RESUMEN
BACKGROUND: Although the latest Gleason grading system in 2014 has distinguished between Gleason 3 + 4 and 4 + 3, Gleason 8 and Gleason 9-10 are remained systemically classified. METHODS: A total of 261,125 patients diagnosed with prostate cancer (PCa) were selected between 2005 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. We used propensity score matching to balance clinical variables and then compared overall survival (OS) and cancer-specific survival (CSS) between Gleason score subgroups. We further establish a new Gleason survival grading system based on the hazard ratio (HR) values of each Gleason subgroup. Cox proportional hazards models and Kaplan-Meier curves were used to compare patient survival. RESULTS: Among PCa patients with Gleason score 8 disease, patients with Gleason 5 + 3 had significantly worse OS and CSS than those with Gleason 3 + 5 (OS: HR = 1.26, p = 0.042; CSS: HR = 1.42, p = 0.005) and 4 + 4 (HR = 1.50 for OS and HR = 1.69 for CSS, p < 0.001 for all). PCa patients with Gleason 5 + 3 and Gleason 4 + 5 may have the similar OS and CSS (reference Gleason score <=6, 5 + 3: OS HR = 2.44, CSS HR = 7.63; 4 + 5: OS HR = 2.40, CSS HR = 8.92; p < 0.001 for all). The new Gleason survival grading system reclassified the grades 4 and 5 of the 2014 updated Gleason grading system into three hierarchical grades, which makes the classification of grades more detailed and accurate. CONCLUSION: PCa patients with Gleason 8-10 may have three different survival subgroups, Gleason 3 + 5 and 4 + 4, Gleason 5 + 3 and 4 + 5, and Gleason 5 + 4 and 5 + 5. Our results maximize risk stratification for PCa patients, provide guidance for clinicians to assess their survival and clinical management, and make a recommendation for the next Gleason grading system update.
Asunto(s)
Clasificación del Tumor , Neoplasias de la Próstata/patología , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Neoplasias de la Próstata/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Programa de VERF , Análisis de Supervivencia , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
To investigate the role of previous cancer on overall survival in patients with bladder cancer (BCa) and to establish an effective prognostic tool for individualized overall survival prediction.A total of 78,660 patients diagnosed with BCa between 2000 and 2013 were selected from the Surveillance, Epidemiology, and End Results (SEER) database, among which 8915 patients had a history of other cancers. We compared the overall survival between patients with and without previous cancer after propensity score matching and we further established a nomogram for overall survival prediction.Univariate and multivariate Cox analyses were used to determine independent prognostic factors. The calibration curve and concordance index (C-index) were used to assess the accuracy of the nomogram. Cox proportional hazards models and Kaplan-Meier analysis were used to compare survival outcomes.BCa patients with previous cancer had worse overall survival compared with those without previous cancer (HRâ=â1.37; 95%CIâ=â1.32-1.42, Pâ<â.001). Cancers in lung prior to BCa had the most adverse impact on overall survival (HRâ=â2.35; 95%CIâ=â2.10-2.63; Pâ<â.001), and the minimal impact was located in prostate (HRâ=â1.16; 95%CIâ=â1.10-1.22; Pâ<â.001) for male and in gynecological (HRâ=â1.15; 95%CIâ=â1.02-1.30; Pâ=â.027) for female. The shorter interval time between 2 cancers and the higher stage of the previous cancer development, the higher risk of death. Age, race, sex, marital status, surgery, radiation, grade, stage, type of previous cancer as the independent prognostic factors were selected into the nomogram. The favorable calibration curve and C-index value (0.784, 95%CIâ=â0.782-0.786) indicated the nomogram could accurately predict the 1-, 3-, and 5-year overall survival rate of BCa patients.Previous cancer has a negative impact on the overall survival of BCa patients and requires more effective clinical management. The nomogram provides accurate survival prediction for BCa patients and might be helpful for clinical treatment selection and follow-up strategy adjustment.
