Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 168.013
Filtrar
1.
Rev Med Liege ; 75(1): 29-36, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920041

RESUMO

Heart transplantation remains undoubtedly the most effective treatment for end-stage heart failure, whatever its cause. Last decade has witnessed significant improvements in terms of morbidity and mortality following heart transplant. The 5-year survival rate is now beyond 70 %. However, the shortage of potential donors limits its use and requires strict criteria before listing a candidate for heart transplantation. Herein, we present a review of current indications and results of the heart transplantation program at the University hospital of Liège.


Assuntos
Insuficiência Cardíaca , Transplante de Coração , Hospitais Universitários , Humanos , Taxa de Sobrevida , Doadores de Tecidos
2.
Medicine (Baltimore) ; 99(1): e18506, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895785

RESUMO

BACKGROUND: Whether the occurrence of refeeding syndrome (RFS), a metabolic condition characterized by electrolyte shifts after initiation of nutritional therapy, has a negative impact on clinical outcomes remains ill-defined. We prospectively investigated a subgroup of patients included in a multicentre, nutritional trial (EFFORT) for the occurrence of RFS. METHODS: In this secondary analysis of a randomized-controlled trial investigating the effects of nutritional support in malnourished medical inpatients, we prospectively screened patients for RFS and classified them as "RFS confirmed" and "RFS not confirmed" based on predefined criteria (i.e. electrolyte shifts, clinical symptoms, clinical context, and patient history). We assessed associations of RFS and mortality within 180 days (primary endpoint) and other secondary endpoints using multivariable regression analysis. RESULTS: Among 967 included patients, RFS was confirmed in 141 (14.6%) patients. Compared to patients with no evidence for RFS, patients with confirmed RFS had significantly increased 180-days mortality rates (42/141 (29.8%) vs 181/826 (21.9%), adjusted odds ratio (OR) 1.53 (95% CI 1.02 to 2.29), P < .05). Patients with RFS also had an increased risk for ICU admission (6/141 (4.3%) vs 13/826 (1.6%), adjusted OR 2.71 (95% CI 1.01 to 7.27), P < .05) and longer mean length of hospital stays (10.5 ±â€Š6.9 vs 9.0 ±â€Š6.6 days, adjusted difference 1.57 days (95% CI 0.38-2.75), P = .01). CONCLUSION: A relevant proportion of medical inpatients with malnutrition develop features of RFS upon hospital admission, which is associated with long-term mortality and other adverse clinical outcomes. Further studies are needed to develop preventive strategies for RFS in this patient population.


Assuntos
Pacientes Internados/estatística & dados numéricos , Desnutrição/mortalidade , Apoio Nutricional/efeitos adversos , Síndrome da Realimentação/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Síndrome da Realimentação/etiologia , Fatores de Risco , Taxa de Sobrevida
3.
Br J Radiol ; 93(1105): 20190743, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670581

