Objective To evaluate the efficacy and toxicity of whole brain radiotherapy concurrent with capecitabine for treatment of brain mestastases from breast cancer with post-operative.Methods Fifty patients with brain mestastases from breast cancer with post-operative were randomized into two groups:25 patiens were treatend with whole brain radiotherapy concurrent with capecitabine (treatment group) and the other 25 patients were treated with whole brain radiotherapy alone (control group).Radiation dose was 40 Gy in 20 fractions over 4 weeks.Capecitabine was administered concurrently with radiotherapy in escalatiny dose from the 1st day of RT to the end day (850 mg/m2,twice/day).Results The survival rates at 1-and 2-year were 60.0 ％ (15/25) and 28.0 ％ (7/25) in treatment group,44.0 ％ (11/25) and 16.0 ％ (4/25) in control group (x2 =1.28,1.05,P ＞ 0.05).Toxicities were tolerable.Conclusion Whole brain radiotherapy concurrent with capecitabine was effective and safe in treatment for patients with breat cancer and well-tolerated toxicity.

Background Small incision lenticule extraction (SMILE) was a new procedure which is miniinvasion and flapless,but few attentions were paid to the visual quality after SMILE.To understand the changes of intraocular straylight after SMILE is of important significance for the assession of the visual quality after the procedure.Objective This study was to compare the characteristic of straylight between SMILE and femtosecond laser assisted laser in situ keratomileusis (FS-LAISK) after surgery.Methods A retrospective study was designed.Written informed consent was obtained from each patient prior to accepting the surgery.One hundred and twenty-seven eyes of 68 patients with myopia and myopic astigmatism were included in Tianjin Eye Hospital from January 2011 to July 2013.SMILE was performed on 64 eyes of 35 patients and FS-LASIK was carried out in 63 eyes of 33 patients at the same period.Stray light was detected with C-Quant stray light meter before and 1 week,1 month and 6 months after surgery.The changes of stray light values following the surgery were compared between the two groups,and the correlations between postoperative stray light values with operative parameters were analyzed.Results The mean stray light values were (1.03 ±0.19)D and (0.95±0.16)D at 1 week and 1 month after surgery,which were higher than (0.88 ±0.18)D at preoperation in the FS-LASIK group (P =0.000,0.012).The stray light values were (0.98±0.16),(0.95±0.14) and (0.94±0.16)D at 1 week,1 month or 6 months after surgery,and no statistically significant differences were found in comparison with (0.91 ±0.15)D in preoperation in the SMILE group (all at P＞0.05).No significant intergroup difference was seen in the stray light values (Fgroup =0.077,P=0.781).The stray light differences of various time points after surgery and before surgery were increased in the FS-LASIK group compared with SMILE group (Fgroup =14.798,P＜0.001),with the significant difference in postoperative 1 week between the two groups (P＜0.01).The negative correlations were found between stray light values at 1 week,1 month and 6 months after SMILE with the lenticule thickness/central corneal thickness (CCT) (R2=0.123,0.145,0.098,all at P＜0.05) or between stray light change.Conclusions Intraocular stray light appears less change in operative eyes after SMILE.However,intraocular stray light increases in the eyes received FS-LASIK,especially at early stage after operation.The stray light shifts return to normal with the lapse of postoperative time.

Objective To explore the effect of electronic antiemetic acupuncture in combination with palonosetron in preven‐ting tardive vomiting induced by highly emetogenic chemotherapy for cancer patients .Methods One hundred and twenty cancer pa‐tients undergoing highly emetogenic chemotherapy were divided into observation group and control group(n=60) .The observation group was treated with electronic antiemetic acupuncture in combination with palonosetron and the control group was treated with palonosetron .The different effects against nausea and vomiting between these two groups were evaluated after 24 hours of the chemotherapy .Results Response rate of improvement of nausea for the observation group and control group from the 2nd day to the 8th day were 90 .0% vs 71 .7% ,68 .3% vs 41 .7% ,60 .0% vs 36 .7% ,65 .0% vs 40 .0% ,80 .0% vs 58 .3% ,91 .7% vs 81 .7% , 98 .3% vs 96 .6% .From the 2nd day to the 6th day there were statistical difference of the two groups(P<0 .05) in the prevention of nausea and from the 7th day to the 8th day ,there was no significantly difference between the two groups(P>0 .05) .Response rate of prevention of vomit for the observation group and control group from the 2nd day to the 6th day were 98 .3% vs 88 .3% , 81 .7% vs 65 .0% ,75 .0% vs 51 .7% ,90 .0% vs 70 .0% ,98 .3% vs 88 .3% ,and there were statistical difference of the two groups (P<0 .05) .The prevention of vomiting in the 7th day and 8th day of the two groups were 98 .3% vs 86 .7% ,98 .3% vs 88 .3% , there were also statistical difference(P<0 .05) .Conclusion The treatment of electronic antiemetic acupuncture in combination with palonosetron have greater effect in prevention of tardive vomiting than palonosetron caused by highly emetogenic chemotherapy .It can be used conventionally in the chemotherapy .

