Comparison of Preoperative Nutritional Indexes for Outcomes after Primary Esophageal Surgery for Esophageal Squamous Cell Carcinoma

Background: This study aimed to compare the controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) for predicting postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing esophagectomy. Methods: We retrospectively reviewed the data of 1265 consecutive patients who underwent elective esophageal surgery. The patients were classified into no risk, low-risk, moderate-risk, and high-risk groups based on nutritional scores. Results: The moderate-risk (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.24–1.92, p < 0.001 in CONUT; HR: 1.61, 95% CI: 1.22–2.12, p = 0.001 in GNRI; HR: 1.65, 95% CI: 1.20–2.26, p = 0.002 in PNI) and high-risk groups (HR: 1.91, 95% CI: 1.47–2.48, p < 0.001 in CONUT; HR: 2.54, 95% CI: 1.64–3.93, p < 0.001 in GNRI; HR: 2.32, 95% CI: 1.77–3.06, p < 0.001 in PNI) exhibited significantly worse 5-year overall survival (OS) compared with the no-risk group. As the nutritional status worsened, the trend in the OS rates decreased (p for trend in all indexes < 0.05). Conclusions: Malnutrition, evaluated by any of three nutritional indexes, was an independent prognostic factor for postoperative survival.     

中性粒细胞与淋巴细胞比率评估胃癌预后的Meta分析

目的分析探讨中性粒细胞与淋巴细胞比率(neutrophil-lymphocyte ratio, NLR)对胃癌患者预后评估的价值。 方法采用循证医学的meta分析研究。首先,从Embase、Medline和Web of Science数据库中检索关键词gastric cancer、stomach cancer、gastric carcinoma、stomach carcinoma、gastric neoplasm、stomach neoplasm、neutrophil和lymphocyte。然后,根据各纳入研究的总生存率(overall survival, OS)和无进展生存期(progression-free survival, PFS)/无疾病生存期(disease-free survival, DFS)合并生存危险比(hazard ratio, HR)的异质性,决定用固定或随机效应模型计算OS和PFS/DFS的合并HR。若合并HR>1,且其95%可信区间(confidence interval, CI)也>1, 则为NLR升高与胃癌患者OS或PFS/DFS的降低有显著联系。 结果收集18篇文献共纳入5 065例胃癌患者进行meta分析。升高的NLR与OS降低存在显著关联(HR为1.79,95%CI 1.54~2.08)。亚组分析中,胃癌多种治疗方案组和化疗组NLR升高均与OS降低存在显著关联[HR分别为1.84, (95% CI 1.48~2.29)和1.69, (95% CI 1.41~2.03)];而NLR≤3.2组和NLR>3.2组亦均与OS的降低存在显著关联[HR分别为1.80, (95% CI 1.46~2.23)和1.93, (95% CI 1.58~2.36)]。在胃癌患者OS的单因素meta回归分析中, 发表年份、种族、NLR临界值、治疗方案、患者数、进展期患者比例和男性比例都不是引起胃癌患者异质性来源的可能原因(P值分别为0.585、0.887、0.731、0.697、0.613、0.877、0.775)。 结论胃癌患者中升高的NLR与OS降低存在显著的关联,NLR可作为评价胃癌患者预后的标志物。     

Prognostic value of quality of life measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma

Purpose

Pretreatment quality of life (QoL) has been used to predict survival in cancer patients. In this study, we examined the prognostic value of QoL measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma (NPC).

Methods

We enrolled 273 patients with NPC who had been curatively treated for more than 1 year. The EORTC QLQ-C30 and H&N35 questionnaires were completed 1 year after radiotherapy. The predictability of QoL variables on disease-specific survival (DSS) and overall survival (OS) was analyzed using Cox’s proportional hazards models.