RESUMO

OBJECTIVES: Anatomic changes may occur during chemoradiation treatment for lung cancers, requiring adaptive replanning. Here we characterize these cases. METHODS: We retrospectively studied lung cancer cases that underwent resimulation and adaptive replanning during 1/2016-3/2019. We compared first and second CT-simulation regarding tumor location, timing of change, tumor volume, anatomical alteration and change in simulation technique. We also compared dosimetric parameters between the plans, recorded local control, and overall survival outcomes. RESULTS: Out of 281 patients, 58 underwent replanning (20.6%). Histology included small cell (22.4%) and non-small cell (77.6%). Stage III was in 91.4%. Mean radiation dose of 59.4 Gray (Gy) (range 50-66Gy).Tumor location was peribronchial in 53.5%. Timing of replanning was in the first, second and final third of the treatment course in 26%, 43% and 31% respectively. Changes in gross tumor volume were observed in 74%; mean gross tumor volume was 276.7cc vs 192.7 cc (first vs second simulation, p = 0.001). Anatomical changes were identified in 35.4% including pleural fluid accumulation, atelectasis or pneumothorax alteration. Change in simulation technique was performed in 25.9%, including breath-hold or continuous positive airway pressure.Changes in dosimetric parameters when the same technique was used: lung V20Gy 26% (standard deviation, SD 7.6) vs 25.3% (SD 6.6) (p = 0.36), mean lung dose 15.1 Gy (SD 3.7) vs 14.7Gy (SD 3.3) (p = 0.23), heart V40Gy 10.2% (SD13) vs 7.2% (SD 9.8) (p = 0.037). When simulation technique changed: lung V20Gy 30.8% (SD 8.2) vs 27.3% (SD 8) (p = 0.012), mean lung dose 17.3 Gy (SD 4.4) vs 15.3 Gy (SD 3.8) (p = 0.007), heart V40Gy 11.1% (SD 14.7) vs 6.5% (SD 6.7) (p = 0.014).2 year local control was 60.7% (95% confidence interval, 34.5-79.2%), and median overall survival was 19.7 months. CONCLUSION: Adaptive replanning of radiation was performed in a fifth of locally advanced lung cancer patients. In most cases tumor volume decreased, or atelectasis resolved, causing mediastinal shifts, which, if unidentified and left uncorrected, may have led to local failure and increased toxicity. The heart V40Gy was reduced significantly in all cases, but significant reduction in lung doses was evident only if simulation technique was altered. ADVANCES IN KNOWLEDGE: In locally advanced lung cancer image-guidance with cone beam CT can detect significant mediastinal shifts and gross tumor volume changes that raise the need for adaptive replanning. Image guidance-triggered adaptive replanning should be added to the armament of advanced radiation treatment planning in locally advanced lung cancer.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Quimiorradioterapia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Taxa de Sobrevida
4.
Ann Hematol ; 99(1): 49-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31853702

RESUMO

Immune thrombocytopenia (ITP) has been reported to be associated with thrombotic events. The incidence of thrombosis in 303 newly diagnosed ITP patients in our institute between 2000 and 2016 was retrospectively reviewed. During a median follow-up of 3.6 years, 16 thrombotic events (12 arterial and four venous) occurred. The median platelet count at thrombotic events was 102 × 109/l. At 10 years, the cumulative thrombosis incidence was 10%. A univariate analysis showed that smoking, hypertension, male gender, a history of thrombosis, and atrial fibrillation (Af) were significantly associated with the occurrence of thrombosis, and a multivariate analysis identified smoking and Af as independent risk factors. The thrombotic risk was not increased by lupus anticoagulant positivity or ITP treatment. At 5 years, the cumulative incidence of bleeding and overall survival probability was 5.6% and 92%, respectively. This study demonstrates that smoking and Af were associated with an increased risk of thrombosis. Previously identified risk factors were not confirmed in these Japanese ITP patients.


Assuntos
Púrpura Trombocitopênica Idiopática , Trombose , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Trombose/etiologia , Trombose/mortalidade
5.
J Urol ; 203(1): 57-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31600114

RESUMO

PURPOSE: We sought to determine the trend of neoadjuvant chemotherapy use for nonmetastatic muscle invasive urothelial bladder cancer and whether it is associated with adverse perioperative morbidity after robot-assisted radical cystectomy. MATERIALS AND METHODS: We retrospectively reviewed the IRCC (International Robotic Cystectomy Consortium) database between 2006 and 2017. After excluding patients with nonmuscle invasive bladder cancer the patients were divided into 2 groups, including those who did vs did not receive neoadjuvant chemotherapy. Data were reviewed for demographics, preoperative, operative and 90-day perioperative outcomes. We used the Cochran-Armitage trend test to assess trends of neoadjuvant chemotherapy associations with high grade and overall complications with time. Multivariate stepwise regression analyses were done to determine whether neoadjuvant chemotherapy was associated with prolonged operative time, 90-day postoperative complications, readmissions, reoperations and mortality after robot-assisted radical cystectomy. RESULTS: A total of 298 patients (26%) received neoadjuvant chemotherapy. These patients were younger (age 67 vs 69 years, p=0.01) and more frequently had an ASA™ (American Society of Anesthesiologists™) score of 3 or greater (62% vs 55%, p=0.02) and pathological T3 stage or greater disease (28% vs 22%, p=0.04). The use of neoadjuvant chemotherapy increased significantly from 10% in 2006 to 2007 to 42% in 2016 to 2017 (p <0.01). On multivariate analysis neoadjuvant chemotherapy was not significantly associated with prolonged operative time, hospital stay, 90-day postoperative complications, reoperation or mortality. Neoadjuvant chemotherapy was associated with 90-day readmissions after robot-assisted radical cystectomy (OR 5.90, 95% CI 3.30-10.90, p <0.01). CONCLUSIONS: Neoadjuvant chemotherapy utilization has significantly increased in the last decade. It was not associated with perioperative surgical morbidity after robot-assisted radical cystectomy.


