Establishment and evaluation of a multivariate Cox proportional-hazards prediction model for mortality during short-term hospitalization in patients with liver cirrhosis and sepsis / 临床肝胆病杂志

Objective To establish a Cox proportional-hazards prediction model for mortality during short-term hospitalization in patients with liver cirrhosis and sepsis. Methods A retrospective analysis was performed for the clinical data of 336 patients with liver cirrhosis and sepsis who were admitted to The Third People's Hospital of Kunming from January 2012 to August 2022, and according to whether the patient died during short-term hospitalization, they were divided into death group with 40 patients and survival group with 296 patients. Demographic data, comorbidities, and clinical biochemical parameters were collected and compared between the two groups. The independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The multivariate Cox analysis was used for screening of variables, then a Cox proportional-hazards prediction model was established, and hazard ratio ( HR ) and its 95% confidence interval [ CI ] were calculated; C-index index was used to evaluate the prediction accuracy of the model. The Cox proportional-hazards prediction model was visualized by a nomogram, and calibration curve was plotted to evaluate the consistency between the prediction results of the model and the actual condition. Results Among the 336 patients, there were 261 male patients (77.7%) and 75 female patients (22.3%), with a mean age of 50.0±10.6 years, and 40 patients died, with a mean hospital stay of 16.8±11.3 days (range 8.2-23.0 days). Compared with the survival group, the death group had a significantly higher proportion of patients with an age of ≥60 years, a history of invasive operation within the past two weeks, gastrointestinal bleeding, hepatic encephalopathy (HE) or hepatorenal syndrome (HRS), a significantly higher Modified Early Warning Score (MEWS) score, and significantly higher levels of prothrombin time (PT), activated partial thromboplastin time, international normalized ratio, D-dimer, CD4/CD8 ratio, lactate, white blood cell count, norepinephrine, total bilirubin, interleukin-6, procalcitonin, high-sensitivity C-reactive protein (hsCRP), blood urea nitrogen, and creatinine (all P < 0.05), as well as significantly lower levels of red blood cell count, hemoglobin, albumin, total cholesterol, low-density lipoprotein, and high-density lipoprotein (all P < 0.05). The multivariate Cox regression analysis showed that age ( HR =2.602, 95% CI : 1.277-5.303, P =0.008), HE ( HR =2.516, 95% CI : 1.258-5.033, P =0.009), HRS ( HR =2.324, 95% CI : 1.010-5.349, P =0.047), hsCRP ( HR =1.008, 95% CI : 1.003-1.013, P =0.004), MEWS score ( HR =1.205, 95% CI : 1.022-1.422, P =0.027), and PT ( HR =1.076, 95% CI : 1.030-1.124, P =0.027) were independent influencing factors for death in patients with liver cirrhosis and sepsis. The model showed a C-index of 0.857 (95% CI : 0.815-0.920), suggesting that the model had relatively high prediction accuracy, and the calibration curve showed good consistency between the predicted risk and the actual risk. Conclusion The Cox proportional-hazards prediction model established for death during short-term hospitalization in patients with liver cirrhosis and sepsis can be used to predict the risk of death during short-term hospitalization in patients with liver cirrhosis and sepsis, thereby guiding clinical medical staff to take targeted intervention measures to avoid or reduce the possibility of death in patients.

Establishment and application of a nomogram model for prognostic risk prediction in patients with epithelial ovarian cancer / 中华妇产科杂志

Objective:To explore the prognostic factors of epithelial ovarian carcinoma (EOC), construct a nomogram model, and evaluate the prognosis of EOC patients.Methods:A retrospective analysis was performed on clinicopathological data of 208 cases of EOC patients who received initial treatment in the First Affiliated Hospital of Army Medical University from August 11, 2016 to July 11, 2018, including age, preoperative ascites, preoperative neoadjuvant chemotherapy, surgical method, pathological type, pathological differentiation degree, surgical pathology stage, preoperative and post-chemotherapy serum cancer antigen 125 (CA 125) level, human epididymal protein 4 (HE4) level, platelet count and platelet/lymphocyte number ratio (PLR). The univariate and multivariate Cox risk ratio models were used to analyze the related factors affecting progression free survival (PFS) in EOC patients, and the prediction nomogram of PFS in EOC patients was established to evaluate its efficacy in predicting PFS. Results:Univariate analysis showed that preoperative neoadjuvant chemotherapy, pathological type, pathological differentiation degree, surgical pathology stage, serum CA 125 and HE4 level before operation and after chemotherapy, platelet count and PLR before operation and after chemotherapy were significantly correlated with PFS in EOC patients (all P<0.05). Multivariate analysis showed that surgical pathology stage, preoperative PLR, serum CA 125 and HE4 level after chemotherapy were independent prognostic factors affecting PFS of EOC patients (all P<0.01). The index coefficient of the prediction model for the prognosis of EOC patients established by this method was 0.749 (95% CI: 0.699-0.798), which had good prediction ability, and could help clinicians to more accurately evaluate the prognosis of EOC patients. Conclusion:The nomogram model constructed based on surgical pathology stage, preoperative PLR, serum CA 125 and HE4 level after chemotherapy could effectively predict the PFS of EOC patients after initial treatment, could help clinicians to screen high-risk patients, provide individualized treatment, and improve the prognosis of EOC patients.