Objective To evaluate the efficacy and toxicity of the combination of oxaliplatin and S-1 in the treatment of patients with advanced breast cancer.Methods A total of 72 patients with advanced breast cancer after the treatment failuer of anthracycline and taxane were treated with oxaliplatin and S-1.The first day,they were given oxaliplatin,135 mg/m2,with the 5％ glucose injection 500 ml,the time of intravenous drip should be more than 2 hours.And the S-1 was taken after breakfast and dinner,the dose was 40-60 mg,and the time of duration was 2 weeks,then they had 7 days to rest.The cycle was 21 days.Every 2 cycles,we estimated the efficacy.Patients who were effective and stable kept that chemotherapy regimens,the maximum duration was 6 cycles.The efficacy and toxicities were evaluated after cycles of chemotherapy.Results Two cases (2.8％) had complete response (CR),26 cases (36.1％) had partial response (PR).The response rate (RR) was 38.9％ and the disease control rate (DCR) was 69.4％.The median progress free survival (PFS) was 7.7 months and the median overall survival (OS) was 12.3 months.Subgroup analysis showed that the OS of patients who belong to stage Ⅳ,had two or more metastases or with failure treatment after being treated with anthracycline and taxane was notably shorter than the patients who belong to stage Ⅲ C,only one metastasis,with effective treatment after being treated with anthracycline and taxane,and the differences were statistically significant (10.5 months vs.15.0 months,x2 =4.469,P =0.035;9.3 months vs.15.0 months,x2 =8.297,P=0.004;10.0 months vs.14.0 months,x2 =4.077,P=0.043).The main side effects were neutropenia (19.4％),nausea (8.3％) and nerve toxicity (2.8％),mainly 3-4 degree,and could be welltolerated.The others were diarrhea,impaired liver function,stomatitis,anemia and hand-foot syndrome,mainly 1-2 degree.Conclusion Oxaliplatin combined with S-1 is effective and tolerable in treatment of patients with advanced breast cancer,the adverse reactions can be tolerated.

Objective:To explore the impact of the number of pathological lymph node metastasis areas on the prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC) after radical surgery.Methods:The clinicopathologic data of 153 patients with ESCC treated by radical surgery at the Department of Thoracic Surgery of the Affiliated Taixing People′s Hospital of Yangzhou University from January 2012 to December 2014 were retrospectively analyzed. Among these patients, 76 had no adjuvant therapy, and 77 received adjuvant radiotherapy or chemoradiotherapy after surgery. According to the lymph node classification criteria of American Thoracic Association and the number of pathological lymph node metastasis areas, the patients were divided into non-regional lymph node metastasis group ( n=68), oligo-regional lymph node metastasis group (1-2 regional lymph node metastasis, n=54) and multi-regional lymph node metastasis group (≥3 regional lymph node metastasis, n=31). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The Cox proportional hazards model was used to analyze prognostic factors, receiver operating characteristic (ROC) curve was used to analyze the predictive value of the number of lymph node metastasis areas. Results:The median overall survival (OS) was 37.0 months for the 153 patients, and the 1-, 3- and 5-year OS rates were 97.4%, 51.0% and 30.7% respectively. In the non-regional lymph node metastasis group, the median OS was 46.0 months, and the 1-, 3- and 5-year OS rates were 97.1%, 58.8% and 39.7% separately. In the oligo-regional lymph node metastasis group, the median OS was 39.0 months, and the 1-, 3- and 5-year OS rates were 94.4%, 55.6% and 35.2% respectively. In the multi-regional lymph node metastasis group, the median OS was 26.0 months, and the 1-, 3- and 5-year OS rates were 98.1%, 25.8% and 3.2% separately. There was a statistically significant difference among the three groups ( χ2=18.257, P<0.001). Among the 76 patients without