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Purpose: To improve the three dimensional (3D) and two dimensional (2D) image correlation and differentiation of 3D endoluminal lesions in the traditional surface rendering (SR) computed tomographic endoscopy (CTE), a target gray level mapping (TGM) technique is developed and applied to computed tomographic colonography (CTC) in this study. Methods: A study of sixty-two various endoluminal lesions from thirty patients (13 males, 17 females; age range 31-90 years) was approved by our institutional review board and evaluated retrospectively. The endoluminal lesions were segmented using gray level threshold. The marching cubes algorithm was used to detect isosurfaces in the segmented volumetric data sets. TGM allows users to interactively apply grey level mapping (GM) to region of interest (ROI) in the 3D CTC. Radiologists conducted the clinical evaluation and the resulting data were analyzed. Results: TGM and GM are significantly superior to SR in terms of surface texture, 3D shape, the confidence of 3D to 2D, 2D to 3D image correlation, and clinical classification of endoluminal lesions (P < 0.01). The specificity and diagnostic accuracy of GM and TGM methods are significantly better than those of SR (P < 0.01). Moreover, TGM performs better than GM (specificity: 75.0-85.7% vs. 53.6-64.3%; accuracy: 88.7-93.5% vs. 77.4-83.9%). TGM is a preferable display mode for further localization and differentiation of a lesion in CTC navigation. Conclusions: Compared with only the spatial shape information in traditional SR of CTC images, the 3D shapes and gray level information of endoluminal lesions can be provided by TGM simultaneously. 3D to 2D image correlations are also increased and facilitated at the same time. TGM is less affected by adjacent colon surfaces than GM. TGM serves as a better way to improve the image correlation and differentiation of endoluminal lesions.
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INTRODUCTION: Although palliative chemotherapy during end-of-life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end-of-life care and less use of hospice service. This is a population-based study of the association between palliative chemotherapy and aggressiveness of end-of-life care. PATIENTS AND METHODS: Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2-6 months before death were included. Aggressiveness of end-of-life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end-of-life care. The association between palliative chemotherapy and hospice care was studied. RESULTS: Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician's specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p < .001), more than one intensive care unit admission (p < .001), and endotracheal intubation (p = .02) during end-of-life care were significantly more common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p < .001). CONCLUSION: Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end-of-life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. IMPLICATIONS FOR PRACTICE: Palliative chemotherapy is used for patients with incurable cancer toward the end of life (EOL). Aggressiveness of EOL care and hospice care are related to the quality of life of these patients. This study of data from the Taiwanese National Health Insurance Research Database found that palliative chemotherapy led to more aggressive EOL care and less hospice care. There is a need to provide patients with terminal cancer access to care information that best meets their needs, especially those patients who receive palliative chemotherapy.
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Neoplasias/tratamento farmacológico , Cuidados Paliativos , Assistência Terminal , Idoso , Humanos , Pessoa de Meia-IdadeRESUMO
The dose-response effect of proton pump inhibitors on colorectal cancer prognosis is still under exploration. This population-based study in Taiwan was designed to examine the effect of proton pump inhibitors on overall death, colorectal cancer-specific death, and recurrence in colorectal cancer patients with different cumulative proton pump inhibitor dose levels. This cohort study was based on the Taiwan Cancer Registry and Taiwan National Health Insurance Research Database from 2005 to 2020. After frequency matching with a 1:1 ratio, a total of 20,889 users with proton pump inhibitors and 20,889 without proton pump inhibitors were analyzed. The cumulative defined daily dose level of proton pump inhibitor was stratified to explore the dose-response relationship. A proton pump inhibitor exposure cumulative defined daily dose > 60 after colorectal cancer diagnosis had higher risk of all-cause death than non-proton pump inhibitor users with adjusted hazard ratios of 1.10 (95% CIs: 1.04-1.18). For recurrence, a proton pump inhibitor exposure cumulative defined daily dose > 60 had reduced recurrence risk with an adjusted hazard ratio of 0.84 (95% CIs: 0.76-0.93). This study demonstrated that the long-term use of proton pump inhibitors in patients with colorectal cancer was associated with an increased risk of death that related to the proton pump inhibitor exposure cumulative defined daily dose > 60 and had different dose-response effect in various dose level.
