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1.
Clin. transl. oncol. (Print) ; 24(7): 1381-1394, julio 2022. tab
Artigo em Inglês | IBECS | ID: ibc-203837

RESUMO

BackgroundThe present study aims to identify immune-related RBPs signature to predict prognosis and therapy response in prostate cancer.MethodsDifferentially expressed RBPs were compared and visualized using R packages. Immune-related RBPs were selected by Pearson correlation analysis. The prognostic immune-related RBPs were identified using the Kaplan–Meier method and LASSO regression. A multivariable Cox regression model was used to construct immune-related RBPs signature.ResultsWe constructed a prognostic predictive risk model of prostate cancer containing ten immune-related RBP genes. We found that high-risk prostate cancer patients presented poorer prognosis, higher tumor immune cell infiltration, higher rates of genomic alterations, and were more sensitive to targeted and immunotherapy than the low-risk group.ConclusionsThe immune-related RBPs’ signature is an independent prognostic marker that could help screen patients with advanced prostate cancer who are better suited for targeted and immunotherapy.


Assuntos
Humanos , Imunoterapia , Modelos de Riscos Proporcionais , Neoplasias da Próstata/genética , Neoplasias da Próstata/terapia , Prognóstico , RNA
2.
Environ Health Prev Med ; 27(0): 22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35644539

RESUMO

BACKGROUND: We investigated whether family histories of herpes zoster (HZ) are associated with the risk of incident HZ in a Japanese population. METHODS: A total of 12,522 Japanese residents aged ≥50 years in Shozu County participated in the baseline survey between December 2008 and November 2009 (the participation rate = 72.3%). They were interviewed at baseline by research physicians regarding the registrants' history of HZ. A self-administered questionnaire survey was conducted to evaluate the potential confounding factors. 10,530 participants without a history of HZ were followed up to ascertain the incidence of HZ during 3-years follow-up until the end of November 2012 with Japanese nationals. We estimated hazard ratios (HRs) of incident HZ according to first-degree family histories using the Cox proportional hazard regression after adjusting for age, sex, and other potential confounding factors. RESULTS: Compared to no HZ history of each family member, a history of brother or sister was associated with a higher risk of incident HZ while histories of father and mother were not. The multivariable HR (95%CI) of incident HZ for a history of brother or sister was 1.67 (1.04-2.69). When comparing to no family histories of all first-degree relatives, the multivariable HRs (95%CIs) were 1.34 (0.77-2.34) for a history of brother or sister alone, but 4.81 (1.78-13.00) for a history of mother plus brother or sister. As for the number of family histories, the multivariable HRs (95%CIs) were 1.08 (0.76-1.54) for one relative (father, mother, or brother or sister) and 2.75 (1.13-6.70) for two or more relatives. CONCLUSION: Family histories of mother plus brother or sister and two or more first-degree relatives were associated with a higher risk of incident HZ.


Assuntos
Herpes Zoster , Feminino , Herpes Zoster/epidemiologia , Humanos , Incidência , Masculino , Mães , Modelos de Riscos Proporcionais
3.
J Cancer Res Ther ; 18(2): 391-398, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35645105

RESUMO

Objective: This study evaluated the survival outcomes of young (<50 years) and elderly patients (>80 years) with high-risk prostate cancer (PCa) postradical local treatments. Materials and Methods: We identified <50 and >80-year-old patients with high-risk PCa between 2004 and 2015 in the Surveillance, Epidemiology, and End Results database. The patients aged 65 and 66 years were also identified as the control group. The propensity-score matching method was adopted to compare the young and elderly patients with the control group. Kaplan-Meier analysis and Cox regression were conducted to evaluate the PCa-specific survival (PCSS) and overall survival. Results: A total of 17726 patients were identified, and 3355 were under 50 years old, whereas 4798 of them were >80 years old. The young patient group (<50 years) had similar PCSS with the control group (65-66 years) in both the overall cohort (hazard ratio [HR]: 0.88, 95% confidence interval [CI] [0.73-1.06], P = 0.132) and matched cohort (HR: 0.96, 95% CI [0.74-1.24], P = 0.527). Young patients with both high-risk and very high-risk PCa after radical prostatectomy (RP) treatment had apparent longer mean cancer-specific survival time than those after external-beam radiotherapy (EBRT) and/or brachytherapy (BT) treatment (high-risk group: 153.38 ± 0.82 months vs. 149.72 ± 3.03 months; very high-risk group: 148.3 ± 1.84 months vs. 139.33 ± 3.25 months). For the elderly patients (>80 years), the PCSS outcomes were significantly worse than the control group (65-66 years) in both overall cohort (HR: 2.69, 95% CI [2.31-3.13], P < 0.001) and matched cohort (HR: 1.61, 95% CI [1.34-1.94], P < 0.001). Patients receiving RP treatment had similar PCSS outcomes with those receiving EBRT and/or BT in the high-risk PCa group (139.45 ± 9.98 months vs. 139.41 ± 1.84 months), and better PCSS in very high-risk PCa group (132.73 ± 13.56 months vs. 128.82 ± 3.43 months). Conclusion: The PCSS outcomes of young PCa patients (<0 years) were identical to those of the control group (65-66 years). RP had similar or better PCSS benefits than EBRT and/or BT in both young (<50 years) and elderly patients (>80 years).


