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1.
J Surg Res ; 281: 321-327, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36240718

RESUMEN

INTRODUCTION: Incidence of colorectal cancer (CRC) among young patients has increased in the last 20 y often with more aggressive tumor biology. It is unclear if age < 50 y is an independent factor for shorter overall survival in CRC patients. Our objective was to determine if younger age at diagnosis was associated with worse overall survival. METHODS: This study used the National Cancer Data Base (2004-2016), retrospectively reviewing patients who underwent surgical resection for CRC. Patients were limited to only those without comorbidities and primary outcome was overall survival for all patients. RESULTS: Older patients have worse overall survival as compared to younger patients at a lower stage of disease (I and II) after adjusting for tumor location, gender, histology, stage, and systemic chemotherapy (< 36 y old versus 36-55 y old hazard ratio [HR] 1.16, confidence interval [CI] 1.03-1.29). This survival benefit is eliminated at a higher stage of disease, stage III in 36-55 y old versus < 36 y old (HR 0.96 [CI 0.90-1.03.99]) and stage IV (HR 0.94 [CI 0.89-0.99]). CONCLUSIONS: Older patients (aged > 36 y) have worse overall survival at a lower stage of disease, but the survival among all age groups was similar for stage III or IV disease in CRC.


Asunto(s)
Neoplasias Colorrectales , Humanos , Pronóstico , Neoplasias Colorrectales/patología , Estadificación de Neoplasias , Estudios Retrospectivos , Modelos de Riesgos Proporcionales
2.
J Surg Res ; 281: 57-62, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36116208

RESUMEN

INTRODUCTION: Parathyroid carcinoma is a rare diagnosis. The association of clinical and pathologic factors as well as treatment on overall survival (OS) is not well established. METHODS: A retrospective review of patients with parathyroid carcinoma was performed using the National Cancer Database for patients diagnosed from 2004 through 2017. Clinical and demographic variables were assessed. A Cox proportional hazards model was used to assess for factors associated with survival. OS rates were determined for 5 and 10 y. RESULTS: Data for 1057 patients were analyzed. The mean age at diagnosis was 57.5 y (standard deviation [SD] 14.0), and 542 (51.3%) were male. The median tumor size was 2.7 cm (interquartile range 2.0-3.7 cm). For the extent of surgery, 38 (3.6%) had no surgery, 568 (53.7%) had incomplete resection, 359 (34.0%) had complete resection, 58 (5.5%) had radical resection, and 34 (3.2%) did not have specified and were not used in the Cox proportional hazard regression model. For the cohort, 488 (46.2%) had lymph nodes resected with a mean of 5.5 (SD 6.6) removed. Of these, 32 (8.3%) had nodal metastases with one to six positive nodes. For adjuvant therapy, 159 (15.0%) had external beam radiation with a mean dose of 5463 cGy (SD 1464). Overall, 214 patients died (21.55%), and the estimated 5- and 10-y OS were 82.9% and 57.0%, respectively. In a Cox proportional hazard regression model, age at diagnosis as a continuous variable with hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.06, P = 0.003, and extent of surgery as a categorical variable with no surgery as the referent group: incomplete surgery HR 0.05, 95% CI 0.01-0.19, P < 0.001; complete surgery HR 0.04, 95% CI 0.01-0.19, P < 0.001; radical surgery HR 0.10, 95% CI 0.02-0.45, P < 0.001; and tumor size as a continuous variable was not associated with OS with an HR of 1.00, 95% CI 0.99-1.00, P = 0.738. CONCLUSIONS: Patient age and extent of surgery are modestly associated with survival for parathyroid carcinoma but not patient sex, nodal metastases, or adjuvant therapy in this cohort.


Asunto(s)
Neoplasias de las Paratiroides , Humanos , Masculino , Femenino , Neoplasias de las Paratiroides/cirugía , Radioterapia Ayuvante , Modelos de Riesgos Proporcionales , Tasa de Supervivencia , Ganglios Linfáticos/patología , Estudios Retrospectivos , Estadificación de Neoplasias
3.
J Affect Disord ; 320: 211-217, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36183828