Results

Twenty-nine (10.6 %) patients developed locoregional relapse and 27 (9.9 %) had distant metastasis after the QoL survey with subsequent 5-year DSS and OS rates of 87.9 % and 84.0 %, respectively. Based on the QLQ-C30, scales of physical functioning, fatigue, and appetite loss significantly predicted DSS and OS (p < 0.05). In the H&N35, only sexuality was significantly correlated with DSS and OS (p < 0.05). An increment of 10 points in physical functioning (HR: 0.69; 95 % CI: 0.48–0.90; p = 0.004) or a decline of 10 points in fatigue problems (HR: 1.40; 95 % CI: 1.19–1.61; p = 0.0002), appetite loss (HR: 1.21; 95 % CI: 1.03–1.40; p = 0.02), and sexuality (HR: 1.14; 95 % CI: 1.02–1.25; p = 0.019) was associated with better OS.

Conclusion

Some QoL variables measured after the treatment provide prognostic value on subsequent survival in patients with NPC.     

血小板与性别的交互作用对食管鳞癌根治术患者预后的影响

  目的  探讨血小板(platelets, PLT)对食管鳞癌(esophageal squamous cell carcinoma, ESCC)根治术患者预后的影响及其与性别、年龄间的交互作用。  方法  选取2014年2月1日―2018年11月30日582例符合入组标准的ESCC患者进行回顾性分析。Kaplan-Meier法用于绘制生存曲线并行log-rank检验。运用Cox比例风险回归模型进行多因素分析,计算总生存时间(overall survival, OS)、无病生存时间(disease free survival, DFS)的危险系数(hazard ratios, HR)及其95% CI。  结果  PLT仅与性别存在交互作用(HR=2.417, 95% CI: 1.150~5.078, P=0.018)。分层分析显示,男性PLT增多组的死亡风险是PLT正常组的1.713倍(HR=1.713, 95% CI: 1.203~2.441, P=0.003);女性PLT增多组与PLT正常组预后差异无统计学意义(HR=0.590, 95% CI: 0.299~1.165, P=0.129)。  结论  PLT与性别对ESCC根治术患者预后的预测存在交互作用,采用PLT预测患者预后时应注意性别的差异。     

Neutrophil-lymphocyte ratio and nutritional status are clinically useful in predicting prognosis in colorectal cancer patients

Abstract

Background: Neutrophil-lymphocyte ratio (NLR) and nutritional status may provide a prognostic value in colorectal cancer (CRC). Thus, aim of this study was to evaluate the prognostic value of nutritional status and NLR in CRC patients.

Methods: A retrospective analysis was conducted in CRC patients. The independent variables were body mass index (BMI), weight loss (WL) and NLR. Logistic regression was used to estimate the odds chance of low NLR. Kaplan-Meier curves and Cox regression were used to evaluate the overall survival at 5?years old.

Results: In the 148 patients evaluated, the most prevalent nutritional status was overweight/obesity (43.2%) and 27.0% had severe WL. Sixty-seven subjects (45.3%) had NLR ≥ 3 that was associated with the lower OS (P?<?0.001). There was a higher OS for overweight/obese patients (P?=?0.002) and a lower among subjects with severe WL (P?=?0.009). The NLR ≥3 (HR: 3.639; 95% CI, 1.708–7.771) was an independent poor prognostic factor for OS. Patients without WL (HR: 0.367, 95% CI, 0.141–0.954) and classified as overweight/obesity (HR: 0.260; 95% CI, 0.106–0.639) presented better prognostic.

Conclusion: NLR, WL, BMI assessments are promising prognostic indicators in the CRC.     