adjuvant treatment, the 1-, 3- and 5-year OS rates were 94.7%, 50.0% and 34.2% in patients with non-regional lymph node metastasis, 90.9%, 36.4% and 9.1% in patients with oligo-regional lymph node metastasis, 97.4%, 18.8% and 0 in patients with multi-regional lymph node metastasis, and there was a statistically significant difference ( χ2=8.201, P=0.017). Among the 77 patients with adjuvant therapy, the 1-, 3- and 5-year OS rates were 97.7%, 66.7% and 46.7% in patients with non-regional lymph node metastasis, 96.9%, 68.8% and 53.1% in patients with oligo-regional lymph node metastasis, 93.3%, 26.7% and 6.7% in patients with multi-regional lymph node metastasis, and there was a statistically significant difference ( χ2=18.083, P<0.001). Univariate analysis showed that age ( HR=1.534, 95% CI: 1.041-2.260, P=0.030), T stage ( HR=1.757, 95% CI: 1.197-2.579, P=0.004), N stage ( HR=1.548, 95% CI: 1.043-2.297, P=0.030), TNM stage ( HR=1.392, 95% CI: 1.114-2.459, P=0.015), adjuvant therapy ( HR=0.545, 95% CI: 0.370-0.803, P=0.002) and number of lymph node metastasis areas (multi-regional lymph node metastasis versus non-regional lymph node metastasis: HR=0.385, 95% CI: 0.238-0.624, P<0.001; multi-regional lymph node metastasis versus oligo-regional lymph node metastasis: HR=0.442, 95% CI: 0.269-0.726, P=0.001) were closely related to OS in patients with ESCC after operation. Multivariate analysis showed that T stage ( HR=1.699, 95% CI: 1.143-2.525, P=0.009), adjuvant therapy ( HR=0.577, 95% CI: 0.386-0.864, P=0.008) and number of lymph node metastasis areas (multi-regional lymph node metastasis versus non-regional lymph node metastasis: HR=0.553, 95% CI: 0.411-0.996, P=0.011; multi-regional lymph node metastasis versus oligo-regional lymph node metastasis: HR=0.550, 95% CI: 0.328-0.924, P=0.024) were independent prognostic factors for OS. The number of lymph node metastasis areas (AUC=0.648, 95% CI: 0.560-0.735, P=0.004) was better than the number of lymph node metastasis (AUC=0.595, 95% CI: 0.497-0.694, P=0.061) in predicting OS of patients with ESCC after radical surgery. Conclusion:The number of postoperative pathological lymph node metastasis areas in thoracic ESCC has important value in predicting survival prognosis, and adjuvant therapy can significantly improve the OS of patients with oligo-regional lymph node metastasis.

Objective:To investigate the current status and influencing factors of stroke patients.Methods:Using stratified sampling method, 458 stroke patients was investigated for the health behavior from October to December, 2015. Based on PROCEDE-PROCEED model, logistic regression analysis was conducted with the health behavior level of the subjects as the dependent variable, and the characteristic factors in the chi-square test as the independent variables to analyze the factors which influence the health behavior level of stroke patients from predisposing factors, enabling factors and reinforcing factors.Results:The health behavior score of stroke patients was (14.5±3.9), which was at medium level. The score of each dimension was nutrition (0.80±0.25), disease management (0.60±0.26), interpersonal relationship (0.57±0.33), and medication compliance (0.49±0.41). The multiple logistic regression analysis showed that the predisposition factors including age ( OR=2.03, 95% CI=1.08-3.80) and history of hypertension( OR=2.35, 95%=1.16-4.76), the enabling factors including the allocation of social resources ( OR=1.73, 95% CI=0.89-3.36), and the reinforcing factors including family support ( OR=2.03, 95% CI=0.99-4.17) were important factors which affect the health behavior of stroke patients. Conclusion:The health behavior level of stroke patients need to be improved. The relevant community resource allocation system continuously, and focus on the impact of family environment and particularly the elderly and patients with a history of hypertension should be attentioned when improving the health behavior of patients.