RESUMEN

BACKGROUND: Cognitive and brain reserve aim to explain individual differences in susceptibility to dementia and may also affect the risk of late-life depressive events. We assessed whether higher cognitive and brain reserve are associated with lower risk of a late-life depressive event. METHODS: This study included 4509 participants from the population-based Rotterdam Study (mean age: 63.4 ± 10.2 years, 55 % women) between 2005 and 2019. Participants completed cognitive testing and brain-MRI at baseline. Cognitive reserve was defined as the common variance across cognitive tests, while adjusting for demographic factors and brain MRI-markers. Brain reserve was defined as total brain volume divided by intracranial volume. Depressive events (depressive symptoms/depressive syndrome/major depressive disorder) were repeatedly measured (follow-up: 6.6 ± 3.9 years) with validated questionnaires, clinical interviews, and follow-up of medical records. Hazard ratios (HR) with 95 % confidence intervals (CI) were estimated using Cox-regressions. RESULTS: Higher cognitive (HR: 0.91/SD, 95%CI: 0.84; 1.00) and brain reserve (HR: 0.88/SD, 95%CI: 0.77; 1.00) were associated with a lower risk of a depressive event after adjustment for baseline depressive symptoms. These associations attenuated when participants with clinically relevant depressive symptoms at baseline were excluded (HR: 0.95/SD, 95%CI: 0.86; 1.05, HR: 0.89/SD, 95%CI: 0.76; 1.03, respectively). LIMITATIONS: No data was available on depression in early-life and the number of participants with major depressive disorder was relatively low (n = 105). CONCLUSIONS: Higher cognitive and brain reserve may be protective factors for late-life depressive events, particularly in those who have experienced clinical relevant depressive symptoms before. Further research is needed to determine whether cognitive and brain reserve could be used as targets for the prevention of late-life depression.


Asunto(s)
Reserva Cognitiva , Trastorno Depresivo Mayor , Humanos , Femenino , Persona de Mediana Edad , Anciano , Masculino , Trastorno Depresivo Mayor/diagnóstico por imagen , Trastorno Depresivo Mayor/epidemiología , Pruebas Neuropsicológicas , Encéfalo/diagnóstico por imagen , Modelos de Riesgos Proporcionales , Depresión/psicología
4.
Urol Oncol ; 41(1): 52.e11-52.e20, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36319552

RESUMEN

PURPOSE: Primary mesothelioma of the tunica vaginalis (TVM) is a rare and poorly understood malignancy with insufficient population-level data to guide management decisions. MATERIALS AND METHODS: A retrospective analysis of TVM cases recorded in the National Cancer Database from 2004 to 2015 was performed. Cases were identified using International Classification of Diseases for Oncology histology codes. Associations between demographic, clinical and therapeutic factors were analyzed using Kaplan-Meier survival estimates for overall survival (OS) and Cox proportional hazard modeling. Propensity score matching for receipt of systemic chemotherapy was performed to assess the impact on OS. RESULTS: One hundred fifty-one men with a median age of 65 years (interquartile range [IQR] 51-78) were included. Median OS from diagnosis was 72.5 months (IQR 20.2-Not Reached [NR]) after a median follow up of 34.9 months. Multivariate analysis demonstrated an increased risk of death for patients in the fourth quartile of age (hazard ratio [HR] 5.57, 95% confidence interval [CI] 1.70-18.17, P = 0.004), those with biphasic or fibrous histology (HR 2.59, 95% CI 1.15-6.42, P = 0.04) and positive surgical margins (HR 3.27, 95% CI 1.61-6.63, P = 0.001). There was no significant difference in OS associated with receiving chemotherapy (P = 0.5) even after propensity score matching (P = 0.07). CONCLUSIONS: Margin-negative surgical resection is paramount to improving OS. There are insufficient data to recommend for or against adjuvant systemic chemotherapy or RT, although the limited available data does not suggest apparent benefit in terms of OS.


Asunto(s)
Mesotelioma Maligno , Mesotelioma , Masculino , Humanos , Anciano , Estudios Retrospectivos , Mesotelioma/cirugía , Mesotelioma/diagnóstico , Quimioterapia Adyuvante , Modelos de Riesgos Proporcionales , Márgenes de Escisión
5.
Environ Res ; 216(Pt 3): 114703, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36334822

RESUMEN

INTRODUCTION: Incorporation of greenspace may be a novel environmental policy that might result in positive health effects; hence, this study aimed to investigate the association between residential greenness and dementia incidence. The effects of particulate air pollution on mediating dementia were also determined. METHODS: A prospective cohort study involving 375,342 UK biobank participants was conducted, in which Cox regression models were used to determine the association of greenspace exposure with the risks of all-cause dementia (ACD), Alzheimer's disease (AD) and vascular dementia (VD). Sociodemographic variables, lifestyle or dietary characteristics and apolipoprotein E4 status were controlled using two levels of adjusted models. Mediation analyses were performed to determine the mediation effects of PMs. RESULTS: The results indicated that there were 4929 ACD, 2132 AD, and 1184 VD incidents throughout the 8-year study. In the multi-adjusted model, each interquartile increment in greenspace (buffer 300m) conferred the lower risks of ACD (HR = 0.968, 95% confidence intervals [CI]: 0.938-1.000]) and VD (HR = 0.926, 95% CI: 0.867-0.989). The fourth greenspace quartile conferred also reduced risks of ACD (HR = 0.891, 95% CI: 0.804-0.989) and VD (HR = 0.778, 95% CI: 0.630-0.960) in reference to the first quartile. With regard to 1000m catchment, each interquartile increment conferred a 5.0% (95% CI: 1.8-8.1) lower risk of ACD, and the fourth greenspace quartile conferred a 10.9% (95% CI: 0.9-19.8) lower risk of ACD compared to the first quartile. The protective effect of greenness might be mediated based on the reduction of PM2.5 and PM10 (Pindirect effect<0.05). CONCLUSIONS: Increasing greenness reduces the risk of dementia. This study suggests that greenspace is an environmental strategy that helps prevent dementia.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Enfermedad de Alzheimer , Humanos , Estudios Prospectivos , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Incidencia , Modelos de Riesgos Proporcionales , Exposición a Riesgos Ambientales/análisis , Contaminantes Atmosféricos/análisis , Material Particulado/análisis
6.
Gene ; 851: 146964, 2023 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-36261080

