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1.
Lung Cancer ; 159: 145-152, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34340111

RESUMO

OBJECTIVES: To estimate the average treatment effect of immune checkpoint inhibitors in any line of treatment in a 2016-2018 population-based cohort of patients with advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: The cohort, and information on the tumor, were derived from the cancer registry of the Agency for Health Protection of Milan, Italy. Inclusion criteria were adult age, microscopically confirmed NSCLC, stage IIIB or IV at diagnosis, and having received at least one line of treatment. Treatment with all licensed anti PD-1/PD-L1 inhibitors was derived from inpatients and outpatients' pharmaceutical databases of the ATS and vital status at 31 December 2019 from the health registry office of the Lombardy region. We investigated, with a causal approach, the relationship between survival and anti PD-1/PD-L1 treatment at any line constructing a directed acyclic graph and fitting a Marginal Structural Cox Model (MSCM). RESULTS: Of 1673 subjects, 324 received anti PD-1/PD-L1 at any treatment line. Overall, one-year survival was 61.1% (95 %CI, 55.6-66.2%) in the group treated with anti PD-1/PD-L1 at any line and 31.1% (95 %CI, 28.6-33.5%) among not treated. One-year hazard ratio (HR) of death for not treated vs. treated was 2.15 (95 %CI, 1.91-2.41), decreasing to 1.23 (95 %CI, 1.03-1.46) at two years and reaching one in the third year. CONCLUSION: In un unselected population-based cohort with advanced lung cancer, treatment with anti PD-1/PD-L1 at any line lowered the hazard of death up to two-years from date of diagnosis, confirming the efficacy of immunotherapy outside clinical trials.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Antígeno B7-H1 , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Humanos , Inibidores de Checkpoint Imunológico , Imunoterapia , Itália/epidemiologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/epidemiologia
2.
Lung Cancer ; 159: 153-161, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34352591

RESUMO

OBJECTIVES: Robust economic evaluations are needed to identify efficient strategies for lung cancer prevention that combine brief and intensive smoking cessation intervention programmes with screening using low-dose computed tomography (LDCT) at different ages, frequencies, and coverages. We aimed to assess the cost-effectiveness of smoking cessation approaches combined with lung cancer screening in the European context at a population level from a societal perspective. MATERIALS AND METHODS: A microsimulation model that describes the natural history of lung cancer and incorporates several prevention strategies was developed. Discounted lifetime QALYs and costs at a rate of 3% were used to calculate incremental cost-effectiveness ratios, defined as additional costs in 2017 Euros per QALY gained. RESULTS: Smoking cessation interventions reduce the incidence of lung cancer by 8%-46% and are consistently more effective and cost-effective when starting at younger ages. Screening reduces lung cancer mortality by 1%-24% and is generally less effective and more costly than smoking cessation interventions. The most cost-effective strategy would be to implement intensive smoking cessation interventions at ages 35, 40 and 45, combined with screening every three years between the ages of 55 and 65. CONCLUSIONS: Combining smoking cessation interventions with LDCT screening is a very attractive prevention strategy that substantially diminishes the burden of lung cancer. These combined prevention strategies, especially when providing several intensive interventions for smoking cessation at early ages, are more cost-effective than both approaches separately and allow for a more intensified LDCT without losing efficiency.


Assuntos
Neoplasias Pulmonares , Abandono do Hábito de Fumar , Adulto , Idoso , Análise Custo-Benefício , Detecção Precoce de Câncer , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/prevenção & controle , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida
3.
Artigo em Inglês | MEDLINE | ID: mdl-34360260

