1
|
Jiang Q, Wang Y, Xie D, Wei J, Li X, Zeng C, Lei G, Yang T. Trends, complications, and readmission of allogeneic red blood cell transfusion in primary total hip arthroplasty in china: a national retrospective cohort study. Arch Orthop Trauma Surg 2024; 144:483-491. [PMID: 37737901 DOI: 10.1007/s00402-023-05051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Decrease in allogenic red blood cell (RBC) transfusion rates following total hip arthroplasty (THA) has been reported in the United States, but whether other countries share the same trend remains unclear. Additionally, the relation of allogenic RBC transfusion to the risk of complications in THA remains controversial. Using the Chinese national inpatient database, the current study aimed to examine trends, complications, charges, and readmission patterns of allogeneic RBC transfusion in THA. MATERIALS AND METHODS Patients undergoing primary THA between 2013 and 2019 were included, and then stratified into the transfusion and the non-transfusion group based on the database transfusion records. A generalized estimating equation model was used to investigate trends in transfusion rates. After propensity-score matching, a logistic regression model was used to compare the complications, rates and causes of 30-day readmission between two groups. RESULTS A total of 10,270 patients with transfusion and 123,476 patients without transfusion were included. Transfusion rates decreased from 19.11% in 2013 to 9.94% in 2019 (P for trend < 0.001). After matching, no significant differences in the risk of of in-hospital death (odds ratio [OR], 4.00; 95% confidence interval [CI] 0.85-18.83), wound infection (OR 0.72; 95%CI 0.45-1.17), myocardial infarction (OR 1.17; 95%CI 0.62-2.19), deep vein thrombosis (OR 1.25; 95%CI 0.88-1.78), pulmonary embolism (OR 2.25; 95%CI 0.98-5.17), readmission rates (OR 1.07; 95%CI 0.88-1.30) and readmission causes were observed between two groups. However, the transfusion group had higher hospitalization charges than the non-transfusion group (72,239.89 vs 65,649.57 Chinese yuan [CNY], P < 0.001). CONCLUSIONS This study found that allogeneic RBC transfusion in THA was not associated with the increased risk of complications and any-cause readmission. However, the currently restrictive transfusion policy should be continued because excessive blood transfusion may increase the socioeconomic burden.
Collapse
Affiliation(s)
- Qiao Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqing Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tuo Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
2
|
Mnatzaganian G, Taylor M, He F, Yuen N, McIntyre HD, Woodward M, Ma L, Huxley RR. Differences in neonatal adverse outcomes among women with gestational diabetes mellitus managed by diet or medication: a propensity score matched analysis of a population-based sample. Gynecol Endocrinol 2023; 39:2250005. [PMID: 37608764 DOI: 10.1080/09513590.2023.2250005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Neonatal outcomes in women with and without medically managed gestational diabetes mellitus (GDM) were compared after accounting for differences in maternal baseline characteristics using a propensity score (PS) analysis. METHODS Women without preexisting diabetes, delivering singletons during 2010-2017 in a large hospital, were eligible for inclusion. Using nearest-neighbour PS matching, women with non-pharmacological managed GDM were matched with women whose GDM was medically managed. A conditional logistic regression consequently compared the neonatal adverse outcomes between the groups after adjusting for gestational age, induction of labor, birth type, and number of ultrasounds conducted during the pregnancy. RESULTS Of the overall 10028 births, GDM was diagnosed in 930 (9.3%), of whom 710 (76.3%) were successfully matched. The conditional regressions found higher risk of neonatal adverse outcomes in neonates of women with non-pharmacological managed GDM compared to neonates of women with medically managed GDM. These included a higher risk of hypoglycemia (odds ratio (OR) 1.56, 95% confidence interval (CI) 1.03-2.38, p = 0.037), hypothermia (OR 2.29, 95%CI 1.05-5.00, p = 0.037), and birth injuries (OR 3.50, 95%CI 1.62-7.58, p = 0.001), and a higher risk of being small for gestational age (OR 2.06, 95%CI 1.01-4.18, p = 0.046) and being admitted to a special care unit (OR 2.04, 95%CI 1.29-3.21, p = 0.002). CONCLUSIONS The increased neonatal morbidity associated with non-medicated GDM identified in our study may indicate that diet and lifestyle changes alone are not sufficient to achieve glycaemic control in some women with GDM. Our findings indicate that gestational diabetes management approach is independently associated with neonatal outcomes.
Collapse
Affiliation(s)
- George Mnatzaganian
- Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Marietta Taylor
- Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Fan He
- Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Nicola Yuen
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - H David McIntyre
- Obstetric Medicine, Mater Health Services, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Rachel R Huxley
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| |
Collapse
|
3
|
Duan W, Yang S, Zhao T, Hu L, Qin Y, Jia J, Wang J, Lu S, Jiang H, Zhang X, Xu L, Wang Y, Lai Y, Shi H, Huang X, Jiang Q. Comparison of efficacy between homoharringtonine, aclarubicin, cytarabine (HAA) and idarubicin, cytarabine (IA) regimens as induction therapy in patients with de novo core binding factor acute myeloid leukemia. Ann Hematol 2023; 102:2695-2705. [PMID: 37572135 DOI: 10.1007/s00277-023-05400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
To compare efficacy between homoharringtonine combined with cytarabine and aclarubicin (HAA) and idarubicin and cytarabine (IA) regimens as first induction chemotherapy in patients with core binding factor acute myeloid leukemia (CBF-AML). Cox regression model and propensity score matching (PSM) were used to identify the regimen associated with a better remission rate and outcomes. In total, 374 patients with CBF-AML (243 with RUNX1::RUXN1T1 and 131 with CBFB::MYH11) were included in this study. The patients received the HAA or IA regimen (187 each) as the first induction therapy. For patients with RUNX1::RUXN1T1, multivariate analyses showed that the HAA regimen was significantly associated with a higher CR/CRi rate after the first induction (hazard ratio [HR] = 5.3 [95% CI 2.3, 12.2]; p < 0.001) and more favorable relapse-free survival (RFS) (HR = 0.5 [0.3, 0.8], p = 0.01). In PSM analysis, the HAA regimen also had a higher CR/CRi rate (96% vs. 77%, p < 0.001), especially for those harboring wild-type KIT (KITWT) (96% vs. 83%, p = 0.02) or non-D816 KIT mutation (100% vs. 63%, p = 0.002), as well as more favorable RFS (p = 0.01), compared with the IA regimen. However, there was no difference in the remission rate or outcomes between the two regimens for patients with CBFB::MYH11. The HAA regimen as first induction chemotherapy resulted in a higher CR/CRi rate in AML patients with RUNX1::RUNX1T1, especially those harboring KITWT and non-D816 KIT mutation, and a more favorable RFS compared with the IA regimen. The efficacy between the two regimens did not differ in those with CBFB::MYH11.