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To explore the interior of a lesion in a 3D endoluminal view, this study investigates the application of an 'electronic biopsy' (EB) technique to computed tomographic colonography (CTC) for further differentiation and 2D image correlation of endoluminal lesions in the air spaces. A retrospective study of sixty-two various endoluminal lesions from thirty patients (13 males, 17 females; age range, 31 to 90 years) was approved by our institutional review board and evaluated. The endoluminal lesions were segmented using gray-level threshold and reconstructed into isosurfaces using a marching cube algorithm. EB allows users to interactively erode and apply grey-level mapping (GM) to the surface of the region of interest (ROI) in 3D CTC. Radiologists conducted the clinical evaluation, and the resulting data were analyzed. EB significantly improves 3D gray-level presentation for evaluating the surface and inside of endoluminal lesions over that of SR, GM or target GM (TGM) (P < 0.01) with preservation of the 3D spatial effect. Moreover, 3D to 2D image correlation were achieved in any layer of the lesion using EB as did GM/TGM on the surface. The specificity and diagnostic accuracy of EB are significantly greater than those of SR (P < 0.01). These performance can be better further with GM/TGM and reach the best with EB (specificity, 89.3-92.9%; accuracy, 95.2-96.8%). EB can be used in CTC to improve the differentiation of endoluminal lesions. EB increases 3D to 2D image correlations of the lesions on or beneath the lesion surface.
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Pólipos do Colo , Colonografia Tomográfica Computadorizada , Enteropatias , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo/diagnóstico por imagem , Estudos Retrospectivos , Imageamento Tridimensional/métodos , Sensibilidade e Especificidade , Colonografia Tomográfica Computadorizada/métodos , Colo , BiópsiaRESUMO
Type 2 diabetes might be influenced by colonic disease; however, the association between colonic resection and type 2 diabetes has rarely been discussed. This population-based cohort study explored the association between colectomy and type 2 diabetes in patients without colorectal cancer. A total of 642 patients who underwent colectomy for noncancerous diseases at any time between 2000 and 2012 in the National Health Insurance Research Database of Taiwan were enrolled. The enrolled patients were matched with 2568 patients without colectomy at a 1:4 ratio using a propensity score that covered age, sex, and comorbidities. The risk of type 2 diabetes was assessed using a Cox proportional hazards model. The mean (standard deviation) follow-up durations in colectomy cases and non-colectomy controls were 4.9 (4.0) and 5.6 (3.6) years, respectively; 65 (10.1%) colectomy cases and 342 (15.5%) non-colectomy controls developed type 2 diabetes. After adjustment, colectomy cases still exhibited a decreased risk of type 2 diabetes (adjusted HR = 0.80, 95% CI: 0.61-1.04). A stratified analysis for colectomy type indicated that patients who underwent right or transverse colectomy had a significantly lower risk of developing type 2 diabetes (adjusted HR = 0.57, 95% CI: 0.34-0.98). In the present study, colectomy tended to be at a reduced risk of type 2 diabetes in patients without colorectal cancer, and right or transverse colectomies were especially associated with a significantly reduced risk of type 2 diabetes.
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Colorectal cancer (CRC) is one of the most malignant tumors in humans and causes mass mortality. In the age of precise medicine, more and more subtypes of CRC were classified. The caudal-related homeobox transcription factor 2 (CDX2) is an intestine-specific transcription factor which is implicated in differentiation, proliferation, cell-adhesion, and migration. The loss of CDX2 in immunohistochemical stain was reported to be a prognostic factor of colon cancer, but the clinical application remained controversial. Most of the CRCs expressed or over-expressed CDX2. Homeobox genes can display either an oncogenic or a tumor-suppressing activity. CDX2 regulates the developing intestinal epithelium and CRC by different pathways. The complex regulation of CDX2 and its complex targets cause the difficulties of application for CDX2 in the prediction of prognosis. However, CDX2 is a potential biomarker applied in the precise classification of CRC for personalized medicine. This review partially clarifies the role of CDX2 in CRC.
