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Savarrakhsh A, Vakilpour A, Davani SZN, Daskareh M, Morsaghian M, Salari A, Mirrazeghi SF. Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study. J Cardiothorac Surg 2021; 16:298. [PMID: 34645482 PMCID: PMC8511285 DOI: 10.1186/s13019-021-01684-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary pericardial mesothelioma (PPM) is a rare malignancy with a high prevalence of mortality. The diagnosis is usually challenging using a variety of imaging modalities and invasive procedures and is generally performed at the later stages of the disease or in autopsy. This case study points to an unconventional presentation of PPM and the challenges in diagnosing this rare mortal malignancy. Case presentation This study presents a 44-year-old woman with no remarkable medical history with an initial diagnosis of effusive constrictive pericarditis at first hospitalization. Imaging evaluations, including transthoracic echocardiography and chest computed tomography scan, demonstrated visible thickened pericardium, pericardial effusion, and mass-like lesions in pericardium and mediastinum. The definite diagnosis of primary pericardial mesothelioma was established after pericardiectomy and histopathology examinations. Chemotherapy with pemetrexed and carboplatin was administrated to the patient, and she has been through four cycles of chemotherapy with no complications to date. Conclusion Constrictive pericarditis is an uncommon presentation of PPM. Due to the high mortality rate and late presentation, difficulties and uncertainties in diagnosis, being aware of this rare malignant entity in different cardiac manifestations, particularly when there is no clear explanation or response to treatment in such conditions, is highly important. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01684-8.
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Affiliation(s)
- Amir Savarrakhsh
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital School of Medicine, Guilan University of Medical Sciences, 15 Khordad Street, District 2, Rasht, Guilan Province, Iran
| | - Azin Vakilpour
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital School of Medicine, Guilan University of Medical Sciences, 15 Khordad Street, District 2, Rasht, Guilan Province, Iran
| | - Sam Zeraatian-Nejad Davani
- Department of Cardiology, Rasool Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahyar Daskareh
- Department of Radiology, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Morsaghian
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital School of Medicine, Guilan University of Medical Sciences, 15 Khordad Street, District 2, Rasht, Guilan Province, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital School of Medicine, Guilan University of Medical Sciences, 15 Khordad Street, District 2, Rasht, Guilan Province, Iran
| | - Seyedeh Fatemeh Mirrazeghi
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital School of Medicine, Guilan University of Medical Sciences, 15 Khordad Street, District 2, Rasht, Guilan Province, Iran.
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He J, Xu S, Pan H, Li S, He J. Does size matter? -a population-based analysis of malignant pleural mesothelioma. Transl Lung Cancer Res 2020; 9:1041-1052. [PMID: 32953483 PMCID: PMC7481612 DOI: 10.21037/tlcr-19-488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The 8th edition staging system for malignant pleural mesothelioma (MPM) has been proposed. The size of tumor is not taken into consideration. We intend to elucidate the prognostic value of the size of MPM and evaluate the current staging system via the data of SEER database. Methods All cases of primary MPM were identified and extracted from the SEER database during the period of 2004–2016. The endpoints were overall survival (OS) and cancer-specific survival (CSS) which were analyzed using Kaplan-Meier method. Log-rank test and Cox regression were utilized to identify the prognostic factors. Results A total of 2,138 patients were included in the primary cohort. The 1-, 3- and 5-year survival rates of MPM were 39.4%, 11.8% and 3.8%. Older, male and advanced stage patients accounted for larger proportion of the cohort. Besides tumor extension, lymph node involvement and metastatic status, tumor size, pathological type and differentiation grade were significant prognostic factors. In the stratified analysis of tumor extension, size is a significant prognostic factor in T2 patients and indicates inferior survival outcomes. Surgery, chemotherapy and radiation can increase both OS and CSS in MPM patients. Triple combination treatments showed a superiority to other treatments. Conclusions Tumor size matters in the prognosis of MPM especially in the early stage of MPM patients. The adjusted TNM staging system incorporating tumor size has better accuracy than the 8th edition IMIG system. However, some stages had not been fully identified. More cases of early stages are warranted for essential revision.
