Starting with the Aalen （1989） version of Cox （1972） ＇regression model＇ we show the method for construction of ＂any＂ joint survival function given marginal survival functions. Basically, however, we restrict o...Starting with the Aalen （1989） version of Cox （1972） ＇regression model＇ we show the method for construction of ＂any＂ joint survival function given marginal survival functions. Basically, however, we restrict ourselves to model positive stochastic dependences only with the general assumption that the underlying two marginal random variables are centered on the set of nonnegative real values. With only these assumptions we obtain nice general characterization of bivariate probability distributions that may play similar role as the copula methodology. Examples of reliability and biomedical applications are given.展开更多
In the applications of COX regression models, we always encounter data sets t<span>hat contain too many variables that only a few of them contribute to the</span> model. Therefore, it will waste much more ...In the applications of COX regression models, we always encounter data sets t<span>hat contain too many variables that only a few of them contribute to the</span> model. Therefore, it will waste much more samples to estimate the “noneffective” variables in the inference. In this paper, we use a sequential procedure for constructing<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "="">the fixed size confidence set for the “effective” parameters to the model based on an adaptive shrinkage estimate such that the “effective” coefficients can be efficiently identified with the minimum sample size. Fixed design is considered for numerical simulation. The strong consistency, asymptotic distributions and convergence rates of estimates under the fixed design are obtained. In addition, the sequential procedure is shown to be asymptotically optimal in the sense of Chow and Robbins (1965).</span></span></span>展开更多
BACKGROUND Cox health behavior interventions combined with psychological care have the potential to improve recovery outcomes and psychological well-being in patients with hypertensive cerebral hemorrhage accompanied ...BACKGROUND Cox health behavior interventions combined with psychological care have the potential to improve recovery outcomes and psychological well-being in patients with hypertensive cerebral hemorrhage accompanied by mental disorders.AIM To explore the impact of combining the Cox Health Behavior Interaction Model with multifaceted psychological nursing in patients with hypertensive intracerebral hemorrhage(ICH)complicated by mental disorders and to provide a reference for the nursing intervention in patients with hypertensive ICH.METHODS Overall,128 patients with hypertensive ICH complicated by mental disorders who were admitted to the Affiliated Hospital of Nantong University between January 2022 and December 2024 were divided into groups using a random number table.The control group(n=64)received multifaceted psychological nursing,and the observation group(n=64)received the Cox Health Behavior Interaction Model intervention based on multifaceted psychological nursing.The mental state,psychological resilience,self-efficacy,and quality of life of the two groups were compared.RESULTS Post-intervention,the mental states of anxiety and depression in the observation group(38.82±3.67 points and 35.14±2.75 points,respectively)were lower than those in the control group(46.96±5.12 points and 41.36±3.71 points,respectively),and the psychological resilience levels(tenacity,self-improvement,and optimism)were higher than those in the control group(P<0.05).Postintervention,the General Self-Efficacy Scale score in the observation group(31.75±2.75 points)was higher than that in the control group(26.76±2.93 points),and the physical health-and social and mental health-related quality of life were both higher than those in the control group(P<0.05).CONCLUSION Combining the Cox Health Behavior Interaction Model with multifaceted psychological nursing for patients with hypertensive ICH and mental disorders relieves anxiety and depression and improves resilience,self-efficacy,and quality of life.展开更多
Modeling HIV/AIDS progression is critical for understanding disease dynamics and improving patient care. This study compares the Exponential and Weibull survival models, focusing on their ability to capture state-spec...Modeling HIV/AIDS progression is critical for understanding disease dynamics and improving patient care. This study compares the Exponential and Weibull survival models, focusing on their ability to capture state-specific failure rates in HIV/AIDS progression. While the Exponential model offers simplicity with a constant hazard rate, it often fails to accommodate the complexities of dynamic disease progression. In contrast, the Weibull model provides flexibility by allowing hazard rates to vary over time. Both models are evaluated within the frameworks of the Cox Proportional Hazards (Cox PH) and Accelerated Failure Time (AFT) models, incorporating critical covariates such as age, gender, CD4 count, and ART status. Statistical evaluation metrics, including Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), log-likelihood, and Pseudo-R2, were employed to assess model performance across diverse patient subgroups. Results indicate that the Weibull model consistently outperforms the Exponential model in dynamic scenarios, such as younger patients and those with co-infections, while maintaining robustness in stable contexts. This study highlights the trade-off between flexibility and simplicity in survival modeling, advocating for tailored model selection to balance interpretability and predictive accuracy. These findings provide valuable insights for optimizing HIV/AIDS management strategies and advancing survival analysis methodologies.展开更多