Collapse
Affiliation(s)
- Wenbing Duan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Sen Yang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Ting Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Lijuan Hu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Yazhen Qin
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Jinsong Jia
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Jing Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Shengye Lu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Hao Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Xiaohui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Lanping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Yueyun Lai
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Hongxia Shi
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China.
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
- Peking University People's Hospital, Qingdao, China.
| |
Collapse
|
4
|
Claps F, van de Kamp MW, Mayr R, Bostrom PJ, Shariat SF, Hippe K, Bertz S, Neuzillet Y, Sanders J, Otto W, van der Heijden MS, Jewett MAS, Stöhr R, Zlotta AR, Trombetta C, Eckstein M, Mertens LS, Burger M, Soorojebally Y, Wullich B, Bartoletti R, Radvanyi F, Pavan N, Sirab N, Mir MC, Pouessel D, van der Kwast TH, Hartmann A, Lotan Y, Bussani R, Allory Y, van Rhijn BWG. Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy. BJU Int 2023; 132:170-180. [PMID: 36748180 DOI: 10.1111/bju.15984] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC). MATERIALS AND METHODS We analysed a multi-institutional cohort of 1082 patients treated with upfront RC for cT1-4aN0M0 urothelial BCa at eight centres. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on DSS in overall cohort and three stage-based analyses. The stages were defined as 'organ-confined' (≤pT2N0), 'locally advanced' (pT3-4N0) and 'node-positive' (pTanyN1-3). RESULTS Overall, 784 patients (72.5%) had pure urothelial carcinoma (UC), while the remaining 298 (27.5%) harboured a VH. Squamous differentiation was the most common VH, observed in 166 patients (15.3%), followed by micropapillary (40 patients [3.7%]), sarcomatoid (29 patients [2.7%]), glandular (18 patients [1.7%]), lymphoepithelioma-like (14 patients [1.3%]), small-cell (13 patients [1.2%]), clear-cell (eight patients [0.7%]), nested (seven patients [0.6%]) and plasmacytoid VH (three patients [0.3%]). The median follow-up was 2.3 years. Overall, 534 (49.4%) disease-related deaths occurred. In uni- and multivariable analyses, plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort (both P = 0.04). In univariable analyses, sarcomatoid VH was significantly associated with worse DSS, while lymphoepithelioma-like VH had favourable DSS compared to pure UC. Clear-cell (P = 0.015) and small-cell (P = 0.011) VH were associated with worse DSS in the organ-confined and node-positive cohorts, respectively. CONCLUSIONS More than 25% of patients harboured a VH at time of RC. Compared to pure UC, clear-cell, plasmacytoid, small-cell and sarcomatoid VHs were associated with worse DSS, while lymphoepithelioma-like VH was characterized by a DSS benefit. Accurate pathological diagnosis of VHs may ensure tailored counselling to identify patients who require more intensive management.
Collapse
Affiliation(s)
- Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Maaike W van de Kamp
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Roman Mayr
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Peter J Bostrom
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katrin Hippe
- Department of Pathology, University Medical Center - Regensburg, Regensburg, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yann Neuzillet
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Joyce Sanders
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Wolfgang Otto
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Michiel S van der Heijden
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Robert Stöhr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Alexandre R Zlotta
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maximilian Burger
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Yanish Soorojebally
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Bernd Wullich
- Department of Urology & Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Riccardo Bartoletti
- Unit of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - François Radvanyi
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Nicola Pavan
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nanour Sirab
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - M Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Damien Pouessel
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
- Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, France
| | - Theo H van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA
| | - Rossana Bussani
- Department of Pathology, University of Trieste, Trieste, Italy
| | - Yves Allory
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
- Department of Pathology, Institut Curie, Paris, France
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
5
|
Yang S, Zhang X, Gale RP, Du X, Chen CY, Weng JY, Huang J, Li F, Zeng Y, Xiao Z, Hu JD, Yang LJ, Liu ZG, Li GH, Sun XL, Yang W, Feng R, Han YQ, Jing Y, Xu N, Liu XL, Liu ZF, Wang XD, Wu SX, Liang R, Zhang YL, Yang YF, Zhu HL, Pan L, Meng L, Zhao YH, Yi H, Liu YL, Zhang WH, Zheng YJ, Zhou ZP, Chen SN, Qiu HY, Li WM, Jia ZL, Bai YL, Lin LE, Liu BC, Liu CS, Luo JM, Meng JX, Sun ZQ, Zhang YQ, Huang XJ, Jiang Q. Imatinib compared with second-generation tyrosine kinase-inhibitors in persons with chronic myeloid leukemia presenting in accelerated phase. Am J Hematol 2023. [PMID: 37128776 DOI: 10.1002/ajh.26943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Sen Yang
- National Clinical Research Center for Haematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Haematology, Beijing, China
| | - Xiaoshuai Zhang
- National Clinical Research Center for Haematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Haematology, Beijing, China
| | - Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London, UK
| | - Xin Du
- Department of Hematology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Chun-Yan Chen
- Department of Haematology, Qilu Hospital, Shandong University, Jinan, China
| | - Jian-Yu Weng
- Department of Haematology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Jian Huang
- Department of Haematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
- Department of Haematology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fei Li
- Center of Haematology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Zeng
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Xiao
- The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Jian-da Hu
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Li-Jie Yang
- Xi'an International Medical Center Hospital, Xi'an, China
| | - Zhuo-Gang Liu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guo-Hui Li
- Xi'an International Medical Center Hospital, Xi'an, China
| | - Xiu-Li Sun
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ru Feng
- Department of Hematology, Beijing Hospital, Beijing, China
| | - Yan-Qiu Han
- The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Yu Jing
- Department of Hematology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Na Xu
- Department of Haematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao-Li Liu
- Department of Haematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhen-Fang Liu
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Dong Wang
- Department of Haematology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Haematology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Shi-Xin Wu
- The Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Rong Liang
- Department of Haematology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yan-Li Zhang
- Department of Haematology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun-Fan Yang
- Department of Haematology, Institute of Haematology, West China Hospital, Sichuan University, Chengdu, China
| | - Huan-Ling Zhu
- Department of Haematology, Institute of Haematology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Pan
- Department of Haematology, Institute of Haematology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Meng
- Department of Haematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Hong Zhao
- The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Hai Yi
- Hematology Department, The General Hospital of Western Theater Command, PLA, Chengdu, China
| | - Yi-Lan Liu
- Hematology Department, The General Hospital of Western Theater Command, PLA, Chengdu, China
| | - Wei-Hua Zhang
- First Hospital of Shangxi Medical University, Shangxi, China
| | - Yuan-Jun Zheng
- First Hospital of Shangxi Medical University, Shangxi, China
| | - Ze-Ping Zhou
- Dept. of Hematology, The Second Hospital Affiliated to Kunming medical university, Kunming, China
| | - Su-Ning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China
