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Background Because of the mutual influence of liver dysfunction and malignancy, overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC). We developed a nomogram integrating albumin–bilirubin (ALBI) grade, a new index of hepatic reserve, and tumor characteristics of HCC for predicting OS following curative liver resection. Methods The nomogram was built to estimate the probabilities of 1, 3, and 5-y OS based on training cohort of 709 HCC, which was validated in an international independent dataset. The prognostic value of the nomogram was determined by concordance index (C-index), time-dependent receiver operating characteristics (tdROC), and decision curves, comparing with ALBI grade alone, the Cancer of the Liver Italian Program (CLIP), the Barcelona Clinic Liver Cancer (BCLC), and Okuda staging systems. Results Independent factors derived from multivariable Cox analysis of the training cohort to predict OS were tumor grade, microvascular invasion, tumor size and ALBI grade which were assembled into nomogram. The calibration curves for probability of OS showed optimal agreement between nomogram-prediction and actual observation, which was tested in validation cohort. The C-index, tdROC and decision curves showed the nomogram was superior to CLIP, ALBI grade, BCLC and Okuda. The patients could also be stratified into low, intermediate risk, and high risk of the mortality by the normogram in both development and validation cohorts. Conclusions The nomogram integrating hepatic reserve and tumor characteristics provided a highly accurate estimation of OS in patients with HCC after curative liver resection, contributing to assess patient prognosis. [ABSTRACT FROM AUTHOR]

Background Homeobox A11 antisense (HOXA11-AS), a newly identified lncRNA, is up-regulated in various carcinomas. We conducted the present meta-analysis to explore the potential of HOXA11-AS as a common predictive biomarker for metastasis and prognosis in malignant tumors. Methods A systematic literature search on the online electronic databases of PubMed, Web of Science, and Embase was carried out to determine relevant studies (as of July 9, 2017). The pooled hazard ratios (HRs)/odds rates (ORs), and their 95% confidence intervals (CIs) were used to evaluate the relationship. Results A total of 608 patients from seven studies were included in the current meta-analysis. The pooled results indicated that high HOXA11-AS expression was related to poor overall survival (OS) (HR = 2.02, 95% CI: 1.48–2.75, P < 0.001) and progression-free survival (PFS) (HR = 1.91, 95% CI: 1.15–3.17, P = 0.012). Further analyses reveal that patients with high HOXA11-AS expression are prone to develop distant metastasis (DM) (OR = 6.05, 95% CI: 1.66–22.06, P = 0.006). Conclusions This meta-analysis showed that increased expression of HOXA11-AS is a risk factor for poor clinical outcomes in numerous tumors and may act as a novel biomarker for poor prognosis and metastasis in cancers. [ABSTRACT FROM AUTHOR]

Background Several non-invasive diagnostic scores for non-alcoholic fatty liver (NAFL) have been developed, but the clinical application is limited because of their complexity. Aim To develop and validate an easy-to-calculate scoring system to identify ultrasound-diagnosed NAFL. Methods 48,489 patients from 2 centers were included in this study. Multivariable logistic regression models were employed for model development. Ultrasonography was applied to diagnose NAFL. The selected variables were assigned an integer score proportional to the estimated coefficient from the logistic regression analysis, namely NAFL Screening Score (NSS). The ability of the NSS to identify NAFL was assessed by analyzing the area under the receiver operating characteristic curve (AUROC) and was tested in an independent validation cohort. Additionally, the performance of NSS was compared with existing models. Results NSS was developed as a basic score comprising of age, body mass index (BMI), triglyceride (TG), ALT/AST, fasting plasma glucose (FPG) and uric acid (UA) in both sexes. NSS showed a relatively good discriminative power (AUROC = 0.825 for males, 0.861 for females in the validation cohort) in comparison with other models. The optimal cut-off point was 32 for males and 29 for females. Conclusion We developed and validated NSS, an easy-to-use score sheet identify ultrasound-diagnosed NAFL. NSS may be clinically useful for initial diagnosing NAFL. [ABSTRACT FROM AUTHOR]

Background Recent studies have indicated that long non-coding RNA actin filament–associated protein 1 antisense RNA 1 (lncRNA AFAP1-AS1) was increased in non–small cell lung cancer and associated with unfavorable patient prognosis. AFAP1-AS1 also participates in promoting invasion and metastasis in non–small cell lung cancer cells. However, the diagnosis value of serum AFAP1-AS1 in non–small cell lung cancer was unclear. In this study, we aimed to explore whether circulating AFAP1-AS1 can be used as a diagnostic biomarker for non–small cell lung cancer. Method The serum AFAP1-AS1 expression level in 126 non–small cell lung cancer patients and 60 healthy controls was detected by quantitative real-time polymerase chain reaction (qRT-PCR). The concentrations of serum cyfra21-1 were detected through chemiluminescence method using the Roche Cobas e601. Receiver operating characteristic curve analysis was applied to assess the diagnostic value of serum AFAP1-AS1 and cyfra21-1 in non–small cell lung cancer. Result The results demonstrated that AFAP1-AS1 expression level was significantly elevated in non–small cell lung cancer patients compared with that in normal controls ( p = 0.000). Serum AFAP1-AS1 could be used as molecular marker for distinguishing non–small cell lung cancer patients from healthy people with an area under the curve of 0.759 (95% confidence interval = 0.692–0.826; p = 0.000). The combination of FAP1-AS1 and cyfra21-1 showed that the area under the curve was 0.860 (95% confidence interval = 0.808–0.912; p = 0.000). Further analysis found that high serum AFAP1-AS1 expression levels correlated with distant metastasis ( p = 0.03), lymph node metastasis ( p = 0.017), poor clinical stage ( p = 0.019), and larger tumor size ( p = 0.015). Furthermore, AFAP1-AS1 was significantly upregulated in positive distant metastasis group ( p = 0.003), positive lymph node metastasis ( p = 0.017), poor clinical stage group ( p = 0.019), and larger tumor size group ( p = 0.015). Conclusion Serum AFAP1-AS1 could serve as an ideal combined biomarker for the diagnosis of non–small cell lung cancer. [ABSTRACT FROM AUTHOR]