Construction and verification of tumor microenvironment-related gene prognostic model for adrenocortical carcinoma / 肿瘤研究与临床

Objective:Bioinformatics method was used to screen out prognostic model constructed by the tumor microenvironment (TME)- related genes of adrenocortical carcinoma (ACC), and the prognostic model was verified to provide clinical guidances and related biomarkers for the diagnosis and treatment of ACC.Methods:Transcriptome and clinicopathological data of 79 ACC patients were collected from the Cancer Genome Atlas (TCGA) database. ESTIMATE algorithm was used to calculate immune score, stromal score (both reflect TME) and ESTIMATE score; VennDiagram was used to select differentially expressed genes among immune score, high and low stromal score groups (grouped by median value); Gene Ontology (GO) database and Kyoto Encyclopedia of Genes and Genome (KEGG) database were used to perform functional enrichment analysis on selected genes and to explore the potential function and pathway of genes. Univariate Cox analysis, lasso regression analysis and multivariate Cox analysis were used to screen out genes related to ACC TME and to establish risk score (RS) model for ACC patients. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of RS. The data sets GSE33371 and GSE19750 of Gene Expression Omnibus (GEO) were used as external validation sets to validate the prognostic model. The data of 79 ACC patients were extracted from the TCGA database, and the clinicopathological factors and the RS of the established prognostic model were included in the Cox regression analysis to obtain the prognostic factors of ACC patients.Results:According to the immune score and stromal score, 1 205 differentially expressed genes from intersection of both scores were screened out by using VennDiagram, including 833 up-regulated genes and 372 down-regulated genes. After continuing the regression analysis and screening of differentially expressed genes, the ACC prognostic model containing 9 TME-related genes (GREB1, POU4F1, HIC1, HOXC9, CACNB2, RAB27B, ZIC2, C3, CYP2D6) was finally constructed, that was, RS = GREB1×0.223 6+POU4F1×0.671 7+HIC1×0.167 5+HOXC9×0.211 3+CACNB2×0.156 0+RAB27B×0.956 5+ZIC2×0.582 7+C3×(-0.003 1)+CYP2D6×0.819 3. The area under the curve (AUC) of ROC for the 1, 3, and 5-year overall survival of 79 ACC patients predicted by the model in the TCGA database was 0.876, 0.919, 0.917, respectively. In the GEO validation set, the AUC of the 1, 3, and 5-year overall survival for 45 ACC patients predicted by the model was 0.689, 0.704, and 0.708, respectively, indicating that the model had a high prediction accuracy for survival results of ACC patients. Cox regression analysis on the data of 79 ACC patients in the TCGA database showed that the TME-related gene prognostic model RS was an independent factor influencing the prognosis of ACC patients ( HR = 1.011, 95% CI 1.005-1.016, P < 0.01). Conclusions:The established ACC TME-related gene prognostic model can be used to predict the prognosis of ACC patients. The model including 9 genes may become a new target for studying the pathogenesis and immunotherapy of ACC, and it is worthy of further research.