| | - Hui-Ying Qiu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China
| | - Wei-Ming Li
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Lin Jia
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan-Liang Bai
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Li-E Lin
- Hainan General Hospital, Hainan, China
| | - Bing-Cheng Liu
- National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | | | - Jian-Min Luo
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Zhi-Qiang Sun
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Yan-Qing Zhang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Jun Huang
- National Clinical Research Center for Haematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Haematology, Beijing, China
- Collaborative Innovation Center of Haematology, Soochow University, Suzhou, China
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Haematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Jiang
- National Clinical Research Center for Haematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Haematology, Beijing, China
- Collaborative Innovation Center of Haematology, Soochow University, Suzhou, China
| |
Collapse
|
6
|
Taylor M, Masood M, Mnatzaganian G. Differences in complete denture longevity and replacement in public and private dental services: A propensity score-matched analysis of subsidised dentures in adult Australians across 20 years. Community Dent Oral Epidemiol 2023; 51:318-326. [PMID: 35338502 DOI: 10.1111/cdoe.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the differences in treatment outcomes for patients who received subsidized complete dentures in private dental clinics and in public dental clinics over 20 years in Victoria, Australia. METHODS Between 2000 and 2019, 187 227 complete dentures were provided to eligible public patients by the Victorian public dental system. Of these, approximately 52% were provided to public patients in private clinics through the voucher system. Of the 97 107 participants who received denture care in private clinics, 70 818 were matched 1:1 by propensity score (PS) quantiles with participants who received denture care in public clinics. The PS matching balanced the characteristics between these two groups. Subsequently, a conditional logistic regression model investigated the binary outcome of denture replacement whilst a conditional Poisson regression modelled the number of years to denture replacement. A frailty Cox regression after PS matching investigated denture survival over time. RESULTS Dentures provided in public clinics had a mean time to replacement of 5.5 years (SD: 34.0) and 25.9% were replaced during the observation period. In the first year of denture service, incidence rate per person year (IR) for complete denture replacement in public clinics was 0.04 (95% CI: 0.04-0.04). Dentures provided in private clinics had a mean time to replacement of 6.5 years (SD: 3.8) with 29.4% replaced during the observation period. In the first year of denture service, the IR for complete denture replacement in private clinics was 0.02 (95% CI: 0.02-0.02), which was less than half that of the public IR. Multivariate analyses found that although private dentures were more likely to be replaced during the observation period than those provided in the public sector (odds ratio [OR]: 1.31, 95% CI: 1.28-1.35, p < .001), they had greater longevity (incidence rate ratio [IRR]: 1.23, 95% CI: 1.23-1.24, p < .001). Longer longevity of private dentures was also supported by the frailty Cox regression showing that private dentures had a reduced hazard of denture replacement over time (better survival) in comparison to public dentures (hazard ratio [HR]: 0.94, 95% CI: 0.92-0.97, p < .001). Probabilistic sensitivity analysis supported the study findings. CONCLUSIONS Increased denture longevity, higher rates of denture replacement and lower rates of early denture replacement were associated with receiving denture care in private clinics as compared with dentures provided in the public sector.
Collapse
Affiliation(s)
- Marietta Taylor
- Department of Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mohd Masood
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Institute of Dentistry, University of Turku, Turku, Finland
| | - George Mnatzaganian
- Department of Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Cimellaro A, Addesi D, Cavallo M, Spagnolo F, Suraci E, Cordaro R, Spinelli I, Passafaro F, Colosimo M, Pintaudi M, Pintaudi C. Monoclonal Antibodies and Antivirals against SARS-CoV-2 Reduce the Risk of Long COVID: A Retrospective Propensity Score-Matched Case-Control Study. Biomedicines 2022; 10:biomedicines10123135. [PMID: 36551891 PMCID: PMC9775930 DOI: 10.3390/biomedicines10123135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Long COVID is a complex condition affecting quality of life, with limited therapeutic options. We investigated the occurrence of long COVID in subjects receiving early therapy with monoclonal antibodies (mAbs) or antivirals to reduce the risk of COVID-19 progression. In this retrospective study we enrolled 737 adult patients (aged 65.16 ± 13.46; 361F), who experienced COVID-19 between January 2021 and March 2022. Antiviral or mAbs were administered to symptomatic patients who did not require oxygen therapy or hospital admission for SARS-CoV-2 infection, and who were at high risk of progression to severe disease, as identified by age > 65 years or the presence of comorbidities. Long COVID, defined as newly or persistent long-term symptoms 4 weeks after the onset of the acute illness, was reported in 204 cases (28%). Age (OR 1.03; p < 0.001), gender (OR 1.88; p < 0.001) and at least three comorbidities (OR 3.49; p = 0.049) were directly associated with long COVID; conversely, vaccination (OR 0.59; p = 0.005) and mAbs/antivirals (OR 0.44; p = 0.002) were independently associated with a reduced risk of long COVID. At a propensity-score-matched analysis, the mAbs/antivirals group had a significantly lower occurrence of long COVID in comparison with untreated controls (11% vs. 34%; p = 0.001). In conclusion, mAbs and antivirals administered against the progression of COVID-19 were associated with a reduced risk of long COVID.
Collapse
Affiliation(s)
- Antonio Cimellaro
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
- Correspondence:
| | - Desirée Addesi
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Michela Cavallo
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Francesco Spagnolo
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Edoardo Suraci
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Raffaella Cordaro
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Ines Spinelli
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Francesco Passafaro
- Coordination of Special Unit of Continuity Care for Local Health Authority, Via Vinicio Cortese n.25, 88100 Catanzaro, Italy
| | - Manuela Colosimo
- Microbiology and Virology Unit, Service Department, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Medea Pintaudi
- Neurophysiology and Neurobiology Unit, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo n.200, 00128 Rome, Italy
| | - Carmelo Pintaudi
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | | |
Collapse
|
8
|
Association of alpha-fetoprotein and metastasis for small hepatocellular carcinoma: A propensity-matched analysis. Sci Rep 2022; 12:15676. [PMID: 36127436 PMCID: PMC9489872 DOI: 10.1038/s41598-022-19531-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/30/2022] [Indexed: 12/09/2022] Open
Abstract
Metastasis is crucial for the prognosis of hepatocellular carcinoma (HCC). Distinguishing the potential risk factors for distant metastasis in small HCC (diameter ≤ 5 cm) is of great significance for improving the prognosis. HCC patients in the Surveillance, Epidemiology and End Results (SEER) registry with tumors ≤ 5 cm in diameter between January 2010 and December 2015 were retrieved. Demographic and clinicopathological metrics were extracted, including age, sex, race, marital status, tumor size, histological grade, T stage, N stage, M stage, alpha-fetoprotein (AFP), and liver fibrosis score. Univariate and multivariate logistic regression analyses were used to identify independent risk factors correlated with extrahepatic metastasis in small HCC. Propensity score matching (PSM) analysis was performed to balance the confounding factors in baseline characteristics. A total of 4176 eligible patients were divided into a non-metastasis group (n = 4033) and a metastasis group (n = 143) based on metastasis status. In multivariate analysis, larger tumor size, poor histological differentiation, regional lymph node metastasis, and elevated serum AFP levels were identified as independent risk factors for distant metastasis (P < 0.05), while age, sex, race, marital status, and liver fibrosis score were not associated with extrahepatic metastasis. After propensity score analysis, the AFP level was no longer associated with metastatic risk. The present study provided no evidence for a correlation between the clinical threshold of AFP and metastasis in small hepatocellular carcinoma.