Assuntos
Braquiterapia , Neoplasias da Próstata , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Próstata , Prostatectomia/métodos , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/radioterapia
4.
BMC Med ; 20(1): 218, 2022 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-35692046

RESUMO

BACKGROUND: Neurofilament light chain (NfL) is released into the blood during neuronal damage. NfL is linked to mortality in neurological disorders, remaining unexplored in population studies. We investigated whether initial (v1) and annualized change (δ) in plasma NfL can predict all-cause mortality in middle-aged dementia-free urban adults. METHODS: Longitudinal data were from 694 participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span study (HANDLS, mean agev1: 47.8 years, 42% male, 55.8% African American). Plasma NfL was measured prospectively at three visits. Analyses included Cox proportional hazards models for all-cause mortality risk and 4-way decomposition testing for interaction and mediation. RESULTS: Unlike men, women exhibited a direct association between δNfL (above vs. below median) and all-cause mortality risk in both the minimally (HR = 3.91, 95% CI 1.10-13.9, p = 0.036) and fully adjusted models (HR = 4.92, 95% CI 1.26-19.2, p = 0.022), and for δNfL (per unit increase) in the full model (HR = 1.65, 95% CI 1.04-2.61, p = 0.034). In both models, and among women, 1 standard deviation of NfLv1 was associated with an increased all-cause mortality risk (reduced model: HR = 2.01, 95% CI 1.24-3.25, p = 0.005; full model: HR = 1.75, 95% CI 1.02-2.98, p = 0.041). Only few interactions were detected for cardio-metabolic risk factors. Notably, NfLv1 was shown to be a better prognostic indicator at normal hsCRP values among women, while HbA1c and δNfL interacted synergistically to determine mortality risk, overall. CONCLUSIONS: These findings indicate that plasma NfL levels at baseline and over time can predict all-cause mortality in women and interacts with hsCRP and HbA1c to predict that risk.


Assuntos
Proteína C-Reativa , Filamentos Intermediários , Biomarcadores , Feminino , Hemoglobina A Glicada , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais
5.
JNCI Cancer Spectr ; 6(1)2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-35699499

RESUMO

When designing a comparative oncology trial for an overall or progression-free survival endpoint, investigators often quantify the treatment effect using a difference in median survival times. However, rather than directly designing the study to estimate this difference, it is almost always converted to a hazard ratio (HR) to determine the study size. At the analysis stage, the hazard ratio is utilized for formal analysis, yet because it may be difficult to interpret clinically, especially when the proportional hazards assumption is not met, the observed medians are also reported descriptively. The hazard ratio and median difference contrast different aspects of the survival curves. Whereas the hazard ratio places greater emphasis on late-occurring separation, the median difference focuses locally on the centers of the distributions and cannot capture either short- or long-term differences. Having 2 sets of summaries (a hazard ratio and the medians) may lead to incoherent conclusions regarding the treatment effect. For instance, the hazard ratio may suggest a treatment difference whereas the medians do not, or vice versa. In this commentary, we illustrate these commonly encountered issues using examples from recent oncology trials. We present a coherent alternative strategy that, unlike relying on the hazard ratio, does not require modeling assumptions and always results in clinically interpretable summaries of the treatment effect.