华裔女性生殖系统肿瘤的预后分析: 基于SEER数据库的回顾性研究

目的 利用 SEER 数据库中华裔女性生殖系统肿瘤的患者数据,展开预后因素研究,以指导临床预后判断和治疗决策。 方法 从 SEER 数据库中提取出患者的人口统计学指标,分期指标,肿瘤特征、诊断治疗指标和生存结果。采用 Kaplan-Meier 法构建生存曲线,利用 long-Rank 检验评估曲线之间的统计学差异;并使用VIF 指标,逐步回归对预后因素进行选择,依据选择的重要预后因素,建立 COX 多因素风险回归模型,依据建模结果绘制列线图和 ROC 曲线,从而量化预后因素,进而帮助临床判断和决策。 结果 年龄增加 (OS: HR =7.543 95% CI : 2.672~21.290 P <0.05),进入更年期 (OS: HR =1.024 95% CI : 0.454~2.312 P <0.05),无伴侣 (OS: HR =1.273 95% CI : 0.931~1.742 P <0.05),春秋季发病 (OS: HR =0.532 95% CI : 0.327~0.867 P <0.05),肿瘤大于6 cm(OS: HR =1.656 95% CI : 1.075~2.551 P <0.05),未手术治疗 (OS: HR =2.554 95% CI : 0.911~7.159 P <0.05),AJCC分期为Ⅳ分期 (OS: HR =8.406 95% CI : 5.980~11.816 P <0.05),病理类型为腺鳞癌 (OS: HR =3.399 95% CI : 1.526~7.571 P <0.05),肿瘤低分化 (OS: HR =1.228 95% CI : 0.868~1.738 P <0.05), 双侧均发病 (OS: HR =1.513 95% CI : 1.051~2.179 P <0.05) 是降低华裔女性生殖系统常见恶性肿瘤总生存率的独立预后因素。 结论 年龄增加、进入更年期、无伴侣、春秋季发病、肿瘤分化、腺鳞癌、Ⅳ分期、肿瘤过大会增加华裔女性生殖系统恶性肿瘤的死亡风险,有伴侣、接受手术治疗、Ⅰ分期对于生殖系统肿瘤的总体生存状况有一定的保护作用。     

Predicting the Prognosis of Gastric Cancer by Albumin/Globulin Ratio and the Prognostic Nutritional Index

Abstract

Background: Albumin-to-globulin ratio (AGR) and the prognostic nutrition index (PNI) are used to assess the nutritional status and severity of disease for a cancer patient. However, the clinical significance of combining these two predictors in gastric cancer (GC) remains unclear. This study evaluated the prognostic value of pretreatment serum AGR and the PNI for GC.

Methods: A total of 273 patients with GC, diagnosed between January 2010 and January 2014, were enrolled. The association of AGR, PNI with clinicopathological characters and prognosis were assessed by Cox regression and Kaplan–Meier methods.

Results: Both low AGR group and low PNI group had poor overall survival (OS) and progression-free survival (PFS) (all p?<?0.001), while patients with low AGR and PNI had the lowest OS rate. Multivariate analyses revealed that AGR (for OS HR?=?0.657, 95%CI: 0.449–0.962, p?=?0.031; for PFS HR?=?0.684, 95%CI: 0.528–0.895, p?=?0.035) was an independent prognostic factor for OS and PFS in patients with GC, and PNI was verified as a predictor for OS (HR?=?0.782, 95%CI: 0.503 –0.997, p?=?0.048).

Conclusions: Low level of pretreatment AGR and PNI may be independent prognostic factors for patients with GC, and patients with both factors indicated the worst OS.     

食管鳞状细胞癌术后患者预后预测列线图的建立

目的 通过对食管鳞状细胞癌（esophageal squamous cell carcinoma,ESCC）患者的术后随访,寻找影响其生存的预后因素,建立ESCC手术患者生存时间的预测列线图。方法 回顾性分析2005-2011年间在福建省漳州市医院接受手术治疗的338例ESCC患者的临床资料,利用Cox回归模型对ESCC手术患者的预后因素进行分析,进而构建ESCC术后患者预后预测列线图模型。结果 338例ESCC术后患者中位生存时间是27.30月（95%CI:22.84~31.76）,在Cox多因素回归分析中,淋巴结转移、肿瘤长度、侵润程度、年龄是影响ESCC术后患者预后的独立危险因素,且差异均具有统计学意义（均有P<0.05）,而淋巴结转移是影响ESCC术后患者预后最重要的危险因素（HR=4.322,95%CI:3.296~5.844,P=0.001）。预测食管鳞癌术后患者预后列线图一致性指数（C-index）为0.74（95%CI:0.72~0.76,P<0.001）。结论 根据淋巴结转移、肿瘤长度、侵润程度等4个临床资料建立的预测ESCC术后患者生存率的列线图有助于临床医生对术后患者预后进行个体化的预测,有助于选择适当的治疗方法。     

