Background: To investigate the significance of the prognostic nutrition index (PNI) as a predictor of survival and guide for treating T1-2N1 breast cancer.Methods: Patients with T1-2N1 breast cancer (N = 380) who underwent a mastectomy at our center were studied. PNI was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm 3 ). The cutoff for the PNI was calculated using the time-dependent receiver operating characteristic (ROC) curve analysis by overall survival (OS) prediction. The associations between the PNI and the clinicopathologic characteristics were analyzed using Pearson's χ 2 test. Survival curves were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Results: Subgroup analyses of patients with low PNI value (≤52.0) and high PNI value (>52.0) showed that a high PNI was significantly associated with HER2 status, the neutrophil-lymphocyte ratio (NLR), the monocyte-lymphocyte ratio (MLR), and KI 67 status. The OS of patients with a high PNI was significantly better than that of patients with a low PNI. We then conducted subgroup analyses based on PNI and radiotherapy. Among patients who received radiotherapy, the OS of those with a high PNI was significantly better than that of patients with a low PNI. Among patients with a high PNI, the OS of those who received radiotherapy was better than that of the patients who did not receive radiotherapy. However, among the patients with a low PNI, the OS of those who received radiation was worse than that of patients who did not receive radiotherapy. The Kaplan-Meier survival analysis and the multivariate analysis of patients with T1-2N1 breast cancer who received radiotherapy showed PNI independently predicted OS. Conclusions:The preoperative PNI may be a reliable predictor of OS of patients with operable T1-2N1 breast cancer, with the capacity to provide a personalized prognosis and facilitate the development of clinical treatment strategies. However, radiotherapy did not achieve satisfactory outcomes in patients with PNI ≤52.0; thus, further studies on treatment optimization are needed.
Natural polysaccharide (NPH)-based injectable hydrogels have shown great potential for critical-sized bone defect repair. However, their osteogenic, angiogenic, and mechanical properties are insufficient. Here, MgO nanoparticles (NPs) were incorporated into a newly synthesized water-soluble phosphocreatine-functionalized chitosan (CSMP) water solution to form an injectable hydrogel (CSMP-MgO) via supramolecular combination between phosphate groups in CSMP and magnesium in MgO NPs to circumvent these drawbacks of chitosan-based injectable hydrogels. Water-soluble chitosan deviate CSMP was first synthesized by grafting methacrylic anhydride and phosphocreatine into a chitosan chain in a one-step lyophilization process. The phosphocreatine in this hydrogel not only provides sites to combine with MgO NPs to form supramolecular binding but also serves as the reservoir to control Mg 2+ release. As a result, the lyophilized CSMP-MgO hydrogels presented a porous structure with some small holes in the pore wall, and the pore diameters ranged from 50 to 100 μm. The CSMP-MgO injectable hydrogels were restricted from swelling in DI water (lowest swelling ratio was 16.0 ± 1.1 g/g) and presented no brittle failure during compression even at a strain above 85% (maximum compressive strength was 195.0 kPa) versus the control groups (28.0 and 41.3 kPa for CSMP and CSMP-MgO (0.5) hydrogels), with regulated Mg 2+ release in a stable and sustained manner. The CSMP-MgO injectable hydrogels promoted in vitro calcium phosphate (hydroxyapatite (HA) and tetracalcium phosphate (TTCP)) deposition in supersaturated calcium phosphate solution and presented no cytotoxicity to MC3T3-E1 cells; the CSMP-MgO hydrogel promoted MC3T3-E1 cell osteogenic differentiation with upregulation of BSP, OPN, and Osterix osteogenic gene expression and mineralization and HUVEC tube formation. Among them, CSMP-MgO (5) presented most of these properties. Moreover, this hydrogel (CSMP-MgO ( 5)) showed an excellent ability to promote new bone formation in critical-sized calvarial defects in rats. Thus, the CSMP-MgO injectable hydrogel shows great promise for bone regeneration.
Introduction: Albumin and alkaline phosphatase have been previously demonstrated as independent prognostic factors for various types of cancer. Here, we aimed to explore the potential value of pretreatment albumin to alkaline phosphatase ratio (AAPR) on overall survival (OS) in nonmetastatic breast cancer patients. Methods: A total of 746 nonmetastatic breast cancer patients were enrolled in this study. Receiver characteristic curve was used to analyze the AAPR threshold. Survival analysis was conducted using the Kaplan–Meier method and compared with the log-rank test. Both univariate and multivariate analyses were performed using Cox proportional hazards regression methodology. Results: The optimal cutoff value of AAPR in predicting OS in nonmetastatic breast cancer patients was 0.525. Increased pretreatment AAPR level was related to age at diagnosis (≥60 years vs <60 years, P =0.000), tumor size (T≤2 cm vs T>2 cm, P =0.034), estrogen receptor (positive vs negative, P =0.022), progesterone receptor (positive vs negative, P =0.025), carcino-embryonic antigen (abnormal vs normal, P =0.016), surgery (lumpectomy vs mastectomy, P =0.002), chemotherapy (yes vs no, P =0.004), radiotherapy (yes vs no, P =0.013), endocrine therapy (yes vs no, P =0.027) but not with lymph node involvement, HER-2 status or CA-153. The 5-year OS rate was 80.16% for the low AAPR group and 92.66% for the high AAPR group. Kaplan–Meier analysis indicated that patients with low-AAPR levels had shorter OS than patients with high-AAPR levels ( P =0.001). N classification ( P <0.05), Ki-67 (HR=3.603, 95% CI=1.046–12.414, P =0.042) and AAPR (HR=0.447, 95% CI=0.205–0.976, P =0.043) were related to OS in multivariate analyses, respectively. Conclusion: AAPR is an independent prognostic factor for OS in nonmetastatic breast cancer patients. Further prospective studies are required to confirm our findings.
Background: We aimed to assess the prognostic value of the skeletal muscle index (SMI) and monocyteto-lymphocyte ratio (MLR) in lymph node-positive breast cancer patients after mastectomy. Methods:We enrolled female lymph node-positive breast cancer patients who had undergone mastectomy between January 2011 and December 2013 with lymph node metastasis. Skeletal muscle tissue was measured using computed tomography (CT), and the patients were grouped based on the receiver operating characteristic curves to obtain the cut-off point for SMI; similarly, the optimal cutoff point for the MLR was obtained. Survival analysis was chiefly performed to determine overall survival (OS) among the patients. Results:The median age of the 97 included patients was 46 years (range, 27-73 years), whereas the median follow-up duration was 62.5 months. Of these patients, 71 exhibited low SMI and 66 exhibited high MLR.Kaplan-Meier curves indicated that low SMI (5-year OS, 97.2% vs. 84.6%; log-rank P=0.021) and low MLR (5-year OS, 98.5% vs. 83.9%; log-rank P=0.004) were associated with better OS. Moreover, patients with both high SMI and MLR (high SMLR) had significantly worse OS (5-year OS, 66.7% vs. 96.6%; log-rank P<0.001), relative to the low SMLR group. Multivariate analysis indicated that patients with low SMI had a lower overall dying risk, relative to those with high SMI [hazard ration (HR), 0.188; P=0.038], whereas patients with high MLR had a higher risk of death as compared to those with low MLR (HR, 7.152; P=0.021). Furthermore, SMLR was an independent prognostic factor of poor OS (HR, 13.272; P=0.001).Conclusions: Low SMI and low MLR are both associated with better OS in lymph node-positive breast cancer patients after mastectomy. SMI combined with MLR (SMLR) may be powerful prognosis factor for OS among these patients.
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