Assuntos
Neoplasias , Projetos de Pesquisa , Humanos , Oncologia , Neoplasias/terapia , Modelos de Riscos Proporcionais
6.
JNCI Cancer Spectr ; 6(1)2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-35699501

RESUMO

BACKGROUND: Population-based analyses of patterns of care and survival of older patients diagnosed with grade II-III oligodendroglioma (OLI) or astrocytoma (AST) can aid clinicians in their understanding and care of these patients. METHODS: We identified patients diagnosed between 2006 and 2015 with primary glioma diagnoses (OLI or AST) who were older than 65 years using the latest release of the Surveillance, Epidemiology, and End Results-Medicare-linked database. Medicare claims were used to identify cancer treatments (surgery, chemotherapy, and radiation therapy) from 2006 to 2016. Kaplan-Meier methodology was used to describe overall survival (OS). Cox proportional hazards regression was used to associate variables of interest, including treatments in a time-dependent manner, with OS. Hazard ratios (HRs) and 95% confidence intervals (CIs) from multivariable, cause-specific competing risk models identified associations with treatments. All statistical tests were 2-sided. RESULTS: We identified 1291 patients comprising 158 with OLI, 1043 with AST, and 90 with mixed histologies. Median OS was 6.5 (95% CI = 6.1 to 7.3) months for the overall cohort, 22.6 (95% CI = 13.9 to 33.1) months for OLI, and 5.8 (95% CI = 5.3 to 6.4) months for AST. Patients who received surgery and patients who received both chemotherapy and radiation therapy in combination experienced better OS (HR = 0.87, 95% CI = 0.79 to 0.96, and HR = 0.58, 95% CI = 0.35 to 0.96, respectively). Over the time frame studied, there was a 4.0% increase per year in prescription of chemotherapy (P = .03) and a 2.0% improvement in OS for each calendar year (P = .003). CONCLUSIONS: We provide population-based evidence that patients older than 65 years with grade II-III glioma have experienced increased chemotherapy use as well as improvement in survival over time.


Assuntos
Astrocitoma , Glioma , Oligodendroglioma , Idoso , Glioma/epidemiologia , Humanos , Medicare , Oligodendroglioma/terapia , Modelos de Riscos Proporcionais , Estados Unidos/epidemiologia
7.
Stat Med ; 41(14): 2602-2626, 2022 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-35699121

RESUMO

The mixture cure model for analyzing survival data is characterized by the assumption that the population under study is divided into a group of subjects who will experience the event of interest over some finite time horizon and another group of cured subjects who will never experience the event irrespective of the duration of follow-up. When using the Bayesian paradigm for inference in survival models with a cure fraction, it is common practice to rely on Markov chain Monte Carlo (MCMC) methods to sample from posterior distributions. Although computationally feasible, the iterative nature of MCMC often implies long sampling times to explore the target space with chains that may suffer from slow convergence and poor mixing. Furthermore, extra efforts have to be invested in diagnostic checks to monitor the reliability of the generated posterior samples. A sampling-free strategy for fast and flexible Bayesian inference in the mixture cure model is suggested in this article by combining Laplace approximations and penalized B-splines. A logistic regression model is assumed for the cure proportion and a Cox proportional hazards model with a P-spline approximated baseline hazard is used to specify the conditional survival function of susceptible subjects. Laplace approximations to the posterior conditional latent vector are based on analytical formulas for the gradient and Hessian of the log-likelihood, resulting in a substantial speed-up in approximating posterior distributions. The spline specification yields smooth estimates of survival curves and functions of latent variables together with their associated credible interval are estimated in seconds. A fully stochastic algorithm based on a Metropolis-Langevin-within-Gibbs sampler is also suggested as an alternative to the proposed Laplacian-P-splines mixture cure (LPSMC) methodology. The statistical performance and computational efficiency of LPSMC is assessed in a simulation study. Results show that LPSMC is an appealing alternative to MCMC for approximate Bayesian inference in standard mixture cure models. Finally, the novel LPSMC approach is illustrated on three applications involving real survival data.