Screening and identification of potential long non-coding RNA for the prognosis evaluation of glioma patients based on bioinformatics analysis / 肿瘤研究与临床

Objective:To investigate the possibility of screened long non-coding RNA (lncRNA) as a prognostic marker in evaluating glioma.Methods:A total of 694 glioma samples and 5 tumor-adjacent tissues were selected in the Cancer Genome Atlas (TCGA) database from the establishment of the database to December 2018. The differential lncRNA, microRNA (miRNA) and mRNA between glioma tissues and 5 tumor-adjacent tissues were screened out, the correlation between the three and the prognosis of glioma patients was analyzed, and a competitive endogenous RNA (ceRNA) network was constructed. The biological functions of mRNA were enriched and analyzed based on Gene Ontology (GO) database and Kyoto encyclopedia of genes and genomes (KEGG) database. The survival analysis of patients with different expression levels of lncRNA, miRNA or mRNA were performed by using Kaplan-Meier method to obtain lncRNA, miRNA and mRNA related to prognosis. Univariate and multivariate Cox proportional hazards regression models were used to analyze the different lncRNAs in the ceRNA network, and an lncRNA prognosis model for predicting the 5-year overall survival rate of patients was constructed. According to the constructed model, the risk value of each sample in 694 samples in TCGA database was calculated. Taking the median risk value as the critical value, patients were divided into high-risk group (≥ median risk value) and low-risk group (< median risk value), and the survival curves of the two groups were drawn. The receiver operating characteristic (ROC) curve was drawn for predicting the 5-year overall survival rate of glioma patients in TCGA database according to the risk value of lncRNA prognosis model. The heat map of lncRNA gene expression levels in the prognostic model of patients in high-risk and low-risk groups was drawn with pheatmap R software package.Results:A total of differential 44 lncRNAs, 19 miRNAs and 54 mRNAs between glioma and tumor-adjacent tissues were obtained from TCGA database, and the ceRNA network map was drawn. Kaplan-Meier method showed that among them, 22 differential lncRNAs, 7 miRNAs and 38 mRNAs were related to the overall survival of patients. The univariate Cox regression analysis obtained 28 lncRNAs related to prognosis. After multivariate Cox regression analysis, Akaike information criterion (AIC) was used to seek the optimal prognostic risk model involving 16 lncRNAs, that was, risk value = ARHGAP31-AS1×(-0.357 7)+LY86-AS1×(0.155 1)+WARS2-IT1×(0.206 4)+PART1×(-0.110 0)+AC110491.1×(-0.142 6)+CACNA1C-IT2×(-0.381 3)+HAS2-AS1×(0.128 8)+AC092171.1×(-0.161 3)+CCDC26×(-0.144 2)+HCG15×(0.384 0)+AL359541.1×(-0.289 2)+GRM5-AS1×(0.120 5)+LINC00237×(-0.085 1)+LINC00310×(-0.213 0)+VCAN-AS1×(-0.090 3)+ LINC00303×(0.091 5). The median risk value was 0.758 calculated by the constructed model. The 5-year overall survival rate in the high-risk group was 16.8% (95% CI 11.4%-24.7%) and 75.7% (95% CI 68.5%-83.7%) in the low-risk group. The area under of ROC curve of 5-year overall survival predicted by lncRNA model was 0.893. Through the heat map, it can be found that the expression level of all lncRNAs in the model was different between high-risk and low-risk patients. Conclusions:The prognostic risk model constructed based on the screened lncRNAs can better evaluate the prognosis of glioma patients. These lncRNAs are expected to become new candidate biomarkers related to the prognosis of glioma.

Application of conditional inference forest in time-to-event data analysis / 南方医科大学学报

OBJECTIVE@#To explore the application and advantages of conditional inference forest in survival analysis.@*METHODS@#We used simulated experiment and actual data to compare the predictive performance of 4 models, including Coxproportional hazards model, accelerated failure time model, random survival forest model and conditional inference forest model based on their Brier scores.@*RESULTS@#Simulation experiment suggested that both of the two forest models had more accurate and robust predictive performance than the other two regression models. Conditional inference forest model was superior to the other models in analyzing time-to-event data with polytomous covariates, collinearity or interaction, especially for a large sample size and a high censoring rate. The results of actual data analysis demonstrated that conditional inference forest model had the best predictive performance among the 4 models.@*CONCLUSIONS@#Compared with the commonly used survival analysis methods, conditional inference forest model performs better especially when the data contain polytomous covariates with collinearity and interaction.