Background The presence of vascular invasion (VI) in pathology specimens is a well-known unfavorable prognostic factor of hepatocellular carcinoma (HCC) recurrence and overall survival (OS). We investigated the vascular invasion related microRNA (miRNA) expression profiles and potential of prognostic value in HCC. Methods MiRNA and mRNA expression data for HCC were accessed from The Cancer Genome Atlas (TCGA). LASSO logistic regression models were used to develop a miRNA-based classifier for predicting VI. The predictive capability was accessed by area under receiver operating characteristics (AUC). Concordance index (C-index) and time-dependent receiver operating characteristic (td-ROC) were used to determine its prognostic value. We validated the predictive and prognostic accuracy of this classifier in an external independent cohort of 127 patients. Functionally relevant targets of miRNAs were determined using miRNA target prediction, experimental validation and correlation of miRNA and mRNA expression data. Results A 16-miRNA-based classifier was developed which identified VI accurately, with AUC of 0.731 and 0.727 in TCGA set and validation cohort, respectively. C-index and td-ROC showed that the classifier was able to stratify patients into risk groups strongly associated with OS. When stratified by tumor characteristics, the classifier was still a clinically and statistically significant prognostic model. The predictive and prognostic accuracy of the classifier was confirmed in validation cohort. Vascular invasion related miRNA/target pairs were identified by integrating expression patterns of predicted targets, which were validated in cell lines. Conclusions A multi-miRNA-based classifier developed based on the presence of VI, which could effectively predict OS in HCC. [ABSTRACT FROM AUTHOR]

Background Bacterial infection is a frequent complication and severe burden in cirrhotic patients. We determined the utility of neutrophil-to-lymphocyte ratio (NLR) to predict the hospital-acquired (HA) bacterial infections episode in patients with decompensated cirrhosis. Methods We retrospectively included 2066 consecutive decompensated cirrhotic patients from two separate tertiary hospitals, divided into training (n = 1377) and validation (n = 689) set. All data were collected on admission and all overt bacterial infections occurring after > 48 h of hospital stay were registered. Results The incidence of HA bacterial infections in training and validation cohort was 35.87% and 31.05% respectively. Multivariate analysis showed that total bilirubin (TBil), albumin, white blood cell count (WBC) and NLR were independent predictors of HA bacterial infections. We established a Model_NTWA using these four variables and a Model_TWA which did not include NLR. Areas under the curves (AUC) of Model_NTWA (0.859) and NLR (0.824) were higher than which of Model_TWA (0.713), WBC (0.675), TBil (0.593) and Albumin (0.583). Consistent with training cohort, validation cohort showed similar results. Patients with NLR of at least 4.33 had a significantly lower survival (P < 0.001). Conclusions NLR can be used as a novel noninvasive marker to predict the occurrence of HA bacterial infections in decompensated cirrhotic patients. [ABSTRACT FROM AUTHOR]

Background Acute-on-chronic hepatitis B liver failure (ACHBLF) is associated with poor short-term prognosis. The aim of the present study was to construct and validate a model for end-stage liver disease (MELD)-based nomogram for the 3-month mortality estimation for patients with ACHBLF. Methods A total of 551 patients with ACHBLF were prospectively enrolled from 2 independent medical centers and divided into 2 cohorts of training and validation, respectively. The 3-month mortality was recorded as the outcome. The MELD-based nomogram was constructed to predict the 3-month mortality for ACHBLF using the training group of 335 patients and validated using an independent cohort of 216 patients. The predictive capability of MELD-based nomogram was compared with the MELD score system by calibration analysis, receiver operating characteristics (ROC) and decision curve analysis in both training cohort and validation cohort. Results Multivariate analysis suggested that age, serum sodium, and MELD score were independent prognostic indicators associated with the 3-month mortality for ACHBLF, and therefore used for developing the nomogram. In terms of calibration, the predicted survival by the MELD-based nomogram was found to be extremely in line with the observed 3-month mortality both in training cohort and validation cohort. Additionally, both ROC and decision curve analyses showed that the MELD-based nomogram was better than MELD, MELD-Na, MELDNa, and iMELD for ACHBLF prognosis prediction. The results were confirmed in the external cohort of validation. Conclusions The MELD-based nomogram provided a user-friendly, accurate and reproducible tool for predicting 3-month mortality of patients with ACHBLF. [ABSTRACT FROM AUTHOR]