Assuntos
Algoritmos , Teorema de Bayes , Humanos , Cadeias de Markov , Método de Monte Carlo , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes
8.
PLoS One ; 17(6): e0269893, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35709221

RESUMO

This Korean population-based study aimed to describe the patterns of hypothyroidism after adjuvant radiation therapy (RT) in patients with breast cancer. The Korean Health Insurance Review and Assessment Service database was searched for patients with invasive breast carcinomas. We calculated the cumulative incidence and incidence rates per 1,000 person-years of subsequent hypothyroidism and compared them using the log-rank test and the Cox proportional hazards model. Between 2007 and 2018, 117,135 women diagnosed with breast cancer with a median follow-up time of 4.6 years were identified. The 8-year incidence of hypothyroidism was 9.3% in patients treated with radiation and 8.6% in those treated without radiation (p = 0.002). The incidence rates per 1,000 person-years in the corresponding treatment groups were 6.2 and 5.7 cases, respectively. The hazard ratio (HR) in patients receiving RT was 1.081 (95% confidence interval [CI], 1.013-1.134; p = 0.002). After mastectomy, RT showed a trend toward a higher risk of hypothyroidism (HR = 1.248; 95% CI, 0.977-1.595; p = 0.076). Our study provides one of the largest population-based data analyses regarding the risk of hypothyroidism among Korean patients with breast cancer. The adjusted risk for patients treated with RT exceeded that for patients with breast cancer treated without RT. The effect was evident immediately after treatment and lasted up to approximately 9 years.


Assuntos
Neoplasias da Mama , Hipotireoidismo , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Hipotireoidismo/cirurgia , Incidência , Mastectomia/efeitos adversos , Modelos de Riscos Proporcionais , Radioterapia Adjuvante/efeitos adversos , República da Coreia/epidemiologia
9.
Sci Rep ; 12(1): 10131, 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710917

RESUMO

There is large inter-individual heterogeneity in risk of coronary heart disease (CHD). Risk factors traditionally used in primary risk assessment only partially explain this heterogeneity. Residual, unobserved heterogeneity leads to age-related attenuation of hazard rates and underestimation of hazard ratios. Its magnitude is unknown. Therefore, we aimed to estimate a lower and an approximate upper bound. Heterogeneity was parametrized by a log-normal distribution with shape parameter σ. Analysis was based on published data. From concordance indices of studies including traditional risk factors and additional diagnostic imaging data, we calculated the part of heterogeneity explained by imaging data. For traditional risk assessment, this part typically remains unexplained, thus constituting a lower bound on unobserved heterogeneity. Next, the potential impact of heterogeneity on CHD hazard rates in several large countries was investigated. CHD rates increase with age but the increase attenuates with age. Presuming this attenuation to be largely caused by heterogeneity, an approximate upper bound on σ was derived. Taking together both bounds, unobserved heterogeneity in studies without imaging information can be described by a shape parameter in the range σ = 1-2. It substantially contributes to observed age-dependences of hazard ratios and may lead to underestimation of hazard ratios by a factor of about two. Therefore, analysis of studies for primary CHD risk assessment should account for unobserved heterogeneity.


Assuntos
Doença das Coronárias , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Humanos , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco
10.
Zhonghua Yi Xue Za Zhi ; 102(20): 1523-1529, 2022 May 31.
Artigo em Chinês | MEDLINE | ID: mdl-35692068

RESUMO

Objective: To explore the related factors affecting the outcome of treatment free remission (TFR) in patients with chronic myeloid leukemia (CML). Methods: Clinical data of CML patients with automatic discontinuation of tyrosine kinase inhibitor (TKI) from the CML cooperative organization of Henan province between June 2, 2013 to March 27, 2021 and the follow-up time was ≥ 6 months were retrospectively analyzed. Log-rank test was used for univariate analysis and Cox proportional risk regression model was used for multivariate analysis. Results: A total of 135 patients were enrolled, and 69 patients (51.1%) were femal and 66 patients (48.9%)were male. Median age was[M(Q1,Q3)] 49 years (38, 58)at discontinuation.Before discontinuation, 72 patients (53.3%) were on treatment with second-generation TKI, 63 patients (46.7%) were on treatment with IM, 17patients (12.6%) had a history of TKI reduction/withdrawal;median duration of treatment was months 84 (68, 108) for all patients;median time of TKI treatment to DMR was months 12(8, 26);median duration of DMR was months 65 (54, 84), and 9 patients (6.7%) had unsustained DMR.The median follow-up time was months 16(6-96), 35 patients (25.9%) lost MMR at a median months 3(1-22), overall estimated TFR was 74.1%.The univariate analysis results showed that:second-generation TKI was used, the time of TKI treatment to DMR was ≤12 months, DMR duration time ≥48 months, had sustained DMR, without TKI reduction/withdrawal history were favorable factors affecting of TFR in patients with TKI discontinuation (all P<0.05).The TFR rate of the second-generation TKI therapy group was significantly higher than the IM therapy group (81.9% vs 65.1%, P=0.019).The multivariate analysis results showed that second-generation TKI treatment[RR=0.451, 95%CI (0.227-0.896), P=0.023] and had sustained DMR [RR=0.120, 95%CI (0.053-0.271), P<0.001] were the protective factors of TFR in patients with TKI discontinuation. Conclusions: Treated with second-generation TKI and had sustained DMR are the protective factors of TFR in patients with TKI discontinuation.The CML patients who had sustained DMR more≥48 months before TKI discontinuation showed a better TFR.


Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva , Feminino , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Masculino , Modelos de Riscos Proporcionais , Inibidores de Proteínas Quinases/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
11.
Biomed Res Int ; 2022: 7387416, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35692586

RESUMO

Background: Solitary plasmacytoma of bone (SPB) is an isolated plasmacytoma of bone origin, most commonly seen in the elderly, with a poor prognosis. So far, there is no precise nomogram to predict the overall survival (OS) of elderly patients with SPB. Our goal is to construct and validate a nomogram for elderly patients with SPB. Methods: This study collected all elderly patients with SPB in the Surveillance, Epidemiology and End Results (SEER) database from 2000 to 2018, and the variables included were age, sex, race, marital status, primary site, grade, stage, surgery, chemotherapy, and radiotherapy. Independent prognostic factors were identified using univariate and multivariate Cox analysis. The nomogram was constructed to predict 1-, 2-, and 3-year OS of elderly patients with SPB. The receiver-operating characteristic (ROC) and the calibration curves were used to differentiate and calibrate the nomogram. The clinical validity of the nomogram was evaluated by decision curve analysis (DCA). The total OS scores of all elderly SPB patients were calculated and divided into two risk subgroups for comparison. Results: A total of 1837 patients diagnosed with SPB were screened from the SEER database, with a final inclusion of 1180 patients (age ≥ 60 years). Age, radiotherapy, and marital status were significantly correlated with OS. These characteristics were further incorporated into the creation of the nomogram for predicting 1-, 2-, and 3-year OS of elderly patients with SPB. For this predictive model, the area under the ROC curves, calibration curves, and DCA have good performance in terms of differentiation, consistency, and validity, respectively. In addition, patients in the high-risk group (≥96) had a worse prognosis than those in the low-risk group (<96). Conclusion: We constructed a nomogram and a risk classification system that could provide an intuitive and effective tool for clinicians to better predict the OS of elderly SPB patients.


Assuntos
Neoplasias Ósseas , Plasmocitoma , Idoso , Humanos , Pessoa de Meia-Idade , Nomogramas , Prognóstico , Modelos de Riscos Proporcionais , Programa de SEER
12.
Oral Oncol ; 130: 105938, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35653818

RESUMO

PURPOSE: Age ≥ 55 years is regarded as a pivotal component of TNM stage classification in differentiated thyroid carcinoma (DTC). However, whether this cutoff point is still adaptable for differentiated thyroid microcarcinoma (DTMC) is rarely investigated. METHODS: We reviewed and analyzed the data of DTC patients aged ≥ 55 years from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were used to determine the potential risk factors of cancer-specific survival (CSS) in DTMC patients aged ≥ 55 years. The Kaplan-Meier survival curves were used to estimate CSS probability. Receiver operating characteristic (ROC) curves were used to analyze the best age cutoff point for DTMC. RESULTS: Among the DTMC patients, there was no significant difference in the 1-, 3-, 5-, and 7-year CSS probability between the 55-59 years and 60-64-years subgroup (p = 0.72). The ROC curves indicated that 65 years, 65 years, and 64 years were the cutoff age point of 3-, 5-, and 7-year CSS probability in DTMC patients, respectively. Besides, N1b (Hazard ratio (HR) = 3.90, 95% Confidence interval (CI): 2.01-7.57; p < 0.001), extrathyroidal extension (HR = 2.53, 95 %CI: 1.39-4.62; p = 0.002), and M1 (HR = 11.42, 95 %CI: 5.04-25.90; p < 0.001) were the independent risk factors in CSS of DTMC patients. CONCLUSIONS: Our results suggested age at diagnosis ≥ 55 years is not the best cutoff point in stratifying the stage of the DTMC patients. On the contrary, those patients aged above 65 years have a significantly lower probability of CSS, which perhaps should be taken into consideration for treatment decision-making.