Association of Sarcopenia and Expression of Interleukin-16 in Gastric Cancer Survival

We designed the present work to explore the connection between sarcopenia and interleukin-16 (IL-16) expression and their integrated relation with gastric cancer (GC) survival. We deemed the sex-specific third lumbar vertebra skeletal muscle index cutoffs for sarcopenia to be ≤40.8 and ≤34.9 cm²/m² in male and female patients, respectively. Immunohistochemistry was carried out to detect IL-16 levels among GC tissues of the patients. We determined overall survival (OS) and relapse-free survival (RFS) by univariate and multivariate analyses. This study included 225 GC cases, with an average age of 62.7 years. There were 41 (18.2%) female patients, and 107 (47.5%) patients had sarcopenia. Sarcopenia and high IL-16 expression were identified as independent factors to predict OS (hazard ratios [HR] = 1.64 and 1.79, 95% confidence interval [CI] = 1.25–2.23 and 1.16–2.78, respectively) and RFS (HR = 1.43 and 1.60, 95% CI = 1.15–2.95 and 1.10–2.37, respectively). There were more cases showing high IL-16 expression detected in the sarcopenia group (55.7% vs. 37.3%, p = 0.003). Later, we grouped the patients with sarcopenia and IL-16 expression and discovered that the patients with sarcopenia and IL-16 upregulation displayed the poorest OS (HR = 3.02; 95% CI = 1.64–5.91) and RFS (HR = 2.34; 95% CI = 1.47–4.69). In conclusion, more IL-16 upregulation was noted in GC patients with sarcopenia. Sarcopenia accompanied by high IL-16 expression remarkably indicates a dismal prognosis in GC patients. This suggests that these biomarkers may be able to identify patients with GC with poor prognosis and enhance prognostication.     

Self-reported health-related quality of life predicts survival for patients with advanced gastric cancer treated with first-line chemotherapy

Purpose To determine whether patients’ self-reported quality-of-life (QOL) parameters could predict survival for patients with advanced gastric cancer (AGC) treated with first-line chemotherapy, we performed this analysis based on the data obtained from 254 patients enrolled in three consecutive prospective randomized trials at a single institution. Methods Consenting patients with AGC received first-line chemotherapy as specified in the protocols. QOL was assessed at baseline using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaires. Baseline univariate and multivariate analyses were performed on the QOL data and the recognized clinical predictors for survival. Results Of 254 patients, 164 completed the QOL questionnaire at baseline. All patients received fluorouracil-containing first-line chemotherapy for AGC. With 88% observed deaths and a reported median survival of 9.5 months [95% confidence interval (CI) 8.8–10.2 months], there were no significant differences in survival between patients with or without QOL data. The final Cox multivariate model revealed four prognostic factors: age [hazard ratio (HR) 2.08, 95% CI 1.32–3.33, P = 0.002], bone metastasis (HR 2.70, 95% CI 1.30–5.56, P = 0.008), hemoglobin (HR 0.58, 95% CI 0.37–0.92, P = 0.020), and social functioning (HR 0.40, 95% CI 0.23–0.64, P = 0.001). When adjusting for clinical parameters, social functioning was an independently significant prognostic factor for longer survival. Conclusion Baseline social functioning, along with age, presence of bone metastasis, and baseline hemoglobin level, independently predicts survival of AGC patients treated with first-line chemotherapy. QOL assessment should be routinely included to provide useful prognostic information concerning AGC patients.     