Estrategia de autocuidado en los adultos mayores con cáncer colorrectal en la comunidad / Self-care strategy in elderly adults with colorrectal cancer in the community

RESUMEN Fundamento: la probabilidad de adquirir cáncer colorrectal en Cuba a lo largo de la vida es del cuatro al seis por ciento. Alrededor del 80 % de los casos son esporádicos, pero el 20 % tiene una influencia genética. Objetivo: evaluar la estrategia de autocuidado en los adultos mayores con cáncer colorrectal en la comunidad. Métodos: se realizó un estudio de intervención y desarrollo el cual muestra la estrategia de autocuidado en los adultos mayores con cáncer colorrectal en la comunidad contextualizada en el Policlínico Dr. Rudesindo Antonio García del Rijo del municipio y provincia Sancti Spíritus desde el 2007 hasta 2017. Variables utilizadas: nivel de información de los médicos de la familia, autocuidado, estado de salud, prolongación de la sobrevida, alivio del dolor. Se utilizó entrevista estructurada, a los adultos mayores con cáncer colorrectal para conocer la mejoría del estado de salud, después de aplicada la estrategia se compararon las proporciones poblacionales mediante prueba de McNemar. Resultados: se lograron cambios significativos en el nivel de información de los médicos de la familia, al finalizar el programa de capacitación se obtuvo 78,37 %, lo que muestra un nivel aceptable. El 36,62 % del estado de salud de los adultos mayores fue bueno; el autocuidado se alcanzó de forma aceptable en el 44,82 %. La prolongación de la sobrevida después de aplicada la estrategia fue de 49,13 %. El alivio del dolor fue de 76,72 %. Conclusiones: se logró la evaluación de la estrategia de autocuidados en los adultos mayores con cáncer colorrectal, que incluye acciones y actividades que favorecen el logro de cambios significativos en el autocuidado.

ABSTRACT Background: the probability of acquiring colorectal cancer in Cuba throughout life is four to six percent. Approximately 80 % of cases are sporadic, but 20% have a genetic influence. Objective: to evaluate the strategy of self-care in the elderly with colorectal cancer in the community. Method: intervention and development study was carried out, which shows the strategy of self-care in older adults with colorectal cancer in the community contextualized in the Dr. Rudesindo Antonio García del Rijo Polyclinic of the Municipality and Province of Sancti Spíritus in the period 2007-2017. The used variables were level of information of family doctors, self-care, health status, prolongation of survival, pain relief. Structured interview to older adults with colorectal cancer was used to know the improvement of the state of health, after applying the strategy, population proportions were compared by McNemar test. Results: significant changes were achieved in the level of information of family doctors at the end of the training program obtained 78.37 % which shows an acceptable level. 36.62 % of the health status of the elderly was good; self-care was achieved in an acceptable way in 44.82 %. The prolongation of the survival after applying the strategy was 49.13 %. The pain relief was 76.72 %. Conclusions: the evaluation of the self-care strategy in the elderly with colorectal cancer was achieved, which includes actions and activities that favor the achievement of significant changes in self-care.

Construction and evaluation of a predictive model for post-operative prognosis of hepatitis B virus-related hepatocelluar carcinoma / 肿瘤

Objective: To construct and evaluate a nomogram model for predicting the survival rate of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients after radical resection. Methods: The clinical parameters of 396 patients with HBV-related HCC who underwent radical resection were enrolled and sorted out as the training cohort of nomogram model. The data of 200 patients with HBV-related HCC after operation were used as the independent validation cohort to construct the a survival predicting nomogram model. Results: After univariate and multivariate COX regression analyses, the five independent risk factors significantly associated with the overall survival (OS) of patients with HBV-related HCC were identified (all P < 0.01). The five variables were portal vein tumor thrombosis, post-operative antiviral treatment, tumor differentiation, tumor capsule and pre-operative HBV DNA. A nomogram model was constructed based on these five variables. The calibration curves of 1-and 3-year OS showed good concordance between the prediction and actual observation. The concordance index (C-index) obtained from training cohort was 0.74 [95% confidence interval (CI): 0.70-0.77], while that obtained from validation cohort was 0.70 (95% CI: 0.65-0.76). Based on the nomogram scores, the patients in validation cohort were stratified into high-and low-risk groups. The survival rate of the patients in high-risk group was significantly lower than that in low-risk group (P = 9.79×10-6). Conclusion: The nomogram model constructed with 5 independent factors can predict the post-operative OS of HBV-related HCC patients.