Collapse
|
9
|
Yang S, Zhang XS, Gale RP, Huang XJ, Jiang Q. Co-variates associated with outcomes of tyrosine kinase-inhibitor therapy in persons with chronic myeloid leukaemia initially presenting in accelerated phase. Leukemia 2022; 36:1818-1824. [PMID: 35562407 DOI: 10.1038/s41375-022-01583-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 12/28/2022]
Abstract
We interrogated data from 278 consecutive subjects with chronic myeloid leukaemia (CML) presenting in accelerated phase diagnosed by European LeukemiaNet (ELN) criteria receiving initial imatinib (n = 187) or a 2nd-generation tyrosine kinase-inhibitor (2G-TKI; n = 91). In multi-variable analyses, blood and/or bone marrow blasts ≥15% (Hazard ratio [HR] = 3.7 [1.6, 8.5], p = 0.003) and blood basophils <3% (HR = 4.6 [2.0, 10.7], p < 0.001) were significantly-associated with worse transformation-free survival (TFS). Age ≥60 years (HR = 4.3 [1.7, 11.4], p = 0.003), platelet concentration <230 × 10E + 9/L (HR = 4.7 [2.0, 10.7], p < 0.001) and blood and/or bone marrow blasts ≥9% (HR = 3.9 [1.7, 8.7], p = 0.001) were significantly-associated with worse survival. Based on number of adverse prognostic co-variates of TFS and survival, respectively, subjects were classified into the low- (none), intermediate- (one) and high-risk (≥2) cohorts with significant difference in TFS and survival (all p < 0.001). In propensity-score matching analysis subjects initially receiving a 2G-TKI had higher cumulative incidences of cytogenetic and molecular responses but similar TFS and survival to those receiving imatinib. Our data should help inform physicians treating person with CML initially presenting in accelerated phase.
Collapse
Affiliation(s)
- Sen Yang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Shuai Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Robert Peter Gale
- Centre for Haematology Research, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China. .,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China. .,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, 100044, Beijing, China. .,Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, 2019RU029, 100044, Beijing, China.
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China. .,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
| |
Collapse
|
10
|
Jarrett SA, Lo KB, Shah S, Zanoria MA, Valiani D, Balogun OO, Hiedra R, Azmaiparashvili Z, Patarroyo Aponte G. Comparison of Patient Clinical characteristics and Outcomes Between Different COVID-19 Peak Periods: A Single Center Retrospective Propensity Matched Analysis. Cureus 2021; 13:e15777. [PMID: 34295587 PMCID: PMC8291902 DOI: 10.7759/cureus.15777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction While Coronavirus disease 2019 (COVID-19) specific treatments have been instituted, overall mortality rates among hospitalized patients remain significant. Our study aimed to evaluate patient clinical characteristics and outcomes comparing the different COVID-19 infection peak periods. Methods This is a retrospective study of all adult patients hospitalized with a confirmed diagnosis of COVID-19 between March 1 to April 24, 2020 and November 1 to December 31, 2020, which corresponded to the first and second waves of COVID-19 infection in our institution, respectively. Demographic and clinical characteristics of the patients were compared and used for propensity matching. Clinical outcomes, such as need for intubation, renal replacement therapy and inpatient mortality were subsequently compared between the two groups. Results Patients in the second COVID-19 wave had a significantly higher body mass index (32.58 vs 29.83, p <0.001), as well as prevalence of asthma (14% vs 8%, p=0.019) and chronic kidney disease (42% vs 18%, p <0.001). Almost all patients in the second COVID-19 wave received corticosteroid treatment (99% vs 30%, p <0.001), and significantly more patients received remdesivir (43% vs 2%, p <0.001). Meanwhile, none of the patients in the second COVID-19 wave were treated with tocilizumab or hydroxychloroquine. Differences in clinical outcomes, such as need for renal replacement therapy or intubation, and median length of stay were not statistically significant. Inpatient mortality remained largely unchanged between the two COVID-19 peak periods. Discussion/ Conclusion In our institution, after propensity matched analysis, clinical outcomes such as need for renal replacement therapy, intubation and inpatient mortality remained unchanged between the two COVID-19 peak periods.