Assuntos
Quimioterapia Adjuvante , Cistectomia , Terapia Neoadjuvante , Procedimentos Cirúrgicos Robóticos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Antineoplásicos/uso terapêutico , Humanos , Masculino , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
6.
Gut ; 69(1): 168-176, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30878947

RESUMO

OBJECTIVE: Hepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients. DESIGN: 4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables. RESULTS: While incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998-2002, 22.4% in 2003-2007, 30.6% in 2008-2012 up to 31.0% in 2013-2016. Median OS increased from 6 months in 1998-2002 to 12 months in 2008-2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged. CONCLUSION: These real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/secundário , Detecção Precoce de Câncer/mortalidade , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Taxa de Sobrevida/tendências
7.
Medicine (Baltimore) ; 98(50): e18355, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852138

RESUMO

BACKGROUND: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been extensively studied in patients with peritoneal carcinomatosis from various malignancies. However, the effectiveness of HIPEC for ovarian cancer is still controversial. Therefore, we performed this meta-analysis to identify patients with ovarian cancer who can obtain survival benefit from HIPEC. METHODS: Articles regarding HIPEC in the MEDLINE, EMBASE, and Cochrane Library were searched till December 2018. In total, 13 case-control studies and two randomized controlled trials were included in this meta-analysis. We investigated the effect of HIPEC on disease-free survival (DFS) and overall survival (OS), and performed subgroup analyses based on the study design, adjustment of confounding variables, and quality of the study. RESULTS: HIPEC improved both DFS (hazard ratio [HR], 0.603; 95% confidence interval [CI], 0.513-0.709) and OS (HR, 0.640; 95% CI, 0.519-0.789). In cases of primary disease, HIPEC improved DFS (HR, 0.580; 95% CI, 0.476-0.706) and OS (HR, 0.611; 95% CI, 0.376-0.992). Subgroup analyses revealed that HIPEC did not improve OS but improved DFS of patients with residual tumors ≤1 cm or no visible tumors. In cases of recurrent disease, HIPEC was associated with better OS (HR, 0.566; 95% CI, 0.379-0.844) but not with DFS. Subgroup analyses also revealed similar tendencies. However, HIPEC improved DFS of patients with residual tumors ≤1 cm or no visible tumors, while it improved OS of only those with residual tumors ≤1 cm. CONCLUSIONS: HIPEC may improve DFS of patients with ovarian cancer when residual tumors were ≤1 cm or not visible. It may also improve OS of only patients with recurrent disease whose residual tumors were ≤1 cm.


Assuntos
Hipertermia Induzida/mortalidade , Neoplasias Ovarianas/terapia , Seleção de Pacientes , Adulto , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasia Residual , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Resultado do Tratamento
8.
Zhonghua Zhong Liu Za Zhi ; 41(12): 881-890, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874543

RESUMO

Lung cancer is the most common cancer and the leading cause of cancer death in China, with 733 thousands estimated new lung cancer cases and 610 thousands deaths in 2015. In the pathological type of lung cancer, non-small cell lung cancer (NSCLC) accounts for 80%~85%, and 30% of NSCLC patients have already reached stage Ⅲ at diagnosis, who have lost the optimal opportunity for surgical treatment. Stage Ⅲ NSCLC is highly heterogeneous, the 5-year survival rates of stage ⅢA, ⅢB and ⅢC NSCLC are 36%, 26% and 13%, respectively. For the great complexity of making decisions in the clinical practice of stage Ⅲ NSCLC, the experts of this consensus group combine the latest clinical research results and cutting-edge multidisciplinary concepts, conduct in-depth and detailed discussions on the hot issues and controversies in the diagnosis, treatment and follow-up surveillance of stage Ⅲ NSCLC. Chinese Anti-Cancer Association and Committee of Lung Cancer Society jointly publish this consensus to provide guidance for Chinese clinicians.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , China/epidemiologia , Consenso , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Sociedades Médicas , Taxa de Sobrevida
9.
Zhonghua Zhong Liu Za Zhi ; 41(12): 932-936, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874551