RESUMO

Reviews of national and state-specific cancer registries have revealed differences in rates of oral, esophageal, and lung cancer incidence and mortality that have implications for public health research and policy. Many significant associations between these types of cancers and major risk factors, such as cigarette usage, may be influenced by public health policy such as smoking restrictions and bans-including the Nevada Clean Indoor Air Act (NCIAA) of 2006 (and subsequent modification in 2011). Although evaluation of general and regional advances in public policy have been previously evaluated, no recent studies have focused specifically on the changes to the epidemiology of oral and pharyngeal, esophageal, and lung cancer incidence and mortality in Nevada. Methods: Cancer incidence and mortality rate data were obtained from the National Cancer Institute (NCI) Division of Cancer Control and Population Sciences (DCCPS) Surveillance, Epidemiology and End Results (SEER) program. Most recently available rate changes in cancer incidence and mortality for Nevada included the years 2012-2016 and are age-adjusted to the year 2000 standard US population. This analysis revealed that the overall rates of incidence and mortality from these types of cancer in Nevada differs from that observed in the overall US population. For example, although the incidence rate of oral cancer is decreasing in the US overall (0.9%), it is stable in Nevada (0.0%). However, the incidence and mortality rates from esophageal cancer are also decreasing in the US (-1.1%, -1.2%, respectively), and are declining more rapidly in Nevada (-1.5%, -1.9%, respectively). Similarly, the incidence and mortality rates from lung are cancer are declining in the US (-2.5%, -2.4%, respectively) and are also declining more rapidly in Nevada (-3.2%, -3.1%, respectively). Analysis of previous epidemiologic data from Nevada (1999-2003) revealed the highest annual percent change (APC) in oral cancer incidence in the US was observed in Nevada (+4.6%), which corresponded with the highest APC in oral cancer mortality (+4.6%). Subsequent studies regarding reduced rates of cigarette use due to smoking restrictions and bans have suggested that follow up studies may reveal changes in the incidence and mortality rates of oral and other related cancers. This study analysis revealed that oral cancer incidence rates are no longer increasing in Nevada and that mortality rates have started to decline, although not as rapidly as the overall national rates. However, rapid decreases in both the incidence and mortality from esophageal and lung cancer were observed in Nevada, which strongly suggest the corresponding changes in oral cancer may be part of a larger epidemiologic shift resulting from improved public health policies that include indoor smoking restrictions and bans.


Assuntos
Neoplasias Pulmonares , Neoplasias , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , National Cancer Institute (U.S.) , Nevada , Fumar , Estados Unidos/epidemiologia
4.
Rev Bras Epidemiol ; 24: e210044, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34406206

RESUMO

OBJECTIVE: To estimate the degree of agreement and validity of diagnoses of asbestos-related malignant neoplasms registered in the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), in comparison to the Hospital Cancer Registries of the State of São Paulo (HCR/SP). METHODS: Deaths with records of malignant neoplasms associated with asbestos were identified and extracted from SIH/SUS between 2007 and 2014. Deaths in cases registered in the HCR/SP were extracted for the same period. The databases were linked using software Link Plus. A single ICD-10-coded diagnosis selected from each system was analyzed. The proportion of agreement, and the sensitivity, specificity and predictive values were estimated. RESULTS: 19,458 pairs were found with records in both bases. The proportion of agreement was high, ranging from 92.4% for the unknown primary site, to 99.7% for cancer of the pleura. The Kappa Index ranged from 0.05 (95%CI 0.04 - 0.07) for cancer of the pleura to 0.85 (95%CI 0.84 - 0.87) for lung cancer. Sensitivity varied from 0.08 (95%CI 0.01 - 0.25) for cancer of the pleura, to 0.90 (95%CI 0.90 - 0.91) for lung cancer. CONCLUSION: Diagnosis of asbestos-related malignancies reached higher levels of agreement and validity when common. Rare diagnoses showed low accuracy in SIH/SUS.


Assuntos
Asbestos , Sistemas de Informação Hospitalar , Neoplasias Pulmonares , Brasil/epidemiologia , Bases de Dados Factuais , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etiologia
6.
Int J Mol Sci ; 22(14)2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34299277

