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Chen Y, Yang X, Zhu Y, Zhang X, Ni J, Li Y. Malnutrition Defined by Geriatric Nutritional Risk Index Predicts Outcomes in Severe Stroke Patients: A Propensity Score-Matched Analysis. Nutrients 2022; 14:nu14224786. [PMID: 36432473 PMCID: PMC9696179 DOI: 10.3390/nu14224786] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Malnutrition’s prognostic impact in patients with severe stroke requiring ICU admission is not well known. This study aimed to assess the nutritional status of severe stroke patients using the geriatric nutritional risk index (GNRI) and examine the association of GNRI with mortality in that population. Methods: We identified 1145 severe stroke patients requiring ICU admission from the Medical Information Mart for Intensive Care (MIMIC-III) database and divided them into low GNRI (≤98) or high GNRI (>98) groups. We used a propensity score matching (PSM) method to reduce confounding. Cox proportional hazards regression and restricted cubic splines were used to elucidate the association between GNRI and mortality. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Results: A total of 397 (35%) patients were in the low GNRI group (at risk of malnutrition). After PSM, patients in the low GNRI group still suffered higher mortality compared with the high GNRI group at 28 days (27.9 vs. 20.8%), 90 days (35.5 vs. 25.7%), and 1 year (43.4 vs. 30.9%) (p < 0.05). A low GNRI was significantly associated with an increased mortality (HR: 1.38, 95% CI 1.03−1.86 in 28 days; HR: 1.45, 95% CI 1.11−1.89 in 90 days; HR: 1.51, 95% CI 1.19−1.92 in 1 year). Sensitivity analyses yielded consistent results. Restricted cubic splines showed a progressively decreasing risk of mortality with increasing GNRI scores up to 110, approximately. Conclusion: Severe stroke patients with malnutrition experienced an increased risk of death compared to those without malnutrition. GNRI, as a simple and practical nutritional screening tool, can be used as a routine approach to the nutritional status of stroke patients.
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Affiliation(s)
- Ying Chen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Xinguang Yang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Yingying Zhu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
- Division of Clinical Research Design, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Xiaoni Zhang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Jingxian Ni
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Yi Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
- Correspondence: ; Tel.: +86-020-3407-1576
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Zhang M, Yuan L, Ke Z, Jian J, Tan H, Lv G. How Does Social Insurance Affect the Social Interactions of Rural Residents in China: Study on the Impact of Rural Formal Social Security System on Informal Social Security Mechanism. Front Psychol 2022; 13:751946. [PMID: 35356356 PMCID: PMC8959861 DOI: 10.3389/fpsyg.2022.751946] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
With the increasing mobility of the rural population in China and the growing number of residents moving to the cities for work or study, rural society is forming a pluralistic, interest-centered, “open” social networks relations that follows the modern rule of law contract. Based on Chinese General Social Survey (CGSS) data, the results of the empirical study finds that social insurance can significantly enhance the social interactions of rural residents in China, that is, formal social security system in rural areas promotes informal social security mechanisms such as social interactions. The results of the grouping test show that rural residents in China’s different regions were affected by social insurance in different ways. Social insurance has a greater impact on the social interactions in the eastern region than in the middle and western regions. The propensity score matching method was used to reduce the sample selection bias, and the findings of the paper were found to be robust.