This study has provided a starting point for defining and working with Cox models in respect of multivariate modeling. In medical researches, there may be situations, where several risk factors potentially affect pati...This study has provided a starting point for defining and working with Cox models in respect of multivariate modeling. In medical researches, there may be situations, where several risk factors potentially affect patient prognosis, howbeit, only one or two might predict patient’s predicament. In seeking to find out which of the risk factors contribute the most to the survival times of patients, there was the need for researchers to adjust the covariates to realize their impact on survival times of patients. Aside the multivariate nature of the covariates, some covariates might be categorical while others might be quantitative. Again, there might be cases where researchers need a model that has <span style="font-family:Verdana;">the capability of extending survival analysis methods to assessing simulta</span><span style="font-family:Verdana;">neously the effect of several risk factors on survival times. This study unveiled the Cox model as a robust technique which could accomplish the aforementioned cases.</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">An investigation meant to evaluate the ITN-factor vis-à-vis its </span><span style="font-family:Verdana;">contribution towards death due to Malaria was exemplified with the Cox model. Data were taken from hospitals in Ghana. In doing so, we assessed hospital in-patients who reported cases of malaria (origin state) to time until death or censoring (destination stage) as a result of predictive factors (exposure to the malaria parasites) and some socioeconomic variables. We purposefully used Cox models to quantify the effect of the ITN-factor in the presence of other risk factors to obtain some measures of effect that could describe the rela</span><span style="font-family:Verdana;">tionship between the exposure variable and time until death adjusting for</span><span style="font-family:Verdana;"> other variables. PH assumption holds for all three covariates. Sex of patient was insignificant to deaths due to malaria. Age of patient and user status </span></span><span style="font-family:Verdana;">were</span><span style="font-family:Verdana;"> both significant. The magnitude of the coefficient (0.384) of ITN user status depicts its high contribution to the variation in the dependent variable.</span>展开更多
OBJECTIVE To retrospectively analyze clinical data of patientsfrom our hospital who underwent radical surgery for esophagealcarcinoma and for adenocarcinoma of the gastric cardia,as well asto investigate prognostic fa...OBJECTIVE To retrospectively analyze clinical data of patientsfrom our hospital who underwent radical surgery for esophagealcarcinoma and for adenocarcinoma of the gastric cardia,as well asto investigate prognostic factors affecting the long-term survival ofthe patients.METHODS Data from the patients eligible for our study,admitted to the 4th Hospital of Hebei Medical University fromJanuary 1996 to December 2004,were randomized,and 12distinctive clinicopathologic factors influencing the survival rateof those who underwent radical surgery for esophageal carcinomaor carcinoma of the gastric cardia were collected.Univariate andmultivariate analysis of these individual variables were performedusing the Cox proportional hazard model.RESULTS It was shown by univariate analysis that age,tumorsize,pathologic type,lymph node status,TNM staging,depthof infiltration and encroachment into local organs,etc.,were thefactors that markedly influenced the prognosis of patients(P<0.01).Multivariate analysis showed that pathologic type,numberof the lymph node metastases,involvement of local organs,andTNM staging were independent prognostic factors(P<0.05).CONCLUSION The independent factors influencing theprognosis of patients with esophageal cancer and carcinoma ofthe gastric cardia include pathologic type,number of lymph nodemetastases,involvement of local organs and TNM staging.Themain prognostic factors affecting the patient's survival are patientage,tumor size and depth of infiltration.In addition,patients withinvolvement of the local organs have a worse prognosis,and theyshould be closely followed up.展开更多
Penalized empirical likelihood inferential procedure is proposed for Cox＇s pro- portional hazards model with adaptive LASSO（ALASSO）. Under reasonable conditions, we show that the proposed method has oracle property...Penalized empirical likelihood inferential procedure is proposed for Cox＇s pro- portional hazards model with adaptive LASSO（ALASSO）. Under reasonable conditions, we show that the proposed method has oracle property and the limiting distribution of a penal- ized empirical likelihood ratio via ALASSO is a chi-square distributions. The advantage of penalized empirical likelihood is illustrated in testing hypothesis and constructing confidence sets by simulation studies and a real example.展开更多
