Cost-utility analysis of the newly recommended adjuvant chemotherapy for resectable gastric cancer patients in the 2011 Chinese National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Gastric Cancer.

BACKGROUND: Postoperative adjuvant chemotherapy with capecitabine and oxaliplatin was first recommended for resectable gastric cancer patients in the 2011 Chinese National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Gastric Cancer, but the economic influence of this therapy in China is unknown. OBJECTIVE: The aim of the present study was to determine the cost-effectiveness of adjuvant chemotherapy with capecitabine and oxaliplatin after a gastrectomy with extended (D2) lymph-node dissection, compared with a D2 gastrectomy alone, for patients with stage II-IIIB gastric cancer. METHODS: On the basis of data from the CLASSIC trial, a Markov model was created to determine economic and clinical data for patients in the chemotherapy and surgery group (CSG) and the surgery-only group (SOG). The costs, presented in 2010 US dollars and estimated from the perspective of the Chinese health-care system, were obtained from the published literature and the local health system. The utilities were based on published literature. Costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER) were estimated. A lifetime horizon and a 3 % annual discount rate were used. One-way and probabilistic sensitivity analyses were performed. RESULTS: For the base case, the CSG compared with SOG would increase LYs and QALYs in a 3-, 5-, 10- or 30-year time horizon (except the QALYs at 3 or 5 years). In the short run (such as in 3 or 5 years), the medical costs would increase owing to adjuvant chemotherapy of capecitabine plus oxaliplatin after D2 gastrectomy, but in the long run the costs would decline. The ICERs suggested that the SOG was dominant at 3 or 5 years and the CSG was dominant at 10 or 30 years. The one-way sensitivity analysis showed that the utility of disease-free survival for 1-10 years for the SOG and the cost of oxaliplatin were the most influential parameters. The probabilistic sensitivity analysis predicted a 98.6 % likelihood that the ICER for the CSG would be less than US$13,527/QALY (three times the per capita gross domestic product of China). CONCLUSION: For patients in China with resectable disease, our results suggest that adjuvant chemotherapy with capecitabine plus oxaliplatin after a D2 gastrectomy is cost-saving and dominant in the long run on the basis of a current clinical trial, compared with treatment with a D2 gastrectomy alone.

Psychometric features of the body image after breast cancer questionnaire-Chinese version in women with breast cancer / 中南大学学报(医学版)

OBJECTIVE@#To examine the psychometric features of the body image after breast cancer questionnaire-Chinese version (BIBCQ-C) in Chinese women with breast cancer.@*METHODS@#A total of 545 women with breast cancer received a demographics investigation: BIBCQ-C and hospital anxiety and depression scale (HAD). Four weeks later, 31 patients were selected randomly to finish BIBCQ-C again.@*RESULTS@#The Cronbach's alpha coefficient for the total scale was 0.90, and that for the 6 factors ranged from 0.62 to 0.87. The mean inter-item correlation coefficient of the total scale was 0.16, and the mean inter-item correlation coefficient of the subscales ranged from 0.21 to 0.57, and the test-retest reliability of the total scale and 6 factors was over 0.60. The confirmatory factor analyses supported the 6-factor model, and BIBCQ-C were significantly correlated with the symptom scales of anxiety and depression (r=0.20, 0.21, P<0.01).@*CONCLUSION@#BIBCQ-C is reliable and valid, which can effectively assess body image of Chinese women with breast cancer.

Expressions of tumor-associated glycoprotein 72 and glucose-regulated protein 94 in the benign and malignant breast lesions and their clinicopathological significance / 肿瘤

Objective:To study the expression levels of tumor-associated glycoprotein (TAG72) and glucose-regulated protein 94 (GRP94) in the breast benign and malignant lesions and detect their clinicopathological significance. Methods:EnVisionTM immunohistochemistry was used for assaying expressive levels of TAG72 and GRP94 in conventional paraffin-embedded sections from specimens of breast cancer (n=60) and benign lesions (n=30). The survival analysis was performed by using Kaplan-Meier method.Results:The positive rates and scores of TAG72 and GRP94 were significantly higher in breast cancer than those in benign lesions (TAG72: 68.3% vs 10.0%, 2.53±1.86 vs 0.37±1.13; GRP94: 63.3% vs 13.3%, 2.73±2.23 vs 0.47±1.22; P=0.000). The positive rates and scores of TAG72 and GRP94 were significantly lower in the intra-ductal,histological grade Ⅰ or Ⅱ , with maximal diameter ≤3 cm, without lymph node metastasis, estrogen receptor (ER)-positive, p53 and CA15-3-negative breast cancer than those in the ductal invasive (P3 cm (P<0.05), with lymph node metastasis (P<0.01), ER-negative (P<0.05) , p53-positive (P<0.01), and CA15-3-positive (P<0.01) breast cancer tissues. Kaplan-Meier survival analysis showed that the median survival time were significantly shorter in the TAG72-positive, GRP94-positive or TAG72 and GRP94-positive breast cancer patients than those with negative TAG72 and/or GRP94 expression (P<0.01). Multivariate COX regression analysis showed that TAG72 and/or GRP94-positive expression were negatively associated with postoperative survival rate and positively related with death rate. Both of them were independent prognostic factors for breast cancer. Conclusion:The expressive levels of TAG72 and/or GRP94 might have important effects on the carcinogenesis, progression, biologic behaviors and prognosis of breast cancer. The breast cancer patients with over-expression of TAG72 and/or GRP94 might have poor prognosis.