Objective To evaluate the effects of the size of lymph node metastasis (LNM) on the chemoradiotherapy efficacy and prognosis for the patients after resection of thoracic esophageal squamous cell carcinoma (ESCC).Methods Between 2011 and 2014,a total of 75 esophageal squamous carcinoma patients with secondary LNM after resection of ESCC were recruited in this retrospective study.They were treated with curative radiotherapy only or concurrent chemoradiotherapy in the Affiliated Taixing People's Hospital of Yangzhou University.Thc LNM volume and maximum diameters were measured by the Monaco treatment planning system.The enrolled patients were grouped according to the median values of LNM volume and maximum diameters.The relationship between the responsiveness to treatment and these markers was analyzed by univariate and multivariate logistic analysis.The Kaplan-Meier method and Log-rank test were adopted to calculate and compare the overall survival (OS) rates with these markers.The Cox proportional hazards model was used to carry out univariate and multivariate analyses.Results The overall effective rate was 69.3％ for all enrolled patients.The response rates were 81.6％ with LNM volume ＜57 cm3 and 56.8％ with LNM volume ≥57 cm3.The response rates were 83.8％ with LNM maximum diameter ＜ 5 cm and 55.3％ with LNM maximum diameter ≥5 cm.The responses to treatment were highly associated with treatment method (OR =1.825,95％ CI:1.134-3.658,P =0.017),LNM volume (OR =4.183,95％ CI:1.416-12.354,P =0.010) and maximum diameter (OR =3.374,95％ CI:1.185-9.611,P =0.023) by univariate logistic regression analysis.Multivariate logistic regression analysis showed that therapeutic method (OR =1.225,95％ CI:1.085-2.837,P =0.038) and LNM volume (OR =1.614,95％ CI:1.003-3.025,P =0.048) were independent risk factors for tumor response.The median OS time of this cohort was 14 months,and the 1,2 and 3 year OS rates were 60.7％,25.3％ and 20.1％,respectively.Kaplan-Meier survival analysis revealed that TNM stage (HR =2.039,95 ％ CI:1.234-3.370,P =0.005),treatment methods (HR =1.858,95 ％ CI:1.385-2.958,P =0.013),LNM volume (HR =2.642,95％ CI:1.552-4.497,P ＜ 0.001) and LNM maximum diameter (HR =3.399,95 ％ CI:1.939-5.958,P ＜ 0.001) were significantly associated with OS.Furthermore,multivariate Cox proportional hazard regression model analysis for OS was performed and the results showed that TNM stage (HR =2.023,95 ％ CI:1.149-3.560,P =0.015),LNM volume (HR =2.055,95 ％ CI:1.041-4.055,P =0.038) and maximum diameter (HR =1.910,95％ CI:1.137-3.895,P =0.045) were considered as independent prognostic risk factors for OS.Conclusion LNM volume in ESCC patients with secondary LNM after esophagectomy has great values for predictive therapeutic effects and survival outcomes,and LNM maximum diameter has significant value for survival outcomes.