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Cardiometabolic disorders were discussed and might be changed by microbiota in recent years. Since the colon acts as the primary reservoir of microbiota, we designed the present study to explore the association between colectomy and cardiovascular disease (CVD). We identified a total of 18,424 patients who underwent colectomy between 2000-2012 for reasons other than colorectal cancer from the National Health Insurance Research Database of Taiwan. Patients were matched with 18,424 patients without colectomy using a 1:1 propensity score by age, sex, and comorbidity. Cox proportional-hazards regression was used to assess the risk of CVD. Patients with colectomy were found to be at lower risk of CVD (hazard ratio [HR]: 0.95, 95% confidence interval [CI] = 0.90-0.99) than patients without colectomy. Stratified analysis according to the type of surgery revealed patients who underwent cecectomy and right hemicolectomy were at lower risk of CVD (cecectomy: adjusted HR [aHR] = 0.77, 95% CI = 0.64-0.94; right hemicolectomy: aHR = 0.88, 95% CI = 0.82-0.96). Patients who underwent left hemicolectomy were at higher risk of CVD (aHR = 1.19, 95% CI = 1.08-1.32). Our results indicate that the different colectomy procedures influence the risk for the CVD differently.
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Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Colectomia/efeitos adversos , Neoplasias Colorretais/cirurgia , Adulto , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , TaiwanRESUMO
BACKGROUND/AIMS: Although laparoscopic colorectal cancer surgery is not widely used for several reasons especially for concerning inadequate resection, recent data showed equivalent oncologic outcomes between open colectomy (OC) and laparoscopic-assisted colectomy (LAC). However, there is no clinical trial for the LAC supported by hand-assisted laparoscopic colectomy (HALC), named as LAC/HALC. METHODOLOGY: Patients were assigned to either OC or LAC/HALC group. Clinical data, operation times, conversion rates from LAC to HALC, complications, early results, and long-term results were analyzed retrospectively. RESULTS: The short-term outcomes including pain, ambulation, oral resumption, wound infections, and hospital stays were favorable for LAC/HALC group. HALC was subsequently required in seven LAC cases but none of them required open colectomies. Functional recovery was the benchmark for early discharge for LAC/HALC group. Specimen size and number of lymph nodes harvested were similar. Local recurrence, disease-free and overall survival rates were comparable. CONCLUSION: The current study demonstrated that LAC/HALC was associated with favorable recoveries even in oncologic clearance in the long-term follow-up. HALC reduces the conversion rate from LAC to OC and maintains the benefits of minimal invasive surgery. Therefore, we suggest LAC/HALC is a suitable surgical hybrid for the treatment of resectable colorectal cancers.
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Colectomia/métodos , Neoplasias Colorretais/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Laparoscopia , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Medição da Dor , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A 72-year-old man had rectal adenocarcinoma with partial obstruction with liver and lung metastases. Bone scan showed special pattern with bony destructions to the lateral aspect of the left first to fourth and right first to 10th ribs (in a row in continuous vertical alignment), the costal end of the left second rib, the left sternoclavicular junction, and sternum. Patient recalled a car traffic accident with airbag deployment trauma to the anterior aspect of the chest about 2 months prior. Chest CT confirmed that the bone lesions were all fractures.