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Affiliation(s)
- Jiaxi He
- Department of Pathology, University of Maryland Baltimore, School of Medicine, Baltimore, MD, USA.,Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Songhui Xu
- Department of Pathology, University of Maryland Baltimore, School of Medicine, Baltimore, MD, USA
| | - Hui Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
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Fulong X, Chao L, Dianjiang Z, Qihong Z, Wei Z, Jun Z, Fang H. Recursive Partitioning Analysis of Fractional Low-Frequency Fluctuations in Narcolepsy With Cataplexy. Front Neurol 2018; 9:936. [PMID: 30450078 PMCID: PMC6225790 DOI: 10.3389/fneur.2018.00936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022] Open
Abstract
Objective: To identify narcolepsy related regional brain activity alterations compared with matched healthy controls. To determine whether these changes can be used to distinguish narcolepsy from healthy controls by recursive partitioning analysis (RPA) and receiver operating characteristic (ROC) curve analysis. Method: Fifty-one narcolepsy with cataplexy patients (26 adults and 25 juveniles) and sixty matched heathy controls (30 adults and 30 juveniles) were recruited. All subjects underwent a resting-state functional magnetic resonance imaging scan. Fractional low-frequency fluctuations (fALFF) was used to investigate narcolepsy induced regional brain activity alterations among adult and juveniles, respectively. Recursive partitioning analysis and Receiver operating curve analysis was used to seek the ability of fALFF values within brain regions in distinguishing narcolepsy from healthy controls. Results: Compared with healthy controls, both adult and juvenile narcolepsy had lower fALFF values in bilateral medial superior frontal gyrus, bilateral inferior parietal lobule and supra-marginal gyrus. Compared with healthy controls, both adult and juvenile narcolepsy had higher fALFF values in bilateral sensorimotor cortex and middle temporal gyrus. Also juvenile narcolepsy had higher fALFF in right putamen and right thalamus compared with healthy controls. Based on RPA and ROC curve analysis, in adult participants, fALFF differences in right medial superior frontal gyrus can discriminate narcolepsy from healthy controls with high degree of sensitivity (100%) and specificity (88.9%). In juvenile participants, fALFF differences in left superior frontal gyrus can discriminate narcolepsy from healthy controls with moderate degree of sensitivity (57.1%) and specificity (88.9%). Conclusion: Compared with healthy controls, both the adult and juvenile narcolepsy showed overlap brain regions in fALFF differences after case-control comparison. Furthermore, we propose that fALFF value can be a helpful imaging biomarker in distinguishing narcolepsy from healthy controls among both adults and juveniles.
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Affiliation(s)
- Xiao Fulong
- Department of Respiratory and Critical Care Medicine, Sleep Medicine Center, Peking University People's Hospital, Beijing, China
| | - Lu Chao
- Department of Radiology, Peking University International Hospital, Beijing, China
| | - Zhao Dianjiang
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Zou Qihong
- PKU-Upenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Zhang Wei
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Zhang Jun
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Han Fang
- Department of Respiratory and Critical Care Medicine, Sleep Medicine Center, Peking University People's Hospital, Beijing, China
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Rahouma M, Aziz H, Ghaly G, Kamel M, Loai I, Mohamed A. Survival in Good Performance Malignant Pleural Mesothelioma Patients; Prognostic Factors and Predictors of Response. Asian Pac J Cancer Prev 2017; 18:2073-2078. [PMID: 28843224 PMCID: PMC5697462 DOI: 10.22034/apjcp.2017.18.8.2073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: Malignant pleural mesothelioma (MPM) has a poor prognosis in general. Here we sought to evaluate
prognostic factors and predictors of response to chemotherapy in good performance (PS=0-I) patients. Methods: We
retrospectively reviewed our database and enrolled patients with MPM who received platinum containing chemotherapy
(2012-2014). Clinico-pathological and laboratory data were retrieved and Cox and logistic regression multivariate
analyses (MVA) were respectively used to identify predictors of survival and response to chemotherapy. Comparison
of good vs poor performance status (PS≥II) was accomplished using the Chi (X2) test. Kaplan–Meier survival curves
were also obtained and propensity-score matching was performed for survival comparison. Results: Among 114 patients
listed during the study period, 82 had good PS=0-I (median age 45years, 43 men, 30 smokers, median weight=77Kg,
pretreatment haemoglobin (Hb) level=12g/dL, platelet count=372,000/μL, leukocytes=9,700/μL, neutrophils=6,100/μL,
lymphocytes=1,890/μL and neutrophil/lymphocyte ratio (NLR)=3.60 ). Some 65 had asbestosis, 23 had chronic disease,
55 (67.1%) were responders to platinum containing first line chemotherapy. A total of 49 (59.8%) had epithelial MPM.