Objective To investigate the prognostic values of systemic inflammatory markers,including preoperative neutrophil-to-lymphocyte ratio (NLR),platelet-to-lymphocyte ratio (PLR) and the lymphocyte-to-monocyte ratio (LMR),in patients with esophageal squamous cell carcinoma (ESCC) by curative esophagectomy.Methods A total of 117 patients with ESCC from January 2010 to December 2012 in Affiliated Taixing People's Hospital of Yangzhou University were retrospectively analyzed.They were treated with standard curative esophagectomy.These patients were divided into NLR≥2.8 group and NLR ＜2.8 group,PLR≥127.3 group and PLR ＜127.3 group,LMR≥3.8 group and LMR ＜3.8 group for comparing the patients' general survival conditions and analyzing the influence on the progression-free survival (PFS) and overall survival (OS) rates according to the median values 2.8,127.3,3.8 of NLR,PLR and LMR,respectively.The COX proportional hazards models of NLR,PLR and LMR were used to carry out univariate and multivariate analyses for PFS and OS.The evaluation of prognostic values of NLR,PLR and LMR were carried by receiver operating characteristic (ROC) curve.Results For 117 patients,the median PFS time was 17 months,and the PFS rates at the 1-,3-and 5-year period were 66.7％,21.4％ and 17.9％,respectively;the median OS time was 36 months,and the OS rates at the 1-,3-and 5-year time were 94.9％,46.2％ and 28.2％,separately.In addition,a close relationship was identified between high NLR,high PLR,low LMR and tumor relapse (all P ＜0.05).Furthermore,in the NLR ＜2.8 group,the median PFS time was 24 months (95％ CI:19.788-28.212),and the 1-,3-,5-year PFS rates were 78.9％,35.1％ and 31.6％ separately,while in the NLR≥2.8 group,the median PFS time was 13 months (95％CI:10.153-15.847),and the 1-,3-,5-year PFS rates were 55.0％,8.3％ and 5.0％,respectively (x2 =15.601,P ＜ 0.001).In the PLR ＜ 127.3 group,the median PFS time was 24 months (95％ CI:19.891-28.109),and the 1-,3-,5-year PFS rates were 78.0％,30.5％ and 27.1％.In the PLR≥ 127.3 group,the median PFS time was 15 months (95％CI:11.832-18.168),and the 1-,3-,5-year PFS rates were 55.2％,12.1％ and 8.6％ (x2 =7.621,P =0.006).In the LMR ＜3.8 group,the median PFS time was 14 months (95％ CI:11.534-16.466),and the 1-,3-,5-year PFS rates were 57.9％,8.8％ and 5.3％,whilein the LMR≥3.8 group,the median PFS time was 21 months (95％ CI:16.783-25.217),and the 1-,3-,5-year PFS rates were 75.0％,33.3％ and 30.0％ (x2 =10.201,P =0.001).Correspondingly,the median OS time was 42 months (95％ CI:29.188-48.282) and the 1-,3-,5-year OS rates were 98.2％,56.1％ and 47.4％ in the NLR ＜2.8 group.While the median OS time was 27 months (95％ CI:20.358-33.642) and the 1-,3-,5-year OS rates were 91.7％,36.7％ and 10.0％ in the NLR ≥2.8 group (x2 =19.161,P ＜ 0.001).Themedian OS time was 38 months (95％ CI:31.310-44.690) and the 1-,3-,5-year OS rates were 94.9％,54.2％ and 37.3 ％ in the PLR ＜ 127.3 group and the median OS time was 27 months (95 ％ CI:19.537-34.463) and the 1-,3-,5-year OS rates were 93.1％,37.9％ and 19.6％ in the PLR≥127.3 group (x2 =7.019,P =0.008).The median OS time was 30 months (95％ CI:23.659-36.341) and the 1-,3-,5-year OS rates were 91.2％,36.8％ and 12.3％ in the LMR ＜ 3.8 group.While the median OS time was 38 months (95％ CI:27.878-48.121) and the 1-,3-,5-year OS rates were 95.0％,55.3％ and 43.3％ in the LMR≥3.8 group (x2 =10.201,P=0.001).In univariate analysis,the following factors were significantly associated with poor PFS:T stage (HR =1.292,95％ CI:1.077-2.211,P =0.048),N stage(HR =1.773,95％ CI:1.186-2.651,P =0.005),TNM stage (HR =1.768,95 ％ CI:1.181-2.645,P =0.006),NLR (HR =2.193,95 ％ CI:1.450-3.316,P＜0.001),PLR(HR =1.722,95％CI:1.149-2.581,P =0.009) and LMR (HR =0.531,95％CI:0.353-0.799,P =0.002).The univariate analysis further revealed that T stage (HR =1.982,95％ CI:1.162-3.383,P=0.012),N stage (HR =1.910,95％ CI:1.243-2.934,P =0.003),TNM stage (HR =2.115,95％ CI:1.375-3.252,P =0.001),NLR (HR =2.599,95％ CI:1.657-4.078,P ＜ 0.001),PLR (HR =1.764,95％CI:1.145-2.717,P =0.010) and LMR (HR =0.470,95％ CI:0.303-0.728,P =0.001) were also significantly associated with poor OS.Furthermore,multivariate COX regression analysis showed that TNM stage (HR=1.608,95％CI:1.057-2.445,P =0.026) and NLR (HR =1.886,95％CI:1.133-3.138,P=0.015) were independent prognostic factors for PFS in patients with ESCC after surgery.Correspondingly,TNM stage (HR =1.867,95 ％ CI:1.190-2.928,P =0.007) and NLR (HR =2.226,95 ％ CI:1.292-3.835,P =0.004) were also independent prognostic factors for OS in ESCC