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Acidentes de Trânsito , Adenocarcinoma/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Retais/patologia , Fraturas das Costelas/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Idoso , Air Bags , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/secundário , Masculino , Neoplasias Retais/diagnóstico por imagem , Fraturas das Costelas/etiologiaRESUMO
OBJECTIVE: In traditional surface rendering (SR) computed tomographic endoscopy, only the shape of endoluminal lesion is depicted without gray-level information unless the volume rendering technique is used. However, volume rendering technique is relatively slow and complex in terms of computation time and parameter setting. We use computed tomographic colonography (CTC) images as examples and report a new visualization technique by three-dimensional gray level mapping (GM) to better identify and differentiate endoluminal lesions. METHODS: There are 33 various endoluminal cases from 30 patients evaluated in this clinical study. These cases were segmented using gray-level threshold. The marching cube algorithm was used to detect isosurfaces in volumetric data sets. GM is applied using the surface gray level of CTC. Radiologists conducted the clinical evaluation of the SR and GM images. The Wilcoxon signed-rank test was used for data analysis. RESULTS: Clinical evaluation confirms GM is significantly superior to SR in terms of gray-level pattern and spatial shape presentation of endoluminal cases (p < 0.01) and improves the confidence of identification and clinical classification of endoluminal lesions significantly (p < 0.01). The specificity and diagnostic accuracy of GM is significantly better than those of SR in diagnostic performance evaluation (p < 0.01). CONCLUSION: GM can reduce confusion in three-dimensional CTC and well correlate CTC with sectional images by the location as well as gray-level value. Hence, GM increases identification and differentiation of endoluminal lesions, and facilitates diagnostic process. Advances in knowledge: GM significantly improves the traditional SR method by providing reliable gray-level information for the surface points and is helpful in identification and differentiation of endoluminal lesions according to their shape and density.
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Pólipos do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Imageamento Tridimensional/métodos , Neoplasias Intestinais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Esophageal cancer is the sixth leading cause of cancer mortality. More than 90% of patients with esophageal cancer in Taiwan have squamous cell carcinoma. Survival of such patients is related to socioeconomic status (SES). We studied the association between SES (individual and neighborhood) and the survival of working-age patients with esophageal cancer in Taiwan. A population-based study was conducted of 4097 patients diagnosed with esophageal cancer between 2002 and 2006. Each was traced for 5 years or until death. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income and dichotomized into advantaged or disadvantaged. Multilevel logistic regression was used to compare the survival rates by SES group after adjustment for possible confounding and risk factors. Hospital and neighborhood SES were used as random effects in multilevel logistic regression. In patients younger than 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjustment for patient characteristics, esophageal cancer patients with high individual SES had a 39% lower risk of mortality than those with low individual SES (odds ratio 0.61, 95% confidence interval 0.48-0.77). Patients living in disadvantaged areas with high individual SES were more likely to receive surgery than those with low SES (odds ratio 1.45, 95% confidence interval 1.11-1.89). Esophageal cancer patients with low individual SES have the worst 5-year survival, even with a universal healthcare system. Public health, education, and social welfare programs should address the inequality of esophageal cancer survival.
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Neoplasias Esofágicas/mortalidade , Características de Residência , Classe Social , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , TaiwanRESUMO
We studied the effect of Age-Adjusted Comorbidity Index Score in colorectal cancer patients who underwent similarly aggressive treatment. Using the National Health Insurance Research Database of Taiwan, we identified 5643 patients with colorectal cancer who underwent surgical resection and chemoradiation from 2007 through 2011. We estimated survival according to Age-Adjusted Comorbidity Index Scores and 5-year survival using Cox proportional hazard regression analysis, adjusting for sex, oxaliplatin-based chemotherapy, socioeconomic status, geographic region, and hospital characteristics. In the cohort were 3230 patients with colonic cancer and 2413 patients with rectal cancer, who had undergone combined surgical resection and either neoadjuvant or adjuvant chemoradiation. After adjusting for patient characteristics (sex, oxaliplatin-based chemotherapy, socioeconomic status, geographic region, and hospital-characteristics), colonic cancer patients with age-adjusted Charlson (AAC) ≥ 6 had a 106% greater risk of death within 5 years (adjusted HR = 2.06; 95% CI, 1.66-2.56). In rectal cancer patients, patients with an AAC score of 4-5 had a 28% greater risk of death within 5 years (adjusted HR = 1.28; 95% CI, 1.02-1.61), and those with AAC ≥ 6 had a 47% greater risk (adjusted HR = 1.47; 95% CI, 1.15-1.90). Age and burden of comorbidities influence survival of patients with colonic or rectal cancer. Age-Adjusted Comorbidity Score remains an independent prognostic factor even after adjusting for the aggressiveness of treatment.