Interactions between Alcohol Consumption and Adjuvant Hormone Therapy in Relation to Breast Cancer-Free Survival / 한국유방암학회지

PURPOSE: Alcohol consumption is associated with an increase in breast cancer risk, but findings on the association of alcohol with survival after breast cancer diagnosis have been inconsistent. Further, whether these associations could differ by adjuvant hormone therapy status is unknown. We examined interactions between alcohol consumption and adjuvant hormone therapy in relation to breast cancer-free survival among women with a primary breast cancer diagnosis. METHODS: Participants in this study included 1,399 women diagnosed with primary breast cancer between 2007 and 2012 at the Moffitt Cancer Center. Alcohol consumption during the year preceding diagnosis was assessed in a patient survey. Information on tumor characteristics, breast cancer treatment and outcomes was available from the Moffitt Cancer Registry. Associations were examined using Cox proportional hazards models in stratified analyses by adjuvant hormone therapy status, after adjustment for potential confounders. RESULTS: Overall, alcohol consumption was associated with significantly improved breast cancer-free survival (any vs. none: hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.65–0.92). Among women without adjuvant hormone therapy, alcohol consumption was associated with better survival in heavy drinkers (HR, 0.63; 95% CI, 0.43–0.93). Among women with adjuvant hormone therapy, survival was better in women consuming alcohol as compared to nondrinkers (moderate: HR, 0.69, 95% CI, 0.51–0.93; heavy: HR, 0.74, 95% CI, 0.57–0.96; any: HR, 0.71, 95% CI, 0.57–0.87). There was no significant interaction between alcohol and adjuvant hormone therapy (p-interaction=0.54 for alcohol modeled as none or any and p=0.34 for alcohol modeled as none, moderate, and heavy). CONCLUSION: Associations of alcohol consumption with breast cancer-free survival are similar in women with and without adjuvant hormone therapy. Future studies are warranted to elucidate potential mechanisms underlying the observed inverse associations.

Prognostic models for locally advanced cervical cancer: external validation of the published models / 부인종양

OBJECTIVE: To externally validate the prognostic models for predicting the time-dependent outcome in patients with locally advanced cervical cancer (LACC) who were treated with concurrent chemoradiotherapy in an independent cohort. METHODS: A historical cohort of 297 women with LACC who were treated with radical concurrent chemoradiotherapy from 1999 to 2014 at the 12 de Octubre University Hospital (H12O), Madrid, Spain. The external validity of prognostic models was quantified regarding discrimination, calibration, measures of overall performance, and decision curve analyses. RESULTS: The review identified 8 studies containing 13 prognostic models. Different (International Federation of Gynecology and Obstetrics [FIGO] stages, parametrium involvement, hydronephrosis, location of positive nodes, and race) but related cohorts with validation cohort (5-year overall survival [OS]=70%; 5-year disease-free survival [DFS]=64%; average age of 50; and over 79% squamous cell) were evaluated. The following models exhibited good external validity in terms of discrimination and calibration but limited clinical utility: the OS model at 3 year from Kidd et al.'s study (area under the receiver operating characteristic curve [AUROC]=0.69; threshold of clinical utility [TCU] between 36% and 50%), the models of DFS at 1 year from Kidd et al.'s study (AUROC=0.64; TCU between 24% and 32%) and 2 years from Rose et al.'s study (AUROC=0.70; TCU between 19% and 58%) and the distant recurrence model at 5 years from Kang et al.'s study (AUROC=0.67; TCU between 12% and 36%). CONCLUSION: The external validation revealed the statistical and clinical usefulness of 4 prognostic models published in the literature.

Establishment of a predictive model for early virologic response in previously untreated chronic hepatitis B patients treated with telbivudine / 临床肝胆病杂志

ObjectiveTo investigate the establishment of a predictive model for early virologic response in previously untreated chronic hepatitis B (CHB) patients treated with telbivudine, since early virologic response can predict the long-term efficacy of nucleotide analogues. MethodsA total of 135 CHB patients who visited Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2007 to August 2014 were enrolled and treated with telbivudine (600 mg qd) for at least 24 weeks. Follow-up was performed once every 2 weeks, and the patients′ baseline data and data measured during treatment were recorded. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and the Cox proportional hazards regression model was used to analyze the influencing factors for early virologic response and establish the predictive model. ResultsThe patients without a family history of hepatitis B virus (HBV) infection (P=0.000 3) and with high baseline levels of total bilirubin (TBil) (P=0.002 6) and aspartate aminotransferase (AST) (P=0.007 4) and a low HBV DNA load (P=0.002 3) tended to show early virologic response. The predictive model was established based on these variables, and the risk score (R) of CHB patients was calculated. The CHB patients with R＞0.85 were more likely to achieve early virologic response. ConclusionThe model established based on the four variables of family history, baseline TBil level, baseline AST level, and HBV DNA level can well predict early virologic response in previously untreated CHB patients treated with telbivudine.