Collapse
Affiliation(s)
- Simone A Jarrett
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | - Kevin B Lo
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | - Samir Shah
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | | | - Dahnish Valiani
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | - Omotola O Balogun
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | - Raul Hiedra
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | - Zurab Azmaiparashvili
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, USA
- Medicine, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, USA
| | - Gabriel Patarroyo Aponte
- Pulmonary and Critical Care and Sleep Medicine, Albert Einstein Medical Center, Philadelphia, USA
- Medicine, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, USA
| |
Collapse
|
11
|
Schneider N, Fisher C, Glennie A, Urquhart J, Street J, Dvorak M, Paquette S, Charest-Morin R, Ailon T, Manson N, Thomas K, Rasoulinejad P, Rampersaud R, Bailey C. Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse. Spine J 2021; 21:821-828. [PMID: 33248271 DOI: 10.1016/j.spinee.2020.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The indication to perform a fusion and decompression surgery as opposed to decompression alone for lumbar degenerative spondylolisthesis (LDS) remains controversial. A variety of factors are considered when deciding on whether to fuse, including patient demographics, radiographic parameters, and symptom presentation. Likely surgeon preference has an important influence as well. PURPOSE The aim of this study was to assess factors associated with the decision of a Canadian academic spine surgeon to perform a fusion for LDS. STUDY DESIGN/SETTING This study is a retrospective analysis of patients prospectively enrolled in a multicenter Canadian study that was designed to evaluate the assessment and surgical management of LDS. PATIENT SAMPLE Inclusion criteria were patients with: radiographic evidence of LDS and neurogenic claudication or radicular pain, undergoing posterior decompression alone or posterior decompression and fusion, performed in one of seven, participating academic centers from 2015 to 2019. OUTCOME MEASURES Patient demographics, patient-rated outcome measures (Oswestry Disability Index [ODI], numberical rating scale back pain and leg pain, SF-12), and imaging parameters were recorded in the Canadian Spine Outcomes Research Network (CSORN) database. Surgeon factors were retrieved by survey of each participating surgeon and then linked to their specific patients within the database. METHODS Univariate analysis was used to compare patient characteristics, imaging measures, and surgeon variables between those that had a fusion and those that had decompression alone. Multivariate backward logistic regression was used to identify the best combination of factors associated with the decision to perform a fusion. RESULTS This study includes 241 consecutively enrolled patients receiving surgery from 11 surgeons at 7 sites. Patients that had a fusion were younger (65.3±8.3 vs. 68.6±9.7 years, p=.012), had worse ODI scores (45.9±14.7 vs. 40.2±13.5, p=.007), a smaller average disc height (6.1±2.7 vs. 8.0±7.3 mm, p=.005), were more likely to have grade II spondylolisthesis (31% vs. 14%, p=.008), facet distraction (34% vs. 60%, p=.034), and a nonlordotic disc angle (26% vs. 17%, p=.038). The rate of fusion varied by individual surgeon and practice location (p<.001, respectively). Surgeons that were fellowship trained in Canada more frequently fused than those who fellowship trained outside of Canada (76% vs. 57%, p=.027). Surgeons on salary fused more frequently than surgeons remunerated by fee-for-service (80% vs. 64%, p=.004). In the multivariate analysis the clinical factors associated with an increased odds of fusion were decreasing age, decreasing disc height, and increasing ODI score; the radiographic factors were grade II spondylolisthesis and neutral or kyphotic standing disc type; and the surgeon factors were fellowship location, renumeration type and practice region. The odds of having a fusion surgery was more than two times greater for patients with a grade II spondylolisthesis or neutral and/or kyphotic standing disc type (opposed to lordotic standing disc type). Patients whose surgeon completed their fellowship in Canada, or whose surgeon was salaried (opposed to fee-for-service), or whose surgeon practiced in western Canada had twice the odds of having fusion surgery. CONCLUSIONS The decision to perform a fusion in addition to decompression for LDS is multifactorial. Although patient and radiographic parameters are important in the decision-making process, multiple surgeon factors are associated with the preference of a Canadian spine surgeon to perform a fusion for LDS. Future work is necessary to decrease treatment variability between surgeons and help facilitate the implementation of evidence-based decision making.
Collapse
Affiliation(s)
- Nicole Schneider
- Division of Orthopaedics, Department of Surgery, Western University /London Health Sciences Centre, London, Ontario, Canada
| | - Charles Fisher
- Department of Orthopeadic Surgery, Spine Division, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer Urquhart
- Lawson Health Research Institute /London Health Sciences Centre, E4-120, 800 Commissioners Road, East, London, Ontario N6A 4G5, Canada
| | - John Street
- Department of Orthopeadic Surgery, Spine Division, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel Dvorak
- Department of Orthopeadic Surgery, Spine Division, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Paquette
- Department of Orthopeadic Surgery, Spine Division, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphaele Charest-Morin
- Department of Orthopeadic Surgery, Spine Division, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamir Ailon
- Department of Orthopeadic Surgery, Spine Division, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil Manson
- Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick, Canada
| | - Ken Thomas
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Parham Rasoulinejad
- Division of Orthopaedics, Department of Surgery, Western University /London Health Sciences Centre, London, Ontario, Canada; Lawson Health Research Institute /London Health Sciences Centre, E4-120, 800 Commissioners Road, East, London, Ontario N6A 4G5, Canada
| | - Raja Rampersaud
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chris Bailey
- Division of Orthopaedics, Department of Surgery, Western University /London Health Sciences Centre, London, Ontario, Canada; Lawson Health Research Institute /London Health Sciences Centre, E4-120, 800 Commissioners Road, East, London, Ontario N6A 4G5, Canada.
| |
Collapse
|
12
|
Diao YK, Liu JW, Wu H, Wang MD, Fan XP, Chen TH, Wang JY, Zhou YH, Gu WM, Wang H, Li J, Liang YJ, Chen ZY, Lau WY, Liang L, Li C, Zhang CW, Shen F, Huang DS, Yang T. Long-term oncologic outcomes of liver resection for hepatocellular carcinoma in adolescents and young adults: A multicenter study from A hepatitis B virus-endemic area. Am J Surg 2021; 222:751-758. [PMID: 33741185 DOI: 10.1016/j.amjsurg.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is common among adolescents and young adults (AYAs) in areas with endemic hepatitis B virus infection. We sought to characterize clinical features and long-term outcomes among AYAs versus older adults (OAs) who underwent HCC resection. METHODS From a Chinese multicenter database, patients were categorized as AYA (aged 13-39 years) versus OA (aged ≥40 years). Patient clinical features, perioperative outcomes, overall survival (OS) and time-to-recurrence (TTR) were compared. Multivariable Cox-regression analyses were performed to identify the impact of age on OS and TTR. RESULTS Among 1952 patients, 354(22.2%) were AYAs. AYAs were less likely to have cirrhosis yet were likely to have advanced tumor pathological characteristics than OAs. Postoperative morbidity and mortality were comparable. Compared with OAs, AYAs had a comparable OS but a decreased TTR. Multivariable analyses identified that young age (<40 years) was independently associated with poorer TTR. CONCLUSIONS Compared with OAs, AYAs had a higher incidence of recurrence following liver resection among patients with HCC, suggesting that enhanced surveillance for postoperative recurrence may be required among AYAs.
Collapse
Affiliation(s)
- Yong-Kang Diao
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jun-Wei Liu
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Xin-Ping Fan
- Department of General Surgery, Pingxiang Mining Group General Hospital, Jiangxi, China
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People's Hospital, Sichuan, China
| | - Jian-Yu Wang
- Department of General Surgery, Ziyang First People's Hospital, Sichuan, China
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu'er People's Hospital, Yunnan, China
| | - Wei-Min Gu
- The First Department of General Surgery, The Fourth Hospital of Harbin, Heilongjiang, China
| | - Hong Wang
- Department of General Surgery, Liuyang People's Hospital, Hunan, China
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People's Hospital, Fuyang, Anhui, China
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Lei Liang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chao Li
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Cheng-Wu Zhang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Dong-Sheng Huang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Tian Yang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China.
| |
Collapse
|
13
|
Alhazzani W, Jaeschke R. Convalescent Plasma in COVID-19: To what Degree should Clinicians Rely on Currently Available Data? SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:1-2. [PMID: 33519336 PMCID: PMC7839581 DOI: 10.4103/sjmms.sjmms_882_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Waleed Alhazzani
- Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Roman Jaeschke
- Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
14
|
Chiu CC, Wang JJ, Hung CM, Lin HF, Hsien HH, Hung KW, Chiu HC, Jennifer Yeh SC, Shi HY. Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching. Brain Sci 2021; 11:brainsci11020161. [PMID: 33530541 PMCID: PMC7912561 DOI: 10.3390/brainsci11020161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 02/07/2023] Open
Abstract
Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost-illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.