RESUMEN

The RAD51 gene plays an important role in DNA repair by homologous recombination, and is involved in the development and progression of multiple cancers. Single nucleotide polymorphisms in RAD51 have been previously described to impact the prognosis of patients with cancers, however, it is still unclear whether this is also true for hepatocellular carcinoma (HCC). This study therefore aimed to identify genetic variants in RAD51 and determine the effect on the survival of patients with HCC. In this study, we performed genotyping assays for RAD51 polymorphisms in a cohort of 368 patients with HCC who had underwent hepatectomy. Using multivariate cox proportional hazards model and Kaplan-Meier analyses with log-rank tests, we compared the survival of patients with HCC according to RAD51 SNP genotypes. We identified one potential functional variant, rs12593359, located in a microRNA (miRNA) binding site in the RAD51 3' untranslated region, to be an independent predictor of overall survival of patients with HCC in the dominant model. Patients carrying GT/TT genotypes had a significantly increased risk of death when compared with those carrying GG genotype (adjusted hazard ratio = 1.34, 95 % confidence interval = 1.02-1.76, P = 0.035). Kaplan-Meier curve analysis showed a markedly shorter survival time for patients with HCC carrying GT/TT genotypes of SNP rs12593359 (19.0 months vs 36.0 months; Plog-rank = 0.012). Notably, this effect was particularly pronounced in several subgroups of patients (e.g., males, Hepatitis B virus-positive patients, patients with a single tumor nodule, patients with alpha-fetoprotein (AFP) < 400 ng/ml, or patients who were cancer embolus-free). Additional expression analysis of quantitative trait loci showed that SNP rs12593359 was significantly associated with RAD51 mRNA expression levels in 483 cell-cultured fibroblasts (P = 1.1 × 10-4). These findings provide evidence that RAD51 rs12593359 is associated with HCC survival and may serve as a promising predictor of survival in patients with HCC.


Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Masculino , Humanos , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/patología , Regiones no Traducidas 3' , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patología , Hepatectomía , Polimorfismo de Nucleótido Simple , Modelos de Riesgos Proporcionales , Recombinasa Rad51/genética
7.
Maturitas ; 167: 46-52, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36306666

RESUMEN

OBJECTIVE: To identify occupational hazards associated with earlier onset of natural menopause. STUDY DESIGN: A national cross-sectional study was conducted to explore the reproductive health of Chinese female workers. The final sample size was 17,948. MAIN OUTCOME MEASURES: Participants completed a self-report instrument that recorded working conditions, chemical and physical agents in the occupational environment, socioeconomic factors, lifestyle, reproductive history, and occupational information. A Cox regression model was used to examine the association between each occupational hazard and onset of menopause. RESULTS: Abnormal workload (19.31 %), aromatic compounds (7.95 %), and noise (24.94 %) were the three most frequently self-reported occupational hazards in the three categories of working conditions, chemical agents, and physical agents, respectively. Abnormal workload (HR = 1.133, p = 0.038), noise (HR = 1.233, p < 0.001), and heat stress (HR = 1.178, p = 0.041) were associated with earlier age at natural menopause in the analyses of each hazard, after adjustment. Only noise (HR = 1.187, p = 0.003) remained statistically significant after including all possible occupational hazards. CONCLUSIONS: In a national survey of 17,948 female workers, this study investigated the association of age at natural menopause with multiple occupational hazards, some of which have not been addressed. Occupational noise was identified as a risk factor for reproductive senescence for the first time. However, further research is needed to confirm our findings.