RESUMO

This study developed a novel methodology to correlate genome-scale microRNA (miRNA) expression profiles in a lung squamous cell carcinoma (LUSC) cohort (n = 57) with Surveillance, Epidemiology, and End Results (SEER)-Medicare LUSC patients (n = 33,897) as a function of composite tumor progression indicators of T, N, and M cancer stage and tumor grade. The selected prognostic and chemopredictive miRNAs were extensively validated with miRNA expression profiles of non-small-cell lung cancer (NSCLC) patient samples collected from US hospitals (n = 156) and public consortia including NCI-60, The Cancer Genome Atlas (TCGA; n = 1016), and Cancer Cell Line Encyclopedia (CCLE; n = 117). Hsa-miR-142-3p was associated with good prognosis and chemosensitivity in all the studied datasets. Hsa-miRNA-142-3p target genes (NUP205, RAN, CSE1L, SNRPD1, RPS11, SF3B1, COPA, ARCN1, and SNRNP200) had a significant impact on proliferation in 100% of the tested NSCLC cell lines in CRISPR-Cas9 (n = 78) and RNA interference (RNAi) screening (n = 92). Hsa-miR-142-3p-mediated pathways and functional networks in NSCLC short-term survivors were elucidated. Overall, the approach integrating SEER-Medicare data with comprehensive external validation can identify miRNAs with consistent expression patterns in tumor progression, with potential implications for prognosis and prediction of chemoresponse in large NSCLC patient populations.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , MicroRNAs/genética , Biomarcadores Tumorais/genética , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/genética , Biologia Computacional/métodos , Bases de Dados Factuais , Bases de Dados Genéticas , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/genética , Masculino , Medicare , Prognóstico , Programa de SEER , Taxa de Sobrevida , Estados Unidos/epidemiologia
8.
Lung Cancer ; 159: 96-106, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34320421

RESUMO

OBJECTIVES: To describe characteristics, treatment and outcomes of non-small cell lung cancer (NSCLC) patients with MET alterations (MET exon 14 [METex14] skipping or MET amplification [METamp]) in real-world clinical care. METHODS: This non-interventional cohort study used real-world data extracted from electronic medical records from academic oncology sites in Israel, The Netherlands, Taiwan, and the USA. Patients had confirmed diagnosis of advanced (Stage IIIB-IV) NSCLC harboring MET alterations (date of diagnosis = index date) between 1 Jan 2010 and 30 Sept 2018. Medical history was assessed prior to and at the index date (baseline period), and outcomes from first date of treatment to death, loss to follow-up, or end of study period. RESULTS: A total of 117 patients were included (METex14 n = 70; METamp n = 47); testing methods were heterogeneous. Concomitant oncogenic mutations were more common in the METamp cohort than METex14. Patients in the METex14 cohort were older than those in METamp, and a larger proportion were never smokers. Anticancer first-line therapies received by patients (METex14; METamp) included chemotherapy only (44%; 41%), MET inhibitors (33%; 29%), immune checkpoint inhibitor (ICI) mono-(12%; 15%) and combination-therapy (8%; 3%). Second-line therapies included chemotherapy (35%; 30%) and MET inhibitors (30%; 39%). In the METex14 cohort, objective response rate (ORR) was generally low (first-line 28%; second-line 30%); no patients who received ICIs had a response. In the METamp cohort, ORR was 36% in first-line and 22% in second-line. Median (95% confidence interval) overall survival from start of first-line therapy was 12.0 months (6.8, 19.2) in the METex14 cohort and 22.0 months (9.8, 31.2) in METamp. CONCLUSIONS: Heterogeneous treatments reflect the changing landscape and availability of new treatments, as well as the high unmet medical need in older, METex14 patients who had more advanced disease at diagnosis. MET-targeted therapies could be beneficial in patients with these rare MET alterations.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Idoso , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/genética , Estudos de Coortes , Éxons , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/genética , Mutação
9.
Lung Cancer ; 159: 117-126, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34332333

RESUMO

OBJECTIVES: Immunohistochemical expression of programmed death-ligand 1 (PD-L1) is used as a predictive biomarker for prescription of immunotherapy to non-small cell lung cancer (NSCLC) patients. Accurate assessment of PD-L1 expression is therefore crucial. In this study, the extent of interlaboratory variation in PD-L1 positivity in the Netherlands was assessed, using real-world clinical pathology data. MATERIALS AND METHODS: Data on all NSCLC patients in the Netherlands with a mention of PD-L1 testing in their pathology report from July 2017 to December 2018 were extracted from PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands. PD-L1 positivity rates were determined for each laboratory that performed PD-L1 testing, with separate analyses for histological and cytological material. Two cutoffs (1% and 50%) were used to determine PD-L1 positivity. Differences between laboratories were assessed using funnel plots with 95% confidence limits around the overall mean. RESULTS: 6,354 patients from 30 laboratories were included in the analysis of histology data. At the 1% cutoff, maximum interlaboratory variation was 39.1% (32.7%-71.8%) and ten laboratories (33.3%) differed significantly from the mean. Using the 50% cutoff, four laboratories (13.3%) differed significantly from the mean and maximum variation was 23.1% (17.2%-40.3%). In the analysis of cytology data, 1,868 patients from 23 laboratories were included. Eight laboratories (34.8%) differed significantly from the mean in the analyses of both cutoffs. Maximum variation was 41.2% (32.2%-73.4%) and 29.2% (14.7%-43.9%) using the 1% and 50% cutoffs, respectively. CONCLUSION: Considerable interlaboratory variation in PD-L1 positivity was observed. Variation was largest using the 1% cutoff. At the 50% cutoff, analysis of cytology data demonstrated a higher degree of variation than the analysis of histology data.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Antígeno B7-H1 , Biomarcadores Tumorais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-34204140