RESUMO

Objective: To explore the clinical characteristics, treatment strategy and prognosis of adenoid cystic carcinoma of the head and neck (ACCHN). Methods: A retrospective analysis of the clinical and follow-up treatment of 79 patients with ACCHN from June 2008 to July 2017 was conducted in the Cancer Hospital of Zhengzhou University. Results: A total of 79 ACCHN cases, including 31 males and 48 females. The age ranged from 19 to 77 (median, 52). The clinical manifestations of ACC were related to the locations of primary tumor.The mean size of the tumor was 2.6 cm (range from 1.5 to 7.7 cm). 50 of 79 patients with a definitive pathological diagnosis received surgical resection. 59 cases received chemotherapy and 62 cases received radiotherapy. With a median follow-up of 55 months, the 5-year, 10-year survival rate of these patients were 69.6% and 54.4%, respectively. Conclusions: ACCHN is an uncommon neoplasm with the characteristics of epithelial nerve growth, being inclined to distant metastasis, and high early misdiagnosis rate. The clinical manifestation, imaging and pathological result are need to be combined together to diagnose ACCHN.


Assuntos
Carcinoma Adenoide Cístico/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/cirurgia , Adulto , Idoso , Carcinoma Adenoide Cístico/diagnóstico , Carcinoma Adenoide Cístico/mortalidade , Carcinoma Adenoide Cístico/patologia , China/epidemiologia , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
10.
Zhonghua Zhong Liu Za Zhi ; 41(12): 937-942, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874552

RESUMO

Objective: To explore the effect of nutritional status pre-and during chemoradiotherapy on the prognosis of patients with limited- stage small cell lung cancer (LS-SCLC). Methods: We retrospectively collected medical records of 172 LS-SCLC patients undergoing concurrent chemoradiotherapy in our hospital from 2000 to 2014, with 126 males and 46 females. The data of complete blood count and hepatic and renal function were collected before initial treatment, before radiotherapy, 4 weeks during radiotherapy, and 1 month after complete of treatment. The prognostic nutritional index(PNI)was calculated. Kaplan-Meier method was used to calculate the survival rate. Log-rank test was performed used to compare the survival differences between groups. Multivariate prognostic analysis was performed using Cox regression model. Results: The median overall survival (OS) was 21 months, with median progression-free survival (PFS) of 11 months. At the beginning of treatment, patients with pre-treatment PNI ≥ 53 had significantly superior OS (median 37 vs 15 months, P=0.001) and PFS (median 16 vs 10 months, P=0.017). Patients with pre-treatment hemoglobin ≥140 g/L and <140 g/L had an median OS of 32 months and 17 months (P=0.019), and median PFS of 16 months and 9 months (P=0.040), respectively. During chemoradiation, patients with elevated hemoglobin had similar median OS compared with those had decreased hemoglobin (27 vs 18 months, P=0.063, but superior median PFS (15 vs 9 months, P=0.017). Multivariate analysis revealed that prophylactic cranial irradiation, pre-treatment hemoglobin ≥140 g/L, and pretreatment PNI ≥53 were independent predictors of OS and PFS in patients with LS-SCLC. Conclusion: Pre-treatment nutritional status and the changes of nutritional status during chemoradiotherapy is significantly associated with the prognosis of patients with limited-stage small cell lung cancer. The patients with better pre-treatment nutritional status have a better prognosis.