Asunto(s)
Envejecimiento , Menopausia , Humanos , Femenino , Estudios Transversales , Factores de Riesgo , Modelos de Riesgos Proporcionales
8.
Sci Rep ; 12(1): 18599, 2022 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-36329101

RESUMEN

Inflammation may contribute to excess mortality in rheumatoid arthritis (RA) patients. We investigated associations to all-cause mortality of the inflammation markers high-sensitivity C-reactive protein (CRP), lactoferrin (neutrophil activation marker), and neopterin (monocyte activation marker). From the population-based Trøndelag Health Study (3rd wave 2006-2008), 316 RA patients and 43,579 controls were included. Lactoferrin and neopterin were quantified in a nested cohort (n = 283 RA patients, n = 3698 controls). Follow-up was until death found by linkage to the Norwegian Cause of Death Registry or 31.12.2018. All-cause mortality was analyzed using Cox regression and Cox regression-based mediation analysis. Having RA (hazard ratio (HR): 1.25, 95%CI: 1.00, 1.56, p = 0.048), and CRP ≥ 3 mg/L (HR: 1.50, 95%CI: 1.41, 1.60, p < 0.001) were associated with all-cause mortality. The overall excess relative mortality risk of having RA was 38%. CRP ≥ 3 mg/L mediated approximately 1/4 of this risk (p < 0.001). In the nested cohort, CRP ≥ 3 mg/L (HR: 1.51, 95%CI: 1.26, 1.80, p < 0.001) and neopterin (HR: 1.17, 95%CI: 1.01, 1.36, p = 0.031) were associated with all-cause mortality. In conclusion, CRP levels ≥ 3 mg/L mediated approximately a quarter of the 38% excess relative all-cause mortality risk associated with RA. Using definitions of RA remission with emphasis both on joint status and the level of general inflammation may help guide the most efficient treatment regimens.


Asunto(s)
Artritis Reumatoide , Lactoferrina , Humanos , Neopterin/metabolismo , Lactoferrina/metabolismo , Artritis Reumatoide/complicaciones , Inflamación/complicaciones , Modelos de Riesgos Proporcionales , Proteína C-Reactiva/metabolismo , Biomarcadores , Factores de Riesgo
9.
Sci Rep ; 12(1): 18650, 2022 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-36333394

RESUMEN

A discrepancy in subjective and objective estimations of sleep duration, which often diverge, could have long-term adverse effects on health outcomes in older adults. Using data from 2674 older adult men (≥ 65 years of age) of the Osteoporotic Fractures in Men Sleep Study, we assessed the longitudinal association between misperception index (MI), calculated as MI = (objective sleep duration - subjective sleep duration)/objective sleep duration, and all-cause mortality. During the follow-up with a mean (standard deviation) of 10.8 (4.2) years, 1596 deaths were observed. As a continuous variable, MI showed a linear relationship with all-cause mortality after adjusting for multiple covariates, including polysomnography-measured objective sleep duration [fully adjusted hazard ratio (HR), 0.69; 95% confidence interval [CI], 0.56-0.84]. As a categorical variable, the lowest MI quartile (vs. the interquartile MI range) was associated with increased mortality (fully adjusted HR, 1.28; 95% CI, 1.12-1.46), whereas the highest MI quartile was not associated with mortality (fully adjusted HR, 0.97; 95% CI, 0.85-1.11). The subjective overestimation of sleep duration may be a risk factor for all-cause mortality in older men. Future studies should examine why subjective overestimation of sleep duration is associated with all-cause mortality from a physiological perspective.


Asunto(s)
Sueño , Masculino , Humanos , Anciano , Polisomnografía , Factores de Riesgo , Modelos de Riesgos Proporcionales , Sueño/fisiología
10.
Sci Rep ; 12(1): 18555, 2022 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-36329070

RESUMEN

Females are known to have a better survival rate than males in the general population, but previous studies have shown that this superior survival is diminished in patients on dialysis. This study aimed to investigate the risk of mortality in relation to sex among Korean patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). A total of 4994 patients with kidney failure who were receiving dialysis were included for a prospective nationwide cohort study. Cox multivariate proportional hazard models were used to determine the association between sex and the risk of cause-specific mortality according to dialysis modality. During a median follow-up of 5.8 years, the death rate per 100 person-years was 6.4 and 8.3 in females and males, respectively. The female-to-male mortality rate in patients on dialysis was 0.77, compared to 0.85 in the general population. In adjusted analyses, the risk of all-cause mortality was significantly lower for females than males in the entire population (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.71-0.87, P < 0.001). No significant differences in the risk of cardiovascular and infection-related deaths were observed according to sex. The risk of mortality due to sudden death, cancer, other, or unknown causes was significantly lower for females than males in the entire population (HR 0.66, 95% CI 0.56-0.78, P < 0.001), in patients on HD (HR 0.75, 95% CI 0.62-0.90, P = 0.003), and in patients on PD (HR 0.49, 95% CI 0.34-0.70, P < 0.001). The survival advantage of females in the general population was maintained in Korean dialysis patients, which was attributed to a lower risk of noncardiovascular and noninfectious death.Trial registration: ClinicalTrials.gov Identifier: NCT00931970.