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Quimiorradioterapia , Colectomia , Neoplasias Colorretais , Compostos Organoplatínicos/uso terapêutico , Fatores Etários , Idoso , Antineoplásicos/uso terapêutico , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Estudos de Coortes , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Comorbidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Oxaliplatina , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Sistema de Registros , Análise de Regressão , Fatores de Risco , Taxa de Sobrevida , Taiwan/epidemiologiaRESUMO
BACKGROUND/PURPOSE: Current treatment options for HCC≥10 cm (huge HCC) are limited. Otherwise, the margin status is known as a prognostic factor. Our aim was to determine the safety, effectiveness, and risk factors for overall survival and disease-free survival for these patients. METHODS: A total of 211 consecutive patients from 2000/08 to 2010/12 were enrolled. Characteristics of patients, tumors, and treatment were compared between the huge group (HCCs; ≥10 cm, n = 23; 11%) and those with smaller group (HCC; <10 cm n = 188; 89%). Disease-free survival (DFS), overall survival (OS), and risk factors were analyzed. RESULTS: Median follow up was 37 months. Patients with huge HCC were more likely to be symptomatic, positive for preoperative portal vein thrombosis, longer surgical time, more blood loss and transfusions, and significantly shorter median OS and DFS. Both groups had similar postoperative mortality and morbidity rates. In the huge HCC, multivariate analysis identified two significant determinants of DFS (preoperative portal vein thrombosis on imaging and tumor-free margin less than 1 mm) and two significant determinants of OS (age over 80 and preoperative portal vein thrombosis). Even with positive margins, it still had no impact on OS. For DFS, 1 mm free margins appeared to be adequate. CONCLUSION: Tumor-free margin is an independent risk factor for recurrence but has no impact on OS. Surgical margin >1 mm is adequate in patients with tumors ≥10 cm. Postoperative close follow up, especially of distant metastasis, and appropriate treatment of recurrence by a multidisciplinary approach may improve prognosis.
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PURPOSE: Gastric cancer is a leading cause of death, particularly in the developing world. The literature reports individual socioeconomic status (SES) or neighborhood SES as related to survival, but the effect of both has not been studied. This study investigated the effect of individual and neighborhood SES simultaneously on mortality in gastric cancer patients in Taiwan. MATERIALS AND METHODS: A study was conducted of 3,396 patients diagnosed with gastric cancer between 2002 and 2006. Each patient was followed for five years or until death. Individual SES was defined by income-related insurance premium (low, moderate, and high). Neighborhood SES was based on household income dichotomized into advantaged and disadvantaged areas. Multilevel logistic regression model was used to compare survival rates by SES group after adjusting for possible confounding factors. RESULTS: In patients younger than 65 years, 5-year overall survival rates were lowest for those with low individual SES. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score), gastric cancer patients with high individual SES had 68% risk reduction of mortality (adjusted odds ratio [OR] of mortality, 0.32; 95% confidence interval [CI], 0.17-0.61). Patients aged 65 and above had no statistically significant difference in mortality rates by individual SES group. Different neighborhood SES did not statistically differ in the survival rates. CONCLUSION: Gastric cancer patients aged less than 65 years old with low individual SES have higher risk of mortality, even under an universal healthcare system. Public health strategies, education and welfare policies should seek to correct the inequality in gastric cancer survival, especially in those with lower individual SES.
