POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin changes) syndrome is a rare multisystem disease, often presenting diagnostic challenges. Here, we report a case of POEMS syndrome in an elderly patient with refractory peritoneal effusion and hypoalbuminemia as the main manifestations. Physical examination revealed cutaneous hyperpigmentation of upper and lower extremities. Tests revealed elevated vascular endothelial growth factor (VEGF) and hypogonadism, while imaging showed enlargement of armpits and groin lymph nodes. Lymph node biopsy excluded tuberculosis and malignancy. Electroneuromyography (EMG) disclosed polyneuropathy of the lower extremities. Finally, he was diagnosed with POEMS syndrome via bone marrow biopsy. Notably, he presented endoscopic snakeskin-like appearance of stomach, which was consistent with previous research. POEMS syndrome, a rare cause of ascites, is frequently missed or misdiagnosed. Thus, clinicians should maintain high vigilance. In patients with unexplained refractory ascites and symptoms like neuropathy, lymph nodes enlargement, and endocrine disorders, screening for VEGF levels and M protein should be performed to facilitate early identification of POEMS syndrome.

Abstract Background The IDH-mutant low-grade glioma (LGG) involving corpus callosum (ccLGG) is a rare type of LGG which has a poorer prognosis. To evaluate the efficacy of multimodal techniques (comprising neuronavigation, intraoperative MRI, and neuromonitoring) compared with the conventional approach guided solely by neuronavigation in the resection of IDH-mutant ccLGG, and to identify prognostic factors of ccLGG. Methods The IDH-mutant ccLGG cases that received resection in our center between 2014 and 2022 were collected and reviewed retrospectively. Comparisons were made between the multimodal and conventional groups regarding patient demographics, tumor characteristics, extent of resection (EOR), neurological function, Karnofsky Performance Status (KPS), progression-free survival (PFS), and overall survival (OS). Both univariate and multivariate analysis were employed to assess potential prognostic factors. Results Ultimately, 64 patients in the multimodal group and 34 in the conventional group were enrolled. Compared with the conventional group, the multimodal group achieved a significantly higher median EOR (100% vs. 93.55%, P = 0.001) and a greater gross total resection (GTR) rate (62.5% vs. 35.3%, P = 0.010). No significant differences were observed in postoperative neurological function or KPS between the two groups at any of the time points assessed. Compared with the conventional group, the multimodal group demonstrated significantly longer median PFS (78.5 vs. 48.1 months, P = 0.010) and OS (106.1 vs. 66.9 months, P = 0.009). Non-butterfly ccLGG, less tumor volume, genu invasion of CC (compared to splenium invasion), less volume of CC invasion, higher EOR, longer chemotherapy cycles of Temozolomide (TMZ), higher KPS on 3 months and MGMT methylation were positive factors for PFS of ccLGG. While four factors were associated with the longer OS of ccLGG, including genu of CC invasion compared to both genu and body invasion of CC, higher EOR, longer TMZ cycles and MGMT methylation. Conclusion Multimodal techniques are useful for achieving maximal safe resection and better prognosis of ccLGG. As higher EOR independently predicts improved survival in IDH-mutant ccLGG, maximal safe resection should be suggested and achieved by appropriate means tailored to available resources. The postoperative chemotherapy should also be recommended to patients with high risks. While whether postoperative radiotherapy should be performed should consider and balance many factors.

Mitochondrial dysfunction represents a pivotal aspect of the pathogenesis and progression of diabetic kidney disease (DKD). Central to the orchestration of mitochondrial biogenesis is the peroxisome proliferator-activated receptor γ coactivator 1-α (PGC1-α), a master regulator with a profound impact on mitochondrial function. In the context of DKD, PGC1-α exhibits significant downregulation within intrinsic renal cells, precipitating a cascade of deleterious events. This includes a reduction in mitochondrial biogenesis, heightened levels of mitochondrial oxidative stress, perturbed mitochondrial dynamics, and dysregulated mitophagy. Concurrently, structural and functional abnormalities within the mitochondrial network ensue. In stark contrast, the sustained expression of PGC1-α emerges as a beacon of hope in maintaining mitochondrial homeostasis within intrinsic renal cells, ultimately demonstrating an impressive renoprotective potential in animal models afflicted with DKD. This comprehensive review aims to delve into the recent advancements in our understanding of the renoprotective properties wielded by PGC1-α. Specifically, it elucidates the potential molecular mechanisms underlying PGC1-α’s protective effects within renal tubular epithelial cells, podocytes, glomerular endothelial cells, and mesangial cells in the context of DKD. By shedding light on these intricate mechanisms, we aspire to provide valuable insights that may pave the way for innovative therapeutic interventions in the management of DKD.