Assuntos
Carcinoma de Células Pequenas/tratamento farmacológico , Carcinoma de Células Pequenas/radioterapia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Estado Nutricional , Carcinoma de Pequenas Células do Pulmão/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Pequenas/química , Quimiorradioterapia , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/mortalidade , Taxa de Sobrevida
11.
Zhonghua Zhong Liu Za Zhi ; 41(12): 943-948, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874553

RESUMO

Objective: To investigate the relevant prognostic factors of liposarcoma (LPS). Methods: The data of 78 patients with LPS treated in our hospital from July 2009 to March 2017 were reviewed. The 78 patients included 41 males and 37 females, and the average age was (60.5 ±13.4) years (ranged from 18 to 85 years). Among the 78 LPS patients, 27 were well-differentiated LPS, 13 were myxoid LPS, 35 were dedifferentiated LPS and 3 were pleomorphic LPS.The distribution of lesion location included 40 cases of extremities and 38 cases of retroperitoneal. 21 cases were treated with radical excision, 57 cases were treated with marginal resection. 7 patients were treated with postoperative radiotherapy and 9 patients with postoperative chemotherapy. Progression free survival (PFS) and overall survival (OS) of LPS patients were analyzed as clinical outcomes. Prognostic factors were analyzed by univariate and multivariate analyses. Results: 43 patients had local recurrence (9 of extremities/ 34 of retroperitoneal), 18 patients with metastasis (4 of extremities/ 14 of retroperitoneal). The 5-year PFS rate was 31.4% and 5-year OS rate was 44.3%. Univariate analysis showed that the histological subtype and the tumor location were related with PFS (P<0.05), while the histological subtype, the tumor location, the tumor size, the recurrence and metastasis were related with OS (P<0.05). Multivariate cox regression analysis showed that the tumor location was the independent prognostic factor of PFS (P<0.05), while the histological subtype and metastasis were the independent prognostic factors of OS (P<0.05). The median PFS of patients with myxoid LPS treated with radiotherapy was 34.6 months, which was significantly longer than 28.3 months of myxoid LPS patients without radiotherapy (P<0.05). Conclusions: The tumor location is an independent prognostic factor of PFS in LPS patients.Retroperitoneal LPS is more prone to relapse and metastasize. OS is affected by pathological subtype and metastasis. Radiotherapy can improve the PFS of patients with myxoid LPS.


Assuntos
Lipossarcoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Lipossarcoma/mortalidade , Lipossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Neoplasias Retroperitoneais/mortalidade , Neoplasias Retroperitoneais/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
12.
Cell Physiol Biochem ; 53(5): 805-819, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670920

RESUMO

BACKGROUND/AIMS: Despite effective therapeutic strategies for treating hormone receptor-positive (HR+) breast cancer, resistance to endocrine therapy that is either de novo or acquired still occurs. We investigated epidermal growth factor receptor (EGFR) as a therapeutic target for overcoming endocrine resistance in HR+ breast cancer models. METHODS: Using clinical data from 2,166 patients who had HR+ breast tumors and received tamoxifen, we analyzed survival rates. Levels of mRNA and protein expression were analyzed by real-time PCR and western blotting, respectively. Cell viability was analyzed by MTT assays and anchorage-independent growth by soft agar colony-formation assays. Efficacy of tamoxifen and/or gefitinib was analyzed using orthotopic xenograft mouse models. RESULTS: EGFR expression was significantly associated with more advanced stage and higher grade. EGFR expression was different in luminal A-like (Lum A, 1.3%) versus luminal B-like (Lum B, 11.4%) subtypes. On multivariate analyses for survival Lum B subtype EGFR+ tumors showed a hazard ratio (HR) of 5.22 (95% CI, 1.29-21.15, P = 0.020) for overall survival (OS) and HR of 2.91 (95% CI, 1.35-6.28, P = 0.006) for disease-free survival (DFS). Levels of EGFR inversely correlated with ER-α expression. Basal ER-α level was completely blocked by TGFA or EGF treatment. With TGFA pretreatment, ER+ breast cancer cells were resistant to 4-hydroxytamoxifen (4-OHT). Conversely, downregulation of ER-α by TGFA was reversed by gefitinib with recovered sensitivity to 4-OHT. Tumorigenicity of EGFR and ER+ breast cancer cells were significantly decreased by combined tamoxifen and gefitinib. CONCLUSION: Aberrant EGFR expression was associated with poor prognosis in ER+ breast cancers, especially the Lum B subtype. Loss of ER by EGFR activation induced tamoxifen resistance. Therefore, EGFR could be a therapeutic target for overcoming recurrence of ER+ breast cancer with high EGFR expression.