<strong>Background: </strong><span style="font-family:""><span style="font-family:Verdana;">One of the main objectives of hospital managements is to control the length ...<strong>Background: </strong><span style="font-family:""><span style="font-family:Verdana;">One of the main objectives of hospital managements is to control the length of stay (LOS). Successful control of LOS of inpatients will result in reduction in the cost of care, decrease in nosocomial infections, medication side effects, and better management of the limited number of available patients’ beds. The length of stay (LOS) is an important indicator of the efficiency of hospital management by improving the quality of treatment, and increased hospital profit with more efficient bed management. The purpose of this study was to model the distribution of LOS as a function of patient’s age, and the Diagnosis Related Groups (DRG), based on electronic medical records of a large tertiary care hospital. </span><b><span style="font-family:Verdana;">Materials and Methods: </span></b><span style="font-family:Verdana;">Information related to the research subjects were retrieved from a database of patients admitted to King Faisal Specialist Hospital and Research Center hospital in Riyadh, Saudi Arabia between January 2014 and December 2016. Subjects’ confidential information was masked from the investigators. The data analyses were reported visually, descriptively, and analytically using Cox proportional hazard regression model to predict the risk of long-stay when patients’ age and the DRG are considered as antecedent risk factors. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Predicting the risk of long stay depends significantly on the age at admission, and the DRG to which a patient belongs to. We demonstrated the validity of the Cox regression model for the available data as the proportionality assumption is shown to be satisfied. Two examples were presented to demonstrate the utility of the Cox model in this regard.</span></span>展开更多
Cox Proportional Hazard model is a popular statistical technique for exploring the relationship between the survival time of neonates and several explanatory variables. It provides an estimate of the study variables’...Cox Proportional Hazard model is a popular statistical technique for exploring the relationship between the survival time of neonates and several explanatory variables. It provides an estimate of the study variables’ effect on survival after adjustment for other explanatory variables, and allows us to estimate the hazard (or risk) of death of newborn in NICU of hospitals in River Nile State-Sudan for the period (2018-2020). Study Data represented (neonate gender, mode of delivery, birth type, neonate weight, resident type, gestational age, and survival time). Kaplan-Meier method is used to estimate survival and hazard function for survival times of newborns that have not completed their first month. Of 700 neonates in the study area, 25% of them died during 2018-2020. Variables of interest that had a significant effect on neonatal death by Cox Proportional Hazard Model analysis were neonate weight, resident type, and gestational age. In Cox Proportional Hazard Model analysis all the variables of interest had an effect on neonatal death, but the variables with a significant effect included, weight of neonate, resident type and gestational age.展开更多
Background: The Center of Molecular Immunology (CIM) is a center in Cuba devoted to the research, development and manufacturing of biotechnological products. CIMAvax?EGF is a vaccine for the treatment of non-small cel...Background: The Center of Molecular Immunology (CIM) is a center in Cuba devoted to the research, development and manufacturing of biotechnological products. CIMAvax?EGF is a vaccine for the treatment of non-small cell lung cancer patients (NSCL). Purpose: The aim of this work is to evaluate the effects of some potential prognostic factors on the overall survival of patients treated with CIMAvax?EGF vaccine, based on data collected in a phase II and a phase III clinical trials. Methods: The stratified Cox regression model is used to evaluate the effects of these prognostic factors, based on separate analysis for each trial, and on the combined data from both trials. Results: Patients with Performance status 0 or 1, with IV stage of tumor and male under 60 years obtain more benefit in terms of overall survival if they receive CIMAvax?EGF. Conclusions: Vaccinated group has a better performance if patients have a performance status 0 or 1, stage IV and age under 60 years. These prognostic factors influence overall survival in a positive way for those patients that received CIMAvax?EGF.展开更多
Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives ...Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.展开更多
AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer an...AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer and compared it with the Cox model.Three thousand and eighteen gastric cancer patients who received a gastrectomy between 1980 and 2004 were retrospectively evaluated.Clinic-pathological factors were included in a log-normal model as well as Cox model.The akaike information criterion (AIC) was employed to compare the efficiency of both models.Univariate analysis indicated that age at diagnosis,past history,cancer location,distant metastasis status,surgical curative degree,combined other organ resection,Borrmann type,Lauren's classification,pT stage,total dissected nodes and pN stage were prognostic factors in both log-normal and Cox models.RESULTS:In the final multivariate model,age at diagnosis,past history,surgical curative degree,Borrmann type,Lauren's classification,pT stage,and pN stage were significant prognostic factors in both log-normal and Cox models.However,cancer location,distant metastasis status,and histology types were found to be significant prognostic factors in log-normal results alone.According to AIC,the log-normal model performed better than the Cox proportional hazard model (AIC value:2534.72 vs 1693.56).CONCLUSION:It is suggested that the log-normal regression model can be a useful statistical model to evaluate prognostic factors instead of the Cox proportional hazard model.展开更多
BACKGROUND Fibrinogen-to-albumin ratio(FAR)has been found to be of prognostic significance for several types of malignant tumors.However,less is known about the association between FAR and survival outcomes in hepatoc...BACKGROUND Fibrinogen-to-albumin ratio(FAR)has been found to be of prognostic significance for several types of malignant tumors.However,less is known about the association between FAR and survival outcomes in hepatocellular carcinoma(HCC)patients.AIM To explore the association between FAR and prognosis and survival in patients with HCC.METHODS A total of 366 histologically confirmed HCC patients diagnosed between 2013 and 2018 in a provincial cancer hospital in southwestern China were retrospectively selected.Relevant data were extracted from the hospital information system.The optimal cutoff for baseline serum FAR measured upon disease diagnosis was established using the receiver operating characteristic(ROC)curve.Univariate and multivariate Cox proportional hazards models were used to determine the crude and adjusted associations between FAR and the overall survival(OS)of the HCC patients while controlling for various covariates.The restricted cubic spline(RCS)was applied to estimate the dose-response trend in the FAR-OS association.RESULTS The optimal cutoff value for baseline FAR determined by the ROC was 0.081.Multivariate Cox proportional hazards model revealed that a lower baseline serum FAR level was associated with an adjusted hazard ratio of 2.43(95%confidence interval:1.87–3.15)in the OS of HCC patients,with identifiable dose-response trend in the RCS.Subgroup analysis showed that this FAR-OS association was more prominent in HCC patients with a lower baseline serum aspartate aminotransferase or carbohydrate antigen 125 level.CONCLUSION Serum FAR is a prominent prognostic indicator for HCC.Intervention measures aimed at reducing FAR might result in survival benefit for HCC patients.展开更多
Objective： In this study, we aimed to expand current knowledge of head and neck squamous cell carcinoma （HNSCC）-associated long noncoding RNAs （IncRNAs）, and to discover potential IncRNA prognostic biomarkers for...Objective： In this study, we aimed to expand current knowledge of head and neck squamous cell carcinoma （HNSCC）-associated long noncoding RNAs （IncRNAs）, and to discover potential IncRNA prognostic biomarkers for HNSCC based on next-generation RNA-seq. Methods： RNA-seq data of 546 samples from patients with HNSCC were downloaded from The Cancer Genome Atlas （TCGA）, including 43 paired samples of tumor tissue and adjacent normal tissue. An integrated analysis incorporating differential expression, weighted gene co-expression networks, functional enrichment, clinical parameters, and survival analysis was conducted to discover HNSCC-associated IncRNAs. The function of CYTOR was verified by cell-based experiments. To further identify IncRNAs with prognostic significance, a multivariate Cox proportional hazard regression analysis was performed. The identified IncRNAs were validated with an independent cohort using clinical feature relevance analysis and multivariate Cox regression analysis. Results： We identified nine HNSCC-relevant IncRNAs likely to play pivotal roles in HNSCC onset and development. By functional enrichment analysis, we revealed that CYTOR might participate in the multistep pathological processes of cancer, such as ribosome biogenesis and maintenance of genomic stability. CY-I-OR was identified to be positively correlated with lymph node metastasis, and significantly negatively correlated with overall survival （OS） and disease free survival （DFS） of HNSCC patients. Moreover, CYTOR inhibited cell apoptosis following treatment with the chemotherapeutic drug diamminedichloroplatinum （DDP）. HCG22, the most dramatically down-regulated IncRNA in tumor tissue, may function in epidermis differentiation. It was also significantly associated with several clinical features of patients with HNSCC, and positively correlated with patient survival. CYTOR and HCG22 maintained their prognostic values in- dependent of several clinical features in multivariate Cox hazards analysis. Notably, validation either based on an independent HNSCC cohort or by laboratory experiments confirmed these findings. Conclusions： Our transcriptomic analysis suggested that dysregulation of these HNSCC-associated IncRNAs might be involved in HNSCC oncogenesis and progression. Moreover, CYTOR and HCG22 were confirmed as two independent prognostic factors for HNSCC patient survival, providing new insights into the roles of these IncRNAs in HNSCC as well as clinical applications.展开更多