Prognostic Value of Prealbumin in Liver Cancer: A Systematic Review and Meta-Analysis

Abstract

Accumulated studies have reported the prognostic significance of prealbumin in liver cancer, but the results were not conclusive. The aim of this study was to evaluate the association between pretreatment serum prealbumin and clinical outcome of liver cancer patients through a meta-analysis. We comprehensively searched EMBASE, PubMed, Web of Science and the Cochrane library to identify eligible studies. The pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) were utilized to evaluate the prognostic value of pretreatment serum prealbumin in overall survival (OS) and recurrence-free survival (RFS) of liver cancer patients. A total of 3470 patients from 10 eligible studies were finally included for analysis. The combined effects of prealbumin on liver cancer patients’ OS and RFS were HR?=?1.83, 95% CI: 1.46–2.30, P?<?0.001 and HR?=?1.47, 95% CI: 1.01–2.14, P?=?0.045, respectively. Sensitivity and subgroup analysis showed that the pooled HR of prealbumin on liver cancer patients’ OS was stable. Since potential publication bias was identified in the OS studies, the trim-and-fill method therefore was performed to explore publication bias, and the results showed reliability. This meta-analysis shows that low pretreatment serum prealbumin is significantly associated with poor prognosis of liver cancer patients.     

Systematic Review and Meta-Analysis of the Prognostic Value of Serum High-Density Lipoprotein Cholesterol Levels for Solid Tumors

Numerous studies have demonstrated that serum high-density lipoprotein cholesterol (HDL-C) levels correlate strongly with cancer patient survival. However, other studies have had the opposite results. We therefore conducted a systematic review and meta-analysis to assess the prognostic value of HDL-C levels in people with cancer. We searched PubMed, Embase, and the Cochrane Library (last update by December 28, 2017) for studies evaluating the effect of serum HDL-C levels on cancer patient prognosis. Data from 25 studies covering13,140 patients were included. Combined hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS) were assessed using fixed-effects and random-effects models. High serum HDL-C levels were associated with better OS (pooled HR = 0.70; 95% confidence interval (CI) (0.60–0.82). In the subgroup, the relative high level of HDL-C yielded a favorable outcome in most of tumor types. However, in the nasopharyngeal carcinoma subgroup, the correlation was not significant (combined HR = 1.31; 95% CI (0.91–1.90)). High serum HDL-C levels were associated with better DFS (pooled HR = 0.64; 95% confidence interval (CI) (0.50–0.81)). This meta-analysis demonstrates that high serum HDL-C levels are associated with better OS in patients with solid tumors, but not nasopharyngeal carcinoma; and high serum HDL-C levels are associated with better DFS.     

福建省牙龈癌患者预后风险预测模型的构建

  目的  探讨福建地区牙龈癌患者预后影响因素并构建预后风险预测模型。  方法  收集福建医科大学附属第一医院口腔颌面外科2005年1月―2017年6月经病理确诊的牙龈癌患者共198例,对其进行随访。利用多因素COX回归分析模型分析计算死亡风险比值（hazard rate,HR）及其95%置信区间（95% confidence interval,95% CI）,筛出牙龈癌患者预后的影响因素,并基于β系数构建每个个体的预后指数（prognostic index,PI）。运用X-tile软件确定PI的最佳截断点,并根据最佳截断点把研究对象分成低、中、高危组。  结果  在牙龈癌患者中,年龄≥60岁（HR=1.668,95% CI:1.002~2.777,P=0.049）,有复发转移（HR=3.996,95% CI:2.295~6.959,P < 0.001）的患者预后更差;临床Ⅳ期与临床Ⅰ期相比预后更差（HR=3.002,95% CI:1.134~7.947,P=0.027）;经手术治疗的患者与未经手术治疗的相比预后更好（HR=0.246,95% CI:0.118~0.511,P < 0.001）。此外,构建的PI预后预测模型预测性能良好（AIC=611.605,C-index=0.747,AUC=0.765）。  结论  本研究发现年龄（≥60岁）、临床分期高、未进行手术治疗及存在复发转移均是影响牙龈癌患者预后的危险因素,且构建的PI预后预测模型能够较好的预测患者预后。     