BackgroundEmerging evidence suggests a potential role of immune response and inflammation in the pathogenesis of diabetic kidney disease (DKD). The systemic immune-inflammation index (SII) offers a comprehensive measure of inflammation; however, its relationship with the prognosis of DKD patients remains unclear.MethodsUsing data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, this cross-sectional study involved adults diagnosed with DKD. Cox proportional hazards models were utilized to assess the associations between SII and all-cause or cardio-cerebrovascular disease mortality. Additionally, restricted cubic spline, piecewise linear regression, and subgroup analyses were performed.ResultsOver a median follow-up duration of 6.16 years, 1338 all-cause deaths were recorded. After adjusting for covariates, elevated SII levels were significantly associated with increased risks of all-cause and cardio-cerebrovascular disease mortality. Specifically, per one-unit increment in natural log-transformed SII (lnSII), there was a 29% increased risk of all-cause mortality (P < 0.001) and a 23% increased risk of cardio-cerebrovascular disease mortality (P = 0.01) in the fully adjusted model. Similar results were observed when SII was analyzed as a categorical variable (quartiles). Moreover, nonlinear association was identified between SII and all-cause mortality (P < 0.001) through restricted cubic spline analysis, with threshold value of 5.82 for lnSII. The robustness of these findings was confirmed in subgroup analyses. Likewise, the statistically significant correlation between SII levels and cardio-cerebrovascular disease mortality persisted in individuals with DKD.ConclusionIncreased SII levels, whether examined as continuous variables or categorized, demonstrate a significant association with elevated risks of all-cause and cardio-cerebrovascular disease mortality among DKD patients. These findings imply that maintaining SII within an optimal range could be crucial in reducing mortality risk.

Background:The incidence of cancer is increasing, and cancer survivors are also growing exponentially. Cancer is defined as a new chronic disease. Nevertheless, the management of cancer in the form of chronic diseases in China is still in its infancy, without a standardized care model.Objective:This study aimed to explore the current status of management of cancer care from the patient's perspective.Methods:This cross-sectional study was a questionnaire survey of patients diagnosed with cancer, including information of the current situation of daily medical consultation, status of comorbidity, and expectations of seeking cancer care in future. Chi-square test and logistic regression analysis were used to explore the factors influencing patients' choice of cancer management mode.Results:A total of 200 cancer patients were included in the study. The majority (n = 150) of cancer patients chose an oncologist in a tertiary hospital for cancer care. Difficulty in registration (45%), time-consuming (34.5%), repeated examinations (34.5%) and different treatment opinions (12.0%) were the main difficulties they encountered currently during tertiary hospital visits. In community hospital, lack of trust in general practitioners (n = 33) and the necessary drugs or testing items in community hospitals (n = 47) were the main difficulties during their visits. Logistic regression analysis showed that male (OR = 2.737, 95% CI, 1.332-5.627, p = 0.006) and elderly patients (OR = 3.186, 95% CI, 1.172-8.661, p = 0.023) were more likely to choose general practitioners (GPs) in community hospitals. Twenty-nine (14.5%) patients hope to have an integrated multidisciplinary management in tertiary and community hospitals with the active participation of GPs for cancer care.Conclusion:Improving drug availability, equipment and quality of cancer care services can help to increase cancer patients' recognition of community hospital. In addition, the multidisciplinary management integrated tertiary hospitals and communities with the participation of GPs is a worth exploring mode that improves the management of cancer care.