Assuntos
Neoplasias da Glândula Tireoide , Humanos , Estimativa de Kaplan-Meier , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Neoplasias da Glândula Tireoide/patologia
13.
Cancer Causes Control ; 33(7): 921-928, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35676377

RESUMO

PURPOSE: Prior epidemiological studies evaluating the association between fish intake and melanoma risk have been few and inconsistent. Few studies distinguished different types of fish intake with risk of melanoma. METHODS: We examined the associations between intake of total fish and specific types of fish and risk of melanoma among 491,367 participants in the NIH-AARP Diet and Health Study. We used multivariable-adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: During 6,611,941 person-years of follow-up with a median of 15.5 years, 5,034 cases of malignant melanoma and 3,284 cases of melanoma in situ were identified. There was a positive association between higher total fish intake and risk of malignant melanoma (HR = 1.22, 95% CI = 1.11-1.34 for top vs. bottom quintiles, ptrend = 0.001) and melanoma in situ (HR = 1.28, CI = 1.13-1.44 for top vs. bottom quintiles, ptrend = 0.002). The positive associations were consistent across several demographic and lifestyle factors. There were also positive associations between tuna intake and non-fried fish intake, and risk of malignant melanoma and melanoma in situ. However, fried fish intake was inversely associated with risk of malignant melanoma, but not melanoma in situ. CONCLUSIONS: We found that higher total fish intake, tuna intake, and non-fried fish intake were positively associated with risk of both malignant melanoma and melanoma in situ. Future studies are needed to investigate the potential biological mechanisms underlying these associations.


Assuntos
Melanoma , Animais , Dieta , Humanos , Melanoma/epidemiologia , Melanoma/etiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Neoplasias Cutâneas
14.
Maturitas ; 161: 33-39, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35688492

RESUMO

OBJECTIVES: We examined the association between maternal age at first childbirth and death from cardiovascular disease and all-cause mortality in Korean women. METHODS: We used data from a community-based cohort with a follow-up of 18 years (2001-2018). Participants were subdivided into three groups according to the tertiles of age at first childbirth [≤ 23 (n=1498), 24 and 25 (n=1033), and ≥ 26 years (n=1513)]. Kaplan-Meier survival analysis was performed to assess CVD mortality rates and all-cause mortality rates. We compared mortality hazard ratios (HRs) using the Cox proportional hazards model and investigated whether hypertension and diabetes mellitus (DM) affected this association using mediation analysis. RESULTS: Participants' mean ages at first childbirth and at survey entry were 24.7 and 52.4 years, respectively. Age at first childbirth and mortality (CVD and all-cause) showed a U-shaped association. Compared with the group aged 24 and 25 years at first childbirth, the adjusted HRs were significantly higher in the younger and older groups. Hypertension and DM did not mediate the association between maternal age at first childbirth and CVD and all-cause mortality rates. CONCLUSION: Mothers who had given birth at an early or late age were at greater risk of CVD and all-cause mortality than mothers who had given birth in their mid-20 s. We suggest that further research is needed to determine whether maternal age at first childbirth affects women's health and lifespan.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Hipertensão , Estudos de Coortes , Feminino , Humanos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
15.
Sci Rep ; 12(1): 9594, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35688929

RESUMO

Although a mitral inflow pattern usually changes from a normal pattern to an abnormal relaxation pattern as part of the aging process in healthy people, some early advanced-age individuals maintain a normal pattern. We investigated whether a normal pattern of mitral inflow predicts a better prognosis following cardiovascular (CV) events in early advanced-age patients. We enrolled 425 patients aged 60-65 years with 0.6 < E/A < 1.5. Patients were divided according to their mitral inflow pattern, i.e., a normal pattern group (E/A ≥ 1.0, n = 77) and an abnormal relaxation pattern group (E/A < 1, n = 348), and were evaluated the relationship with CV events. Multivariate regression analysis found that the normal inflow pattern was associated with odds ratios of 0.859 for body mass index (BMI; 95% confidence interval [CI]: 0.778-0.937), 0.529 for hypertension (0.303-0.924), and 0.325 for heart rate (0.228-0.463). During the follow-up period (4.9 ± 1.8 years), the adjusted-hazard ratio was significantly lower in the normal pattern group (HR: 0.119, 95% CI 0.016-0.910). Kaplan-Meier curves showed a higher event-free rate for the normal pattern group than for the abnormal relaxation pattern group (p = 0.0292). Normal inflow pattern in early advanced-age patients predicts a better prognosis following CV events.