Asunto(s)
Disparidades en el Estado de Salud , Diálisis Renal , Insuficiencia Renal , Femenino , Humanos , Masculino , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Diálisis Renal/mortalidad , Insuficiencia Renal/mortalidad , Insuficiencia Renal/terapia , Factores de Riesgo , Distribución por Sexo , Corea (Geográfico)/epidemiología , Tasa de Supervivencia
11.
Sci Rep ; 12(1): 20218, 2022 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-36418854

RESUMEN

Chronic inflammation is a continuous low-grade activation of the systemic immune response. Whereas downstream inflammatory markers are associated with atrial fibrillation (AF), upstream inflammatory effectors including eicosanoids are less studied. To examine the association between eicosanoids and incident AF. We used a liquid chromatography-mass spectrometry for the non-targeted measurement of 161 eicosanoids and eicosanoid-related metabolites in the Framingham Heart Study. The association of each eicosanoid and incident AF was assessed using Cox proportional hazards models and adjusted for AF risk factors, including age, sex, height, weight, systolic/diastolic blood pressure, current smoking, antihypertensive medication, diabetes, history of myocardial infarction and heart failure. False discovery rate (FDR) was used to adjust for multiple testing. Eicosanoids with FDR < 0.05 were considered significant. In total, 2676 AF-free individuals (mean age 66 ± 9 years, 56% females) were followed for mean 10.8 ± 3.4 years; 351 participants developed incident AF. Six eicosanoids were associated with incident AF after adjusting for multiple testing (FDR < 0.05). A joint score was built from the top eicosanoids weighted by their effect sizes, which was associated with incident AF (HR = 2.72, CI = 1.71-4.31, P = 2.1 × 10-5). In conclusion, six eicosanoids were associated with incident AF after adjusting for clinical risk factors for AF.


Asunto(s)
Fibrilación Atrial , Femenino , Humanos , Persona de Mediana Edad , Anciano , Masculino , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Estudios Longitudinales , Modelos de Riesgos Proporcionales , Antihipertensivos/uso terapéutico , Eicosanoides
12.
World J Surg Oncol ; 20(1): 367, 2022 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-36419077

RESUMEN

BACKGROUND: The debate surrounding systematic lymphadenectomy in the epithelial cancers of the ovary (EOC) was temporarily put to rest by the LION trial. However, there was a glaring disparity between the number of patients registered and the number of patients randomized suggesting inadvertent selection. A subsequent meta-analysis after this trial included all types of studies in the literature (randomized, non-randomized, case series, and, retrospective cohort), thus diluting the results. METHODS: We conducted a meta-analysis of hazard ratios of randomized controlled trials, to study the role of systematic para-aortic and pelvic lymph node dissection in the EOC. A detailed search of MEDLINE, Cochrane, and Embase databases was done to look for the published randomized controlled trials (RCT) comparing lymphadenectomy versus no lymphadenectomy in EOC. A meta-analysis of hazard ratios (HR) was performed for overall survival (OS) and progression-free survival (PFS) using fixed and random effect models. The quality of the RCTs was evaluated on Jadad's score, and the risk of bias was estimated by the Cochrane tool. RESULTS: A total of 1342 patients with EOC were included for quantitative analysis. On meta-analysis, HR for PFS was 0.9 (95% CI 0.79-1.04) favoring lymphadenectomy. HR for OS was 1 (95% CI 0.84-1.18) signifying no benefit of systematic lymphadenectomy. CONCLUSION: The results show a trend towards increased PFS which did not reach statistical significance nor translate into any meaningful benefit in OS. There is still a need for a greater number of well-conducted, suitably powered trials to convincingly answer this question.


Asunto(s)
Escisión del Ganglio Linfático , Neoplasias Ováricas , Femenino , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Modelos de Riesgos Proporcionales , Neoplasias Ováricas/cirugía , Supervivencia sin Progresión
13.
Biomed Res Int ; 2022: 5639174, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36420093