Collapse
Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan; (C.-C.C.); (C.-M.H.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Department of General Surgery, Chi Mei Medical Center, Liouying 73657, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Chao-Ming Hung
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan; (C.-C.C.); (C.-M.H.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Hsiu-Fen Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan;
| | - Hong-Hsi Hsien
- Department of Internal Medicine, St. Joseph Hospital, Kaohsiung 80288, Taiwan;
| | - Kuo-Wei Hung
- Division of Neurology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung 80249, Taiwan;
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (S.-C.J.Y.)
- Institute of Hospital Management, Tsinghua University, Beijing 100084, China
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-7-3211101 (ext. 2648); Fax: +886-7-3137487
| |
Collapse
|
15
|
Bandini M, Ross JS, Zhu Y, Ye DW, Ornellas AA, Watkin N, Ayres BA, Hakenberg OW, Heidenreich A, Salvioni R, Catanzaro M, Raggi D, Giannatempo P, Marandino L, Haidl F, Pederzoli F, Briganti A, Montorsi F, Chipollini J, Azizi M, De Meerleer G, Brouwer OR, Grass GD, Johnstone PA, Albersen M, Spiess PE, Necchi A. Association Between Human Papillomavirus Infection and Outcome of Perioperative Nodal Radiotherapy for Penile Carcinoma. Eur Urol Oncol 2020; 4:802-810. [PMID: 33199252 DOI: 10.1016/j.euo.2020.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Data on the impact of human papillomavirus (HPV) infection status and outcomes for perioperative treatments for patients with lymph node-involved penile squamous-cell carcinoma (PSCC) are lacking. OBJECTIVE To analyze the benefit from perioperative radiotherapy (RT) for PSCC according to HPV infection status. DESIGN, SETTING, AND PARTICIPANTS In an international multicenter database of 1254 patients with PSCC who received inguinal lymph node dissection (ILND), 507 had suitable clinical information. INTERVENTION ILND, with or without chemotherapy or RT for involved lymph nodes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier and restricted mean survival time (RMST) analyses for overall survival (OS) were performed for all patients and after propensity score-matching (PSM; n = 136), for which patient age, histology, type of penile surgical procedure, pathological tumor and nodal stage, ILND laterality, pelvic LND, and perioperative treatment were taken into account when assessing differences between HPV+ and HPV- patients. Finally, we looked at genomic alterations in PSCC using data from the Foundation Medicine database (n = 199) to characterize HPV+ PSCC. RESULTS AND LIMITATIONS Patients with HPV+ PSCC (n = 86; 17%) had lower clinical N stage (p < 0.001) and inguinal lymph node metastasis density (p < 0.001). Perioperative RT was delivered in 49 patients (9.7%), with the vast majority receiving adjuvant RT (n = 40). HPV+ patients had similar median OS (p = 0.1) but longer RMST than HPV- patients at different time points. Nevertheless, HPV+ patients treated with perioperative RT exhibited longer median OS (p = 0.015) and longer RMST compared to HPV- patients. In the PSM cohorts, HPV+ status remained significantly associated with longer OS after RT. The HPV- PSCC group had a higher frequency of TP53 mutations compared to HPV+ PSCC (75% vs 15%; p < 0.001). The results are limited by the retrospective nature of the data. CONCLUSIONS Perioperative RT was more effective in the HPV+ PSCC subgroup. Reasons for the enhanced radiosensitivity may be related to the lack of TP53 mutations. PATIENT SUMMARY We analyzed data from a large multicenter database for patients with penile cancer who had received inguinal lymph node dissection, with or without chemotherapy or radiotherapy. We found that for tumors positive for human papillomavirus (HPV), use of radiotherapy resulted in prolonged survival compared to HPV-negative tumors. On the basis of these results we are inspired to design studies on the use of radiotherapy in HPV-selected patients.
Collapse
Affiliation(s)
- Marco Bandini
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, MA, USA; Upstate Medical University, Syracuse, NY, USA
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding-Wei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Antonio A Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | - Nick Watkin
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Benjamin A Ayres
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Filippo Pederzoli
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Juan Chipollini
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mounsif Azizi
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Oscar R Brouwer
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - G Daniel Grass
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | - Andrea Necchi
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| |
Collapse
|
16
|
Li JD, Diao YK, Li J, Wu H, Sun LY, Gu WM, Wang H, Chen TH, Zeng YY, Zhou YH, Wang Y, Zhang YM, Liang YJ, Lau WY, Li C, Liang L, Wang MD, Zhang CW, Shen F, Shao CH, Yang T. Association between preoperative prealbumin level and postoperative mortality and morbidity after hepatic resection for hepatocellular carcinoma: A multicenter study from a HBV-endemic area. Am J Surg 2020; 221:1024-1032. [PMID: 32951853 DOI: 10.1016/j.amjsurg.2020.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prealbumin is a more sensitive serum biomarker in reflecting liver function and nutritional status than albumin, because of its shorter half-life and its characteristics that could hardly be affected by supplemental venous infusion of albumin or blood transfusion. This study aimed to identify whether preoperative prealbumin level was associated with postoperative mortality and morbidity after hepatic resection for patients with hepatocellular carcinoma (HCC). METHODS From a Chinese multicenter database, patients who underwent hepatic resection for HCC were divided into the low and normal prealbumin groups by using 17 mg/dL as the cut-off level for serum prealbumin taken within a week before surgery. Using univariable and multivariable logistic regression analyses, independent predictors associated with postoperative 30-day and 90-day mortality, 30-day overall and major morbidity, and postoperative hepatic insufficiency were identified. RESULTS Among 1356 patients, 409 (30.2%) had a low preoperative prealbumin level. Postoperative 30-day and 90-day mortality, and 30-day overall and major morbidity in the low prealbumin group were significantly higher than the normal prealbumin group (2.9% vs. 0.5%, 5.1% vs. 1.5%, 35.7% vs. 18.4%, and 14.4% vs. 6.5%, respectively, all P < 0.001). Multivariable analyses identified that preoperative prealbumin level, but not albumin level, was independently associated with postoperative 30-day mortality (OR: 3.486, 95% CI: 1.184-10.265), 90-day mortality (2.504, 1.219-5.145), 30-day overall morbidity (1.727, 1.302-2.292), 30-day major morbidity (1.770, 1.155-2.711) and postoperative hepatic insufficiency (1.967, 1.119-3.427). CONCLUSIONS Preoperative prealbumin level could be used to predict postoperative morbidity and mortality for patients treated with hepatic resection for HCC.
