这项回顾性研究包括16至45岁的患者,确诊为胃癌,在病理科的支持下,在上消化道接受手术的人,2006年1月至2012年12月。收集的数据包括性别、年龄,肿瘤大小,手术类型,总生存率,无病期,肿瘤的类型和组织学程度,癌症的临床阶段,和R0切除(治愈性切除)。所有确诊为胃癌的患者均接受手术治疗,并接受D1有限解剖或延长D2解剖。在手术治疗之前接受过化疗的患者和在21世纪国家医学中心外接受过手术治疗的患者被排除在外。结果共纳入104例患者,以弥漫性腺癌为主的组织学类型占79.8%,组织学3级占81.7%。在41.3%的病例中,最常见的临床分期是IIIA。在53.8%的病例中,我们获得了R0切除。53.8%的患者行D2淋巴结清扫术,总生存率为82.69%。生存的重要预后因素包括T4深度和死亡风险增加(OR:25.93;95%CI:6.41-53.54;p=0.001),淋巴结状态(OR:14.76;95%CI:4.6-46.83;p<0.001),大小大于5厘米(OR:1.8;95%CI:0.61-6.35;p<0.001)。结论胃癌多见于60岁以上的成年人。但是45岁以下的年轻人的发病率一直在增加。尽管年轻的胃癌患者表现出更积极的肿瘤行为,与老年患者相比,这些患者可以有相似甚至更好的总生存率,在某些情况下是35%,尤其是在可切除的设置中。仍然需要进一步的研究来充分表征年轻人胃癌的独特生物学和最佳管理。
    Introduction Gastric cancer is a significant major global health concern, particularly prevalent in Asia. In recent years, a large number of new cases have been diagnosed worldwide, leading to a substantial number of deaths. The disease tends to present more aggressively in these cases, leading to debates about the prognosis and survival outcomes. Nonetheless, research has shown that survival rates improve significantly when the tumor is completely surgically resected. Materials and methods This retrospective study included patients between 16 and 45 years old, diagnosed with gastric cancer, with the support of the pathology department, who underwent surgery in the upper GI service, in the period from January 2006 to December 2012. Data collected encompassed variables such as gender, age, tumor size, type of surgery, overall survival, disease-free period, type and histological degree of the tumor, clinical stage of the cancer, and R0 resection (curative resection). All patients with a confirmed diagnosis of gastric cancer were included and treated with surgery and D1 limited dissection or extended D2 dissection. Patients who have received chemotherapy prior to surgical treatment and those who have been surgically treated outside the XXI Century National Medical Center were excluded. Results A total of 104 patients were included; the predominant histological type was diffuse adenocarcinoma accounting for 79.8% and 81.7% of the cases were histological grade 3. The most common clinical stage was IIIA in 41.3% of the cases. In 53.8% of the cases, we obtained an R0 resection. D2 lymphadenectomy was performed in 53.8% of the cases, with an overall survival rate of 82.69%. Significant prognostic factors for survival included T4 depth with an increase in risk for mortality (OR: 25.93; 95% CI: 6.41-53.54; p=0.001), lymph node status (OR: 14.76; 95% CI: 4.6-46.83; p<0.001), and size greater than 5 cm (OR: 1.8; 95% CI: 0.61-6.35; p<0.001). Conclusions Gastric cancer is more common in adults aged above 60 years old, but the incidence in young adults under 45 years old has been increasing. Although young gastric cancer patients present with more aggressive tumor behavior, these patients can have similar or even better overall survival compared to older patients, being 35% in some cases, especially in the resectable setting. Further research is still needed to fully characterize the unique biology and optimal management of gastric cancer in young adults.
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  • 文章类型: Journal Article
    背景:一些指南建议使用不同的分类器来确定HR+HER2-乳腺癌患者的复发风险(ROR)和治疗决策。然而,在拉丁美洲(LA)患者中仍缺乏其有用性的数据。我们的目的是评估真实世界LA队列中不同ROR分类器的比较预后和预测性能。
    方法:乳腺癌分子谱研究(MPBCS)是一项LA病例队列研究,随访5年。第一阶段和第二阶段,接受辅助激素治疗和/或化疗的临床淋巴结阴性HR+HER2-患者(n=340),进行了分析。随时间变化的接受者-操作者特征-曲线下面积,使用单变量和多变量Cox比例风险回归(CPHR)模型比较了几种风险生物标志物的预后表现.具有相互作用模型的多变量CPHR测试了选定风险分类器的预测能力。
    结果:在此队列中,基于转录组的分类器,如复发评分(RS),EndPredict(EP风险和EPClin),和PAM50复发风险评分(ROR-S和ROR-PC)对淋巴结阴性患者的预后表现(单变量C指数0.61-0.68,校正C指数0.77-0.80,高和低风险之间的校正风险比[HR]:4.06-9.97)优于传统分类器Ki67和诺丁汉预后指数(单变量C指数0.53-0.59,校正C-72-85),1.54.RS(在某种程度上,EndoPredict)还显示了淋巴结阴性患者化疗获益的预测能力(相互作用P分别为.0200和.0510)。
    结论:总之,我们可以证明大多数基于转录组的风险分类器的临床有效性,以及它们在异质性中优于基于临床和免疫组织化学的方法,真实世界节点阴性HR+HER2-MPBCS队列。
    BACKGROUND: Several guidelines recommend the use of different classifiers to determine the risk of recurrence (ROR) and treatment decisions in patients with HR+HER2- breast cancer. However, data are still lacking for their usefulness in Latin American (LA) patients. Our aim was to evaluate the comparative prognostic and predictive performance of different ROR classifiers in a real-world LA cohort.
    METHODS: The Molecular Profile of Breast Cancer Study (MPBCS) is an LA case-cohort study with 5-year follow-up. Stages I and II, clinically node-negative HR+HER2- patients (n = 340) who received adjuvant hormone therapy and/or chemotherapy, were analyzed. Time-dependent receiver-operator characteristic-area under the curve, univariate and multivariate Cox proportional hazards regression (CPHR) models were used to compare the prognostic performance of several risk biomarkers. Multivariate CPHR with interaction models tested the predictive ability of selected risk classifiers.
    RESULTS: Within this cohort, transcriptomic-based classifiers such as the recurrence score (RS), EndoPredict (EP risk and EPClin), and PAM50-risk of recurrence scores (ROR-S and ROR-PC) presented better prognostic performances for node-negative patients (univariate C-index 0.61-0.68, adjusted C-index 0.77-0.80, adjusted hazard ratios [HR] between high and low risk: 4.06-9.97) than the traditional classifiers Ki67 and Nottingham Prognostic Index (univariate C-index 0.53-0.59, adjusted C-index 0.72-0.75, and adjusted HR 1.85-2.54). RS (and to some extent, EndoPredict) also showed predictive capacity for chemotherapy benefit in node-negative patients (interaction P = .0200 and .0510, respectively).
    CONCLUSIONS: In summary, we could prove the clinical validity of most transcriptomic-based risk classifiers and their superiority over clinical and immunohistochemical-based methods in the heterogenous, real-world node-negative HR+HER2- MPBCS cohort.
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