RESUMO

In this research, we take a multivariate, multi-method approach to predicting the incidence of lung cancer in the United States. We obtain public health and ambient emission data from multiple sources in 2000-2013 to model lung cancer in the period 2013-2017. We compare several models using four sources of predictor variables: adult smoking, state, environmental quality index, and ambient emissions. The environmental quality index variables pertain to macro-level domains: air, land, water, socio-demographic, and built environment. The ambient emissions consist of Cyanide compounds, Carbon Monoxide, Carbon Disulfide, Diesel Exhaust, Nitrogen Dioxide, Tropospheric Ozone, Coarse Particulate Matter, Fine Particulate Matter, and Sulfur Dioxide. We compare various models and find that the best regression model has variance explained of 62 percent whereas the best machine learning model has 64 percent variance explained with 10% less error. The most hazardous ambient emissions are Coarse Particulate Matter, Fine Particulate Matter, Sulfur Dioxide, Carbon Monoxide, and Tropospheric Ozone. These ambient emissions could be curtailed to improve air quality, thus reducing the incidence of lung cancer. We interpret and discuss the implications of the model results, including the tradeoff between transparency and accuracy. We also review limitations of and directions for the current models in order to extend and refine them.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Neoplasias Pulmonares , Adulto , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental , Humanos , Neoplasias Pulmonares/epidemiologia , Material Particulado/análise , Saúde Pública , Estados Unidos/epidemiologia , Emissões de Veículos/análise , Emissões de Veículos/toxicidade
11.
Prev Med ; 151: 106640, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217419

RESUMO

Cancer screening rates declined sharply early in the COVID-19 pandemic. The impact of the pandemic may have exacerbated existing disparities in cancer screening due to the disproportionate burden of illness and job loss among racial/ ethnic minorities, and potentially, uneven resumption of care between different racial/ ethnic groups. Using electronic health record data from Mass General Brigham (MGB), we assessed changes in rates of breast, cervical, colorectal and lung cancer screening before and during the pandemic. Among patients who received primary care in an MGB-affiliated primary care practice, cancer screening rates were calculated as the number of individuals who received a screening test for each cancer type over the number of individuals due for each test, during each month between April 2019-November 2020. We conducted an interrupted time-series analysis to test for changes in screening rates by race/ethnicity before and during the pandemic. Prior to the pandemic, relative to White individuals, Asian women were less likely to receive breast cancer screening (p < 0.001), and Latinx and Black individuals were less likely to screen for lung cancer (p < 0.001 and p = 0.02). Our results did not show significant improvement or worsening of racial/ethnic disparities for any cancer screening type as screening resumed. However, as of November 2020 rates of screening for breast cancer were lower than pre-pandemic levels for Latinx individuals, and lung cancer screening rates were higher than baseline for Latinx, Black or White individuals. Further monitoring of disparities in cancer screening is warranted as the pandemic evolves.


Assuntos
COVID-19 , Neoplasias Pulmonares , Detecção Precoce de Câncer , Grupos Étnicos , Feminino , Disparidades em Assistência à Saúde , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-34299799

