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Background: The geriatric oncology population tends to be complex because of multimorbidity, functional and cognitive decline, malnutrition and social frailty. Prognostic indices for predicting survival of elderly cancer patients to guide treatment remain scarce. A nomogram based on all domains of the geriatric assessment was previously developed at the National Cancer Centre Singapore (NCCS) to predict overall survival (OS) in elderly cancer patients. This nomogram comprised of six variables (age, eastern cooperative oncology group performance status, disease stage, geriatric depression scale (GDS), DETERMINE nutritional index and serum albumin). Objectives: To externally validate the NCCS prognostic nomogram. Design: This is a prospective cohort study. Methods: The nomogram was developed based on a training cohort of 249 patients aged ⩾70 years who attended the NCCS outpatient geriatric oncology clinic between May 2007 and November 2010. External validation of the nomogram using the Royston and Altman approach was carried out on an independent testing cohort of 252 patients from the same clinic between July 2015 and June 2017. Model misspecification, discrimination and calibration were assessed. Results: Median OS of the testing cohort was 3.1 years, which was significantly higher than the corresponding 1.0 year for the training cohort (log-rank p < 0.001). The nomogram achieved a high level of discrimination in the testing cohort (0.7112), comparable to the training cohort (0.7108). Predicted death probabilities were generally well calibrated with the observed death probabilities, as the joint test of calibration-in-the-large estimates at year 1, 2 and 3 from zeros and calibration slope from one was insignificant with p = 0.432. There were model misspecifications in GDS and serum albumin. Conclusion: This study externally validated the prognostic nomogram in an independent cohort of geriatric oncology patients. This supports the use of this nomogram in clinical practice.
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Polycyclic aromatic hydrocarbons (PAHs) are among the most health-relevant air pollutants. Herein, we conducted meta-analysis and experimental validation to evaluate PAHs in our surroundings and carcinogenic risks. We summarized the occurrence of PAHs in outdoors and indoors from 131 studies with 6,766 samples collected in different countries in 1989-2019. The global weighted-median concentration in outdoor air, indoor air and dust of ΣPAHs were 142 ng/m3, 369 ng/m3 and 10,201 ng/g; respectively. ΣPAHs have decreased in indoor air but remained steady in outdoor air and indoor dust. More carcinogenic PAHs in indoor/outdoor air was observed in Asia, while in dust was North America. Monte-Carlo simulation further showed indoor sources for children's exposure from dust and air can exceed outdoor. To further validate the health effect of PAHs from indoors, 15 more recent indoor dust samples were collected to examine their mutagenicity. The results showed that ΣPAHs were found to be significantly correlated with mutagenicity potency in the dust sample metabolically activated with liver S9 subcellular fraction and likely accounted for 0.42-0.50 of the mutagenic activity. Our findings indicated that PAHs are still likely to have carcinogenic activity in indoor environments and exposure risk of children to indoor dust should be emphasized.