Asunto(s)
Carcinoma de Células Transicionales/mortalidad , Neoplasias Primarias Secundarias/mortalidad , Neoplasias de la Vejiga Urinaria/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nomogramas , Programa de VERFRESUMEN
BACKGROUND: Currently, the prognosis of kidney cancer depends mainly on the pathological grade or tumor stage. Clinicians have few effective tools that can personalize and adequately evaluate the prognosis of kidney cancer patients. METHODS: A total of 70 481 kidney cancer patients were selected from the Surveillance, Epidemiology, and End Results database, among which patients diagnosed in 2005-2011 (n = 42 890) were used to establish nomograms for overall survival (OS) and cancer-specific survival (CSS), and those diagnosed in 2012-2015 (n = 24 591) were used for external validation. Univariate and multivariate Cox analyses were used to determine independent prognostic factors. Concordance index (C-index), receiver operating characteristic curve, and calibration curve were used to evaluate the predictive capacity of the nomograms. We further reduced subgroup classification and used propensity score matching to balance clinical informations, and analyzed the effect of other variables on survival. We established a new kidney cancer prognostic score system based on the effect of all available variables on survival. Cox proportional hazard model and Kaplan-Meier curves were used for survival comparison. RESULTS: Age, gender, marital status, surgery, grade, T stage, and M stage were included as independent risk factors in the nomograms. The favorable area under the curve (AUC) value (for OS, AUC = 0.812-0.858; and for CSS, AUC = 0.890-0.921), internal (for OS, C-index = 0.776; and for CSS, C-index = 0.856), and external (for OS, C-index = 0.814-0.841; and for CSS, C-index = 0.894-0.904) validation indicated that the proposed nomograms could accurately predict 1-, 3-, and 5-year OS and CSS of kidney cancer patients. The Aggtrmmns prognostic scoring system based on age, gender, race, marital status, grade, TNM stage, and surgery of kidney cancer patients could stage patients more explicitly than the AJCC staging system. CONCLUSION: The nomogram and Aggtrmmns scoring system can predict OS and CSS in kidney cancer patients effectively, which may help clinicians personalize prognostic assessments and clinical decisions.
Asunto(s)
Carcinoma de Células Renales/mortalidad , Neoplasias Renales/mortalidad , Nomogramas , Programa de VERF/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
OBJECTIVE: Follicle-stimulating hormone plays a crucial role in spermatogenesis. The aim of this study was to evaluate the efficacy of treatment with FSH in Chinese infertility population. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical study. PATIENTS: A total of 354 men affected by idiopathic oligozoospermia from three medical centres. MEASUREMENTS: This study contained three parts: (i) treatment with different doses of rhFSH (50 IU, 100 IU, 200 IU and 300 IU); (ii) the efficacy of rhFSH at different periods (2, 3, 4, 5 months); (iii) FSH treatment in patients with different levels of inhibin B (normal-level group, low-level group and high-level group). Semen parameters were evaluated in all subjects. The patients who had not reached spontaneous pregnancy underwent assisted reproductive techniques. RESULTS: Sperm number was significantly increased after treatment with FSH at doses of at least 200 IU, and the improvement was observed beginning at the third month. The significant improvement in both morphology and forward motility was observed beginning at the fifth month. Moreover, 300 IU rhFSH administration for 5 months could significantly improve the spontaneous pregnancy rate (12/40) and ART pregnancy rate (14/28), while the rates for placebo group were two of twenty-nine and five of twenty-seven, respectively. The seminal parameters (total sperm count, sperm concentration, forward motility and morphology) were significantly improved in the normal- and low-level inhibin B groups, but no significant variation was observed in the high-level group at the end of the study. CONCLUSIONS: The efficacy of FSH treatment was associated with the dose of FSH and duration of treatment, and FSH therapy was more effective in patients with normal level and low level of inhibin B.