Assuntos
Neoplasias da Mama/patologia , Receptor ErbB-2/metabolismo , Adulto , Idoso , Animais , Antineoplásicos/química , Antineoplásicos/farmacologia , Neoplasias da Mama/mortalidade , Linhagem Celular Tumoral , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Receptor alfa de Estrogênio/metabolismo , Feminino , Humanos , Camundongos , Camundongos Nus , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Receptor ErbB-2/antagonistas & inibidores , Receptores Estrogênicos/metabolismo , Taxa de Sobrevida , Tamoxifeno/análogos & derivados , Tamoxifeno/química , Tamoxifeno/farmacologia
13.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(5): 720-724, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31762244

RESUMO

OBJECTIVE: To study and compare the practical use of three prognostic predication models in clinical non-metastatic renal cell carcinoma (RCC). METHODS: We retrospectively collected the data of 1 202 clinical non-metastatic RCC patients operated on between 1999 and 2012 at West China Hospital of Sichuan University. Survival analysis method was used to establish three prognostic prediction models including SSIGN, Leibovich and UISS based on different clinical and pathological indicators. The predictive ability was evaluated by the area under receiver operating characteristic curve (AUC). RESULTS: Of the 1 202 clinical non-metastatic RCC patients, 1 030 cases were limited RCC patients, and 172 cases were locally advanced RCC patients. The median follow-up time of the patients was 63.02 months. The 2-year and 5-year overall survival rate were 94.7% and 87.6%, respectively. The 5-year overall survival rates of patients with different clinical stages and grades were significantly different. The predictive accuracies for limited RCC of UISS, SSIGN and Leibovich model were 0.667, 0.785 and 0.758, respectively. For locally advanced RCC, the predictive accuracies of the three models were all lower than 0.6. CONCLUSIONS: SSIGN has certain predictive value in clinical non-metastatic RCC. However, for the advanced RCC, all the prognostic models demonstrate limited predictive value.


Assuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , China , Humanos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida
14.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(5): 760-764, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31762248

RESUMO

OBJECTIVE: To analyze of the minimum graft-to-recipient weight ratio (GRWR) required for living donor liver transplantation (LDLT) without middle hepatic vein branch (MHVT) reconstruction. METHODS: We retrospectively collected the clinical data and outcomes of 303 LDLT patients over 16 years from 2001 to 2017. The minimum GRWR of non-middle hepatic vein reconstruction was analyzed by propensity score (PSM). RESULTS: With PSM analysis, no significant differences were observed in postoperative complications, SFSS, inpatient time, liver function, and coagulation function, but significant differences in 1-year, 3-year and 5-year survival between MHVT reconstruction and non-reconstruction group. The patients with MHVT reconstruction had better short-term and long-term survival than those without reconstruction. CONCLUSION: For LDLT patients without HMVT reconstruction, GRWR should be greater than 0.86%; for patients with HMVT reconstruction, GRWR is acceptable between 0.5% and 0.6%.


Assuntos
Veias Hepáticas/cirurgia , Transplante de Fígado , Fígado/anatomia & histologia , Doadores Vivos , Sobrevivência de Enxerto , Humanos , Tamanho do Órgão , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
15.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 772-776, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31734991

RESUMO

Objective: To investigate the prognostic value of albumin-to-bilirubin scores in the assessment of autoimmune hepatitis-related cirrhosis. Methods: The receiver operating characteristic curve was used to evaluate the accuracy of ALBI, Child-Pugh and model for end-stage liver disease (MELD) for prognosis prediction. Survival analysis was performed according to the ALBI classification. Spearman correlation analysis was performed on the ALBI score and the Child-Pugh score. Survival curves were plotted by Kaplan-Meier method, and Log-rank method was used to compare the survival difference curves between different groups. Results: 149 patients were recruited in the study. The ROC analysis showed that the ALBI scores (0.861, 0.826, 0.779, 0.744)was superior to Child-Pugh scores(0.703, P = 0.006; 0.672, P < 0.001; 0.613, P < 0.001; 0.583, P < 0.001)and MELD score(0.774, P = 0.031; 0.731, P = 0.007; 0.669, P < 0.001; 0.631, P < 0.001) for predicting 6, 12, 24, and 36 months mortality. Patients with ALBI grade 3 had a significantly lower survival rate than those with ALBI grade1 and grade 2. Conclusion: ALBI score may be useful to evaluate the long-term prognosis of patients with autoimmune hepatitis-related cirrhosis.