Cox regression analysis of prognostic factors of operative patients with colorectal cancer with time covariates / 肿瘤研究与临床

Objective To study the prognostic factors of operative patients with colorectal cancer.Methods Four hundreds and ninety-four patients with colorectal cancer treated from January 2003 to December 2009 in Shanxi Cancer Hospital were involved in this study.The demographic data,clinical and pathological features,serum levels of tumor markers were analyzed retrospectively.The prognostic factors were analyzed by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazards models.Results The 1-,2-,3-,4-,5-year survival rates of 494 patients were 92.31％,69.43 ％,50.00 ％,31.17 ％ and 12.96 ％ respectively.Non-Cox proportional hazards model with time-according to coefficient of multivariate analysis showed that Duke stage,tumor metastasis,pathological diagnosis and serum carcinocmbryonic antigen (CEA) levels were the prognostic factors of colorectal cancer.Conclusion The Duke stage,tumor metastasis,pathological diagnosis and CEA levels are the prognostic factors of colorectal cancer,which should be considered in the choice of clinical treatment and prognosis judgement.

Establishing a predictive model for aspirin resistance in aging male with coronary heart disease / 中华老年医学杂志

Objective To quantify the risk factors for aspirin resistance so as to increase the prognosis for risk of coronary heart disease,and to establish a predictive model for aspirin resistance in order to guide the clinical anti-platelet therapy.Methods A total of 938 elderly male patients with stable coronary heart disease (CHD) receiving oral aspirin therapy (＞75 mg/d) over 2 months were included in this study.Their clinical data were collected.Logistic regression analysis was performed to establish a predictive model and risk score for aspirin resistance.Hosmer Lemeshow (H-L) test and an area under the receiver operating characteristic (ROC) curve (the area under the ROC curve) were performed to test the calibration and discrimination of the model.Results Seven risk factors were included in the predictive model,including serum creatinine (＞110 μmol/L:score of 1),fasting blood glucose (＞7.0 mmol/L:score of 1),hyperlipidemia (score of 1),number of coronary arteries in lesion (2 branches:score of 2,≥≥3 branches:score of 4),body mass index[(20-25) kg/m2:score of 2,＞25 kg/m2:score of 4],percutaneous coronary intervention (score of 2),smoking (score of 3).H-L test showed P≥0.05 and the area under the ROC curve＞0.70 in this model.Conclusions the risk factors for aspirin resistance,and establishing a valid predictive model for aspirin resistance,could provide an important reference for anti-platelet therapy in CHD patients.

Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort / 부인종양

OBJECTIVE: Concurrent chemoradiotherapy (CCRT) is the primary treatment for locally advanced cervical cancer. We studied prognostic factors for patients treated with CCRT. METHODS: We retrospectively reviewed records of 85 consecutive patients with cervical cancer who were treated with CCRT between 2002 and 2011, with external beam radiation therapy, intracavitary brachytherapy, and platinum-based chemotherapy. Survival data were analyzed with Kaplan-Meier methods and Cox proportional hazard models. RESULTS: Of the 85 patients, 69 patients (81%) had International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease; 25 patients (29%) had pelvic lymph node enlargement (based on magnetic resonance imaging), and 64 patients (75%) achieved clinical remission following treatment. Median maximum tumor diameter was 5.5 cm. The 3- and 5-year overall survival rates were 60.3% and 55.5%, respectively. Cox regression analysis showed tumor diameter >6 cm (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.2 to 4.6), pelvic lymph node enlargement (HR, 2.2; 95% CI, 1.1 to 4.5), and distant metastasis (HR, 10.0; 95% CI, 3.7 to 27.0) were significantly and independently related to poor outcomes. CONCLUSION: New treatment strategies should be considered for locally advanced cervical cancers with tumors >6 cm and radiologically enlarged pelvic lymph nodes.