Assuntos
Ecocardiografia , Hipertensão , Humanos , Valva Mitral/diagnóstico por imagem , Prognóstico , Modelos de Riscos Proporcionais
16.
Ther Adv Respir Dis ; 16: 17534666221103213, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35748569

RESUMO

BACKGROUND: Infection due to nontuberculous mycobacteria (NTM) is an emerging issue worldwide, and we aimed to address the epidemiology and mortality association of NTM infection requiring treatment in Taiwan. METHODS: We used the 2003-2018 data of 2 million representative individuals in Taiwan's National Health Insurance Research Database. We identified patients with newly diagnosed NTM infection and received treatment as NTM cases. Age- and sex-matched (1:40) as well as propensity score-matched (PSM) (1:2) non-NTM individuals were selected as non-NTM controls. We used a Cox proportional hazard model to determine hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: We identified 558 patients with NTM infection requiring treatment. The mean age was 62.5 ± 15.4 years, and 57.5% of them were male. The incidence increased from 0.54 per 100,000 person-year in 2003 to 3.35 per 100,000 person-year in 2018. The overall mortality was 35.2%, with a mean follow-up duration of 4.1 ± 3.6 years. We found that NTM infection was independently associated with a greater risk of mortality (HR: 1.71; 95% CI: 1.47-1.98) compared with age- and sex-matched controls, and the association remained consistent (HR: 1.44; 95% CI: 1.19-1.75) compared with propensity-matched controls. We also found that old age, male, high Charlson comorbidity index, and the use of steroids or anti-neoplastic agents/immunosuppressants were associated with mortality risk. CONCLUSION: In conclusion, we found a steady increase in patients with NTM infection requiring treatment in Taiwan and further demonstrated that NTM infection was associated with greater risk of mortality using two comparable non-NTM control subjects.


Assuntos
Infecções por Mycobacterium não Tuberculosas , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Micobactérias não Tuberculosas , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taiwan/epidemiologia
17.
J Diabetes ; 14(6): 414-424, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35762391

RESUMO

BACKGROUND: Family history of diabetes, unhealthy lifestyles, and metabolic disorders are individually associated with higher risk of diabetes, but how different combinations of the three risk categories are associated with incident diabetes remains unclear. We aimed to estimate the associations of comprehensive risk profiles of family history and lifestyle and metabolic risk factors with diabetes risk. METHODS: This study included 5290 participants without diabetes at baseline with a mean follow-up of 4.4 years. Five unhealthy lifestyles and five metabolic disorders were each allocated a score, resulting in an aggregated lifestyle and metabolic risk score ranging from 0 to 5. Eight risk profiles were constructed from combinations of three risk categories: family history of diabetes (yes, no), lifestyle risk (high, low), and metabolic risk (high, low). RESULTS: Compared with the profile without any risk category, other profiles exhibited incrementally higher risks of diabetes with increasing numbers of categories: the hazard ratio (HR, 95% confidence interval [CI]) for diabetes ranged from 1.34 (1.01-1.79) to 2.33 (1.60-3.39) for profiles with one risk category, ranged from 2.42 (1.45-4.04) to 4.18 (2.42-7.21) for profiles with two risk categories, and was 4.59 (2.85-7.39) for the profile with three risk categories. The associations between the numbers of risk categories and diabetes risk were more prominent in women (pinteraction  = .025) and slightly more prominent in adults <55 years (pinteraction  = .052). CONCLUSIONS: This study delineated associations between comprehensive risk profiles with diabetes risk, with stronger associations observed in women and slightly stronger associations in adults younger than 55 years.