The procollagen C-protease enhancer ( PCOLCE ) has been identified to influence tumor growth and metastasis in multiple cancers. However, the relationship between PCOLCE activity and the progression of gliomas remains largely unknown. Glioma RNA-seq data were derived from the Chinese Glioma Genome Atlas (CGGA) and The Cancer Genome Atlas databases for analysis. Kaplan–Meier survival curve, clinical characterization correlation, univariate and multivariate Cox, and receiver operating characteristic curve analyses were performed to assess the prognostic role of PCOLCE . Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and Gene Set Enrichment Analysis were used to determine the functions or pathways associated with PCOLCE . The ESTIMATE and CIBERSORT algorithms, Spearman’s rank correlation analysis, and Tumor Immune Estimation Resource (TIMER) databases were used to explore the relationship between PCOLCE and immune infiltration. Correlation analysis between PCOLCE , related genes, and immune cell markers was conducted using the TIMER database. Immunophenoscore assays were performed to determine differential PCOLCE expression levels in glioma. The sensitivity of multi-drugs were determined to explore potential chemotherapeutic agents in between PCOLCE. Compared to normal brain tissue, PCOLCE expression was increased in glioma and correlated with shorter overall survival (OS). Furthermore, significant differences were observed in the immune scores and immune cell infiltration levels. PCOLCE is positively associated with immune checkpoints and many immune markers. Additionally, PCOLCE expression was higher in gliomas with higher IPS Z-scores in CGGA. High expression of PCOLCE increased sensitivity to multiple chemotherapy agents in CGGA (P < 0.001), and TCGA. These results suggest that PCOLCE significantly influences the prognosis of patients with glioma, can serve as an independent prognostic factor, and is related to tumor immunity. PCOLCE may be a novel immune-related target for treating gliomas. Additionally, analysis of chemosensitivity in gliomas with high PCOLCE expression may provide a promising direction for drug development.

PurposeTo establish a predictive model to predict the occurrence of language deficit for patients after surgery of glioma involving language areas (GILAs) under general anesthesia (GA).MethodsPatients with GILAs were retrospectively collected in our center between January 2009 and December 2020. Clinical variables (age, sex, aphasia quotient [AQ], seizures and KPS), tumor-related variables (recurrent tumor or not, volume, language cortices invaded or not, shortest distance to language areas [SDLA], supplementary motor area or premotor area [SMA/PMA] involved or not and WHO grade) and intraoperative multimodal techniques (used or not) were analyzed by univariate and multivariate analysis to identify their association with temporary or permanent language deficits (TLD/PLD). The predictive model was established according to the identified significant variables. Receiver operating characteristic (ROC) curve was used to assess the accuracy of the predictive model.ResultsAmong 530 patients with GILAs, 498 patients and 441 patients were eligible to assess TLD and PLD respectively. The multimodal group had the higher EOR and rate of GTR than conventional group. The incidence of PLD was 13.4% in multimodal group, which was much lower than that (27.6%, P<0.001) in conventional group. Three factors were associated with TLD, including SDLA (OR=0.85, P<0.001), preoperative AQ (OR=1.04, P<0.001) and multimodal techniques used (OR=0.41, P<0.001). Four factors were associated with PLD, including SDLA (OR=0.83, P=0.001), SMA/PMA involved (OR=3.04, P=0.007), preoperative AQ (OR=1.03, P=0.002) and multimodal techniques used (OR=0.35, P<0.001). The optimal shortest distance thresholds in detecting the occurrence of TLD/PLD were 1.5 and 4mm respectively. The optimal AQ thresholds in detecting the occurrence of TLD/PLD were 52 and 61 respectively. The cutoff values of the predictive probability for TLD/PLD were 23.7% and 16.1%. The area under ROC curve of predictive models for TLD and PLD were 0.70 (95%CI: 0.65-0.75) and 0.72 (95%CI: 0.66-0.79) respectively.ConclusionThe use of multimodal techniques can reduce the risk of postoperative TLD/PLD after removing GILAs under general anesthesia. The established predictive model based on clinical variables can predict the probability of occurrence of TLD and PLD, and it had a moderate predictive accuracy.

Background: Recent studies have shown that the prognosis of low-grade glioma (LGG) patients is closely correlated with the immune infiltration and the expression of long-stranded non-coding RNAs (lncRNAs). It's meaningful to find the immune-related lncRNAs (irlncRNAs). Methods: The Cancer Genome Atlas (TCGA) data was employed in the study to identify irlncRNAs and Cox regression model was applied to construct the risk proportional model based on irlncRNAs. Results: In the study, we retrieved transcriptomic data of LGG from TCGA and identified 10 lncRNA signatures consisting of irlncRNAs by co-expression analysis. Then we plotted 1-year receiver operating characteristic (ROC) curves and calculated the area under the curve (AUC). LGG patients were divided into high-risk and low-risk groups according to the risk model. We found there were differences in survival prognosis, clinical characteristics, degree of immune cell infiltration, expression of immune gene checkpoint genes, and sensitivity to the commonly used chemotherapeutic agents of high-risk and low-risk groups. Conclusions: IrlncRNA-based risk assessment model can be used as a prognostic tool to predict the survival outcome and clinical characteristics of LGG and to guide treatment options.

Purpose To compare the multimodal techniques (including neuronavigation, intraoperative MRI [iMRI], and neuromonitoring [IONM]) and conventional approach (only guided by neuronavigation) in removing glioblastoma (GBM) with corpus callosum (CC) involvement (ccGBM), their effectiveness and safety were analyzed and compared. Methods Electronic medical records were retrospectively reviewed for ccGBM cases treated in our hospital between January 2016 and July 2020. Patient demographics, tumor characteristics, clinical outcomes, extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were obtained and compared between the multimodal group (used multimodal techniques) and the conventional group (only used neuronavigation). Both groups only included patients that had maximal safe resection (not biopsy). Postoperative radiochemotherapy was also performed or not. Univariate and multivariate analyses were performed to identify significant prognostic factors and optimal EOR threshold. Results Finally 56 cases of the multimodal group and 21 cases of the conventional group were included. The multimodal group achieved a higher median EOR (100% versus 96.1%, P = 0.036) and gross total resection rate (60.7% versus 33.3%, P = 0.032) and a lower rate of permanent motor deficits (5.4% versus 23.8%, P = 0.052) than the conventional approach. The multimodal group had the longer median PFS (10.9 versus 7.0 months, P = 0.023) and OS (16.1 versus 11.6 months, P = 0.044) than the conventional group. Postoperative language and cognitive function were similar between the two groups. In multivariate analysis, a higher EOR, radiotherapy, and longer cycles of temozolomide chemotherapy were positive prognostic factors for survival of ccGBM. An optimal EOR threshold of 92% was found to significantly benefit the PFS (HR = 0.51, P = 0.036) and OS (HR = 0.49, P = 0.025) of ccGBM. Conclusion Combined use of multimodal techniques can optimize the safe removal of ccGBM. Aggressive resection of EOR > 92% using multimodal techniques combined with postoperative radiochemotherapy should be suggested for ccGBM.

Wingless/Int-1 (Wnt) signaling is one of the most well-known oncogenic pathways. Numerous studies have uncovered an aberrant expression of Wnt in cancer and its association with multiple oncogenic processes, such as cell proliferation, epithelial–mesenchymal transition (EMT), and invasiveness. Most previous studies mainly focused on the canonical branch of Wnt signaling pathway, i.e., Wnt/β-catenin signaling. The Wnt/planar cell polarity (PCP) signaling pathway, as the most recently described branch of Wnt signaling, was much less investigated in oncology research. In this study, we thoroughly characterized the activity of the Wnt/PCP regulation pathway in low-grade glioma (LGG) patients. Subtyping based on the expression pattern of the Wnt/PCP regulation pathway revealed three (C1–C3) subgroups with significant survival differences. Each group displayed distinct genomic characteristics. For instance, C1 was enriched with capicua transcriptional repressor (CIC) truncating mutations and 1p19q codel. C2 was characterized with tumor protein p53 (TP53) and ATRX chromatin remodeler (ATRX) inactivating mutations but depletion of telomerase reverse transcriptase (TERT) promoter mutations. C3 showed elevated malignancy reflected from several oncogenic characteristics, such as tumor heterogeneity and cell stemness, and demonstrated the worst survival outcome. In addition, C3 showed elevated macrophage segregation via induction of cytokines that are able to enhance the permeability of the brain–blood barrier (BBB). Lastly, we developed a prognostic model based on the risk score system. Validation indicated that our model can independently predict the prognosis of LGG patients.