Assuntos
Albuminas/administração & dosagem , Bilirrubina/sangue , Hepatite Autoimune/diagnóstico , Cirrose Hepática/diagnóstico , Hepatite Autoimune/sangue , Humanos , Cirrose Hepática/sangue , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
16.
Pan Afr Med J ; 33: 289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692808

RESUMO

Introduction: This study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest. Methods: We conducted a prospective, observational study in pre hospital emergency services. We included adults' patients, with a suspicion of non-traumatic cardiac arrest (CA) in an out of hospital environment, who received or not cardiopulmonary resuscitation (CPR) by our mobile emergency medical service teams. An analytic study was conducted in order to identify independent factors that could influence the decision to resuscitate OHCA. Results: During study, 228 patients were enrolled, the mean age was 64 +/- 14 years and 59% were men. Eighteen patients (8%) received bystander CPR by witnesses. The median time elapsed to arrive at the scene was 13 [8-25] min. The median "noflow" was 22 [10-34] min. The resuscitation decision was taken by the mobile EMS staff for 106 patients (46.5%). For other patients, the decision not to resuscitate was motivated solely by the finding of a confirmed state of death in an elderly patient (p = 0.045). The predictive decision factor for resuscitation was the no flow time less than 18.5 min, Odds Ratio adjusted with 95% confidence interval to: 1.38 (1.24 - 3.55) (p <0.001). Overall out of hospital survival rate was 17% of resuscitated patients. Conclusion: The decision to resuscitate a cardiac arrest outside of the hospital depends more on the "no flow" time than on the presumed etiologies.


Assuntos
Reanimação Cardiopulmonar/métodos , Tomada de Decisões , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo
17.
Zhonghua Wai Ke Za Zhi ; 57(11): 834-839, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694132

RESUMO

Objective: To discuss the rationality of stage pT3 in the AJCC 8(th) TNM criteria of gallbladder carcinoma. Methods: A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage: tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure; (2) pT3b stage: tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females, aged 36 to 80 years, with a median age of 59 years; 43 patients with pT3b, including 24 males and 19 females, aged 41 to 78 years old, median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t-test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non-normally distributed measurement data.The comparison of the count data was performed by χ(2) test or Fisher exact probability method. Survival analysis was performed using Kaplan-Meier method, and survival rate was compared using Log-rank test. Results: (1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19-9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816, -1.966, -3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days) (P<0.05). (2) The 1-, 3-, 5-year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ(2)=5.117, P=0.024). (3)The 1-, 3-year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ(2)=4.976, P=0.026). Conclusions: pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8(th) gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient's basic condition and surgical tolerance.


Assuntos
Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/patologia , Estadiamento de Neoplasias/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
18.
Rinsho Ketsueki ; 60(10): 1411-1417, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31695000

RESUMO

Because multiple myeloma is rare in young people, there are fewer reports on the same. Thus, its clinical aspects and prognosis remain unelucidated. We retrospectively evaluated 30 patients with multiple myeloma aged ≤ 45 years at diagnosis. We divided them into three groups based on their cytogenetic risks: standard risk (SR), high risk (HR), and unknown risk. The frequency of HR patients was 36.6%, the highest of the three groups, unlike the previous report. The median progression-free survival (PFS) was 35 months (SR vs. HR, 46 vs. 29 months), and the median overall survival (OS) was not reached (NR) (SR vs. HR, NR vs. 82 months). The OS was significantly worse, and the PFS also appeared inferior in HR patients. The International Staging System score was not associated with OS. Thus, young patients with myeloma appeared to have a higher frequency of HR features, suggesting that instead of age, the cytogenetic risk was a significant prognostic factor.