Research advances in non-invasive diagnosis models for liver fibrosis in chronic hepatitis B / 临床肝胆病杂志

It is vital for reducing the occurrence of complications, such as liver cirrhosis and hepatic carcinoma, to early diagnose liver fibrosis in chronic hepatitis B and intervene in time with antiviral therapy. Although liver biopsy is the "golden standard" for the diagnosis of fibrosis, it has certain disadvantages, such as complicated operation, invasion, and occurrence of complications. Therefore, non-invasive diagnosis models have gained more and more attention clinically. In this review, we summarizes the non-invasive diagnosis models for chronic hepatitis B that have been established throughout the world. It is noticed that there are a number of models being studied and each model has a diagnostic value, to some degree, but a lack of consensus exists. The development of more efficient models that can replace liver biopsy still needs further research to assess liver fibrosis in chronic hepatitis B and guide antiviral therapy.

Significance of predictive models/risk calculators for HBV-related hepatocellular carcinoma / 临床肝胆病杂志

Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) is a major public health problem in Southeast Asia. In recent years, researchers from Hong Kong and Taiwan have reported predictive models or risk calculators for HBV-associated HCC by studying its natural history, which, to some extent, predicts the possibility of HCC development. Generally, risk factors of each model involve age, sex, HBV DNA level, and liver cirrhosis. This article discusses the evolution and clinical significance of currently used predictive models for HBV-associated HCC and assesses the advantages and limits of risk calculators. Updated REACH-B model and LSM-HCC model show better negative predictive values and have better performance in predicting the outcomes of patients with chronic hepatitis B (CHB). These models can be applied to stratified screening of HCC and, meanwhile, become an assessment tool for the management of CHB patients.

COX regression analysis influence factors of the intra-laboratory turnaround time / 中华检验医学杂志

Objective To explore the factors influencing the intra-laboratory turnaround time ( ILTAT) and establish a COX regression model.Methods Data of 5 weeks with a total of 904 cases from the samples of blood routine examinations from January 2014 to June 2014 in The Third Hospital of Xingtai were randomly collected.The records of the samples included test dates , times of arrival , times of test , sample statuses, time consumption, time duration, operators, project portfolios, delay, PLT counts, results of 30-minute treatment and test weeks.Based on SPSS 17.0, the above indicators were analyzed by COX single factor analysis and then COX mutiple-factor regression analysis.Results Within the prescribed time , 421 cases were sent taking up 46.6%of the total samples.The ratios of sent cases in 10, 20, 30, 40 and 50 minutes are 10.4%, 24.7%, 46.6%, 58.7% and 82.1% respectively.The results of COX single factor analysis showed that times of arrival , sample statuses, times of examination, operators, project portfolios and delay had statistical significance for ILTAT ( P0.05).Conclusions Times of arrival, times of test, operators, project portfolios and delay were the independent risk factors leading to the delay in ILTAT.Other laboratories could determine the variable number of proportional hazards models based on their sample transport , test procedures and principal influence factors , and carry out quantitative evaluation on the factors in sample processing for improvement.Thus, significant decrease on ILTAT would be achieved.

Time-Dependent Effects of Prognostic Factors in Advanced Gastric Cancer Patients

PURPOSE: This study aimed to identify time-dependent prognostic factors and demonstrate the time-dependent effects of important prognostic factors in patients with advanced gastric cancer (AGC). MATERIALS AND METHODS: We retrospectively evaluated 3,653 patients with AGC who underwent curative standard gastrectomy between 1991 and 2005 at the Korea Cancer Center Hospital. Multivariate survival analysis with Cox proportional hazards regression was used in the analysis. A non-proportionality test based on the Schoenfeld residuals (also known as partial residuals) was performed, and scaled Schoenfeld residuals were plotted over time for each covariate. RESULTS: The multivariate analysis revealed that sex, depth of invasion, metastatic lymph node (LN) ratio, tumor size, and chemotherapy were time-dependent covariates violating the proportional hazards assumption. The prognostic effects (i.e., log of hazard ratio [LHR]) of the time-dependent covariates changed over time during follow-up, and the effects generally diminished with low slope (e.g., depth of invasion and tumor size), with gentle slope (e.g., metastatic LN ratio), or with steep slope (e.g., chemotherapy). Meanwhile, the LHR functions of some covariates (e.g., sex) crossed the zero reference line from positive (i.e., bad prognosis) to negative (i.e., good prognosis). CONCLUSIONS: The time-dependent effects of the prognostic factors of AGC are clearly demonstrated in this study. We can suggest that time-dependent effects are not an uncommon phenomenon among prognostic factors of AGC.