Median-OS and PFS in good PS cases were 17 and 9 months, respectively, as compared to 16 and 8 months for the
poor PS group. After matching, better OS was observed among good PS vs poor PS patients (p=0.024) but there was
no PFS difference (p=0.176). Significant decrease in PFS was observed among those with advanced nodal N disease
(median PFS in N0 and N+ was 10 and 5 months, respectively), non-responders (p=0.012), NLR (p=0.026) and those
with an epithelial pathology (p=0.062). MVA demonstrated that advanced (N) status (p=0.015), being a non-responder
(p<0.001), NLR (p=0.015) and smoking (p=0.07) adversely affected the prognosis. The only predictor of response
was absence of metastasis (M0; p=0.04). Conclusions: In addition to previously recognized factors, like nodal status,
response, smoking and NLR, better median survival was evident in our patients with a good PS. Early detection before
development of metastasis warrants greater focus to allow better responses to be obtained.
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Affiliation(s)
- Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt.
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Paliogiannis P, Putzu C, Ginesu GC, Cossu ML, Feo CF, Attene F, Scognamillo F, Nonnis R, Cossu A, Palmieri G, Pirina P, Fois A. Deciduoid mesothelioma of the thorax: A comprehensive review of the scientific literature. CLINICAL RESPIRATORY JOURNAL 2017; 12:848-856. [PMID: 28026144 DOI: 10.1111/crj.12599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/25/2016] [Accepted: 12/20/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Deciduoid mesothelioma is a rare variant of malignant epithelioid mesothelioma. It often involves the peritoneum, but also thoracic cases have been reported. The aim of the present review is to describe the demographic, clinical, radiological, and pathological features of such a rare variant of thoracic mesothelioma, and the state of the art regarding the therapeutic approaches currently available. DATA SOURCE English-language articles published from 1985 to June 2016, and related to thoracic deciduoid mesothelioma cases were retrieved using the Pubmed database. STUDY SELECTION The search terms were "mesothelioma," "thoracic mesothelioma," "epithelial mesothelioma," "pleural mesothelioma," and "deciduoid mesothelioma." RESULTS Forty-four cases included in 16 articles, published in the period under investigation, were analyzed in detail. CONCLUSIONS The mean age of the patients was 63 years, and the male to female ratio 1.7:1. Approximately 58% had exposure to asbestos, and 73% had a smoking history; familiarity was rarely reported. The most common anatomical site of origin was the right pleura, and the most frequent clinical manifestations were chest pain, dyspnea, cough, and weight loss. Thoracic X-ray and computed tomography were the imaging techniques most employed for diagnosis and surgical planning. The pathological diagnosis was obtained by examination of surgical or biopsy specimens in most cases. The best treatment strategy of deciduoid mesothelioma is a matter of debate; nevertheless a multidisciplinary approach is currently the best option for the choice of the adequate therapeutic scheme.