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Affiliation(s)
- Ming Zhang
- College of State Governance, Southwest University, Chongqing, China
| | - Lan Yuan
- College of State Governance, Southwest University, Chongqing, China
| | - Zhanlian Ke
- College of State Governance, Southwest University, Chongqing, China
| | - Juanfeng Jian
- School of Public Policy and Administration, Chongqing University, Chongqing, China
| | - Hong Tan
- Chongqing Youth and Vocational Technical College, Chongqing, China
| | - Gangwu Lv
- College of Resources and Environment, Southwest University, Chongqing, China
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Tao X, Xu C, Zhong X, Mou Y, Li J, Yang X, Huang Y. Real-world Biapenem vs. Meropenem in the treatment of severe community-acquired pneumonia in children: A propensity score matching analysis. Front Pediatr 2022; 10:1047595. [PMID: 36479282 PMCID: PMC9720139 DOI: 10.3389/fped.2022.1047595] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the real-world efficacy and safety of Biapenem and Meropenem for treating severe community-acquired pneumonia (SCAP) in children. METHODS We retrospectively evaluated 915 children with SCAP who were treated with Biapenem or Meropenem from August 2018 to June 2022. A 1:1 propensity score matching (PSM) analysis was used to reduce the actual baseline difference between groups. RESULTS 416 patients participated in the analysis after PSM (Biapenem: Meropenem = 1:1). For the Biapenem group and Meropenem group, the effective rates were 90.4% and 90.9%, respectively (p = 1.0) and the incidence of adverse reactions were 7.7% and 7.2%, respectively (p = 1.0). There were no statistical differences between Biapenem and Meropenem. CONCLUSION In general, the efficacy and safety of Biapenem are comparable to Meropenem in the treatment of children with SCAP.
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Affiliation(s)
- Xuemei Tao
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Changjing Xu
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoyan Zhong
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yao Mou
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingwei Li
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xuping Yang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,School of Pharmacy, Southwest Medical University, Luzhou, China
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Yeh KT, Wu WT, Lee RP, Wang CC, Wang JH, Chen IH. Long-Term Incidence of Total Knee Arthroplasty after Open Reduction and Internal Fixation of Proximal Tibial and Distal Femoral Fractures: A Nationwide Cohort Study. J Clin Med 2021; 10:jcm10235685. [PMID: 34884389 PMCID: PMC8658582 DOI: 10.3390/jcm10235685] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Knee fractures often require open reduction internal fixation (ORIF) for knee function recovery. More than one fifth of patients with knee fractures subsequently develop posttraumatic arthritis, and over 5% of them need total knee arthroplasty (TKA). We conducted this nationwide retrospective cohort study using the data of 2,000,000 people in the general population who received TKA and were followed up in the 17-year period 2001-2017, through random sampling of the Taiwan National Health Insurance Research Database. We matched the ORIF and non-fracture groups by a propensity score, based on age, sex, index date of surgery, and comorbidities enrolled in CCI calculated at a 1:1 ratio. The average proportion of subjects receiving TKA after ORIF for distal femoral or proximal tibial fractures was 2.0 per 1000 person-years, which was significantly higher than that in the non-fracture group. Patients aged 20-65 years and males represented a significantly higher proportion of subjects receiving TKA after ORIF than that in the non-fracture group. The proportion of subjects receiving TKA for the 20-65-year subgroup of the ORIF group was 4%, and that for the male subgroup was 1.5%; both rates increased over the 17-year follow-up period. More aggressive intraoperative and postoperative adjuvant therapies may be necessary for these subgroups.
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Affiliation(s)
- Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (K.-T.Y.); (W.-T.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (K.-T.Y.); (W.-T.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan;
| | - Ru-Ping Lee
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan;
| | - Chen-Chie Wang
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231405, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan; (K.-T.Y.); (W.-T.W.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan;
- Correspondence: ; Tel.: +886-3-8561825 (ext. 14713)
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Wang SS, Liang HS, Yang RY, Hui XS. [Electroacupuncture at Dong's Sanqixue combined with auricular point sticking in treatment of post-operative complications of complex anal fistula: a real world research]. Zhongguo Zhen Jiu 2021; 41:730-4. [PMID: 34259403 DOI: 10.13703/j.0255-2930.20200711-k0003] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the clinical therapeutic effect of electroacupuncture (EA) at Dong's Sanqixue combined with auricular point sticking on post-operative complications of complex anal fistula. METHODS The data of 318 patients undergoing anal fistula surgery were analyzed retrospectively. In accordance with whether accepted the combined treatment with EA at bilateral Dong's Sanqixue and auricular point sticking or not after operation, they were divided into an observation group (157 cases) and a control group (161 cases). At the ratio of 1︰1, the nearest neighbor matching method was adopted to match 125 pairs of patients. The score of visual analogue scale (VAS) on day 1, 7 and 14 after operation, the incidence of urine retention on day 1 and 3 after operation, the anorectal dynamical indexs (anal resting pressure, rectal resting pressure, anal maximum systolic pressure and rectal minimum sensitivity) before and after operation, as well as the clinical therapeutic effect were compared in the patients between the two groups separately. RESULTS For VAS score, there was an interaction between therapeutic method and treatment duration (P<0.05); the main effect was significant for therapeutic method (P<0.05), while, it was not significant for treatment time (P>0.05). On day 7 and 14 after operation, VAS scores were lower than those on day 1 in the two groups (P<0.05), and VAS scores on day 7 and 14 after operation in the observation group were lower than those in the control group (P<0.05). On day 3 after operation, the incidence of urine retention in the observation group was lower than that in the control group (0.8% [1/125] vs 9.6% [12/125], P<0.05). On day 14 after operation, anal resting pressure, anal maximum systolic pressure and rectal minimum sensitivity in the observation group were lower than those in the control group (P<0.05), and rectal resting pressure was higher than that in the control group (P<0.05). In 1 month after operation, the total effective rate was 96.0% (120/125) in the observation group, higher than 80.8% (101/125) in the control group (P<0.05). CONCLUSION Electroacupuncture at Dong's Sanqixue combined with auricular point sticking therapy alleviates pain, reduces the incidence of urine retention, improves anal defecation function and clinical therapeutic effect in the patients after complex anal fistula surgery.
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Affiliation(s)
- Shan-Shan Wang
- Department of Proctology, Chongqing Hospital of TCM, Chongqing 400021, China
| | - Hai-Song Liang
- Department of Orthopedics and Joints, Chongqing Orthopaedic Hospital of TCM
| | - Rui-Yong Yang
- Department of Acupuncture and Moxibustion, Chongqing Jiangbei Hospital of TCM
| | - Xiao-Su Hui
- Department of Proctology, Chongqing Hospital of TCM, Chongqing 400021, China
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Wang J, Zhou L, Yin W, Li D, Hu C, Zuo X. Clinical efficacy of Danhong injection in preventing contrast-induced acute kidney injury based on propensity score matching method. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2020; 45:1193-1198. [PMID: 33268580 DOI: 10.11817/j.issn.1672-7347.2020.190191] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Contrast-induced acute kidney injury (CI-AKI) is the third cause of hospital-acquired AKI, and existing clinical prevention and treatment measures such as hydration therapy and/or administration of antioxidants N-acetylcysteine treatment and other treatments still show little effect on the prevention and treatment of CI-AKI. This study aims to explore the effect of Danhong injection on prevention of CI-AKI. METHODS A total of 12 867 patients, who received coronary angiography, percutaneous coronary intervention, enhanced CT or vascular intervention in a tertiary hospital, were enrolled for this study. Among them, 423 in the treatment group received intravenous drip of Danhong injection, and 12 444 in the control group received routine medicine. Propensity score matching was conducted to balance confounding factors between the 2 groups and then the prevention effect of Danhong injection on CI-AKI was compared between them. RESULTS A total of 423 pairs of patients were matched successfully. The incidence of CI-AKI in the non-Danhong control group was higher than that in the Danhong treatment group (5.7% vs 2.4%). The difference between the 2 groups was statistically significant (P<0.05). CI-AKI occurred maily in the Stage 1 in both the non-Danhong control group and the Danhong treatment group. The number of patients with Stage 1 of AKI in the control group was more than that in the treatment group, and the difference was statistically significant (P<0.05). The incidence of AKI in Stage 2 and Stage 3 was less in both groups, and the difference was not statistically significant (P>0.05). CONCLUSIONS The results of this study support the use of Danhong injection in the prevention of the Stage 1 of CI-AKI.