Assuntos
Mieloma Múltiplo/diagnóstico , Citogenética , Intervalo Livre de Doença , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
19.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(5): 622-629, 2019 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-31699192

RESUMO

Objective To investigate the clinical value of preoperative lymphocyte-to-monocyte ratio(LMR)in evaluating the prognosis of patients with stage T1 non-muscle invasive bladder cancer(NMIBC).Methods A total of 215 patients with stage T1 NMIBC who underwent transurethral resection of bladder tumor were enrolled.Clinical data were collected.Patients were followed up and their disease-free survival(DFS)and overall survival(OS)were recorded.The receiver operating characteristic(ROC)curve of preoperative LMR in detecting patient prognosis was used to determine the optimal cut-off value for LMR.Patients were divided into low LMR group(LMR <3.86,n=77)and high LMR group(LMR ≥ 3.86,n=138).Kaplan-Meier survival curves were explored to compare cumulative DFS and OS rates in patients with different LMR levels,and COX proportional hazards regression model was used to analyze factors associated with DFS and OS.Results All these 215 patients with T1 stage NMIBC were followed up for 2-92 months,and the DFS rate was 59.07% and OS rate was 65.12%.Kaplan-Meier curves showed that the cumulative DFS rate(χ 2=4.784,P=0.029)and cumulative OS rate(χ 2=7.146, P=0.008)in the low LMR group were significantly lower than those in the high LMR group.Tumor size ≥ 3 cm(HR=1.398,95% CI:1.042-1.875,P=0.025),pathological grade G3(HR=1.266,95% CI:1.026-1.563,P=0.028),and LMR ≥ 3.86(HR=2.347,95% CI:1.080-5.101,P=0.031)were independent factors associated with DFS in patients with stage T1 NMIBC.In addition,tumor size ≥ 3 cm(HR=1.228,95% CI:1.015-1.484,P=0.034),pathological grade G3(HR=1.366,95% CI:1.017-1.834,P=0.038),and LMR<3.86(HR=2.008,95% CI:1.052-3.832,P=0.035)were independent factors associated with OS in patients with T1 stage NMIBC. Conclusion Preoperative LMR is an independent factor associated with patients' prognosis in T1 stage NIMBC.Patients with low LMR tend to have higher risk of NMIBC progression and death.


Assuntos
Linfócitos/citologia , Monócitos/citologia , Neoplasias da Bexiga Urinária/diagnóstico , Intervalo Livre de Doença , Humanos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia
20.
Zhonghua Zhong Liu Za Zhi ; 41(11): 854-858, 2019 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-31770854

RESUMO

Objective: The current study aimed to evaluate the predictive performances of anatomic staging system (AS) and prognostic staging system (PS) proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual in patients with pure mucinous breast cancer (PMBC). Methods: Clinicopathologic features and follow-up information were collected from a total of 3628 patients with PMBC. Breast cancer-specific survival (BCSS) were compared among patients in different stage groups. Likelihood ratio (LR) χ(2), Akaike information criterion (AIC) and Harrell's concordance index (C-index) were used to evaluate the predictive performances of AS and PS in PMBC. Results: In PMBC, BCSS was associated with tumor size (P=0.002), lymph node status (P=0.002), grade(P=0.003), PR status(P=0.017)and the receipt of radiation. Compared to AS, 1326 patients (37.54%) underwent stage change after applying PS, with 6.50% upstaged and 37.04% downstaged. There were significant differences in BCSS among patients of different stages under the AS and PS (P<0.001). However, PS was not superior to AS in predicting prognosis (AS vs PS, LR χ(2): 16.41 vs 17.5; AIC: 357.44 vs 358.35; C-index, 0.72 vs 0.73, P=0.667). Conclusions: Both of AS and PS proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual were predictive factors in patients with PMBC. Compared with AS, the PS did not show superiority in prognosis prediction among patients with PMBC.


Assuntos
Neoplasias da Mama/diagnóstico , Estadiamento de Neoplasias , Humanos , Funções Verossimilhança , Gradação de Tumores , Prognóstico , Taxa de Sobrevida , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA