Aim:Patients with muscle-invasive bladder cancer(MIBC)have a low survival rate,with a 5-year survival of approximately 45%,regardless of the treatment received.The risk of death within 5 years after radical cystectomy...Aim:Patients with muscle-invasive bladder cancer(MIBC)have a low survival rate,with a 5-year survival of approximately 45%,regardless of the treatment received.The risk of death within 5 years after radical cystectomy in patients with MIBC remains as high as 60%.Over 80%of patients with bladder cancer are over 65.Therefore,identifying prognostic correlates associated with radical cystectomy in older patients with MIBC could improve survival rates.In addition,radiotherapy and chemotherapy are particularly important as adjuvant treatments for MIBC patients undergoing radical cystectomy.Therefore,this study aimed to find risk factors for cancer-specific survival(CSS)and overall survival(OS)after radical cystectomy in elderly MIBC patients.The difference in survival between radiotherapy and chemotherapy was analyzed by Kaplan-Meier(K-M)curves to provide theoretical support for whether radiotherapy is recommended for such patients.Methods:Patients 65 or older diagnosed with MIBC with radical cystectomy between 2004-2018 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.2004-2015 patients were subjected to column line plot production and internal validation,and 2016-2018 patients were subjected to external temporal validation.A single-factor COX regression model was first used to screen for prognostic correlates.Then a multi-factor COX regression model was used to screen for independent risk factors.A nomogram was constructed by using independent risk factors.The accuracy and reliability of the nomogram were examined using calibration curves,consistency index(C-index),and area under subjects(AUC)as operational characteristic curves.Decision curve analysis(DCA)was performed to evaluate the clinical value of the prediction model.Results:A total of 11,557 patients were included in this study,divided into training set(N=4,712),validation set(N=4,810)and external validation set(N=2,035).Multivariate COX regression models showed that chemotherapy,radiotherapy,TNM stage,race,and age were independent risk factors for CSS and OS patients.We constructed a nomogram to predict CSS and OS in elderly MIBC patients undergoing radical cystectomy.The C-indexes were 0.692(95%CI:0.680-0.704)and 0.690(95%CI:0.678-0.702)for the CSS training and validation sets,respectively,and 0.674 for the OS training and validation sets(95%CI:0.664-0.684)and 0.672(95%CI:0.662-0.682)for the OS training and validation sets,respectively.The C-index of the external validation set CSS was 0.731(95%CI:709-0.753),and that of OS was 0.721(95%CI:0.701-0.741),indicating that the nomogram prediction model has good discriminative power.The calibration curves and AUC also suggested that the nomogram had good accuracy and discrimination.In addition,the KM curves of propensity-matched pre-and post-radiotherapy showed that radiotherapy was detrimental to patient survival.Meanwhile,chemotherapy favored OS and short-term CSS but not long-term CSS.Conclusions:We established a nomogram to predict the CSS and OS in elderly MIBC patients undergoing radical cystectomy.After internal cross-validation and external validation,the nomogram prediction model showed good accuracy and reliability,and the DCA results showed that the nomogram has good clinical value.In addition,this study gave good suggestions on whether radiotherapy or chemotherapy is necessary for radical cystectomy in elderly MIBC patients.展开更多
Background:Pancreatic solid pseudopapillary neoplasms(SPNs)are low-grade malignant tumors of the pancreas.Organ-pre-serving surgery is being increasingly performed for these tumors,although there is little evidence to...Background:Pancreatic solid pseudopapillary neoplasms(SPNs)are low-grade malignant tumors of the pancreas.Organ-pre-serving surgery is being increasingly performed for these tumors,although there is little evidence to support its use.This retro-spective multicenter study aimed to determine the clinicopathologic characteristics of pancreatic SPNs in Central and Western China and to determine the efficacy of organ-preserving surgery.Methods:The clinicopathologic,treatment and follow-up data of 227 pancreatic SPN patients treated between July 2003 and December 2016 at 5 tertiary care centers were retrospectively reviewed.Results:Among the 227 patients(38 males,189 females;mean age 33.30±12.70 years),only 72(31.7%)had symptoms.The mean tumor size was 55.08±29.56 mm.Adjacent organ/lymphovascular invasion was present in 16(7.1%)patients and distant metastasis in 3(1.3%)patients;no patient had spread to distant lymph nodes.Surgery included organ-preserving surgery in 108(47.6%)patients,classic surgery in 115(50.7%)patients,and palliative surgery in 4(1.8%)patients.Tumor recurrence was seen in 8(3.6%)patients.Cox regression analysis showed positive surgical margin(P<.01)and metastasis(P=.03)to be independent predictors of recurrence.Tumor characteristics were comparable between patients receiving organ-preserving surgery and classic surgery.The risk of recurrence was also similar in both groups(P=.72).Conclusions:Organ-preserving surgery appears to be an effective procedure for the treatment of pancreatic SPNs.Resection surgery should aim for negative surgical margins.展开更多
基金The study was supported by:Scientific Research Foundation of Education Department of Yunnan Province(No.2023J0295)Kunming Medical University Joint Project of Department of Science and Technology of Yunnan Province(No.02301AY070001-108)+3 种基金Kunming City Health Science and Technology Talent“1000”training Project(No.2020-SW(Reserve)-112)Kunming Health and Health Commission Health Research Project(No.2020-0201-001)Kunming Medical Joint Project of Yunnan Science and Technology Department(No.202001 AY070001-271)Open Research Fund of Clinical Research Center for Children’s Health and Diseases of Yunnan Province(2022-ETYY-YJ-03).