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Affiliation(s)
- Jianglin Wang
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Lingyun Zhou
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Wenjun Yin
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Daiyang Li
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Can Hu
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Xiaocong Zuo
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha 410013. .,Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Sheng L, Peng H, Pan Y, Wang C, Zhu Y. Evaluating the effect of diabetes on the prognosis of gastric cancer using a propensity score matching method. J Gastrointest Oncol 2020; 11:999-1008. [PMID: 33209493 DOI: 10.21037/jgo-20-375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Gastric cancer (GC) is one of the malignant tumors with high incidence in China. At present, the relationship between type 2 diabetes (T2DM) and the therapeutic effect of various malignant tumors has attracted more and more attention. This study aimed to investigate whether T2DM is a prognostic factor for patients with GC. Methods Patients who had GC and who were admitted to our hospital from November 2008 to December 2015 were included in the study. Among these patients, 84 patients GC complicated with T2DM (GC + T2DM) were enrolled in the observation group, and 215 patients with normal blood glucose were enrolled in the control group. Patients' general information was collected by referring to their electronic and paper medical records, and their living status was followed up by conducting a telephone survey, referring to their hospitalization record, and performing an outpatient review. A propensity score matching method was used to select a 1:1 matched control for each patient with GC and diabetes. An overall survival curve was established using the Kaplan-Meier method. The survival rate was compared via a log-rank test. A Cox proportional hazards regression model was used to the analyse single and multiple factors affecting patient outcomes. Results Before matching was conducted, the differences in gender, stage, treatment, and comorbidity were found to be statistically significant (P>0.05). After matching was completed, the clinical data and pathological differences between the two groups were not statistically significant (P<0.05). A histogram matching the pre- and post-propensity scores showed that the matching was successful. The results of the Cox regression model revealed that grouping, pathological type, and treatment were the independent risk factors of the survival of patients with GC. Survival analysis found that the 3-year, 5-year, and overall survival rates of the observation group were significantly lower than those of the control group (P<0.05). Conclusions T2DM plays an important role in the development of GC, and is a prognostic factor among patients with GC.
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Affiliation(s)
- Lili Sheng
- Department of Oncology, the First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Hui Peng
- Department of Oncology, the First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yang Pan
- Wannan Medical College, Wuhu, China
| | | | - Yiping Zhu
- Department of Oncology, the First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Kodama K, Murata T, Dohi N, Nakano M, Yokoi T, Sakamoto T, Nakao K. Effects of Pimobendan on Prolonging Time to Rehospitalization or Frequency of Rehospitalization in Patients with Heart Failure: A Retrospective Cohort Study Using a Medical Administrative Database (PREFER Study). J Health Econ Outcomes Res 2020; 7:71-84. [PMID: 32685600 PMCID: PMC7343344 DOI: 10.36469/jheor.2020.13246] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND As approximately 24% of patients with chronic heart failure are rehospitalized within 1 year and heart failure is aggravated by repeated hospitalizations, greater importance was attached to the prevention of hospitalization. OBJECTIVE The objective of this study was to investigate the influence of pimobendan on rehospitalization of patients with advanced heart failure using a Japanese medical administrative database. METHODS From January 2010 to February 2018, patients hospitalized two or more times for heart failure were selected for analysis. The primary endpoint was the incidence of hospitalizations for heart failure during the follow-up period, which was compared between pimobendan prescription and non-prescription groups after propensity score matching. RESULTS The total number of patients with heart failure included during the study period was 1 421 110 and we matched 276 patients in both groups. The incidence of rehospitalization throughout the period to completion of follow-up was 365.23/1000 people/yr (95% confidence interval [CI]: 327.78-402.69) in the pimobendan prescription group and 537.81/1000 people/yr (95% CI: 492.36-583.27) in the non-prescription group. The cumulative incidence at 365 days was significantly lower in the pimobendan prescription group (pimobendan prescription group: 35.4% (95% CI: 29.8-41.8), non-prescription group: 51.2% (95% CI: 45.1-57.7), (P < 0.001). The adjusted hazard ratio in the pimobendan prescription group was 0.556 (95% CI: 0.426-0.725, P < 0.001). CONCLUSION Pimobendan was suggested to extend the time to rehospitalization for patients with advanced heart failure. It is necessary to verify the results of this study by performing a prospective study. In addition, the influence of pimobendan on general heart failure patients must be examined.