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Affiliation(s)
- Panagiotis Paliogiannis
- Experimental Pathology and Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, Sassari, 07100, Italy
| | - Carlo Putzu
- Oncology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, Sassari, 07100, Italy
| | - Giorgio Carlo Ginesu
- Surgical Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Maria Laura Cossu
- Surgical Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Claudio Francesco Feo
- Surgical Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Federico Attene
- Experimental Pathology and Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, Sassari, 07100, Italy
| | - Fabrizio Scognamillo
- Experimental Pathology and Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, Sassari, 07100, Italy
| | - Rita Nonnis
- Experimental Pathology and Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, Sassari, 07100, Italy
| | - Antonio Cossu
- Experimental Pathology and Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 43, Sassari, 07100, Italy
| | - Giuseppe Palmieri
- Institute of Biomolecular Chemistry, Cancer Genetics Unit, C.N.R, Traversa La Crucca 3, Sassari, 07040, Italy
| | - Pietro Pirina
- Pulmonology Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Vle V.le San Pietro 43, Sassari 07100, Italy
| | - Alessandro Fois
- Pulmonology Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Vle V.le San Pietro 43, Sassari 07100, Italy
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Incidence of malignant mesothelioma in Germany 2009–2013. Cancer Causes Control 2016; 28:97-105. [DOI: 10.1007/s10552-016-0838-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
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Zhuo Y, Lin L, Wei S, Zhang M. Pretreatment elevated serum lactate dehydrogenase as a significant prognostic factor in malignant mesothelioma: A meta-analysis. Medicine (Baltimore) 2016; 95:e5706. [PMID: 28033270 PMCID: PMC5207566 DOI: 10.1097/md.0000000000005706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lactate dehydrogenase (LDH) as a hypoxia-regulator plays a vital role in alternative metabolic pathways of cancer cells. Numerous studies have assessed the prognostic value of elevated pretreatment LDH in malignant mesothelioma (MM). However, the results have been largely inconsistent. Hence, the aim of current study was to investigate the prognostic value of pretreatment LDH levels in patients with MM by performing a meta-analysis of relevant studies. METHODS A literature search for English language studies, which investigated the association of LDH levels with overall survival (OS) in malignant mesothelioma, was performed in the electronic databases, PubMed, Medline, Embase, and Web of Science. Pooled hazard ratios (HRs) and their 95% confidence intervals (95% CIs) were calculated. Heterogeneity was assessed using Cochran Q and I statistics. Sensitivity analysis, meta-regression model, and subgroup analysis were performed to trace the source of heterogeneity, if applicable. RESULTS A total of 9 studies with a combined study population of 1977 patients came within the purview of this meta analysis. Pooled HR for OS in patients with high LDH level was 1.68 (95% CI = 1.36-2.00). Significant heterogeneity was observed in the included studies (I = 54.1%, P = 0.026). Sensitivity analysis after sequential exclusion of 1 study at a time, and meta-regression with inclusion of 6 confounding factors failed to identify the source of heterogeneity. However, in the subgroup analysis, it was found that the publication of Nojiri et al was the origin of heterogeneity. When omitted the publication of Nojiri et al, the pooled HR of the rest 8 studies was 1.83 (95% CI = 1.45-2.20, I = 0.0%, P = 0.723). Egger test and funnel plots excluded the possibility of publication bias affecting the results of the current meta-analysis. CONCLUSION A negative association was observed between high LDH levels and poor overall survival in the current study. Our findings suggest that pretreatment LDH level could serve as a useful predictor of prognosis in patients with malignant mesothelioma.
