The C-reactive protein/albumin ratio (CAR) has been shown to play a significant prognostic role in several cancers. We aimed to comprehensively explore the potential role of the CAR as a prognostic indicator in solid cancers. In this meta-analysis, we collected data from 10 studies that examined the association between serum CAR and overall survival in patients with cancer. This meta-analysis included 4592 tumor patients. The eligible studies were found through the PubMed and Web of Science databases updated on 6 Oct 2016. The pooled hazard ratio (2.01, 95% CI: 1.58–2.56, p < 0.001) indicated that high CAR yielded worse survival in different cancers. Subgroup analyses showed a significant association between CAR and prognosis, regardless of the cutoff value, cutoff value selection, treatment method, country, sample size, stage and cancer type. This meta-analysis suggests that CAR may be a potential prognostic marker in solid cancers. However, further large prospective studies should be conducted to explore the critical role of CAR in survival of cancer patients.

Incidence and prognosis factors of extragonadal choriocarcinoma in males: a population-based study Jingping Qiu,1 Shi Jia,2 Guang Li1 1Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China; 27th General Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, China Background: Choriocarcinoma usually occurs in females and sometimes occurs in the testicles of males. Extragonadal choriocarcinoma in males was previously described in case reports, and our understanding of this type of cancer has remained limited. The purpose of this study was to explore the incidence, treatment and prognostic factors of extragonadal choriocarcinoma in males. Materials and methods: Two cohorts were identified from the Surveillance, Epidemiology, and End Results (SEER) Program by histology, tumor site and sex. One cohort of 115 patients was created using the SEER nine registries (1973–2014) to estimate the incidence. The other cohort of 197 patients was created using the SEER 18 registries (1973–2013) to estimate the patient demographics and survival. Results: The median age at diagnosis was 30 years. The most common primary tumor location was the mediastinum followed by the retroperitoneum and the brain. Approximately 23% of patients underwent beam radiation therapy, whereas 63.5% underwent surgery. The estimated one- and 5-year cause-specific survival rates were 49% and 35%, respectively. The multivariate analysis showed that the age at diagnosis, ie, a younger age of 0–19 years old, and the primary tumor site, ie, the brain, were the independent prognostic factors and were correlated with a favorable prognosis. The median survival time of patients was 186 months, 13 months and 4 months in the 0–19, 20–49 and 50+ years of age, respectively. Conclusion: Extragonadal choriocarcinoma in males is a rare malignancy with a poor prognosis. A young age at diagnosis and primary tumor site in the brain were the independent prognostic factors. Keywords: choriocarcinoma, incidence, beam radiation, surgery, prognosis

Purpose: The purpose of this study was to estimate the relation between acute esophagitis (AE) and clinical, dosimetric, and position factors in patients with locally advanced non-small-cell lung cancer (NSCLC) receiving intensity-modulated (chemo)radiotherapy. Materials and methods: A retrospective cohort analysis was performed to identify factors associated with Common Toxicity Criteria for Adverse Events grade 2 or worse AE (AE2+). A multivariable model was established including patient- and treatment-related variables and esophageal dose–volume histogram parameters. The esophagus was divided according to physiological anatomy, and logistic regression was used to analyze the position parameter for its correlation with AE2+. Results: The incidence of AE2+ was 27.5%. All models included gender, concurrent chemoradiotherapy (CCRT), position parameter, and one of the dosimetric variables. The model with mean dose showed the best goodness of fit. Gender (OR=2.47, P=0.014), CCRT (OR=3.67, P=0.015), mean dose (OR=1.33, P<0.001), and maximum radiation position (OR=1.65, P=0.016) were significantly related to AE2+. Conclusion: Gender, concurrent chemotherapy, maximum radiation position, and mean dose were independent risk factors for AE2+. The upper part of the esophagus showed a higher sensitivity to radiation toxicity.

Immunotherapy with anti‑programmed cell death protein 1 or programmed death ligand 1 (PD‑L1) agents has demonstrated promising efficacy for the treatment of various types of malignancies. However, the role of PD‑L1 as a tumor prognostic marker remains poorly understood. In the present study, the prognostic value of PD‑L1 expression in esophageal carcinoma (EC) following definitive chemoradiotherapy (CRT) was investigated, and its associations with three systemic inflammation biomarkers, neutrophil‑to‑lymphocyte ratio (NLR), platelet‑to‑lymphocyte ratio (PLR) and lymphocyte-to‑monocyte ratio (LMR) were further explored. A total of 104 patients with non‑metastatic EC, who underwent definitive CRT between January 2009 and December 2012, were retrospectively analyzed. The expression of PD‑L1 was examined by immunohistochemistry and the impact of PD‑L1 expression level on overall survival (OS) was assessed. Furthermore, pretreatment neutrophil, lymphocyte, platelet and monocyte counts were obtained from routine blood tests to calculate the NLR, PLR and LMR. PD‑L1 was overexpressed in EC compared with normal esophageal epithelium, with a positive expression rate of 37.5%. Additionally, patients with positive PD‑L1 expression had a lower NLR than those with negative PD‑L1 expression (P=0.001). On multivariate analysis, the positive staining of PD‑L1 was significantly associated with improved OS (HR, 0.6; 95% CI, 0.372‑0.965; P=0.035). Kaplan‑Meier survival analysis showed a similar result (P=0.009). Additionally, sex (HR, 0.449; 95% CI, 0.229‑0.880; P=0.020), clinical stage III (HR, 2.471; 95% CI, 1.171‑5.212; P=0.018), and receipt of concurrent chemoradiation (HR, 0.590; 95% CI, 0.368‑0.945; P=0.028) were all independent prognostic factors in EC treated with definitive CRT. The correlation of NLR with PD‑L1 expression validated the relevance of immunity and inflammation. In summary, the present study demonstrated that positive PD‑L1 expression is associated with improved survival in patients with EC treated with radical CRT, indicating that PD‑L1 is a promising prognostic marker.

Background/Aims: We aimed to study the clinical characteristics, treatment modality, and the prognosis of synchronous multiple primary esophageal squamous cell carcinomas (SMPESCC).Methods: A total of 117 SMPESCC cases were evaluated retrospectively from 2010 to 2015.Results: The most common locations of SMPESCC were mid- and lower thoracic segments (n = 208, 84.9%). The 1-, 2-, and 3-year overall survival rates were 53.8%, 30.8%, and 15.4%, respectively; the median survival time (MST) was 12.5 months. With definitive radiotherapy and surgery, respectively, the MST of stage I/II patients were 34.2 and 26.7 months, of stage III patients were 8.3 and 13.2 months (p = 0.163), and of stage IV patients were and 8 and 12.6 months (p = 0.379). Clinical stage, family history of cancer, and Karnofsky performance status were independent prognostic factors for the whole cohort by Cox multivariate regression analysis (hazard ratio [HR] = 0.859, p < 0.001; HR = 0.579, p = 0.032; and HR = 0.586, p = 0.013).Conclusions: Although the prognosis of SMPESCC is poor, stage I/II patients can achieve long-term survival with aggressive treatment, especially those with a Karnofsky performance score 90 or higher and who have no family history of cancer. Definitive radiotherapy could achieve a similar survival rate to definitive surgery at different clinical stages.

Purpose: In this retrospective study, we evaluated the treatment patterns and survival after positron emission tomography-computed tomography (PET/CT)-guided local consolidation therapy (LCT) for oligometastatic non-small cell lung cancer (NSCLC). Methods: We reviewed the medical records of Chinese patients with oligometastatic stage IV non-small cell lung cancer (≤ 5 metastases) who had undergone PET/CT and were eligible for systemic therapy at two centers between May 2005 and August 2019. Propensity score matching (1:1) was used to reduce selection bias and imbalanced distribution of confounding factors. Results: We identified 84 eligible patients and used propensity scores to create well-matched groups of 35 patients who did or did not undergo LCT. Among all patients, the 1-year overall survival (OS) rate was 47.6% and the 2-year OS rate was 22.6%. Relative to the group that did not receive LCT, the LCT group had a significantly higher OS rate (13 months vs. 7 months, p = 0.002). The two groups had similar incidences and classifications of LCT-related side effects. In multivariable analysis, LCT was found to be strongly associated with a favorable OS (hazard ratio: 0.508, 95% confidence interval: 0.311–0.828, p = 0.001). Conclusion: We concluded that LCT was significantly associated with improved clinical outcomes among the Chinese patients with oligometastatic NSCLC who were eligible for systemic treatment and could undergo PET/CT evaluation.