Assessment and Impact of Phase Angle and Sarcopenia in Palliative Cancer Patients

Sarcopenia has been evaluated as a separate condition in cancer patients and as an important indicator of adverse outcomes. Muscle mass and phase angle are usually quantified by bioelectrical impedance analysis, due to its lower cost, and availability. The aim of this study was to assess the impact of sarcopenia, phase angle, and other characteristics on overall survival (OS) in palliative cancer patients at the National Cancer Institute of Mexico. We enrolled 628 patients (female, 59%). The most frequent disease was gastric cancer (39.5%). Kaplan–Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.02). Sarcopenia univariably predicted OS [HR 1.4 (95% CI, 1.1–1.8), p = 0.001], but was not significant in multivariable Cox-regression analysis (p = 0.08). Significant predictors for sarcopenia in multivariable Cox-regression analysis were sex, age, body mass index, phase angle, clinical symptoms, and Karnofsky. Our results corroborate the reliability of sarcopenia and phase angle in Mexican population, showing that the measurement of these parameters might also be useful in early-stage cancer patients as prognostic markers.     

Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study

Early identification and treatment of nutritional deficiencies can lead to improved outcomes in the quality of life (QoL) and survival of patients with nonsmall cell lung cancer (NSCLC). Noninvasive techniques are needed to evaluate changes in body composition as part of determining nutritional status. The aim of the study was to evaluate the association of nutritional parameters in health-related quality of life (HRQL) and survival in patients with advanced NSCLC. Chemotherapy-na?ve patients with advanced NSCLC with good performance status Eastern Cooperative Oncology Group (ECOG) 0-2 were included prospectively in the study. We evaluated inflammatory parameters such as C-reactive protein, platelet/lymphocyte index, neutrophil/lymphocyte index, serum interleukin (IL)-6, and tumor necrosis factor-α, and nutritional variables such as body mass index (BMI) and serum albumin levels. Bioelectrical impedance analysis including phase angle was obtained before cisplatin-based chemotherapy was started. HRQL was assessed by application of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-LC13 instruments at baseline. Overall survival (OS) was calculated with the Kaplan-Meier method and analyzed with log-rank and Cox proportional hazard models. One hundred nineteen patients were included. Mean BMI was 24.8 ± 4.5 kg/m(2), average weight loss of patients was 8.4%, and median phase angle was 5.8°. Malnutrition measured by subjective global assessment (SGA), weight loss >10%, BMI >20 was associated with lower HRQL scales. Patients with ECOG 2, high content serum IL-6, lower phase angle, and malnutrition parameters showed lower OS; however, after multivariate analysis, only ECOG 2 [Hazard ratio (HR), 2.7; 95% confidence interval (95% CI), 1.5-4.7; P = 0.001], phase angle ≤5.8° (HR = 3.02; 95% CI: 1.2-7.11; P = 0.011), and SGA (HR = 2.7; 95% CI, 1.31-5.5; P = 0.005) were associated with poor survival. Patients were divided into low-, intermediate-, and high-risk groups according to regression coefficients; OS at 1 yr was 78.4, 53, and 13.8%, respectively. Malnutrition is associated with low HRQL and is an independent prognostic factor in advanced NSCLC. The results warrant prospective trials to evaluate the impact of different nutritional interventions on HRQL and survival.     

术前血清CA19-9和NSE对食管鳞癌患者预后的影响

  目的  研究术前血清癌抗原19-9（cancer antigen 19-9,CA19-9）和神经元特异性烯醇化酶（neuron-specific enolase,NSE）对食管鳞癌（esophageal squamous cell carcinoma,ESCC）患者预后的影响。  方法  前瞻性分析176例经病理确诊的食管鳞癌新发病例。应用χ2检验分析CA19-9和NSE与患者一般临床特征之间的关系。运用Kaplan-Meier法绘制生存曲线,通过Log-rank法进行生存率的比较,利用Cox比例风险回归模型进行多因素分析。  结果  高CA19-9和NSE联合检测组的食管鳞癌患者预后较差（总生存:HR=2.310,95%CI:1.209~4.418;无病生存:HR=2.354,95%CI:1.265~4.381）。相比于两种标志物单独检测,联合检测CA19-9和NSE对食管鳞癌患者生存预测的准确性更高（总生存:C-index=0.686;无病生存:C-index=0.684）。  结论  术前血清CA19-9和NSE是食管鳞癌患者预后的危险因素,联合检测对食管鳞癌患者预后预测的准确性更高。     

