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Chen JX, Huang WT, Zhang QY, Deng CE, Wei JL, Xie YL, Lin R, Feng GZ, Yang GL, Long J, Lu HY, Mo ZN. The optimal intravesical maintenance chemotherapy scheme for the intermediate-risk group non-muscle-invasive bladder cancer. BMC Cancer 2023; 23:1018. [PMID: 37872516 PMCID: PMC10591423 DOI: 10.1186/s12885-023-11523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Although the current European Association of Urology(EAU) guideline recommends that patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) should accept intravesical chemotherapy or Calmette-Guerin (BCG) for no more than one year after transurethral resection of bladder tumor(TURBT), there is no consensus on the optimal duration of chemotherapy. Hence, we explored the optimal duration of maintenance intravesical chemotherapy in patients with intermediate-risk NMIBC. SUBJECTS AND METHODS This was a real-world single-center retrospective cohort study. In total 158 patients with pathologically confirmed intermediate-risk NMIBC were included, who were divided into 4 subgroups based on the number of instillations given. We used Cox regression analysis and survival analysis chart to explore the 3-yr recurrence outcomes of tumor.The optimal duration was determined by receive operating characteristic curve (ROC). RESULTS The median follow-up was 5.2 years. Compared with instillation for 1-2 months, the Hazard Ratios(HR) values of instillation for less than 1 month, maintenance instillation for 3-6 months and > 6 months were 3.57、1.57 and 0.22(95% CI 1.27-12.41;0.26-9.28;0.07-0.80, P = 0.03;0.62;0.02, respectively). We found a significant improvement in 3-yr relapse-free survival in intermediate-risk NMIBC patients who maintained intravesical instillation chemotherapy for longer than 6 months, and the best benefit was achieved with 10.5 months of maintenance chemotherapy by ROC. CONCLUSIONS In our scheme, the optimal duration of intravesical instillation with pirrubicin is 10.5 months. This new understanding provides valuable experience for the precise medical treatment model of intermediate-risk NMIBC.
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Affiliation(s)
- Jian-Xin Chen
- Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
- Center for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Wen-Ting Huang
- Department of Nursing, Guangxi Health Science College, Nanning, Guangxi, 530021, China
| | - Qing-Yun Zhang
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Cheng-En Deng
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jue-Ling Wei
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Yuan-Liang Xie
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Rui Lin
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Guan-Zheng Feng
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Guang-Lin Yang
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jun Long
- Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Hao-Yuan Lu
- Department of Urology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China.
| | - Zeng-Nan Mo
- Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Center for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China.
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Feng LH, Bu KP, Ren S, Yang Z, Li BX, Deng CE. Nomogram for Predicting Risk of Digestive Carcinoma Among Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:1763-1770. [PMID: 32547138 PMCID: PMC7247727 DOI: 10.2147/dmso.s251063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Digestive carcinomas remain a major health burden worldwide and are closely related to type 2 diabetes. The aim of this study was to develop and validate a digestive carcinoma risk prediction model to identify high-risk individuals among those with type 2 diabetes. PATIENTS AND METHODS The prediction model was developed in a primary cohort that consisted of 655 patients with type 2 diabetes. Data were collected from November 2013 to December 2018. Clinical parameters and demographic characteristics were analyzed by logistic regression to develop a model to predict the risk of digestive carcinomas; then, a nomogram was constructed. The performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness. The results were internally validated by a bootstrapping procedure. The independent validation cohort consisted of 275 patients from January 2019 to December 2019. RESULTS Predictors in the prediction nomogram included sex, age, insulin use, and body mass index. The model showed good discrimination (C-index 0.747 [95% CI, 0.718-0.791]) and calibration (Hosmer-Lemeshow test P=0.541). The nomogram showed similar discrimination in the validation cohort (C-index 0.706 [95% CI, 0.682-0.755]) and good calibration (Hosmer-Lemeshow test P=0.418). Decision curve analysis demonstrated that the nomogram would be clinically useful. CONCLUSION We developed a low-cost and low-risk model based on clinical and demographic parameters to help identify patients with type 2 diabetes who might benefit from digestive cancer screening.
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Affiliation(s)
- Lu-Huai Feng
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Kun-Peng Bu
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shuang Ren
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Zhenhua Yang
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Bi-Xun Li
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Bi-Xun Li Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning530021, Guangxi Zhuang Autonomous Region, People’s Republic of ChinaTel +86 18977100069Fax +86 771-5719573 Email
| | - Cheng-En Deng
- Department of Urology, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Correspondence: Cheng-En Deng Department of Urology, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning530021, Guangxi Zhuang Autonomous Region, People’s Republic of ChinaTel +86 18775391817Fax +86 771-5719573 Email
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