Expression of galectin-3 and Sambucus nigra agglutinin and its clinicopathological significance in benign and malignant lesions of breast / 中南大学学报(医学版)

OBJECTIVE@#To detect the expression of galectin-3 (gal-3) and Sambucus nigra agglutinin (SNA) and determine their clinicopathological significance in breast cancers and benign breast lesions.@*METHODS@#Envison immunohistochemistry for staining gal-3 expression, and ABC affinity-cytochemistry to detect SNA expression were used in paraffin-embedded slides from specimens of breast cancers (n=60) and benign lesions (n=30).@*RESULTS@#The positive rates and scoring means of gal-3 and SNA were significantly higher in breast cancer (48.3%, 2.07 +/- 2.25, 2.12 +/- 2.26) than those in benign lesions (26.7%, 1.03 +/- 1.63, 1.07 +/- 1.59, P < 0.05). The scoring means of gal-3 and SNA expression were significantly lower in the positive cases of estrogen receptor (ER) and the negative ones of CA15-3 than those in the negative cases and the positive ones (P < 0.05).The survival analysis of Kaplan-Meier showed the 5-year survival rate and mean survival period were significantly lower in the gal-3 or SNA expression positive cases than those in the negative cases of breast cancer (P<0.01).@*CONCLUSION@#The expressive level of gal-3 and SNA lectins might have important effect on the carcinogenesis, progression and biologic behaviors of breast cancer. The positive cases of gal-3 and /or SNA expression might have poor prognosis.

Cost-effectiveness analysis of adjuvant therapy for operable breast cancer from a Chinese perspective: doxorubicin plus cyclophosphamide versus docetaxel plus cyclophosphamide.

An oncology trial compared four cycles of doxorubicin/cyclophosphamide (AC) with four cycles of docetaxel/cyclophosphamide (TC) in operable breast cancer patients (71% were diagnosed with hormone receptor positive and 48% with node-negative breast cancer). The objective of this study was to estimate the lifetime cost effectiveness of AC versus TC, from a Chinese healthcare provider perspective, based on a clinical trial. A lifetime cost-effectiveness analysis was performed using a Markov model. Events rates and utilities in the Markov model were derived from published papers. Data on cost of breast cancer care were obtained from the Second Xiangya Hospital of Central South University, Changsha, PR China. One-way sensitivity analysis and probabilistic sensitivity analysis were undertaken. Cost estimates were valued in Chinese yuan (Y), year 2008 values. All costs and outcomes were discounted at 3% per annum. Patients receiving TC gained 14.45 QALYs, 0.41 QALYs more than patients receiving AC. The lifetime costs of patients receiving TC were Y93 511, Y10 116 more than that of AC patients. The incremental cost-effectiveness ratios were Y26 742 per life-year gained ( pound 2719.8 per year) and Y24 305 per QALY gained ( pound2471.9 per QALY). The most sensitive parameter in the model was the cost of primary cancer treatments in the TC arm. At a threshold willingness to pay of Y86 514 per QALY, the probability of TC being cost effective was 90%. Our model suggests that TC may be considered cost effective from a Chinese healthcare provider perspective, according to the threshold defined by the WHO.

Studies on the Methods of Cost-utility Analysis for Cholelithiasis Surgery Patients / 中国药房

OBJECTIVE: To explore a research path and statistical analytical method for cost-utility analysis suitable for gallstone surgery patients.METHODS: A decision-making model for the treatment of cholelithiasis surgery was established;the costs(C) and utility values at each nodal point(? U) were collected,with the results subjected to sensitivity analysis and threshold analysis.RESULTS: The cost-utility ratios(CUR) of laparoscopic operation and open surgery were 4 605.6(? 30%) yuan/QALY and 5 979.7(? 30%) yuan/QALY,respectively.One dimension sensitivity analysis of each( every) parameter reveals that the former CUR value is greater than the latter one.C1 and ? U1 showed the biggest impact on the CUR of laparoscopic operation,while C5 and ? U5 did on the CUR of open surgery.When C1=10 205.6 yuan,or ? U1=1.303 or C5=10 979.8 yuan or ? U5=3.095,CUR of laparoscopic operation was equal to CUR of open surgery,which means that the conversion of threshold was achieved.CONCLUSION: The designed research path and statistic analytic methods are suitable for the cost-utility analysis of cholelithiasis surgery patients.

Clinical analysis of 57 cases of thyroid disease with concomitant focal lymphocytic thyroiditis / 中国普通外科杂志

Objective To evaluate the methods of diagnosis and treatment of thyroid disease with concomitant focal lymphocytic thyroiditis(FLT), and explore the reasons for its confused with Hashimoto′s disease(HD).Methods During the recent 25 years, 207 patients underwent surgical trearment for pathologically diagnosed HD.Among this group, 143 cases of HD with other concomitant thyroid disease were retrospectively analysed.Results Of the 143 cases, 57 cases were found to have thyroid disease with concomitant FLT, and this was 27.5%(57/207) of the total HD group, or 39.9%(57/143) of the group with thyroid disease and concomitant HD.Intraoperative pathologic section revealed that focal lymphocytic infiltration was positive in 87.7%(50/57) of cases. The postoperative hypothyroidism occurrence rate was 19.3%(11/57), of which, 7 cases(7/57, 12.3%) were subclinical hypothyroidism.Conclusions The character of pathologic changes of thyroid disease with FLT and with HD was different. Intraoperative pathologic section can be helpful in the diagnosis of this condition and can have important significance as a guide to the scope of (surgical) resection of the thyroid gland.