Objective·To explore the risk factors affecting progression-free survival(PFS)in colorectal cancer(CRC)patients and establish a corresponding prognostic prediction model.Methods·A retrospective cohort study was used for analysis,including 533 patients with surgically resected and pathologically confirmed colorectal adenocarcinoma at Tongren Hospital,Shanghai Jiao Tong University School of Medicine,who were randomly divided into a training set(373 cases)and a validation set(160 cases)in a 7∶3 ratio.The included clinical data were analyzed using univariate and multivariate Cox proportional hazards models to explore independent factors affecting postoperative PFS in patients with CRC and to establish a clinical prognostic prediction model based on these factors.The discrimination and calibration of the prediction model were evaluated by using concordance index(C-index),area under the receiver operating characteristic(ROC)curve(AUC),calibration curve,and survival curve.The independent effects of age,gender,and American Joint Committee on Cancer(AJCC)cancer stage on prognosis were assessed using multivariate Cox regression analysis.Results·Multivariate Cox regression analysis revealed that age,smoking history,liver disease,carbohydrate antigen 724(CA724),and AJCC stage were independent factors influencing PFS.In the training set,the C-index of the PFS model was 0.69,with AUCs of 0.744 and 0.713 at 3 and 5 years,respectively.In the validation set,the C-index of the PFS model was 0.64,with AUCs of 0.706 and 0.683 at 3 and 5 years,respectively.The calibration curves showed that the prediction of PFS for the training and validation sets were close to the standard curve.The survival curves suggested that the progression rate of patients in the low-risk group was significantly lower than that in the high-risk group.Stratified analysis revealed that among patients aged ≥65 years,age,liver disease,and AJCC clinical stage were independent factors affecting postoperative PFS.Among patients aged＜65 years,smoking history,CA724,and AJCC clinical stage were independent factors affecting postoperative PFS.For male patients,age,smoking history,CA724,and AJCC clinical stage were independent factors affecting postoperative PFS,while for female patients,liver disease,CA724,and AJCC clinical staging were independent predictors of postoperative PFS.Among patients with AJCC stage Ⅰ-Ⅱ,age and smoking history were independent factors affecting postoperative PFS,whereas in those with AJCC stage Ⅲ-Ⅳ,age,liver disease,and CA724 were independent factors affecting postoperative PFS.Conclusion·The PFS prognostic model established in this study for CRC patients has good discriminative ability and provides clinicians with an effective risk assessment tool.

Objective·To explore the risk factors affecting progression-free survival(PFS)in colorectal cancer(CRC)patients and establish a corresponding prognostic prediction model.Methods·A retrospective cohort study was used for analysis,including 533 patients with surgically resected and pathologically confirmed colorectal adenocarcinoma at Tongren Hospital,Shanghai Jiao Tong University School of Medicine,who were randomly divided into a training set(373 cases)and a validation set(160 cases)in a 7∶3 ratio.The included clinical data were analyzed using univariate and multivariate Cox proportional hazards models to explore independent factors affecting postoperative PFS in patients with CRC and to establish a clinical prognostic prediction model based on these factors.The discrimination and calibration of the prediction model were evaluated by using concordance index(C-index),area under the receiver operating characteristic(ROC)curve(AUC),calibration curve,and survival curve.The independent effects of age,gender,and American Joint Committee on Cancer(AJCC)cancer stage on prognosis were assessed using multivariate Cox regression analysis.Results·Multivariate Cox regression analysis revealed that age,smoking history,liver disease,carbohydrate antigen 724(CA724),and AJCC stage were independent factors influencing PFS.In the training set,the C-index of the PFS model was 0.69,with AUCs of 0.744 and 0.713 at 3 and 5 years,respectively.In the validation set,the C-index of the PFS model was 0.64,with AUCs of 0.706 and 0.683 at 3 and 5 years,respectively.The calibration curves showed that the prediction of PFS for the training and validation sets were close to the standard curve.The survival curves suggested that the progression rate of patients in the low-risk group was significantly lower than that in the high-risk group.Stratified analysis revealed that among patients aged ≥65 years,age,liver disease,and AJCC clinical stage were independent factors affecting postoperative PFS.Among patients aged＜65 years,smoking history,CA724,and AJCC clinical stage were independent factors affecting postoperative PFS.For male patients,age,smoking history,CA724,and AJCC clinical stage were independent factors affecting postoperative PFS,while for female patients,liver disease,CA724,and AJCC clinical staging were independent predictors of postoperative PFS.Among patients with AJCC stage Ⅰ-Ⅱ,age and smoking history were independent factors affecting postoperative PFS,whereas in those with AJCC stage Ⅲ-Ⅳ,age,liver disease,and CA724 were independent factors affecting postoperative PFS.Conclusion·The PFS prognostic model established in this study for CRC patients has good discriminative ability and provides clinicians with an effective risk assessment tool.