BACKGROUND:Homologous recombination deficiency (HRD) is characterized by overall genomic instability and has emerged as an indispensable therapeutic target across various tumor types, particularly in ovarian cancer (OV). Unfortunately, current detection assays are far from perfect for identifying every HRD patient. The purpose of this study was to infer HRD from the landscape of copy number variation (CNV).METHODS:Genome-wide CNV landscape was measured in OV patients from the Australian Ovarian Cancer Study (AOCS) clinical cohort and >10,000 patients across 33 tumor types from The Cancer Genome Atlas (TCGA). HRD-predictive CNVs at subchromosomal resolution were identified through exploratory analysis depicting the CNV landscape of HRD versus non-HRD OV patients and independently validated using TCGA and AOCS cohorts. Gene-level CNVs were further analyzed to explore their potential predictive significance for HRD across tumor types at genetic resolution.RESULTS:At subchromosomal resolution, 8q24.2 amplification and 5q13.2 deletion were predominantly witnessed in HRD patients (both p < 0.0001), whereas 19q12 amplification occurred mainly in non-HRD patients (p < 0.0001), compared with their corresponding counterparts within TCGA-OV. The predictive significance of 8q24.2 amplification (p < 0.0001), 5q13.2 deletion (p = 0.0056), and 19q12 amplification (p = 0.0034) was externally validated within AOCS. Remarkably, pan-cancer analysis confirmed a cross-tumor predictive role of 8q24.2 amplification for HRD (p < 0.0001). Further analysis of CNV in 8q24.2 at genetic resolution revealed that amplifications of the oncogenes, MYC (p = 0.0001) and NDRG1 (p = 0.0004), located on this fragment were also associated with HRD in a pan-cancer manner.CONCLUSIONS:The CNV landscape serves as a generalized predictor of HRD in cancer patients not limited to OV. The detection of CNV at subchromosomal or genetic resolution could aid in the personalized treatment of HRD patients.

Purpose: To explore molecular alterations and their correlation with the survival of patients with glioblastoma (GBM) with corpus callosum (CC) involvement (ccGBM). Methods: Electronic medical records were reviewed for glioma patients tested for molecular alterations and treated at our hospital between January 2016 and July 2020. ccGBM was compared to GBM without CC involvement (non-ccGBM) to identify differences in molecular alterations. Clinical outcomes and survival were compared between ccGBM and non-ccGBM patients, as well as among patients with ccGBM with different molecular alteration statuses. ccGBM was also compared to diffuse midline glioma (DMG) to clarify their correlation in molecular alterations, the progression-free survival (PFS), and overall survival (OS). Results: Thirty ccGBM and 88 non-ccGBM patients were included. PDGFRA amplification (PDGFRAamp, 33.3 vs. 9.1%, P = 0.004) and missense mutation (PDGFRAmut, 20.0 vs. 3.4%, P = 0.011) both had higher incidences in ccGBM than in non-ccGBM. PDGFRA alteration was associated with the occurrence of ccGBM (OR = 4.91 [95% CI: 1.55–15.52], P = 0.007). ccGBM with PDGFRAamp resulted in a shorter median PFS (8.6 vs. 13.5 months, P = 0.025) and OS (12.4 vs. 17.9 months, P = 0.022) than non-ccGBM with PDGFRAnon-amp. ccGBM with PDGFRAamp combined with PDGFRAmut (PDGFRAamp-mut) had a shorter median PFS (7.6 vs. 8.9 months, P = 0.022) and OS (9.6 vs. 17.8 months, P = 0.006) than non-ccGBM with wild-type PDGFRA and no amplification (PDGFRA-w, non-amp). Compared to ccGBM with PDGFRA-w, non-amp, ccGBM with PDGFRAamp and PDGFRAamp-mut both had a shorter median PFS and OS (P < 0.05). The hazard ratios (HRs) of PDGFRAamp for PFS and OS in ccGBM were 3.08 (95% CI: 1.02–9.35, P = 0.047) and 5.07 (1.52–16.89, P = 0.008), respectively, and the HRs of PDGFRAamp-mut for PFS and OS were 13.16 (95% CI: 3.19–54.40, P < 0.001) and 16.36 (2.66–100.70, P = 0.003). ccGBM may have similar incidences of PDGFRAamp or mut (PDGFRAamp/mut) as DMG, and they also had similar median PFS (10.9 vs. 9.0 months, P = 0.558) and OS (16.8 vs. 11.5 months, P = 0.510). Conclusion: PDGFRA alterations are significantly associated with the occurrence and poor prognosis of ccGBM. ccGBM with PDGFRAamp/mut may be classified as a single subtype of GBM that has a similar survival rate to DMG. PDGFR inhibitors may be a promising treatment method for ccGBM.