RESUMEN

We aimed to determine prognostic factors and develop an effective and practical nomogram for predicting cancer-specific survival in gastrointestinal stromal tumor (GIST) patients. Postoperative data were obtained from the SEER database (2000-2018). Patients were divided into training and validation cohorts at random (7 : 3). Prognostic factors were screened, and a prognostic nomogram was established using log-rank testing and Cox regression. We used DCA, ROC curves, C-index, and calibration curves to evaluate our model's predictive performance. The clinical value of the nomogram and the modified National Institute of Health (M-NIH) classification were compared using the NRI and IDI. The Kaplan-Meier method was applied to examine survival by risk group, and log-rank tests were applied to compare variations in survival curves. Independent prognostic risk factors associated with cancer-specific survival on multivariate Cox proportional hazards regression analysis were age, race, and tumor location, size, grade, and stage. Clinically relevant variables need to be considered in addition to statistically significant variables when developing prognostic models to aid clinical decision-making. We included two additional variables (mitotic rate and chemotherapy) when constructing the prognostic model. The C-index was 0.766 (95% confidence interval (CI): 0.737-0.794) in the training cohort and 0.795 (95% CI: 0.754-0.836) in the internal validation group suggesting robustness. The areas under the ROC curve for three-year and five-year survival were >0.700, indicating satisfactory discrimination. The calibration curves showed good agreement between the predictions of the nomogram and the actual results. The NRI (0.346 for 3-year and 0.265 for 5-year cancer-specific survival for patients with GIST (GSS) prediction; validation cohort: 0.356 for 3-year and 0.246 for 5-year GSS prediction) and IDI values (0.047 for 3-year and 0.060 for 5-year GSS prediction; validation cohort: 0.071 for 3-year and 0.084 for 5-year GSS prediction) suggested that the established nomogram performed significantly better than the M-NIH classification. The DCA indicated that the nomogram was clinically useful and had a high discriminative ability in identifying patients who were at high risk of poor outcomes. According to nomogram findings, patients were divided into three groups (high, moderate, and low risk), with significantly different prognoses in both cohorts. Our nomogram satisfactorily predicted survival in postsurgical GIST patients, which may assist clinicians to evaluate the postoperative status and guide subsequent treatments.


Asunto(s)
Tumores del Estroma Gastrointestinal , Nomogramas , Humanos , Pronóstico , Tumores del Estroma Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/patología , Programa de VERF , Modelos de Riesgos Proporcionales
14.
Medicine (Baltimore) ; 101(46): e31741, 2022 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-36401408

RESUMEN

BACKGROUND: Whether the size of thymic epithelial tumors (TETs) has an impact on prognosis has long been a controversial issue. Our study was designed to investigate the value of tumor size in the prognosis (overall survival (OS) and relapse-free survival) of patients with TETs. METHODS: We searched the databases such as PubMed, EMBASE, Web of Science, and clinical trials registration system for articles illustrating the impact of tumor size on survival data in TETs patients. We did a meta-analysis for OS and relapse-free survival. RESULTS: We recruited 9 studies in our meta-analysis. Our study illustrates that TETs patients with small tumor size had better relapse-free survival (hazard ratio = 1.66, 95% confidence interval 1.18-2.35, P = .004) and OS (hazard ratio = 1.93, 95% confidence interval 1.30-2.80, P = .001) in comparison to patients with large tumor size. CONCLUSIONS: In conclusion, the results of our meta-analysis showed that TET size was significantly associated with overall and relapse-free survival of patients, with relatively small tumors tending to have a better prognosis.


Asunto(s)
Neoplasias Glandulares y Epiteliales , Neoplasias del Timo , Humanos , Pronóstico , Modelos de Riesgos Proporcionales
15.
Technol Cancer Res Treat ; 21: 15330338221136724, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36380607

RESUMEN

Background: This study is a retrospective study. The purpose of this study is to construct and validate an early warning model of lung cancer through machine learning. Methods: The CDKN2A gene expression profile and clinical information were downloaded from The Cancer Genome Atlas (TCGA) database and divided into a tumor group and a normal group (n = 57). The top 5 somatic mutation-related genes were extracted from 567 somatic mutation data downloaded from TCGA database using random forest algorithm. Cox proportional hazard model and nomogram were constructed combining CDKN2A, 5 somatic mutation-related genes, gender, and smoking index. Patients were divided into high-risk and low-risk groups according to risk score. The predictability of the model in the prognosis of lung cancer was estimated by Kaplan-Meier survival analysis and receiver operating characteristics curve. Results: We constructed a prognostic model consisting of 5 somatic mutation-related genes (sphingosine 1-phosphate receptor 1 [S1PR1], dedicator of cytokinesis 7 [DOCK7], DEAD-box helicase 4 [DDX4], laminin subunit beta 3 [LAMB3], and importin 5 [IPO5]), cyclin-dependent kinase inhibitor 2A (CDKN2A), gender, and smoking indicators. The high-risk group had a lower overall survival rate compared to the low-risk group (hazard ratio = 2.14, P = 0 .0323). The area under the curve predicted for 3-year, 5-year, and 10-year survival rates are 0.609, 0.673, and 0.698, respectively. The accuracy, sensitivity, and specificity of the model for predicting the 10-year survival rate of lung cancer are 76.19%, 56.71%, and 86.23%. Conclusion: The lung cancer early warning model and nomogram may provide an essential reference for patients with lung cancer management in the clinic.