Background:Diagnosis of liver cirrhosis in early stage with early intervention may stabilize disease progression, avoiding or delaying the occurrence of decompensation. Seeking non-invasive serum biomarkers is becoming an important topic in the diagnosis and assessment of liver cirrhosis. Aims:To study the value of serum miR-192 and miR-29a as non-invasive biomarkers for the diagnosis of liver cirrhosis. Methods:Differentially expressed serum miRNAs between patients with liver cirrhosis and healthy controls were screened through online literature retrieval and then confirmed by real-time PCR. Serum levels of two confirmed miRNAs,miR-192 and miR-29a were analyzed in 120 patients with liver cirrhosis and 76 healthy volunteers by real-time PCR. A mathematical model of combined detection of miR-192 and miR-29a for diagnosis of liver cirrhosis was established by binary logistic regression. The diagnostic performance of various non-invasive serum indicators was evaluated by ROC curve analysis. Results:Compared with healthy controls,expression level of serum miR-192 in cirrhotic patients was significantly increased and that of serum miR-29a was significantly reduced(P ﹤ 0. 001). The diagnostic performance of risk score obtained from mathematical model of combined detection of serum miR-192 and miR-29a was superior to that of single miRNA detection or other non-invasive serum indicators,such as APRI,FIB-4 and ARR,the areas under ROC curve of the above mentioned indicators were 0. 968,0. 887,0. 933,0. 796,0. 793,and 0. 571,respectively. Serum levels of miR-192,miR-29a and the risk score of their combined detection were significantly correlated with the stage of liver cirrhosis according to the Child-Pugh classification( P ﹤ 0. 05). Conclusions:Serum miR-192,miR-29a and the risk score of their combined detection might be novel non-invasive biomarkers for the diagnosis and assessment of liver cirrhosis.

Objective To evaluate the accuracy of endoscopic ultrasonography (EUS) in preoperative TNM staging of gastric cancer.Methods EUS and abdominal helical computed tomography (HCT) were performed one week before the surgery in 126 gastric cancer patients who would receive surgery to determine the depth of tumor invasion (T),lymph node metastasis (N) and distant metastasis (M) stage and which were also compared with pathologic TNM stage after surgery to evaluate the accuracy of EUS in TNM staging.Pairing x2 test was performed for data analysis.Results Compared with pathologic TNM stage after surgery,the accuracy of EUS in T1,T2,T3 and T4 staging of gastric cancer were 84.6％,14/18,82.0 ％ and 85.7％ respectively.The accuracy of EUSin N0,N1,N2 and N3 staging of gastric cancer were 74.2％,75.0％,57.9％ and 5/17 respectively.The accuracy of HCT in N0,N1,N2 and N3 staging of gastric cancer were 80.6％,75.0％,73.7％ and 12/17 respectively.The accuracy of EUS was similar to HCT in N0 and N1 stage.For N2 and N3 stage,HCT was obviously better than EUS (x2 =4.89,P=0.027; x2 =13.88,P＜0.01).The accuracy of EUS and HCT in M1 stage of gastric cancer were 36.4％ and 95.5％respectively,HCT was better than EUS in M1 determination (x2 =7.90,P=0.001).Conclusions The clinical application value of EUS in the preoperative gastric cancer T staging was high,however the accuracy in determining lymph node metastasis N2 and N3 staging and distant metastasis M staging should be improved.In order to acquire more accurate preoperative TNM stage to guide the treatment selection,the combination with HCT examination is necessary.