Assuntos
Diabetes Mellitus , Estilo de Vida , Adulto , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
18.
BMC Urol ; 22(1): 91, 2022 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-35752822

RESUMO

BACKGROUND: To investigate the effects of the U.S. Preventive Services Task Force's (USPSTF) 2012 recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer on survival disparities based on insurance status. Prior to the USPSTF's 2012 screening recommendation, previous studies found that insured patients with prostate cancer had better outcomes than uninsured patients. METHODS: Using the SEER 18 database, we examined prostate cancer-specific survival (PCSS) based on diagnostic time period and insurance status. Patients were designated as belonging to the pre-USPSTF era if diagnosed in 2010-2012 or post-USPSTF era if diagnosed in 2014-2016. PCSS was measured with the Kaplan-Meier method, while disparities were measured with the Cox proportional hazards model. RESULTS: During the pre-USPSTF era, uninsured patients experienced worse PCSS compared to insured patients (adjusted HR 1.256, 95% CI 1.037-1.520, p = 0.020). This survival disparity was no longer observed during the post-USPSTF era as a result of decreased PCSS among insured patients combined with unchanged PCSS among uninsured patients (adjusted HR 0.946, 95% CI 0.642-1.394, p = 0.780). CONCLUSIONS: Although the underlying reasons are not clear, the USPSTF's 2012 PSA screening recommendation may have hindered insured patients from being regularly screened for prostate cancer and selectively led to worse outcomes for insured patients without affecting the survival of uninsured patients.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Detecção Precoce de Câncer , Humanos , Masculino , Modelos de Riscos Proporcionais , Próstata , Neoplasias da Próstata/diagnóstico , Estados Unidos/epidemiologia
19.
Clin Nutr ; 41(7): 1483-1490, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35667264

RESUMO

BACKGROUND & AIMS: Wholegrain contributes a range of beneficial nutrients and is considered to play a role in the prevention of chronic diseases, but evidence of their influence on nonalcoholic fatty liver disease (NAFLD) is limited. We conducted this study to investigate the prospective association between daily wholegrain consumption and NAFLD in the general population. METHODS: This prospective cohort study included a total of 14,968 (42.2% men) inhabitants living in Tianjin, China. Participants without a history of CVD, cancer, alcoholic fatty liver disease, other liver diseases, or NAFLD were followed up for 1-6 years with a median follow-up duration of 4.2 years. Wholegrain consumption was assessed using a validated self-administered food frequency questionnaire. NAFLD was diagnosed with the results of liver ultrasonography without significant alcohol consumption and other causes of liver disease. Cox proportional hazards regression models were used to estimate the association between wholegrain consumption and NAFLD. RESULTS: A total of 3505 (2171 men) first incident cases of NAFLD occurred during 53,303 person-years of follow-up (median follow-up of 4.2 years). After adjusting for several potential confounders and setting "almost never" as the control group, the multivariable hazard ratios (95% confidence intervals) of the NAFLD were 0.82 (0.73, 0.92) when they consuming ≤1 time/week, 0.78 (0.69, 0.88) when they consuming 2-6 time/week and 0.77 (0.66, 0.90) when they consuming ≥1 time/day (p for trend <0.001). CONCLUSION: The results from our prospective study demonstrated that the higher consumption of wholegrain is associated with a decreased risk of NAFLD in Chinese adults.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
20.
PLoS One ; 17(6): e0270214, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35749444

RESUMO

BACKGROUND: We tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders. METHODS: We conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue; reference group). In each country's cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competing risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, PD modality, hemoglobin, and albumin. A mixed-effects meta-analysis was used to pool hazard ratios (HRs) from both cohorts to model mortality risk for each 10-unit increase in vitality. RESULTS: We used data from 4,285 PD patients (Brazil n = 1,388 and United States n = 2,897). Model estimates showed lower vitality levels within 90 days of starting PD were associated with a higher risk of mortality, which was consistent in Brazil and the United States cohorts. In the multivariate survival model, each 10-unit increase in vitality score was associated with lower risk of all-cause mortality in both cohorts (Brazil HR = 0.79 [95%CI 0.70 to 0.90] and United States HR = 0.90 [95%CI 0.88 to 0.93], pooled HR = 0.86 [95%CI 0.75 to 0.98]). Results for all models provided consistent effect estimates. CONCLUSIONS: Among patients in Brazil and the United States, lower vitality score in the initial months of PD was independently associated with all-cause mortality.


Assuntos
Falência Renal Crônica , Diálise Peritoneal , Adulto , Brasil/epidemiologia , Fadiga/etiologia , Humanos , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
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