patients following surgery.Finally,ROC curves of NLR,PLR and LMR for PFS predictive values were as follows:the area under the curve (AUC) for NLR,PLR and LMR were 0.725 (95％ CI:0.615-0.835,P =0.001),0.657 (95％ CI:0.533-0.781,P =0.025) and 0.290 (95％ CI:0.178-0.402,P =0.003),respectively.ROC curve analysis of NLR,PLR and LMR in diagnostic value of OS indicated that the AUC was 0.731 (95％ CI:0.632-0.829,P ＜ 0.001) for NLR,0.613 (95％ CI:0.501-0.726,P =0.057) for PLR and 0.308 (95％ CI:0.205-0.412,P =0.053) for LMR.Conclusion NLR is superior to PLR.and LMR in predicting the survival outcome of patients with ESCC,and NLR is of great value in predicting the survival and prognosis of patients with thoracic ESCC after operation.

Objective:To explore the influence of clinicopathological factors besides TNM stage, including preoperative tumor volume, length and maximum diameter, on survival prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC), and to evaluate the predictive survival rate of clinicopathological variables with statistical significance by nomogram.Methods:A total of 296 patients with ESCC treated by radical resection at the Department of Thoracic Surgery of Affiliated Taixing People′s Hospital of Yangzhou University from 2011 to 2014 were retrospectively analyzed. These patients were grouped for further analysis according to the optimal threshold of preoperative tumor volume, length and maximum diameter. Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univariate and multivariate Cox models were used to analyze the relationships between clinical variables and survival prognosis. Finally, nomogram model was established by integrating statistically significant clinicopathological parameters, and the predictive value of this model was further verified by calibration curve, concordance index (C-index) and decision curve.Results:The optimal thresholds of preoperative tumor volume were 32 cm 3 and 72 cm 3 by X-tile analysis, and among the patients whose tumor volume was <32 cm 3 ( n=94), the 1-, 3- and 5-year survival rates were 100%, 84.0% and 68.1%; in the 32-72 cm 3 group ( n=118), the 1-, 3- and 5-year survival rates were 98.3%, 42.4% and 24.6%; in the >72 cm 3 group ( n=84), the 1-, 3- and 5-year survival rates were 94.1%, 25.0 and 7.1% ( χ2=86.639, P<0.001). The optimal cutoff values of tumor length were 3.0 cm and 5.0 cm, and among the patients with tumor length <3.0 cm ( n=62), the 1-, 3-, and 5-year survival rates were 99.5%, 87.1% and 69.4%; in the 3.0-5.0 cm group ( n=146), the 1-, 3-, and 5-year survival rates were 98.6%, 47.9% and 30.1%; in the >5.0 cm group ( n=88), the 1-, 3-, and 5-year survival rates were 94.3%, 29.6%, 13.6%, respectively ( χ2=53.607, P<0.001). The thresholds of tumor maximum diameter were 2.5 cm and 3.5 cm, and among these, the 1-, 3- and 5-year survival rates were 99.5%, 84.3% and 74.5% in the maximum diameter <2.5 cm group ( n=51); 98.3%, 57.0% and 36.4% in the 2.5-3.5 cm group (n=121); and 96.0%, 29.0% and 13.7% in the maximum diameter >3.5 cm group ( n=124, χ2=62.109, P<0.001). In univariate analysis, the following factors were significantly associated with overall survival (OS): tumor location, differentiation grade, T stage, N stage, TNM stage, adjuvant therapy, preoperative tumor volume, length and maximum diameter (all P<0.05). Furthermore, multivariate Cox regression analysis showed that differentiation grade ( HR=0.514, 95% CI: 0.366-0.723, P=0.019), TNM stage ( HR=1.757, 95% CI: 1.267-2.612, P=0.015), adjuvant therapy ( HR=0.669, 95% CI: 0.503-0.889, P=0.006), preoperative tumor volume (set <32 cm 3 as the dummy variable, 32-72 cm 3: HR=3.689, 95% CI: 2.415-5.637, P<0.001; >72 cm 3: HR=5.720, 95% CI: 3.606-9.075, P<0.001) were independent risk factors for OS. Finally, the C-index of OS by nomogram incorporated the statistically significant clinicopathological parameters was predicted to be 0.722 (95% CI: 0.687-0.757), which was significantly higher than the 7th AJCC TNM stage, the C-index 0.633 (95% CI: 0.595-0.671). In addition, the calibration curve of nomogram model was highly consistent with actual observation for the five-year OS rate, and the decision curve analysis also showed that nomogram model had higher clinical application potentials than TNM staging model in predicting survival prognosis of thoracic ESCC after surgery. Conclusion:The nomogram incorporated preoperative tumor volume is of great value in predicting survival prognosis of patients with thoracic ESCC.