RESUMO

Biomarkers of tobacco exposure are known to be associated with disease risk but previous studies are limited in number and restricted to certain regions. We conducted a nested case-control study examining baseline levels and subsequent lung cancer incidence among current male exclusive cigarette smokers in the Golestan Cohort Study in Iran. We calculated geometric mean biomarker concentrations for 28 matched cases and 52 controls for the correlation of biomarker levels among controls and for adjusted odds' ratios (ORs) for lung cancer incidence by biomarker concentration, accounting for demographic characteristics, smoking quantity and duration, and opium use. Lung cancer cases had higher average levels of most biomarkers including total nicotine equivalents (TNE-2), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and 3-hydroxyfluorene (3-FLU). Many biomarkers correlated highly with one another including TNE-2 with NNAL and N-Acetyl-S-(2-cyanoethyl)-L-cysteine (2CYEMA), and N-Acetyl-S-(4-hydroxy-2-buten-1-yl)-L-cysteine (t4HBEMA) with N-Acetyl-S-(3-hydroxypropyl-1-methyl)-L-cysteine (3HMPMA) and N-Acetyl-S-(4-hydroxy-2-methyl-2-buten-1-yl)-L-cysteine (4HMBEMA). Lung cancer risk increased with concentration for several biomarkers, including TNE-2 (OR = 2.22, 95% CI = 1.03, 4.78) and NNN (OR = 2.44, 95% CI = 1.13, 5.27), and estimates were significant after further adjustment for demographic and smoking characteristics for 2CYEMA (OR = 2.17, 95% CI = 1.03, 4.55), N-Acetyl-S-(2-carbamoylethyl)-L-cysteine (2CAEMA) (OR = 2.14, 95% CI = 1.01, 4.55), and N-Acetyl-S-(2-hydroxypropyl)-L-cysteine (2HPMA) (OR = 2.85, 95% CI = 1.04, 7.81). Estimates were not significant with adjustment for opium use. Concentrations of many biomarkers were higher at the baseline for participants who subsequently developed lung cancer than among the matched controls. Odds of lung cancer were higher for several biomarkers including with adjustment for smoking exposure for some but not with adjustment for opium use.


Assuntos
Neoplasias Pulmonares , Nitrosaminas , Produtos do Tabaco , Biomarcadores , Carcinógenos , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Fumantes
16.
J Cancer Res Clin Oncol ; 147(10): 2837-2849, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34318357

RESUMO

BACKGROUND: Since little consensus has been reached on whether milder reduction in forced expiratory volume in 1 s (FEV1) increases lung cancer incidence, we conducted a meta-analysis and performed Mendelian randomization (MR) analysis to explore the association and causal relationship between FEV1 and lung cancer incidence. METHODS: We conducted a comprehensive search from PubMed, Medline, EMBASE, and Cochrane Library databases as of February 2020. MR analysis was performed using summary data obtained from two large consortia [International Lung Cancer Consortium (ILCCO) and Neale Lab] to assess the possible causality between FEV1 and lung cancer risk. RESULTS: Eight studies involving 88,743 cases were included. The incidence of lung cancer increased with decreasing FEV1.The combined odds ratio (OR) of decreased FEV1 for lung cancer incidence was 1.91 [95% confidence interval (CI) 1.67-2.19; P < 0.001]. Compared with the highest quintile of FEV1 (quintile 5, > 100% of predicted), the OR was 3.06 (95% CI 2.20-4.24; P < 0.001) for quintile 1 (< 70% of predicted), 1.89 (95% CI 1.50-2.38; P < 0.001) for quintile 2 (70-80% of predicted), 1.53 (95% CI 1.31-1.79; P < 0.001) for quintile 3 (80-90% of predicted), and 1.64 (95% CI 1.18-2.28; P = 0.003) for quintile 4 (90-100% of predicted). In subgroup meta-analysis, the correlation between FEV1 and lung cancer risk was different among men (OR = 1.74; 95% CI 1.49-2.03; P < 0.001) and women (OR = 2.80; 95% CI 1.87-4.19; P < 0.001). However, MR analysis showed no causality between the FEV1 and lung cancer risk (OR = 1.199; 95% CI 0.958-1.500; P = 0.114). CONCLUSION: FEV1 is likely to be a predictor of lung cancer, especially for women. However, genetically decreased FEV1 is not causally correlated with lung cancer incidence.


