ABSTRACT
In this study, our aim was to evaluate the role of lymphovascular invasion (LVI) in the prognosis of patients with early stage breast cancer. The medical records of more than 7000 patients who suffered from invasive breast cancer and had undergone surgical treatment since December 1994 till December 2019, retrospectively. Patient's history, physical examination and the clinicopathological features, histopathology characteristics, immunohistochemical findings, adjuvant systemic therapy, recurrence rate, metastasis-free survival (MFS), disease-free survival (DFS), and overall survival (OS) were reviewed. A total of 5425 eligible patients were categorized into two groups based on the presence of LVI; 3031 (55.9%) patients had no LVI (group 1) and LVI was present in 2394 (44.1%) patients (group 2), then divided into LN-positive and -negative groups. Presence of LVI was significantly associated with patient age ≤ 40 years (p = 0.048), high histological grade (grades II and III, p < 0.001), tumor size between 2-5 cm and > 5 cm (p < 0.001), number of involved LN ≥ 4 (p < 0.001), and negative ER (p = 0.042) tumors. Five-year OS, MFS, and DFS were 93%, 88.9%, and 76.1% and 85.2%, 84.7%, and 73.6 in groups 1 and 2, respectively (P < 0.001). On multivariate analysis, LVI was an independent prognostic factor for DFS in all patients. Furthermore, histological grade II, histological grade III, and a higher number of involved LNs (≥ 4) were independent predictors in all patients. Thus, the presence of LVI can be considered as an independent prognostic factor for patients with operable breast cancer, irrespective of the LN status.
ABSTRACT
BACKGROUND: Diabetes is a serious chronic disease, and its increasing prevalence is a global concern. If diabetes mellitus is left untreated, poor control of blood glucose may cause long-term complications. A big challenge encountered by clinicians is the clinical management of diabetes. Many IT-based interventions such ad CDSS have been made to improve the adherence to the standard care for chronic diseases. OBJECTIVE: The aim of this study is to establish a decision support system of diabetes management based on diabetes care guidelines in order to reduce medical errors and increase adherence to guidelines. MATERIALS AND METHODS: To start the process, at first the existing guidelines in the field of diabetes mellitus such as ADA 2017 and AACE guideline 2017 were reviewed, and accordingly, flowcharts and algorithms for screening and managing of diabetes were designed. Then, it was passed on to the information technology team to design software. RESULTS: The most significant outcome of this research was to establish a smart diabetic screening and managing software, which is an important stride to promote patients' health status, control diabetes and save patients' information as an important and reliable source. CONCLUSION: Health care technologies have the potential to improve the quality of diabetes care through IT-based intervention, such as clinical decision support systems. In a chronic disease like diabetes, the critical component is the disease management. The advantages of this web-based system are on-time registration, reports of diabetic prevalence, uncontrolled diabetes, diabetic complications and reducing the rate of mismanagement of diabetes, so that it helps the physicians in order to manage the patients in a better way.