Objective:To explore the independent risk factors of preoperative CT findings affecting the overall survival of patients with clear cell renal cell carcinoma (ccRCC) and to draw a nomogram.Methods:The retrospective study was performed on 238 patients with ccRCC who underwent preoperative CT scan and were pathologically confirmed in First Affiliated Hospital of Air Force Medical University from October 2011 to December 2015. CT findings of each patient were evaluated by two radiologists, and general information, renal function examination, and World Health Organization/International Society for Urology and Pathology (WHO/ISUP) grading were collected. The Kaplan-Meier survival curve was plotted, and survival rates were compared using log-rank test. Cox proportional hazard regression was used for univariate and multivariate analysis, and the nomogram was drawn according to the results of multivariate analysis, and the C-index was calculated after internal validation by Bootstrap 1000.Results:After 3-74 months of follow-up for 238 patients, 32 cases were in the death group and 206 cases were in the censored group. The tumor diameter of the death group [(65.70±27.29) mm] was larger than that of the censored group [(46.25±26.16) mm], with a statistically significant difference ( t=-3.889, P<0.001). The incidence rate of tumor necrosis ( χ2=45.716, P<0.001), regional lymph node enlargement ( χ2=43.342, P<0.001) and perirenal fat invasion ( χ2=19.324, P<0.001) in the death group were higher than those in the censored group. Survival rates were different in patients with different tumor diameter of ccRCC, with a statistically significant difference ( χ2=17.108, P<0.001). The survival rate of patients with tumor necrosis was lower than those without necrosis ( χ2=48.195, P<0.001). The survival rate of patients with regional lymph node enlargement was lower than those without regional lymph node enlargement ( χ2=47.232, P<0.001). The survival rate of patients with perirenal fat invasion was lower than those without perirenal fat invasion ( χ2=19.964, P<0.001). Survival rates were also different in ccRCC patients with different WHO/ISUP grades, with a statistically significant difference ( χ2=27.765, P<0.001). In Cox multivariate analysis, tumor diameter ( HR=2.90, 95% CI: 1.37-6.14, P=0.006), necrosis ( HR=8.88, 95% CI: 3.33-23.69, P<0.001) and regional lymph node enlargement ( HR=4.48, 95% CI: 2.04-9.86, P<0.001) in CT findings were independent risk factors for death in patients with ccRCC. The C-index of nomogram was 0.870. Conclusion:Preoperative CT findings are correlated with survival rate of patients with ccRCC, in which tumor diameter, tumor necrosis and regional lymph node enlargement are independent risk factors for death, and the nomograms has high accuracy.

Calcium-binding protein is an indispensable protein which performs extensive and important functions in the growth of Schistosoma japonicum. Based on our primary study on tegument surface proteins of S. japonicun, a cDNA encoding a 66 kDa calcium-binding protein of S. japonicum (Chinese strain) was cloned, sequence analysis revealed that it was identical with that of SjIrV1 of Philippines strains S. japonicum. The expression of SjIrV1 were detected by Real-time PCR, using cDNA templates isolated from 7, 14, 21, 28, 35 and 42 days worms and the results revealed that the gene was expressed in all investigated stages, and the mRNA level of SjIrV1 is much higher in 42 d female worms than that in 42 d male worms. The cDNA containing the open reading frame of IrV1 was subcloned into a pET28a (+) vector and transformed into competent Escherichia coli BL21 for expression. The recombinant protein was purified using a Ni-NTA purification system, and confirmed by high performance liquid chromatography (RP-HPLC) and tandem mass spectrometry (MS/MS). Western blotting analysis showed that recombinant SjIrV1 (rSjIrV1) could be recognized by the S. japonicum infected mouse serum and the mouse serum specific to rSjIrV1, respectively. Immunofluorescence observation exhibited that SjIrV1 was mainly distributed on the tegument of the 35-day adult worms. ELISA test revealed that IgG, IgG1 and IgG2a antibodies are significantly increased in the serum of rSjIrV1 vaccinated mice. The study suggested that rSjIrV1 might play an important role in the development of S. japonicum.
Animals ; Antibodies, Helminth ; blood ; Calcium-Binding Proteins ; genetics ; metabolism ; Cloning, Molecular ; Escherichia coli ; metabolism ; Female ; Genetic Vectors ; Helminth Proteins ; genetics ; metabolism ; Male ; Mice ; Recombinant Proteins ; genetics ; metabolism ; Schistosoma japonicum ; genetics ; metabolism