Objective The purpose of this study was to investigate the influence of pre-treatment inflammatory markers on the therapeutic effect and survival outcome in patients with esophageal squamous cell carcinoma (ESCC) who received chemoradiotherapy (CRT) or radiotherapy (RT) alone.Methods A total of 107 patients who were diagnosed with ESCC were retrospectively analysed.They were treated with radical radiotherapy alone or concurrent chemoradiotherapy in the Affiliated Taixing People's Hospital of Yangzhou University between January 2013 and December 2014.According to the median values of neutrophil-lymphocyte ratio (NLR),platelet-lymphocyte ratio (PLR) and CRP/Alb ratio before treatment,the patients were divided into NLR＜3.06 group (54 cases) and NLR≥3.06 group (53 cases),PLR＜145.26 group (54 cases) and PLR≥ 145.26 (53 cases),CRP/Alb＜0.13 group (52 cases) and CRP/Alb≥0.13 (55 cases),respectively.The relationships between the response to treatment and these markers were analysed by univariate and multivariate logistic analyses.The Kaplan-Meier method and logrank test were adopted to calculate and compare associations of the progression-free survival (PFS) rates with these blood markers.Cox proportional hazards models were used for the univariate and multivariate analyses.Results The therapeutic effects of chemoradiotherapy,NLR＜3.06,PLR＜ 145.26 and CRP/ Alb＜ 0.13 were better than those of radiotherapy alone,NLR≥ 3.06,PLR≥ 145.26 and CRP/Alb ≥ 0.13,respectively,and the differences were statistically significant (HR=2.118,4.138,2.297,3.784,P＜0.05).Further analysis showed that chemoradiotherapy (HR =1.342,95％ CI 1.023 ～ 2.467,P＜ 0.05) and CRP/Alb ratio＜ 0.13 (HR =7.004,95％ CI 2.088 ～ 23.496,P＜0.05) were independent risk factors for good tumour response.In addition,TNM stage,treatment modality,NLR,PLR and CRP/Alb ratio were significantly associated with PFS by the univariate analysis (P＜0.05 for all).Furthermore,the multivariate Cox proportional hazard regression model analysis showed that only TNM stage (HR =1.326,95％ CI 1.070-1.833 P＜0.05),treatment modality (HR =0.400,95％ CI 0.230-0.694,P＜0.05) and CRP/Alb ratio (HR=3.518,95％ CI 1.975-6.266,P＜ 0.05) were considered independent prognostic factors for PFS.And according to TNM staging and treatment subgroup analysis,CRP/Alb＜0.13 had better progression-free survival time than CRP/Alb≥ 0.13 ESCC patients.Finally,the ROC curve also confirmed that CRP/Alb was superior to NLR and PLR in predicting short-term efficacy and progression-free survival in ESCC patients receiving chemoradiotherapy.Conclusions Our study demonstrated that CRP/Alb ratio was promising as a predictive marker for the therapeutic effect and survival outcome in ESCC patients receiving CRT or RT alone.