Assuntos
Predisposição Genética para Doença , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Pulmão/fisiopatologia , Análise da Randomização Mendeliana , Polimorfismo de Nucleotídeo Único , Estudos de Coortes , Estudo de Associação Genômica Ampla , Humanos , Incidência , Metanálise como Assunto , Fatores de Risco
17.
Rev Mal Respir ; 38(7): 673-680, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34175166

RESUMO

BACKGROUND: Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. METHOD: All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. RESULTS: From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause readmissions rate was 24.9% (n=27,540). Patients after pneumonectomy had a readmission rate of 37% (n=4918) and 23% after lobectomy (n=2684) (P<0.0001). For the first period, we counted 10 hospitals with a standardized readmissions rate above the 99.8 limit and 10 hospitals above the 95% limit. For the second period, 8 hospitals had a standardized readmission rate above the 99.8% limit and 11 hospitals above the 95% limit. For the third period, 7 hospitals had a standardized readmission rate above the 99.8% limit and 6 hospitals above the 95% limit. CONCLUSION: Readmissions to hospital 30 days after major lung resection for cancer in France declined little during these three periods. Measures to prevent readmissions should be introduced.


Assuntos
Neoplasias Pulmonares , Readmissão do Paciente , Assistência ao Convalescente , Humanos , Pulmão , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Alta do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos
19.
BMC Musculoskelet Disord ; 22(1): 529, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107945

RESUMO

BACKGROUND: The prognosis of lung metastasis (LM) in patients with chondrosarcoma was poor. The aim of this study was to construct a prognostic nomogram to predict the risk of LM, which was imperative and helpful for clinical diagnosis and treatment. METHODS: Data of all chondrosarcoma patients diagnosed between 2010 and 2016 was queried from the Surveillance, Epidemiology, and End Results (SEER) database. In this retrospective study, a total of 944 patients were enrolled and randomly splitting into training sets (n = 644) and validation cohorts(n = 280) at a ratio of 7:3. Univariate and multivariable logistic regression analyses were performed to identify the prognostic nomogram. The predictive ability of the nomogram model was assessed by calibration plots and receiver operating characteristics (ROCs) curve, while decision curve analysis (DCA) and clinical impact curve (CIC) were applied to measure predictive accuracy and clinical practice. Moreover, the nomogram was validated by the internal cohort. RESULTS: Five independent risk factors including age, sex, marital, tumor size, and lymph node involvement were identified by univariate and multivariable logistic regression. Calibration plots indicated great discrimination power of nomogram, while DCA and CIC presented that the nomogram had great clinical utility. In addition, receiver operating characteristics (ROCs) curve provided a predictive ability in the training sets (AUC = 0.789, 95% confidence interval [CI] 0.789-0.808) and the validation cohorts (AUC = 0.796, 95% confidence interval [CI] 0.744-0.841). CONCLUSION: In our study, the nomogram accurately predicted risk factors of LM in patients with chondrosarcoma, which may guide surgeons and oncologists to optimize individual treatment and make a better clinical decisions. TRIAL REGISTRATION: JOSR-D-20-02045, 29 Dec 2020.


Assuntos
Neoplasias Ósseas , Condrossarcoma , Neoplasias Pulmonares , Neoplasias Ósseas/epidemiologia , Condrossarcoma/diagnóstico , Condrossarcoma/epidemiologia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Estudos Retrospectivos , Medição de Risco , Programa de SEER
20.
Artigo em Inglês | MEDLINE | ID: mdl-34064949

RESUMO

Predicting lung cancer cases at the small-area level is helpful to quantify the lung cancer burden for health planning purposes at the local geographic level. Using Victorian Cancer Registry (2001-2018) data, this study aims to forecast lung cancer counts at the local government area (LGA) level over the next ten years (2019-2028) in Victoria, Australia. We used the Age-Period-Cohort approach to estimate the annual age-specific incidence and utilised Bayesian spatio-temporal models that account for non-linear temporal trends and area-level risk factors. Compared to 2001, lung cancer incidence increased by 28.82% from 1353 to 1743 cases for men and 78.79% from 759 to 1357 cases for women in 2018. Lung cancer counts are expected to reach 2515 cases for men and 1909 cases for women in 2028, with a corresponding 44% and 41% increase. The majority of LGAs are projected to have an increasing trend for both men and women by 2028. Unexplained area-level spatial variation substantially reduced after adjusting for the elderly population in the model. Male and female lung cancer cases are projected to rise at the state level and in each LGA in the next ten years. Population growth and an ageing population largely contributed to this rise.


Assuntos
Neoplasias Pulmonares , Idoso , Teorema de Bayes , Feminino , Previsões , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Masculino , Vitória/epidemiologia
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