文摘Aim:Patients with muscle-invasive bladder cancer(MIBC)have a low survival rate,with a 5-year survival of approximately 45%,regardless of the treatment received.The risk of death within 5 years after radical cystectomy in patients with MIBC remains as high as 60%.Over 80%of patients with bladder cancer are over 65.Therefore,identifying prognostic correlates associated with radical cystectomy in older patients with MIBC could improve survival rates.In addition,radiotherapy and chemotherapy are particularly important as adjuvant treatments for MIBC patients undergoing radical cystectomy.Therefore,this study aimed to find risk factors for cancer-specific survival(CSS)and overall survival(OS)after radical cystectomy in elderly MIBC patients.The difference in survival between radiotherapy and chemotherapy was analyzed by Kaplan-Meier(K-M)curves to provide theoretical support for whether radiotherapy is recommended for such patients.Methods:Patients 65 or older diagnosed with MIBC with radical cystectomy between 2004-2018 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.2004-2015 patients were subjected to column line plot production and internal validation,and 2016-2018 patients were subjected to external temporal validation.A single-factor COX regression model was first used to screen for prognostic correlates.Then a multi-factor COX regression model was used to screen for independent risk factors.A nomogram was constructed by using independent risk factors.The accuracy and reliability of the nomogram were examined using calibration curves,consistency index(C-index),and area under subjects(AUC)as operational characteristic curves.Decision curve analysis(DCA)was performed to evaluate the clinical value of the prediction model.Results:A total of 11,557 patients were included in this study,divided into training set(N=4,712),validation set(N=4,810)and external validation set(N=2,035).Multivariate COX regression models showed that chemotherapy,radiotherapy,TNM stage,race,and age were independent risk factors for CSS and OS patients.We constructed a nomogram to predict CSS and OS in elderly MIBC patients undergoing radical cystectomy.The C-indexes were 0.692(95%CI:0.680-0.704)and 0.690(95%CI:0.678-0.702)for the CSS training and validation sets,respectively,and 0.674 for the OS training and validation sets(95%CI:0.664-0.684)and 0.672(95%CI:0.662-0.682)for the OS training and validation sets,respectively.The C-index of the external validation set CSS was 0.731(95%CI:709-0.753),and that of OS was 0.721(95%CI:0.701-0.741),indicating that the nomogram prediction model has good discriminative power.The calibration curves and AUC also suggested that the nomogram had good accuracy and discrimination.In addition,the KM curves of propensity-matched pre-and post-radiotherapy showed that radiotherapy was detrimental to patient survival.Meanwhile,chemotherapy favored OS and short-term CSS but not long-term CSS.Conclusions:We established a nomogram to predict the CSS and OS in elderly MIBC patients undergoing radical cystectomy.After internal cross-validation and external validation,the nomogram prediction model showed good accuracy and reliability,and the DCA results showed that the nomogram has good clinical value.In addition,this study gave good suggestions on whether radiotherapy or chemotherapy is necessary for radical cystectomy in elderly MIBC patients.
基金This work was supported by the National Natural Science Foundation of China(grant number 81472309).
文摘Background:Pancreatic solid pseudopapillary neoplasms(SPNs)are low-grade malignant tumors of the pancreas.Organ-pre-serving surgery is being increasingly performed for these tumors,although there is little evidence to support its use.This retro-spective multicenter study aimed to determine the clinicopathologic characteristics of pancreatic SPNs in Central and Western China and to determine the efficacy of organ-preserving surgery.Methods:The clinicopathologic,treatment and follow-up data of 227 pancreatic SPN patients treated between July 2003 and December 2016 at 5 tertiary care centers were retrospectively reviewed.Results:Among the 227 patients(38 males,189 females;mean age 33.30±12.70 years),only 72(31.7%)had symptoms.The mean tumor size was 55.08±29.56 mm.Adjacent organ/lymphovascular invasion was present in 16(7.1%)patients and distant metastasis in 3(1.3%)patients;no patient had spread to distant lymph nodes.Surgery included organ-preserving surgery in 108(47.6%)patients,classic surgery in 115(50.7%)patients,and palliative surgery in 4(1.8%)patients.Tumor recurrence was seen in 8(3.6%)patients.Cox regression analysis showed positive surgical margin(P<.01)and metastasis(P=.03)to be independent predictors of recurrence.Tumor characteristics were comparable between patients receiving organ-preserving surgery and classic surgery.The risk of recurrence was also similar in both groups(P=.72).Conclusions:Organ-preserving surgery appears to be an effective procedure for the treatment of pancreatic SPNs.Resection surgery should aim for negative surgical margins.
