Background Lung immune prognostic index (LIPI) is a prognostic marker of extensive-stage small cell lung cancer (ES-SCLC) patients received immunotherapy or chemotherapy. However, its ability in limited-stage SCLC (LS-SCLC) should be evaluated extensively. Methods We retrospectively enrolled 497 patients diagnosed as LS-SCLC between 2015 and 2018, and clinical data included pretreatment lactate dehydrogenase (LDH), white blood cell count, and absolute neutrophil count levels were collected. According to the LIPI scores, the patients were stratified into low-risk (0 points) and high-risk (1–2 points). The correlations between LIPI and overall survival (OS) or progression-free survival (PFS) were analyzed by the Cox regression. Additionally, the propensity score matching (PSM) and inverse probability of treatment weight (IPTW) methods were used to reduce the selection and confounding bias. A nomogram was constructed using on multivariable Cox model. Results Two hundred fifty and 247 patients were in the LIPI high-risk group and low-risk group, and their median OS was 14.67 months (95% CI: 12.30–16.85) and 20.53 months (95% CI: 17.67–23.39), respectively. In the statistical analysis, High-risk LIPI was significantly against worse OS (HR = 1.377, 95%CI:1.114–1.702) and poor PFS (HR = 1.338, 95%CI:1.1–1.626), and the result was similar after matching and compensating with the PSM or IPTW method. A novel nomogram based on LIPI has a decent level of predictive power. Conclusion LIPI stratification was a significant factor against OS or PFS of LS-SCLC patients.

Prophylactic cranial irradiation (PCI), as an essential part of the treatment of limited-stage small-cell lung cancer (LS-SCLC), inevitably leads to neurotoxicity. This study aimed to construct a brain metastasis prediction model and identify low-risk patients to avoid PCI; 236 patients with LS-SCLC were retrospectively analyzed and divided into PCI (63 cases) and non-PCI groups (173 cases). The nomogram was developed based on variables determined by univariate and multivariate analyses in the non-PCI group. According to the cutoff nomogram score, all patients were divided into high- and low-risk cohorts. A log-rank test was used to compare the incidence of brain metastasis between patients with and without PCI in the low-risk and high-risk groups, respectively. The nomogram included five variables: chemotherapy cycles (ChT cycles), time to radiotherapy (RT), lactate dehydrogenase (LDH), pro-gastrin-releasing peptide precursor (ProGRP), and lymphocytes–monocytes ratio (LMR). The area under the receiver operating characteristics (AUC) of the nomogram was 0.763 and 0.782 at 1 year, and 0.759 and 0.732 at 2 years in the training and validation cohorts, respectively. Based on the nomogram, patients were divided into high- and low-risk groups with a cutoff value of 165. In the high-risk cohort, the incidence of brain metastasis in the non-PCI group was significantly higher than in the PCI group (p < 0.001), but there was no difference in the low-risk cohort (p = 0.160). Propensity score-matching (PSM) analysis showed similar results; the proposed nomogram showed reliable performance in assessing the individualized brain metastasis risk and has the potential to become a clinical tool to individualize PCI treatment for LS-SCLC.

BackgroundAspartate aminotransferase (AST), an indicator of liver cell damage, was related to the prognosis of certain malignant tumors. This study examined the predictive value of AST in patients with extranodal natural killer/T cell lymphoma (ENKTL).MethodsWe reviewed 183 cases diagnosed with ENKTL and selected 26 U/L as the optimum cut-off value of AST. We used the univariate and multivariate Cox regression to compare the different AST groups' overall survival (OS) and progression-free survival (PFS).ResultsPrior to propensity score matching (PSM), Kaplan-Meier analysis showed that patients in the low AST subgroup had better OS and PFS than the high AST subgroup. Multivariate analysis revealed that AST was an independent indicator for prognosis. After PSM, the low AST subgroup maintained a significantly better OS and PFS than the high AST subgroup.ConclusionAST might represent a significant prognostic marker for ENKTL patients.

Background: Mild elevation of serum cardiac troponin (Tn) reflects myocardial injury and is associated with cardiovascular events, even without overt cardiovascular disease. The purpose of this study was to investigate the possible mechanism of mild elevation of high-sensitivity cardiac troponin I (hs-cTnI) and its impact on prognosis in patients with non-obstructive coronary artery disease (CAD).Methods: 474 consecutive patients with suspected CAD and without significant coronary artery stenosis (<50%) who underwent adenosine triphosphate disodium (ATP) stress MCE were followed up (median, 41months) for endpoint events. Hs-cTnI was tested before MCE. Replenishment velocity (β), relative myocardial blood flow (rBV) and myocardial blood flow reserve (MBFR) were measured by stress MCE.Results: A total of 214 (45.1%) patients had hs-cTnI concentrations exceeding the limitation of detection (LOD) (0.001 ng/ml). Compared to patients with hs-cTnI below LOD, patients with higher hs-cTnI were older (p<0.05), had higher prevalence of atrial fibrillation (p<0.001) and lower MBFR (p<0.001). After adjustment, the association was still significant between detectable hs-cTnI and MBFR (odds ratio = 0.200; 95% CI: 0.043,0.923, P = .039). Detectable hs-cTnI was associated with endpoint events independent of MBFR (adjusted hazard ratio 8.927,95%CI 1.341-149.48, P=0.028). Hs-cTnI higher than LOD had greater cumulative event rate (log-rank P=0.004). The risk of incident endpoint events was greater for higher hs-cTnI (≥0.001 versus <LOD; adjusted hazard ratio, 13.398; 95% CI, 1.243, 144.371) (P<0.001).Conclusions: In patients with non-obstructive CAD, mild myocardial injury was associated with impaired myocardial perfusion as measured by quantitative MCE; both of them independently affect prognosis; low-level hs-cTnI elevation predicts adverse events independent of myocardial ischemia due to microvascular dilation dysfunction.

BACKGROUND: At present, peripheral blood markers are easily accessible information and clinically valuable prognostic indicators in extranodal nasal-type natural killer/T-cell lymphoma (ENKTCL). Nevertheless, the role of its comprehensive score in ENKTCL remains to be determined. OBJECTIVE: Therefore, this study aimed to investigate the prognostic effect of the peripheral inflammation score on ENKTCL. METHODS: The retrospective study included 183 patients with ENKTCL. Univariate Cox regression analyses and least absolute shrinkage and selection operator (LASSO) Cox regression were used to construct the inflammation-related prognostic index named Risk. Univariate and multivariate Cox regression analyses and regression adjustment with propensity score matching (PSM) were used to evaluate the prognostic ability of risk. The performance of the modified nomogram-revised risk index (NRI) by integrating risk was evaluated with the area under the time-dependent receiver operating characteristic (ROC) curve (AUC), decision curve analysis (DCA), and integrated Brier score (IBS). RESULTS: The risk cut-off value, constructed by the lymphocyte count, platelet count, albumin level, LMR, and PNI, was -1.3486. Before PSM, multivariate analysis showed that risk was significantly associated with OS (HR = 2.577, 95% CI = 1.614–4.114, P< 0.001) and PFS (HR = 2.679, 95% CI = 1.744–4.114, P< 0.001). After PSM adjustment, risk was still an independent factor for OS (HR = 2.829, 95% CI = 1.601–5.001, P< 0.001) and PFS (HR = 2.877, 95% CI = 1.735–4.770, P< 0.001). With the NRI, the modified NRI by integrating risk increased the AUC and clinical net benefit and decreased the integrated Brier score. CONCLUSIONS: Risk is an easily accessible and inexpensive indicator that may be used as a prognostic marker and could improve NRI predictive power in patients with ENKTCL.