Disease-specific and event-free survival in breast cancer patients: a hospital-based study between 1990 and 2001

BACKGROUND: In France, as in other countries, breast cancer care has changed due to therapeutic advances and organized screening programs. Can the effect of new therapeutic procedures over time be measured by health care institutions considering these changes? The present study used data from a hospital-based cancer registry to analyze changes in 5-year disease-specific and event-free survival among women with primary breast cancer over three time periods (1990-1993, 1994-1997, and 1998-2001). METHODS: All cases of primary invasive breast carcinomas, initially treated in a French Comprehensive Cancer Center between 1990 and 2001, were included. In situ breast carcinoma and male breast cancer were excluded. Cox proportional hazards models were used to analyze disease-specific and event-free survival (DSS and EFS) rates over the three time periods (1990-1993, 1994-1997, and 1998-2001). RESULTS: During the 1990-2001 period, 4,165 primary breast cancers were initially treated at the Comprehensive Cancer Center. Out of 1,012 deaths overall, 74.6% were due specifically to primary breast cancer (respectively 98% from cancer itself and 2% from treatment side effects); the cause was unknown for only 3.3% of deaths. Out of 3,810 complete remissions, 18.2% presented local, regional or metastatic relapse and 3.8% presented a second primary breast cancer. Comparison of DSS and EFS rates in a recent reporting period (1998-2001) with those in earlier time periods (1994-1997 and 1990-1993) indicated that substantial survival gains were achieved with respectively 88.4% (95% CI: 86.4-90.5), 83.2% (95% CI: 81.3-85.2), and 79.8% (95% CI: 77.4-82.2) (p<0.01) for 5-year Disease-Specific Survival, and respectively 78.3% (95% CI: 75.7-81.0), 73.9% (95% CI: 71.6-76.3), and 70.1% (95% CI: 67.4-72.8) (p<0.01) for 5-year Event-Free Survival. After adjustment for prognostic factors, period was identified as an independent predictor of survival. CONCLUSION: Survival improvement is likely to be due to changes in routine clinical practice such as an increased use of systemic adjuvant therapy over the study periods, dose modification of epirubicin in adjuvant chemotherapy for node-positive breast cancer since 1994, and organized screening programs since 1997. However the effect of possible early diagnosis and over-diagnosis biases due to screening cannot be assessed.     

Impact of Nutritional Assessment on the Clinical Outcomes of Patients with Non-albicans Candidemia: A Multicenter Study

Several studies have demonstrated that malnutrition is a negative prognostic factor for clinical outcomes. However, there is limited evidence for the effect of malnutrition on clinical outcomes in patients with candidemia. We investigated the relationship between malnutrition and all-cause 28-day mortality among patients with non-albicans candidemia. Between July 2011 and June 2014, all adult patients with non-albicans candidemia, including C. tropicalis, C. glabrata, C. parapsilosis and so on, were enrolled. The Malnutrition Universal Screening Tool (MUST) scores were used to determine the patients’ nutritional status before the onset of candidemia. A total of 378 patients were enrolled; 43.4% developed septic shock and 57.1% had a high risk of malnutrition (MUST ≥ 2). The all-cause 28-day mortality rate was 40.7%. The Cox proportional hazards model revealed that C. tropicalis (HR, 2.01; 95% CI, 1.24–3.26; p = 0.005), Charlson comorbidity index (HR, 1.10; 95% CI, 1.03–1.18; p = 0.007), Foley catheter use (HR, 1.68; 95% CI, 1.21–1.35; p = 0.002), concomitant bacterial infections (HR, 1.55; 95% CI, 1.11–2.17; p = 0.010), low platelet count (HR, 3.81; 95% CI, 2.45–5.91; p < 0.001), not receiving antifungals initially (HR, 4.73; 95% CI, 3.07–7.29; p < 0.001), and MUST ≥ 2 (HR, 1.54; 95% CI, 1.09–2.17; p = 0.014) were independently associated with all-cause 28-day mortality. A simple screening tool for nutritional assessment should be used for patients with non-albicans candidemia to detect early clinical deterioration, and a tailored nutritional care plan should be established for malnourished individuals, to improve their clinical outcomes.     

Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: The SAFES cohort study

Objectives: The aim of the study was, by early identification of deleterious prognostic factors that are open to remediation, to be in a position to assign elderly patients to different mortality risk groups to improve management.Design: Prospective multicentre cohort.Setting: Nine French teaching hospitals.Participants: One thousand three hundred and six (1 306) patients aged 75 and over, hospitalised after having passed through Emergency Department (ED).Measurements: Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. A Cox survival analysis was performed to identify prognostic variables for six-week mortality. Receiver Operating Characteristics analysis was used to study the discriminant power of the model. A mortality risk score is proposed to define three risk groups for six-week mortality.Results: Crude mortality rate after a six-week follow-up was 10.6% (n=135). Prognostic factors identified were: malnutrition risk (HR=2.1; 95% CI: 1.1–3.8; p=.02), delirium (HR=1.7; 95% CI: 1.2-2.5; p=.006), and dependency: moderate dependency (HR=4.9; 95% CI: 1.5–16.5; p=.01) or severe dependency (HR=10.3; 95% CI: 3.2–33.1; p< .001). The discriminant power of the model was good: the c-statistic representing the area under the curve was 0.71 (95% IC: 0.67 – 0.75; p< .001). The six-week mortality rate increased significantly (p< .001) across the three risk groups: 1.1% (n=269; 95% CI=0.5–1.7) in the lowest risk group, 11.1% (n=854; 95% CI=9.4–12.9) in the intermediate risk group, and 22.4% (n=125; 95% CI=20.1–24.7) in the highest risk group.Conclusions: A simple score has been calculated (using only three variables from the CGA) and a practical schedule proposed to characterise patients according to the degree of mortality risk. Each of these three variables (malnutrition risk, delirium, and dependency) identified as independent prognostic factors can lead to a targeted therapeutic option to prevent early mortality.     

评价新辅助化疗用于局部晚期宫颈癌手术治疗前的临床价值

目的 评价新辅助化疗用于局部晚期宫颈癌手术治疗前的临床价值.方法 网上检索MEDLINE、PUBMED、ELSEVIER ScienceDirect、CNKI等,获取全文.筛选文献,实验组是新辅助化疗联合手术,对照组是直接手术,提取用于评价的指标包括：淋巴结转移、脉管浸润、间质浸润、切缘阳性率、3年生存率（OS）、3年无瘤生存率（DFS）、5年生存率、5年无瘤生存率,并进行Meta分析.结果 新辅助化疗组与对照组相比,淋巴结转移的HR和95%CI分别为（0.54,0.33～0.86）,间质浸润的分别为（0.45,0.24～0.86）,脉管浸润的分别为（0.25,0.16～0.38）,差异均有统计学意义（P〈0.05）;切缘阳性率的HR和95%CI分别为（0.45,0.21～0.99）,3年OS分别为（1.24,0.59～2.63）,3年DFS分别为（1.34,0.65～2.78）,5年OS分别为（0.94,0.54～1.64）,5年DFS分别为（0.99,0.71～1.93）,差异均无统计学意义（P〉0.05）.结论 局部晚期宫颈癌,新辅助化疗能减少预后不良相关病理因素,但不能改善患者的生存率.