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Características de Residência/estatística & dados numéricos , Classe Social , Neoplasias Gástricas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Taxa de Sobrevida , Taiwan/epidemiologia , Populações Vulneráveis/estatística & dados numéricosRESUMO
BACKGROUND: Traditional Chinese medicine (CM) appears to be used worldwide, especially by cancer patients. The aim of the present study was to explore CM uses and CM non-users by patients with colorectal cancer (CRC). MATERIALS AND METHODS: A retrospective study was conducted using registration and claims data sets for 2007 from the National Health Insurance Research Database. Patients with colorectal cancer were identified from the Registry for Catastrophic illness Patients. Binary logistic regression was used to estimate odds ratios as the measure of association with the use of CM. RESULTS: A total of 61,211 CRC patients diagnosed in 2007 were analysis. Most CM users preferred to visit private clinics (46.9%) with 306,599 visits. In contrast, the majority of CM non-users preferred to visit private hospitals (42.2%) with 538,769 visits. Among all 176,707 cancer-specific CM visit, there were 66.6% visits to CM outpatient department (OPD) of private hospitals, while in 477,612 non-cancer-specific CM visits, 62.0% was for private clinics. The proportion of expenses for diagnostic fees for CM user in CM visits was much less than that for WM visits and CM non-users (US$4.6 vs. 29.3 vs. 33.5). The average cost for CM user in CM was less than that for WM visits and CM non-users (US$6.3 vs. 25.9 vs. 30.3). Female patients, younger age, and patients not living in the northern region, with higher EC or more comorbidities were more likely to receive CM treatment. CONCLUSION: The prevalence and costs of insurance-covered CM among CRC patients were low. Further longer longitudinal study is needed to follow up this trend.
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Neoplasias Colorretais/terapia , Medicina Tradicional Chinesa/estatística & dados numéricos , Adulto , Idoso , Neoplasias Colorretais/economia , Estudos Transversais , Feminino , Humanos , Benefícios do Seguro , Masculino , Medicina Tradicional Chinesa/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan , Adulto JovemRESUMO
OBJECTIVE: Lymph node yield is recommended as a benchmark of quality care in colorectal cancer. The objective of this study was to evaluate the impact of various factors upon lymph node yield and to identify independent factors associated with lymph node harvest. MATERIALS AND METHODS: The records of 162 patients with Stage I to Stage III colorectal cancers seen in one institution were reviewed. These patients underwent radical surgery as definitive therapy; high-risk patients then received adjuvant treatment. Pathologic and demographic data were recorded and analyzed. The subgroup analysis of lymph node yields was determined using a t-test and analysis of variants. Linear regression model and multivariable analysis were used to perform potential confounding and predicting variables. RESULTS: Five variables had significant association with lymph node yield after adjustment for other factors in a multiple linear regression model. These variables were: tumor size, surgical method, specimen length, and individual surgeon and pathologist. The model with these five significant variables interpreted 44.4% of the variation. CONCLUSIONS: Patients, tumor characteristics and surgical variables all influence the number of lymph nodes retrieved. Physicians are the main gatekeepers. Adequate training and optimized guidelines could greatly improve the quality of lymph node yields.
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Neoplasias Colorretais/cirurgia , Linfonodos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-IdadeRESUMO
Noncoding RNA (ncRNA) plays a critical role in modulating a broad range of diseases. All arthropod-borne flaviviruses produce short fragment ncRNA (sfRNA) collinear with highly conserved regions of the 3'-untranslated region (UTR) in the viral genome. We show that the molar ratio of sfRNA to genomic RNA in Japanese encephalitis virus (JEV) persistently infected cells is greater than that in acutely infected cells, indicating an sfRNA role in establishing persistent infection. Transfecting excess quantities of sfRNA into JEV-infected cells reduced interferon-ß (IFN-ß) promoter activity by 57% and IFN-ß mRNA levels by 52%, compared to mock-transfected cells. Transfection of sfRNA into JEV-infected cells also reduced phosphorylation of interferon regulatory factor-3 (IRF-3), the IFN-ß upstream regulator, and blocked roughly 30% of IRF-3 nuclear localization. Furthermore, JEV-infected sfRNA transfected cells produced 23% less IFN-ß-stimulated apoptosis than mock-transfected groups did. Taken together, these results suggest that sfRNA plays a role against host-cell antiviral responses, prevents cells from undergoing apoptosis, and thus contributes to viral persistence.