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Affiliation(s)
- Kazuhisa Kodama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto,
Japan
| | | | - Naoki Dohi
- Medical Affairs, Toa Eiyo Ltd., Tokyo,
Japan
| | | | | | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto,
Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto,
Japan
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Yao JJ, Jin YN, Liu ZG, Liu QD, Pei XF, Zhou HL, Zhang WJ, Zhang F, Lin L, Lawrence WR, Wang SY, Ma J, Zhou GQ, Sun Y. Do all patients with advanced N-stage nasopharyngeal carcinoma benefit from the addition of induction chemotherapy to concurrent chemoradiotherapy? Ther Adv Med Oncol 2019; 11:1758835919833863. [PMID: 30923578 PMCID: PMC6431774 DOI: 10.1177/1758835919833863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/23/2019] [Indexed: 02/01/2023] Open
Abstract
Background The aim of this study was to evaluate the benefits from the addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) in N2-3 nasopharyngeal carcinoma (NPC). Methods A total of 3089 patients with nonmetastatic NPC, staged as N2-3 were retrospectively reviewed. IC contained cisplatin (80 mg/m2) with 5-fluorouracil (800 mg/m2/day over 120 h), or cisplatin (80 mg/m2) with docetaxel (80 mg/m2), or cisplatin (60 mg/m2) with 5-fluorouracil (600 mg/m2 over 120 h), and docetaxel (60 mg/m2) administered at 3-week intervals for two or three cycles. Concurrent chemotherapy consisted of cisplatin (80 or 100 mg/m2) given in weeks 1, 4, and 7 of radiotherapy, or cisplatin (40 mg/m2) given weekly during radiotherapy. Overall, three well-matched risk groups (low, intermediate, and high risk) were created using propensity score matching, and IC plus CCRT was compared with CCRT in each risk group. Our primary endpoint was distant metastasis-free survival (DMFS). Results A nomogram for DMFS was established with good prognostic accuracy (C-index, 0.69; 95% confidence interval, 0.64-0.73). The survival curves for low, intermediate, and high-risk groups stratified by the nomogram were significantly different between all three risk groups, with corresponding 5-year DMFS rates of 90.7%, 79.4%, and 64.9%, respectively (p < 0.001). IC plus CCRT was significantly associated with superior DMFS as compared with CCRT alone (69.5% versus 56.7%, p = 0.004) in the high-risk group. However, no significant difference between IC plus CCRT and CCRT was observed (p = 0.831 and 0.608, respectively) in the intermediate and low-risk groups. Conclusions Our findings can help accurately guide the treatment of individual patients with advanced N-stage NPC.
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Affiliation(s)
- Ji-Jin Yao
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Ya-Nan Jin
- Department of Head and Neck Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Zhi-Gang Liu
- Department of Head and Neck Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Qiao-Dan Liu
- Department of Head and Neck Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Xiao-Feng Pei
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Huai-Li Zhou
- Department of Thoracic Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Wang-Jian Zhang
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Fan Zhang
- Department of Head and Neck Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Li Lin
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Wayne R Lawrence
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Si-Yang Wang
- Department of Head and Neck Oncology, the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Jun Ma
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong Province, China
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