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BMJ Open ; 11(9): e049581, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489283


OBJECTIVES: To evaluate the cost-effectiveness of four different primary screening strategies: high-risk factor questionnaire (HRFQ) alone, single immunochemical faecal occult blood test (iFOBT), double iFOBT and HRFQ+double iFOBT for colorectal cancer (CRC) screening compared with no screening using the Markov model. METHODS: Treeage Pro V.2011 software was used to simulate the Markov model. The incremental cost-effectiveness ratio, which was compared with the willingness-to-pay (WTP) threshold, was used to reflect the cost-effectiveness of the CRC screening method. One-way sensitivity analysis and probabilistic sensitivity analysis were used for parameter uncertainty. RESULTS: All strategies had greater effectiveness because they had more quality-adjusted life years (QALYs) than no screening. When the WTP was ¥435 762/QALY, all screening strategies were cost-effective compared with no screening. The double iFOBT strategy was the best-buy option compared with all other strategies because it had the most QALYs and the least cost. One-way sensitivity analysis showed that the sensitivity of low-risk adenoma, compliance with colonoscopy and primary screening cost were the main influencing factors comparing single iFOBT, double iFOBT and HRFQ+double iFOBT with no screening. However, within the scope of this study, there was no fundamental impact on cost-effectiveness. Probabilistic sensitivity analysis showed that when the WTP was ¥435 762/QALY, the probabilities of the cost-effectiveness acceptability curve with HRFQ alone, single iFOBT, double iFOBT and HRFQ+double iFOBT were 0.0%, 5.3%, 69.3% and 25.4%, respectively. CONCLUSIONS: All screening strategies for CRC were cost-effective compared with no screening strategy. Double iFOBT was the best-buy option compared with all other strategies. The significant influencing factors were the sensitivity of low-risk polyps, compliance with colonoscopy and cost of primary screening.

Neoplasias Colorretais , Detecção Precoce de Câncer , China , Colonoscopia , Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício , Humanos , Cadeias de Markov , Programas de Rastreamento , Sangue Oculto , Anos de Vida Ajustados por Qualidade de Vida
Psych J ; 9(2): 199-209, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32077267


Deficit in decision-making has been found in patients with schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD), respectively, while the common and distinct characteristics of this deficit among these patients are still unclear. The present study aimed to make a transdiagnostic comparison of the affective decision-making ability in patients with SCZ, MDD, and BD. In this study, 33 patients with SCZ, 23 patients with MDD, 29 patients with BD, and 34 healthy controls (HCs) were recruited and the Iowa Gambling Task (IGT) was used to assess the affective decision-making ability. The results showed that all three diagnostic groups tended to select the disadvantageous decks but not advantageous decks compared to HCs. For patients with SCZ, an excessive preference for the disadvantageous decks with larger-magnitude less frequent punishments (deck B) may be the main reason of the deficit in affective decision-making, while that in patients with MDD was a significantly decreased ability to choose advantageous decks on the whole but with larger-magnitude less frequent punishments (deck D). As regards patients with BD, the concurrence of more choices of deck B and fewer choices of deck D was the characteristic of the deficit in affective decision-making. Our findings suggest a common affective decision-making impairment in the context of multiple choices in patients with SCZ, MDD, and BD, while the underlying mechanisms of the impairment among these patients may be slightly different.

Transtorno Bipolar/psicologia , Tomada de Decisões/fisiologia , Transtorno Depressivo Maior/psicologia , Pacientes/estatística & dados numéricos , Esquizofrenia , Adulto , Feminino , Jogo de Azar/psicologia , Humanos , Masculino , Testes Neuropsicológicos/estatística & dados numéricos
World J Surg Oncol ; 15(1): 138, 2017 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-28750680


BACKGROUND: It is still under debate that whether stage IV colorectal cancer patients with unresectable metastasis can benefit from primary tumor resection, especially for asymptomatic colorectal cancer patients. Retrospective studies have shown controversial results concerning the benefit from surgery. This retrospective study aims to evaluate whether the site of primary tumor is a predictor of palliative resection in asymptomatic stage IV colorectal cancer patients. METHODS: One hundred ninety-four patients with unresectable metastatic colorectal cancer were selected from Sun Yat-sen University Cancer Center Database in the period between January 2007 and December 2013. All information was carefully reviewed and collected, including the treatment, age, sex, carcinoembryonic antigen, site of tumor, histology, cancer antigen 199, number of liver metastases, and largest diameter of liver metastasis. The univariate and multivariate analyses were used to detect the relationship between primary tumor resection and overall survival of unresectable stage IV colorectal cancer patients. RESULTS: One hundred twenty-five received palliative resection, and 69 received only chemotherapy. Multivariate analysis indicated that primary tumor site was one of the independent factors (RR 0.569, P = 0.007) that influenced overall survival. For left-side colon cancer patients, primary tumor resection prolonged the median overall survival time for 8 months (palliative resection vs. no palliative resection: 22 vs. 14 months, P = 0.009); however, for right-side colon cancer patients, palliative resection showed no benefit (12 vs. 10 months, P = 0.910). CONCLUSIONS: This study showed that left-side colon cancer patients might benefit from the primary tumor resection in terms of overall survival. This result should be further explored in a prospective study.

Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Neoplasias Hepáticas/patologia , Cuidados Paliativos/métodos , Adulto , Idoso , Antígenos Glicosídicos Associados a Tumores/sangue , Doenças Assintomáticas/mortalidade , Antígeno Carcinoembrionário/sangue , China/epidemiologia , Neoplasias Colorretais/sangue , Neoplasias Colorretais/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Adulto Jovem
Chin J Cancer ; 34(8): 358-64, 2015 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-26245843


INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer in China. The incidence of CRC has been increasing in recent years. The aim of this study was to explore the incidence trends and the age distribution of CRC by subsite in Guangzhou between 2000 and 2011. METHODS: A total of 22,432 incident cases of CRC between 2000 and 2011 from Guangzhou Cancer Registry were identified. Crude incidence and age-standardized rates (ASRs), using the Segi's world standard population, were calculated for CRC and CRC subsites. The incidence trend was analyzed and the annual percentage change (APC) in incidence was calculated by using JoinPoint software. RESULTS: The crude incidence increased significantly from 23.4/10(5) in 2000 to 37.4/10(5) in 2011 for males and from 20.9/10(5) to 30.5/10(5) for females. The ASRs of CRC incidence stabilized during the period of 2000-2011 for both males and females. The ages at the onset of CRC for both males and females during 2010-2011 were significantly higher compared with those during 2000-2002 (males: t = 1.95, P = 0.05; females: t = 6.03, P < 0.01). For males aged 50-64 years, the CRC incidence increased by 8.50% annually (P = 0.04) during 2000-2004 and by 1.68% annually (P = 0.03) during 2005-2011. For females aged 65 years and older, the CRC incidence increased by 5.77% annually (P = 0.03) during 2000-2004. There were no significant changes for the CRC incidences in males aged 49 and younger and 65 years and older and females aged 64 years and younger during 2000-2004, or for those in all females as well as males aged 49 years and younger and 65 years and older during 2005-2011. The percentage of colon cancer in all CRCs increased significantly for both males and females between the periods of 2000-2002 and 2010-2011. The ASRs of descending colon and sigmoid colon cancer incidences increased significantly for females during 2005-2011 (APC, 5.51% and 1.08%, respectively, both P < 0.05). CONCLUSIONS: The crude incidence of CRC increased significantly between 2000 and 2011 because of the aging, whereas the ASRs kept stable. The percentage of colon cancer in all CRCs increased significantly. Further surveillance, research, and intervention are needed to identify the causes of these changes and to reduce the incidence and mortality of CRC.

Distribuição por Idade , Neoplasias Colorretais , Incidência , Envelhecimento , China , Feminino , Humanos , Masculino , Neoplasias do Colo Sigmoide
PLoS One ; 7(11): e48878, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23145005


BACKGROUND: Several prospective observational studies suggest that gamma-glutamyltransferase(GGT) level is positively associated with risk of hypertension. However, these studies draw inconsistent conclusions. Therefore, we conducted a systematic review and meta-analysis to evaluate the exact association between GGT level and subsequent development of hypertension. METHODS: We searched Pubmed, Embase, and Science Citation Index (ISI Web of Science) for prospective cohort studies examining the association between GGT level and hypertension. Then, pooled effect estimates (RRs) for the association between GGT level and hypertension were calculated. RESULTS: A total of 13 prospective cohort studies including 43314 participants and 5280 cases of hypertension were included. The pooled RR of hypertension was 1.94(95%CI: 1.55-2.43; P<0.001) when comparing the risk of hypertension between the highest versus lowest category of GGT levels. Moreover, the risk of hypertension increased by 23% (summary RR: 1.23; 95%CI: 1.13-1.32; P<0.001) per 1 SD logGGT increment. Subgroup analyses showed significant positive associations in each subgroup except in ≧160/95 subgroup (RR: 2.56, 95%CI: 0.87-7.54; P = 0.088) and nondrinkers subgroup (RR: 1.76, 95%CI: 0.88-3.53; P = 0.113). Sensitivity analyses showed no single study significantly affects the pooled RRs. No publication bias was found in our meta-analysis. CONCLUSIONS: GGT level is positively associated with the development of hypertension. Further studies are needed to confirm our findings and elucidate the exact mechanisms between GGT level and the incidence of hypertension.

Hipertensão/sangue , gama-Glutamiltransferase/sangue , Biomarcadores/sangue , Humanos , Masculino , Razão de Chances , Estudos Prospectivos , Risco , Fatores de Risco