Asunto(s)
Neoplasias Pulmonares , Humanos , Estudios Retrospectivos , Neoplasias Pulmonares/patología , Pronóstico , Aprendizaje Automático , Modelos de Riesgos Proporcionales , beta Carioferinas
16.
Diabetes Res Clin Pract ; 193: 110136, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36341981

RESUMEN

AIMS: To investigate the long-term outcomes of Pay-for-Performance (P4P) care in patients with young-onset (20-40 years of age) diabetes (YOD). METHODS: We recruited 3088 pairs of propensity-score matched patients with and without P4P care from the National Health Insurance Research Database between January 1, 2001, and December 31, 2017. The study used a multivariable Cox regression model to compare the risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes in YOD patients with and without P4P care. RESULTS: The multivariable-adjusted model showed that patients with P4P care had significantly lower risks of mortality (aHR 0.31, 95% CI 0.25-0.38) and hospitalization for cardiovascular events (aHR 0.63, 95% CI 0.5-0.79) but a significantly higher risk of major microvascular outcomes (aHR 1.31, 95% CI 1.07-1.6). Patients with a longer cumulative duration of P4P and complete P4P care showed further lower risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes than those without P4P care. CONCLUSIONS: This nationwide cohort study showed that young-onset diabetes patients with P4P care had lower risks of death and cardiovascular events but a higher risk of major microvascular outcomes. However, patients with a longer duration of P4P care showed lower risks of these outcomes.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Humanos , Reembolso de Incentivo , Diabetes Mellitus Tipo 2/terapia , Estudios de Cohortes , Modelos de Riesgos Proporcionales , Taiwán
17.
BMC Med Res Methodol ; 22(1): 295, 2022 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-36401214

RESUMEN

BACKGROUND: The association structure linking the longitudinal and survival sub-models is of fundamental importance in the joint modeling framework and the choice of this structure should be made based on the clinical background of the study. However, this information may not always be accessible and rationale for selecting this association structure has received relatively little attention in the literature. To this end, we aim to explore four alternative functional forms of the association structure between the CD4 count and the risk of death and provide rationale for selecting the optimal association structure for our data. We also aim to compare the results obtained from the joint model to those obtained from the time-varying Cox model. METHODS: We used data from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) AIDS Treatment programme, the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) study, an open-label, three armed randomised, controlled trial between June 2005 and July 2010 (N=642). In our analysis, we combined the early and late integrated arms and compared results to the sequential arm. We utilized the Deviance Information Criterion (DIC) to select the final model with the best structure, with smaller values indicating better model adjustments to the data. RESULTS: Patient characteristics were similar across the study arms. Combined integrated therapy arms had a reduction of 55% in mortality (HR:0.45, 95% CI:0.28-0.72) compared to the sequential therapy arm. The joint model with a cumulative effects functional form was chosen as the best association structure. In particular, our joint model found that the area under the longitudinal profile of CD4 count was strongly associated with a 21% reduction in mortality (HR:0.79, 95% CI:0.72-0.86). Where as results from the time-varying Cox model showed a 19% reduction in mortality (HR:0.81, 95% CI:0.77-0.84). CONCLUSIONS: In this paper we have shown that the "current value" association structure is not always the best structure that expresses the correct relationship between the outcomes in all settings, which is why it is crucial to explore alternative clinically meaningful association structures that links the longitudinal and survival processes.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Tuberculosis , Humanos , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Recuento de Linfocito CD4 , Infecciones por VIH/complicaciones , Tuberculosis/tratamiento farmacológico , Modelos de Riesgos Proporcionales
18.
J Nutr Sci ; 11: e99, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36405096

RESUMEN

Since conducting a long-term randomised clinical trial is not logical and feasible to find the optimum dosage of salt intake in patients with cirrhosis, cohort studies are the best design to assess the long-term effects of dietary salt on the survival of cirrhotic patients. This cohort study aimed to evaluate the association between dietary intake of salt and mortality risk in cirrhotic patients. The present study was designed as a cohort in three referral hospitals in Iran in 2018. One hundred and twenty-one patients aged between 20 and 70 years with established cirrhosis were recruited. Dietary intakes, demographic data and disease severity were evaluated at the baseline. Participants were followed up annually. Crude survival was greater in patients with low-to-moderate salt consumption rather than in those with high consumption, and in non-consumers [34⋅26 (95 % CI 33⋅04, 35⋅49) v. 30⋅41 (95 % CI 27⋅13, 33⋅69) v. 32⋅72 (95 % CI 30⋅63, 34⋅80), P = 0⋅028; log-rank test]. Using the Cox proportional hazard model, it was shown that the risk of mortality in the high-salt consumption category was approximately 126 % higher than that of the reference category (non-consumers) [HR value 2⋅26, (95 % CI 0⋅91, 5⋅63)], while this risk for the low-to-moderate consumption group was about 28 % lower than the reference category [HR value 0⋅72, (95 % CI 0⋅26, 1⋅99), P-trend = 0⋅04]. In conclusion, a high daily dietary intake of salt might increase the rate of mortality and moderate salt restriction (instead of elimination of salt) decreases the risk of death.