AIM:To analyze certain magnetic resonance imaging (MRI) features as well as six major genetic biomarkers, investigated their associations, and evaluated their prognostic roles in glioblastomas (GBMs).MATERIAL AND METHODS:Strict criteria included newly diagnosed GBM with optimal treatments. Simple manual imaging characteristics (tumor side, location, enhancement, diameter, depth, radiographic necrosis, and edema) were obtained from preoperative conventional MRI. Furthermore, all the status of the MGMT promoter, Chromosome 1p and 19q, IDH, TERT, and BRAF in tumor tissues were detected.RESULTS:Among 126 inpatients, 60 cases were selected and enrolled in the study. The status of the MGMT promoter was significantly associated with the grade of radiographic necrosis (p=0.033). The rate of 19q deletion was significantly higher in tumors with the ring-shaped peritumoral edema (PTE) (p=0.035) and in tumors with the ring-enhanced trait (p=0.023). Univariate analysis showed that a low PTE index and MGMT promoter methylation were both unfavorable prognostic factors. While the PTE index statistically dropped out, the status of the MGMT promoter and the depth of the tumor were observed to be independent prognostic factors in multivariate analysis.CONCLUSION:Based on simple neuroimaging metrics, novel connections between features of preoperative conventional MRI and status of major genetic biomarkers were observed, especially for the MGMT promoter and 19q.

Background: the plasma D-dimer and fibrinogen which are indicators of coagulation-fibrinolysis system has been reported to be associated with survival in several types of cancers, including RCC.The aim of our study was to assess the prognostic significance of preoperative plasma D-dimer and fibrinogen levels in RCC patients.Methods: Data from 449 patients with RCC were assessed retrospectively.Cutoff value for plasma D-dimer and fibrinogen were tested by the standardized cutoff-finder algorithm.Overall survival (OS) and disease-free survival (DFS) were evaluated using the Kaplan-Meier method.Univariate and Multivariate Cox regression models were further applied for two end points.Results: Multivariate analysis identified increased plasma D-dimer and fibrinogen as independent prognostic factors for OS (D-dimer, P=0.017; Fibrinogen, P=0.049) and DFS (D-dimer, P=0.038; Fibrinogen, P<0.001).Moreover, all the patients were stratified using these two factors in the following ways: (1) Low risk: both level of plasma D-dimer and fibrinogen were no more than cutoff value.(2) Intermediate risk: neither low risk nor high risk, (3) high risk: both level of plasma D-dimer and fibrinogen were higher than cutoff value.This model showed significant predictive power for OS and DFS.Conclusion: preoperatively elevated D-dimer and fibrinogen can be regard as independent predictors for patients' prognosis in RCC.Combining both plasma D-dimer and fibrinogen can improve the prognostic accuracy and easy accessibility in clinical practice.