Metastatic pattern of uterine leiomyosarcoma: retrospective analysis of the predictors and outcome in 113 patients / 부인종양

OBJECTIVE: To describe metastatic pattern of uterine leiomyosarcomas (ULMS) and correlate it with clinical and histopathologic parameters. METHODS: We included 113 women (mean age, 53 years; range, 29 to 72 years) with histopathology-confirmed ULMS from 2000 to 2012. Distribution of metastases was noted from imaging by two radiologists in consensus. Predictors of development of metastases were analyzed with univariate and multivariate analysis. Impact of various clinical and histopathologic parameters on survival was compared using Log-rank test and Cox proportional hazard regression model. RESULTS: Distant metastases were seen in 81.4% (92/113) of the patients after median interval of 7 months (interquartile range, 1 to 21). Lung was most common site of metastases (74%) followed by peritoneum (41%), bones (33%), and liver (27%). Local tumor recurrence was noted in 57 patients (50%), 51 of whom had distant metastases. Statistically significant correlation was noted between local recurrence and peritoneal metastases (p<0.001) and between lung and other common sites of hematogeneous metastases (p<0.05). Age, serosal involvement, local recurrence, and the International Federation of Gynecology and Obstetrics (FIGO) stage were predictive factors for metastases. At the time of reporting, 65% (74/113) of the patients have died; median survival was 45 months. Stage, local recurrence, and age were poor prognostic factors. CONCLUSION: ULMS metastasizes most frequently to lung, peritoneum, bone, and liver. Local recurrence was associated with peritoneal spread and lung metastases with other sites of hematogeneous metastases. Age, FIGO stage and local recurrence predicted metastatic disease and advanced stage, older age and local recurrence predicted poor outcome.

Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality Among Middle-aged Men in Korea: The Seoul Male Cohort Study / 예방의학회지

OBJECTIVES: This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea. METHODS: In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics. RESULTS: There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality. CONCLUSIONS: Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality.

Analysis of prognostic factors for patients with hepatitis B viurs-related liver failure and construction of a prognostic assessment model / 中华传染病杂志

Objective The aim of this study was to analyze risk factors which may affect prognosis of patients with hepatits B virus (HBV)-related liver failure,and to construct a model for prognostic evaluation and further assess its predictive ability.Methods In this retrospective cohort study,569 hospitalized patients who were diagnosed with HBV-related liver failure from January 2007 to December 2010 were enrolled.All the patients were followed up and survival analysis was performed using the Kaplan-Meier method.Univariate and multivariate COX proportional hazards regression analyses were applied to variables such as age,sex,complications,biochemical markers,coagulation markers,and HBV DNA levels to construct a model for prognostic evaluation,and 79 independent cases of HBV-related liver failure were used to confirm the model's predictive ability.Accuracy of the constructed model and model for end-stage liver disease (MELD) was evaluated by receiver operating characteristic (ROC) curves.Results The median survival time for all the patients was 59 days.The survival rates at 1,3,6 months were 58.9％,46.2％ and 45.5％,respectively;and survival rates at 1 and 3 years were 44.9％ and 44.5％,respectively.Hepatic encephalopathy,pulmonary infection,upper gastrointestinal bleeding (UGIB),albumin (Alb),aspartate aminotransferase (AST),creatinine (Cr),international normalized ratio (INR) were determined to be independent risk factors (all P＜0.01) which may affect survival of patients with HBV related liver failure.Accordingly,the prognostic index (PI) of the constructed model for prognostic evaluation 4.98 × assignment of hepatic encephalopathy + 4.57 × assignment of pulmonary infection + 4.41 ×assignment of UGIB-9.69 ×lm[Alb (g/L)]+2.46 ×ln[AST (U/L)]+5.18×ln[Cr (mmol/L)]+3.35×ln (INR) 15.36.The area under receiver operating characteristic curve was 0.838 for the constructed model assessing 90-d survival of the patients,and was 0.751 for model for end-stage liver disease,with no significant difference between the two models (Z=1.085,P =0.278).Conclusions Prognosis of patients with HBV-related liver failure can be accurately predicted by the constructed prognostic assessment model,which is consisted of hepatic encephalopathy,pulmonary infection,UGIB,Alb,AST,Cr,and INR as independent risk factors,and is able to predict the 90 d survival.