Collapse
Affiliation(s)
- Ju-Dong Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China; Department of General Surgery, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Yong-Kang Diao
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People's Hospital, Anhui, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Li-Yang Sun
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Wei-Min Gu
- The First Department of General Surgery, The Fourth Hospital of Harbin, Heilongjiang, China
| | - Hong Wang
- Department of General Surgery, Liuyang People's Hospital, Hunan, China
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People's Hospital, Sichuan, China
| | - Yong-Yi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, China
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu'er People's Hospital, Yunnan, China
| | - Yu Wang
- Department of Hepatobiliary Surgery, Chongqing University Cancer Hospital, Chongqing, China
| | - Yao-Ming Zhang
- The 2nd Department of Hepatobiliary Surgery, Meizhou People's Hospital, Guangdong, China
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Chao Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Lei Liang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Cheng-Wu Zhang
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Cheng-Hao Shao
- Department of General Surgery, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, China.
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China.
| |
Collapse
|
17
|
Casarin J, Song C, Multinu F, Cappuccio S, Liu E, Butler KA, Glaser GE, Cliby WA, Langstraat CL, Ghezzi F, Fu AZ, Mariani A. Implementing robotic surgery for uterine cancer in the United States: Better outcomes without increased costs. Gynecol Oncol 2020; 156:451-458. [DOI: 10.1016/j.ygyno.2019.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022]
|
18
|
Identifying predictors of early childhood caries among Australian children using sequential modelling: Findings from the VicGen birth cohort study. J Dent 2020; 93:103276. [DOI: 10.1016/j.jdent.2020.103276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/11/2019] [Accepted: 01/08/2020] [Indexed: 12/24/2022] Open
|
19
|
Traven SA, Brinton DL, Walton ZJ, Leddy LR. A propensity-score matched analysis of limb salvage vs amputation for osteosarcoma. J Surg Oncol 2019; 120:1252-1258. [PMID: 31486107 DOI: 10.1002/jso.25701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES With recent advances in chemotherapy and surgical techniques, the trend in the treatment of osteosarcoma continues to progress towards limb salvage. However, studies comparing limb salvage with amputation continue to be limited by selection bias and small sample sizes. This study utilized propensity-score matching to minimize potential confounders and selection bias to compare the survival rates in patients with osteosarcoma that were treated with amputation vs limb salvage surgery. METHODS The Surveillance, Epidemiology, and End Results Program was utilized to identify all patients with a diagnosis of extremity osteosarcoma. Patients were matched with demographics, tumor characteristics, and treatment information. These variables were then fitted in a multivariate model and hazard ratios (HR) for overall- and disease-specific mortality was calculated. RESULTS A total of 4107 patients were identified, of which, 1538 were left after propensity-score matching. Older age, Black race, upper extremity location, and higher American joint committee on cancer (AJCC) class were associated with worse overall- and disease-specific mortality rates (P ≤ .0389). Compared with their matched counterparts, patients treated with amputation had higher overall mortality (HR 1.677; P < .0001) and higher disease-specific mortality (HR 1.678; P < .0001). CONCLUSION Patients whose tumor characteristics preclude limb salvage have significantly higher overall- and disease-specific mortality rates.
Collapse
Affiliation(s)
- Sophia A Traven
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel L Brinton
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Zeke J Walton
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Lee R Leddy
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
20
|
Contemporary Trends and Survival Outcomes After Aborted Radical Prostatectomy in Lymph Node Metastatic Prostate Cancer Patients. Eur Urol Focus 2019; 5:381-388. [DOI: 10.1016/j.euf.2018.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/22/2017] [Accepted: 01/12/2018] [Indexed: 11/21/2022]
|
21
|
Mnatzaganian G, Hiller JE, Fletcher J, Putland M, Knott C, Braitberg G, Begg S, Bish M. Socioeconomic gradients in admission to coronary or intensive care units among Australians presenting with non-traumatic chest pain in emergency departments. BMC Emerg Med 2018; 18:32. [PMID: 30268098 PMCID: PMC6162924 DOI: 10.1186/s12873-018-0185-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in cardiovascular morbidity have been previously reported showing direct associations between socioeconomic disadvantage and worse health outcomes. However, disagreement remains regarding the strength of the direct associations. The main objective of this panel design was to inspect socioeconomic gradients in admission to a coronary care unit (CCU) or an intensive care unit (ICU) among adult patients presenting with non-traumatic chest pain in three acute-care public hospitals in Victoria, Australia, during 2009-2013. METHODS Consecutive adults aged 18 or over presenting with chest pain in three emergency departments (ED) in Victoria, Australia during the five-year study period were eligible to participate. A relative index of inequality of socioeconomic status (SES) was estimated based on residential postcode socioeconomic index for areas (SEIFA) disadvantage scores. Admission to specialised care units over repeated presentations was modelled using a multivariable Generalized Estimating Equations approach that accounted for various socio-demographic and clinical variables. RESULTS Non-traumatic chest pain accounted for 10% of all presentations in the emergency departments (ED). A total of 53,177 individuals presented during the study period, with 22.5% presenting more than once. Of all patients, 17,579 (33.1%) were hospitalised over time, of whom 8584 (48.8%) were treated in a specialised care unit. Female sex was independently associated with fewer admissions to CCU / ICU, whereas, a dose-response effect of socioeconomic disadvantage and admission to CCU / ICU was found, with risk of admission increasing incrementally as SES declined. Patients coming from the lowest SES locations were 27% more likely to be admitted to these units compared with those coming from the least disadvantaged locations, p < 0.001. Men were significantly more likely to be admitted to such units than similarly affected and aged women among those diagnosed with angina pectoris, arrhythmia, myocardial infarction, heart failure, chest pain, and general signs and symptoms. CONCLUSIONS This study is the first to report socioeconomic gradients in admission to CCU / ICU in patients presenting with chest pain showing a dose-response effect. Our findings suggest increased cardiovascular morbidity as socioeconomic disadvantage increases.