Background: Malnutrition and systemic inflammatory response are frequently associated with prognosis in patients with several types of cancer, including renal cell carcinoma (RCC). The study is aimed to investigate the ability of preoperative serum albumin to globulin ratio (AGR) to predict the long-term mortality of RCC patients. Methods: The study is a retrospective study of an unselected cohort of 895 RCC patients who underwent a curative radical or partial nephrectomy at the Department of Urology in the Sun Yat-Sen University Cancer Center between January 2000 and December 2012 and had documented preoperative serum total protein and albumin (ALB) levels. The preoperative AGR was calculated as the ratio of ALB to (total protein-ALB) and its association with other clinical indices was assessed using survival analysis. Results: Low preoperative AGR was associated with older population, lower hemoglobin, higher total protein, lower ALB, lower body mass index and advanced stage. The univariate and multivariate Cox analyses demonstrated that preoperative AGR was an independent prognostic indicator of overall survival (OS) (hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.43 to 0.93, P=0.022). In addition, patients with low preoperative AGR at pT1-2, pT3-4, pN0, pN1, pM0 and pM1 stages had significantly shorter OS than patients with high preoperative AGR. Conclusion: Preoperative AGR is a proven objective, reproducible, inexpensive survival predictor of RCC patients following surgical resection and should be considered for routine clinical use.

The preoperative C-reactive protein/Albumin (CRP/Alb) ratio has been shown to be valuable in predicting the prognosis of patients with certain cancers. The aim of our study is to explore its prognostic value in patients with renal cell carcinoma (RCC).

PURPOSE:The prognostic value of serum cystatin-C (Cys-C) in renal cell carcinoma (RCC) remains unknown. The purpose of this study is to explore the prognostic value of Cys-C for RCC patients.PATIENTS AND METHODS:The levels of preoperative Cys-C, creatinine (CRE) and estimated glomerular filtration rate (e-GFR) were retrospectively collected in 325 RCC patients undergoing surgery. The cutoff values of Cys-C, CRE and e-GFR were determined by the standardized Cutoff Finder algorithm. The receiver operating characteristic (ROC) curve and pairwise comparison were performed to compare the three variables. Univariate and multivariate Cox regression analyses were performed to investigate the prognostic value of serum Cys-C in RCC.RESULTS:Based on the analysis of Cutoff Finder algorithm, ROC curve and pairwise comparison, the preoperative Cys-C was superior to CRE and e-GFR as a predictive factor in RCC. Multivariate Cox regression analyses showed that high preoperative Cys-C (>1.09 mg/L) was significantly associated with shorter overall survival (OS) in all RCC patients (hazard ratio [HR], 1.59; P = 0.012), patients at pT1-2 (P<0.001), pN0 (P<0.001) and pM0 stages (P<0.001). Moreover, Multivariate Cox regression analyses also showed that in the 306 patients without metastasis, high preoperative Cys-C was also associated with shorter disease-free survival (DFS) (HR, 3.50; P = 0.013).CONCLUSIONS:An elevated preoperative Cys-C level was demonstrated to be related with worse survival in patients with RCC. Measuring preoperative serum Cys-C might be a simple way for finding poor prognostic patients and patients with elevated preoperative Cys-C level should be more closely followed up.

Subtentorial ependymoma is a common central nervous system tumor in young children, but is uncommon in adults. Ependymoma often arises from the cells lining the fourth ventricle. The present study reports a rare case of primary ependymoma that originated from the cerebellopontine angle, with local extension to the two internal auditory canals and remote spinal metastasis, in an adult male. A 50-year-old male presented with headache, tinnitus and bilateral hearing loss that had persisted for 4 months. Magnetic resonance imaging (MRI) revealed a mass in each of the cerebellopontine angles, which had spread to each internal auditory canal and wrapped the VII/VIII cranial nerve complex. A gross total resection was performed to remove the mass in the right side. Histological examination confirmed that the tumor was a World Health Organization grade II papillary ependymoma. Notably, the patient complained of urine retention post-surgery and massive occupational lesions in T3-T4 and L5-S2 were found on full spinal cord MRI. The patient then received combination therapy consisting of temozolomide, and whole-brain and spinal cord radiation. In the final follow-up examination, performed 13 months after treatment, slight shrinkage of the T3 lesion was observed, and no progression of the left cerebellopontine angle and S5-L2 lesions were identified on MRI. In summary, although this clinical entity is rare, the diagnosis of ependymoma and the possibility of spinal cord metastasis should be considered in subtentorial tumors.