Asunto(s)
Conducta Alimentaria , Cloruro de Sodio Dietético , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Estudios de Cohortes , Modelos de Riesgos Proporcionales , Cirrosis Hepática
19.
Front Endocrinol (Lausanne) ; 13: 989063, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36387854

RESUMEN

Background: This study aimed to develop a nomogram to predict the survival for stage IIIC endometrial cancer (EC) patients with adjuvant radiotherapy (ART) alone and personalize recommendations for the following adjuvant chemotherapy (ACT). Methods: In total, 746 stage IIIC EC patients with ART alone were selected from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox regression analysis was performed to identify independent risk factors. A nomogram was developed accordingly, and the area under the receiver operating characteristic curve (AUC) and C-index were implemented to assess the predictive power. The patients were divided into different risk strata based on the total points derived from the nomogram, and survival probability was compared between each risk stratus and another SEER-based cohort of stage IIIC EC patients receiving ART+ACT (cohort ART+ACT). Results: Five independent predictors were included in the model, which had favorable discriminative power both in the training (C-index: 0.732; 95% CI: 0.704-0.760) and validation cohorts (C-index: 0.731; 95% CI: 0.709-0.753). The patients were divided into three risk strata (low risk <135, 135 ≤ middle risk ≤205, and high risk >205), where low-risk patients had survival advantages over patients from cohort ART+ACT (HR: 0.45, 95% CI: 0.33-0.61, P < 0.001). However, the middle- and high-risk patients were inferior to patients from cohort ART+ACT in survival (P < 0.001). Conclusion: A nomogram was developed to exclusively predict the survival for stage IIIC EC patients with ART alone, based on which the low-risk patients might be perfect candidates to omit the following ACT. However, the middle- and high-risk patients would benefit from the following ACT.


Asunto(s)
Neoplasias Endometriales , Femenino , Humanos , Pronóstico , Programa de VERF , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Quimioterapia Adyuvante , Neoplasias Endometriales/tratamiento farmacológico
20.
BMC Pregnancy Childbirth ; 22(1): 844, 2022 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-36384519

RESUMEN

BACKGROUND: Early initiation of childbearing leads to an increase in total fertility rate and population growth. It has been linked with both maternal and child morbidity and mortality. However, there is limited information on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve fertility rate, maternal and child survival. METHODS: The survey used recent (2010 - 2018) Demographic and Health data; a stratified, two-stage cluster sampling technique was used to select the sample. Inverse Weibull gamma shared frailty model was used to model the data at 95% confidence interval. Adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Statistical significance was declared at p value < 0.05. RESULTS: The overall median age at first birth was found to be 19 years (IQR: 16, 21 years). Rural residency (AHR = 1.02, 95%, CI 1.00,1.04), agricultural employee (AHR = 1.14, 95%, CI 1.13, 1.17), and nonagricultural employee (AHR = 1.06, 95%, CI 1.05, 1.08), marriage below 15 years (AHR = 5.47, 95%, CI 5.37, 5.57) and 15-17 years (AHR = 3.27, 95%, CI 3.22, 3.32), had sex below 15 years (AHR = = 1.57, 95%, CI 1.54, 1.61) and 15-17 years (AHR = 1.38, 95%, CI 1.38, 1.43), women who had unmet need for contraceptive (AHR = 1.39, 95%, CI 1.37, 1.42), and met need (AHR = 1.32, 95%, CI 1.30, 1.35), high spousal age gap (AHR = 1.17, 95%, CI 1.15, 1.19), not heard family planning message (AHR = 1.02, 95%, CI 1.01,1.04) were the higher hazard of early childbirth. CONCLUSION: The median age at first birth was found to be 19 years. This is lower than the optimal age for giving first birth, which is between late 20 s and early 30 s years. Rural residences, occupation, hearing family planning massage in the media, early sexual intercourse, early age at first marriage, high spousal gap, and unmet need for family planning were predictors of first birth at an early age. Thus, governments and non-governmental organizations should strive to implement programs that aim to reduce early age at first birth by considering these factors.


Asunto(s)
Orden de Nacimiento , Fragilidad , Niño , Femenino , Humanos , Adulto Joven , Adulto , Fertilidad , Modelos de Riesgos Proporcionales , Servicios de Planificación Familiar
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