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Núcleo Celular/metabolismo , Vírus da Encefalite Japonesa (Espécie)/genética , Fator Regulador 3 de Interferon/metabolismo , Interferon beta/metabolismo , RNA não Traduzido/metabolismo , RNA Viral/metabolismo , Regiões 3' não Traduzidas , Transporte Ativo do Núcleo Celular , Animais , Linhagem Celular , Núcleo Celular/genética , Regulação para Baixo , Vírus da Encefalite Japonesa (Espécie)/fisiologia , Humanos , Fator Regulador 3 de Interferon/genética , Fosforilação , Regiões Promotoras Genéticas , Transporte Proteico , RNA não Traduzido/genética , RNA Viral/genéticaRESUMO
BACKGROUND: The relationship between individual and neighborhood socioeconomic status (SES) and mortality rates in patients with nasopharyngeal carcinoma (NPC) is unknown. This population-based study aimed to examine the association between SES and survival of patients with NPC in Taiwan. MATERIALS AND METHODS: A population-based follow-up study was conducted of 4691 patients diagnosed with NPC between 2002 and 2006. Each patient was traced to death or for 5 years. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income dichotomized into advantaged and disadvantaged areas. Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding factors and risk factors. RESULTS: In NPC patients below the age of 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score), NPC patients with low individual SES residing in disadvantaged neighborhoods were found to have a 2-fold higher risk of mortality than patients with high individual SES residing in advantaged neighborhoods. We found no significant difference in mortality rates between different SES groups in NPC patients aged 65 and above. CONCLUSIONS: Our findings indicate that NPC patients with low individual SES who live in disadvantaged neighborhoods have the higher risk of mortality than their more privileged counterparts. Public health strategies and welfare policies would be well advised to try to offset the inequalities in health care and pay more attention to addressing the needs of this vulnerable group.
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Neoplasias Nasofaríngeas/epidemiologia , Características de Residência , Classe Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/mortalidade , Vigilância da População , Análise de Sobrevida , Taiwan/epidemiologiaRESUMO
BACKGROUND: Positive results between caseloads and outcomes have been validated in several procedures and cancer treatments. However, there is limited information available on the combined effects of surgeon and hospital caseloads. We used nationwide population-based data to explore the association between surgeon and hospital caseloads and survival rates for major cancers. METHODOLOGY: A total of 11,677 patients with incident cancer diagnosed in 2002 were identified from the Taiwan National Health Insurance Research Database. Survival analysis, the Cox proportional hazards model, and propensity scores were used to assess the relationship between 5-year survival rates and different caseload combinations. RESULTS: Based on the Cox proportional hazard model, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer survival rates, and hazard ratios ranged from 1.3 in head and neck cancer to 1.8 in lung cancer after adjusting for patients' demographic variables, co-morbidities, and treatment modality. When analyzed using the propensity scores, the adjusted 5-year survival rates were poorer for patients treated by low-volume surgeons in low-volume hospitals, compared to those treated by high-volume surgeons in high-volume hospitals (P<0.005). CONCLUSIONS: After adjusting for differences in the case mix, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer 5-year survival rates. Payers may implement quality care improvement in low-volume surgeons.
Assuntos
Cirurgia Geral , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Neoplasias/mortalidade , Neoplasias/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Taiwan/epidemiologia , Recursos HumanosRESUMO
BACKGROUND: This population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for major cancers in Taiwan. METHODS: A population-based follow-up study was conducted with 20,488 cancer patients diagnosed in 2002. Each patient was traced to death or for 5 years. The individual income-related insurance payment amount was used as a proxy measure of individual SES for patients. Neighborhood SES was defined by income, and neighborhoods were grouped as living in advantaged or disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding and risk factors. RESULTS: After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score, urbanization, and area of residence), tumor extent, treatment modalities (operation and adjuvant therapy), and hospital characteristics (ownership and teaching level), colorectal cancer, and head and neck cancer patients under 65 years old with low individual SES in disadvantaged neighborhoods conferred a 1.5 to 2-fold higher risk of mortality, compared with patients with high individual SES in advantaged neighborhoods. A cross-level interaction effect was found in lung cancer and breast cancer. Lung cancer and breast cancer patients less than 65 years old with low SES in advantaged neighborhoods carried the highest risk of mortality. Prostate cancer patients aged 65 and above with low SES in disadvantaged neighborhoods incurred the highest risk of mortality. There was no association between SES and mortality for cervical cancer and pancreatic cancer. CONCLUSIONS: Our findings indicate that cancer patients with low individual SES have the highest risk of mortality even under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.