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Affiliation(s)
- Yi Zhuo
- Department of Thoracic Surgery
| | | | - Shushan Wei
- First Affiliated Hospital of Fujian Medical University
| | - Mingwei Zhang
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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Zhuo Y, Lin L, Zhang M. Pretreatment thrombocytosis as a significant prognostic factor in malignant mesothelioma: a meta-analysis. Platelets 2016; 28:560-566. [PMID: 27848258 DOI: 10.1080/09537104.2016.1246712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The current meta-analysis analyzed the prognostic impact of elevated platelet count before the treatment of malignant mesothelioma (MM). We performed a search for articles published up to April 15, 2016 in PubMed, MEDLINE, EMBASE, and Web of Science, which evaluated elevated platelet count and survival outcome of MM. STATA version 12 was used for statistical analysis. The pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) were combined to calculate overall effects. The assessment of heterogeneity was tested by the Cochran Q and I2 statistics. The sensitivity and meta-regression analyses were performed to explore the origin of heterogeneity. We analyzed 18 eligible studies (3602 patients) that evaluated the correlation between pretreatment platelet count and overall survival (OS). Elevated platelet count was a prognostic factor of poor OS, with a pooled HR of 1.56 (95% CI = 1.36-1.77). However, significant heterogeneity was observed in the included studies (I2 = 86.0%, p < 0.001). Sensitivity and meta-regression analyses were performed to trace the origin of heterogeneity. Only the variable type (multivariable or univariate model) was traced as the origin of heterogeneity. Hence, we conducted a subgroup analysis of variable type. The HR was 1.66 (95% CI = 1.41-1.91) in the multivariable group and no significant heterogeneity was observed (I2 = 0.0%, p = 0.476). In conclusion, high pretreatment platelet count resulted in poor OS in MM. Therefore, platelet count could be an adequate and useful factor of prognosis for MM.
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Affiliation(s)
- Yi Zhuo
- a Department of Thoracic Surgery , First Affiliated Hospital of Fujian Medical University , Fuzhou , Fujian , People's Republic of China
| | - Lanying Lin
- b Department of Anesthesiology , First Affiliated Hospital of Fujian Medical University , Fuzhou , Fujian , People's Republic of China
| | - Mingwei Zhang
- c Department of Radiotherapy , First Affiliated Hospital of Fujian Medical University , Fuzhou , Fujian , People's Republic of China
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Abstract
Lymph node ratio (LNR) is a powerful prognostic factor for breast cancer. We conducted a recursive partitioning analysis (RPA) of the LNR to identify the prognostic risk groups in breast cancer patients. Records of newly diagnosed breast cancer patients between 2002 and 2006 were searched in the Taiwan Cancer Database. The end of follow-up was December 31, 2009. We excluded patients with distant metastases, inflammatory breast cancer, survival <1 month, no mastectomy, or missing lymph node status. Primary outcome was 5-year overall survival (OS). For univariate significant predictors, RPA were used to determine the risk groups. Among the 11,349 eligible patients, we identified 4 prognostic factors (including LNR) for survival, resulting in 8 terminal nodes. The LNR cutoffs were 0.038, 0.259, and 0.738, which divided LNR into 4 categories: very low (LNR ≤ 0.038), low (0.038 < LNR ≤ 0.259), moderate (0.259 < LNR ≤ 0.738), and high (0.738 < LNR). Then, 4 risk groups were determined as follows: Class 1 (very low risk, 8,265 patients), Class 2 (low risk, 1,901 patients), Class 3 (moderate risk, 274 patients), and Class 4 (high risk, 900 patients). The 5-year OS for Class 1, 2, 3, and 4 were 93.2%, 83.1%, 72.3%, and 56.9%, respectively (P< 0.001). The hazard ratio of death was 2.70, 4.52, and 8.59 (95% confidence interval 2.32-3.13, 3.49-5.86, and 7.48-9.88, respectively) times for Class 2, 3, and 4 compared with Class 1 (P < 0.001). In conclusion, we identified the optimal cutoff LNR values based on RPA and determined the related risk groups, which successfully predict 5-year OS in breast cancer patients.
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Affiliation(s)
- Yao-Jen Chang
- From the Department of Surgery (Yao-Jen Chang), Taipei Branch, Buddhist Tzu Chi General Hospital; Graduate Institute of Health Policy and Management (K-PC, L-JC), College of Public Health, National Taiwan University; Department of Ophthalmology (L-JC), HepingFuyou Branch; Department of General Surgery (Yun-Jau Chang), Zhong-Xing Branch, Taipei City Hospital; and Department of General Surgery (Yun-Jau Chang), National Taiwan University Hospital, Taipei, Taiwan
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