Collapse
Affiliation(s)
- George Mnatzaganian
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia.
| | - Janet E Hiller
- School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, VIC, Australia.,School of Public Health, The University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Jason Fletcher
- Intensive Care Unit, Bendigo Health, Barnard Street, Bendigo, VIC, Australia
| | - Mark Putland
- Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Cameron Knott
- Intensive Care Unit, Bendigo Health, Barnard Street, Bendigo, VIC, Australia.,Monash Rural Health Bendigo, Monash University, Bendigo, VIC, Australia.,Department of Intensive Care, Austin Health, Heidelberg, VIC, Australia
| | - George Braitberg
- Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.,Centre for Integrated Critical Care Medicine, Department of Medicine and Radiology, The University of Melbourne, Parkville, VIC, Australia
| | - Steve Begg
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia
| | - Melanie Bish
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia
| |
Collapse
|
22
|
Reply letter to: Letter to the editor on the article " Adjuvant systemic therapy and postoperative outcomes after resection of node positive gallbladder cancer". Int J Surg 2018; 54:308-309. [DOI: 10.1016/j.ijsu.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/06/2018] [Indexed: 11/22/2022]
|
23
|
Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer. World J Urol 2018; 36:1399-1407. [DOI: 10.1007/s00345-018-2310-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022] Open
|
24
|
Bandini M, Pompe RS, Marchioni M, Zaffuto E, Gandaglia G, Fossati N, Cindolo L, Montorsi F, Briganti A, Saad F, Karakiewicz PI. Improved cancer-specific free survival and overall free survival in contemporary metastatic prostate cancer patients: a population-based study. Int Urol Nephrol 2017; 50:71-78. [PMID: 29129028 DOI: 10.1007/s11255-017-1744-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Over the past decade, several systemic agents as docetaxel, cabazitaxel, sipuleucel-T, abiraterone and enzalutamide have improved overall survival (OS) in metastatic prostate cancer (mPCa) patients. However, to date the OS benefit was not demonstrated in population-based analysis. METHODS Between 2004 and 2014, 19,047 men with de novo mPCa were identified within the Surveillance Epidemiology and End Results database. Median year of diagnosis resulted in two groups: historical (2004-2008) and contemporary (2009-2014). Due to potentially important differences according to year of diagnosis, we relied on propensity score matching. Propensity-score-matched Kaplan-Meier analyses and Cox regression models (CRMs) tested cancer-specific mortality (CSM) free survival and overall mortality (OM) free survival according to treatment period. RESULTS The propensity-score-matched cohort consisted of 8596 patients with mPCa. Of those, 4298 (50.0%) were historical (2004-2008) and 4298 (50.0%) were contemporary (2009-2014). CSM free survival rates and OM free survival rate were 32 versus 36 months (p < 0.0001) and 26 versus 29 months (p < 0.0001) for, respectively, historical and contemporary patients. In multivariable CRMs, patients diagnosed in contemporary years had lower CSM (HR 0.88; CI 0.82-0.93) and OM (HR 0.88; CI 0.84-0.93) risks compared to historical counterpart (all p < 0.0001). CONCLUSION This population-based study provides the first evidence of improved CSM free survival and OM free survival in patients with de novo mPCa since the introduction of several systemic agents for CRPC patients.
Collapse
Affiliation(s)
- Marco Bandini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
| | - Raisa S Pompe
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Emanuele Zaffuto
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Cindolo
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
| |
Collapse
|
25
|
Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis. World J Urol 2017; 36:7-13. [DOI: 10.1007/s00345-017-2102-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022] Open
|
26
|
Bergquist JR, Thiels CA, Storlie CB, Nagorney DM, Truty MJ. How matching may impact interpretation: Comments on "A matched-cohort analysis of 192 pancreatic anaplastic carcinomas and 960 pancreatic adenocarcinomas: A 13-year North American experience using the National Cancer Data Base (NCDB)". Surgery 2016; 160:1714-1715. [PMID: 27365227 DOI: 10.1016/j.surg.2016.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- John R Bergquist
- Section of Hepatobiliary and Pancreatic Surgery, Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Rochester, MN
| | - Cornelius A Thiels
- Section of Hepatobiliary and Pancreatic Surgery, Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Rochester, MN
| | - Curtis B Storlie
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Rochester, MN
| | - David M Nagorney
- Section of Hepatobiliary and Pancreatic Surgery, Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark J Truty
- Section of Hepatobiliary and Pancreatic Surgery, Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
27
|
Misra D, Lu N, Felson D, Choi HK, Seeger J, Einhorn T, Neogi T, Zhang Y. Does knee replacement surgery for osteoarthritis improve survival? The jury is still out. Ann Rheum Dis 2016; 76:140-146. [PMID: 27190096 DOI: 10.1136/annrheumdis-2016-209167] [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] [Received: 01/11/2016] [Revised: 04/14/2016] [Accepted: 04/24/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The relation of knee replacement (KR) surgery to all-cause mortality has not been well established owing to potential biases in previous studies. Thus, we aimed to examine the relation of KR to mortality risk among patients with knee osteoarthritis (OA) focusing on identifying biases that may threaten the validity of prior studies. METHODS We included knee OA subjects (ages 50-89 years) from The Health Improvement Network, an electronic medical records database in the UK. Risk of mortality among KR subjects was compared with propensity score-matched non-KR subjects. To explore residual confounding bias, subgroup analyses stratified by age and propensity scores were performed. RESULTS Subjects with KR had 28% lower risk of mortality than non-KR subjects (HR 0.72, 95% CI 0.66 to 0.78). However, when stratified by age, protective effect was noted only in older age groups (>63 years) but not in younger subjects (≤63 years). Further, the mortality rate among KR subjects decreased as candidacy (propensity score) for KR increased among subjects with KR, but no such consistent trend was noted among non-KR subjects. CONCLUSIONS While a protective effect of KR on mortality cannot be ruled out, findings of lower mortality among older KR subjects and those with higher propensity scores suggest that prognosis-based selection for KR may lead to intractable confounding by indication; hence, the protective effect of KR on all-cause mortality may be overestimated.
Collapse
Affiliation(s)
- Devyani Misra
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Na Lu
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David Felson
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hyon K Choi
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Seeger
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Thomas Einhorn
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tuhina Neogi
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yuqing Zhang
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
28
|
Modified inflammation-based score as an independent malignant predictor in patients with pulmonary focal ground-glass opacity: a propensity score matching analysis. Sci Rep 2016; 6:19105. [PMID: 26752624 PMCID: PMC4707538 DOI: 10.1038/srep19105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/02/2015] [Indexed: 12/18/2022] Open
Abstract
Pulmonary focal Ground-glass Opacities (fGGOs) would frequently be identified after widely implementation of low-dose computed tomography (LDCT) screening. Because of the high false-positive rate of LDCT, antibiotics should be regarded as advocates in clinical management for detected fGGOs. Retrospectively review consecutive patients with fGGOs between August 2006 and August 2012. Then, relative Glasgow prognostic score (GPS) were constructed in three different systems, traditional GPS system (tGPS), modified GPS system 1 (m1GPS), and modified GPS system 2 (m2GPS). Moreover, propensity score matching (PSM) was employed in balancing baseline covariates. After PSM, patients were matched and included in benign and malignant groups as 1:1 ratio. All reported parameters were balanced in both groups and no statistical differences could be detected. Finally, m1GPS exhibited remarkable different distribution between benign and malignant fGGOs. In detail, m1GPS 1 was more frequently observed in benign fGGOs nodules, while m1GPS 2 in malignant fGGOs nodules. Modified inflammation-based score was identified as an independent predictor of malignancies in patients with pulmonary fGGOs. Patients with m1GPS 1 were more likely to be benign fGGOs, while victims with m1GPS 2 more likely to be malignant.
Collapse
|