In this paper we consider risk processes with two classes of business in which the two claim-number processes are dependent Cox processes. We first assume that the two claim-number processes have a two-dimensional Mar...In this paper we consider risk processes with two classes of business in which the two claim-number processes are dependent Cox processes. We first assume that the two claim-number processes have a two-dimensional Markovian intensity. Under this assumption, we not only study the sum of the two individual risk processes but also investigate the two-dimensional risk process formed by considering the two individual processes separately. For each of the two risk processes we derive an expression for the ruin probability, and then construct an upper bound for the ruin probability. We next assume that the intensity of the two claim-number processes follows a Markov chain. In this case, we examine the ruin probability of the sum of the two individual risk processes. Specifically, a differential system for the ruin probability is derived and numerical results are obtained for exponential claim sizes.展开更多
Three hundred and eight patients with hepatocellular carcinoma underwent radical resection during 1975- 1991.The 1-,2-, 3-,4-,5-,and 10-year recurrent rates were 12.7%,28.7%,41.2%, 47.5%,54.1% and 64.4% respectively.B...Three hundred and eight patients with hepatocellular carcinoma underwent radical resection during 1975- 1991.The 1-,2-, 3-,4-,5-,and 10-year recurrent rates were 12.7%,28.7%,41.2%, 47.5%,54.1% and 64.4% respectively.By the end of March 1992,recurrence had occurred in 134 patients.Risk factors for recurrence were analyzed.Cox univariate analysts identified the following five factors to be correlated with increasing risk: high γ-GT,discovery by clinical,macronodular cirrhosis,minor resection and portal vein embolus.However,only high γ-GT,macronodular cirrhosis,and minor resection have been proved significant risk factors for recurrence in Cox multivariate analysis.Larger hepatic resection might reduce recurrence,intra-andlor post-operation comprehensive treatments are adevocated.展开更多
Objective: To evaluate the major prognostic factors in patients with pancreatic carcinoma. Methods:113 cases of a particular disease were retrospectively analysed and 9 factors for prognosis were studied by multiva...Objective: To evaluate the major prognostic factors in patients with pancreatic carcinoma. Methods:113 cases of a particular disease were retrospectively analysed and 9 factors for prognosis were studied by multivaritate analysis with Cox proportional hazards survival model.Survival rate was calculated by Kaplan-Meier estimation. Results:In this group,survival time was 0.1 to 82 months,and the median survival time was 3 months.Overall survival rates at month 6,12,18,36 were 35.6%,20.3%,15.9% and 6.2%,respectively.Multivariate analyses revealed significant prognostic factors as follows:jaundice,metastasis,therapy method and synthetic therapy. Conclusion: The prognosis of pancreatic carcinoma is determined by various factors.Jaundice and metastasis are independent predictors of poor survival.Radical operation and synthetic therapy will improve the prognosis.展开更多
BACKGROUND Heart transplant recipients are at higher risk of developing skin cancer than the general population due to the long-term immunosuppression treatment.Cancer has been reported as one of the major causes of m...BACKGROUND Heart transplant recipients are at higher risk of developing skin cancer than the general population due to the long-term immunosuppression treatment.Cancer has been reported as one of the major causes of morbidity and mortality for patients after heart transplantation.Among different types of skin cancers,cutaneous squamous cell carcinoma(cSCC)is the most common one,which requires timely screening and better management.AIM To identify risk factors and predict the incidence of cSCC for heart transplant recipients.METHODS We retrospectively analyzed adult heart transplant recipients between 2000 and 2015 extracted from the United Network for Organ Sharing registry.The whole dataset was randomly divided into a derivation set(80%)and a validation set(20%).Uni-and multivariate Cox regression were done to identify significant risk factors associated with the development of cSCC.Receiver operating characteristics curves were generated and area under the curve(AUC)was calculated to assess the accuracy of the prediction model.Based on the selected risk factors,a risk scoring system was developed to stratify patients into different risk groups.A cumulative cSCC-free survival curve was generated using the Kaplan-Meier method for each group,and the log-rank test was done to compare the intergroup cSCC rates.RESULTS There were 23736 heart-transplant recipients during the study period,and 1827 of them have been reported with cSCC.Significant predictors of post-transplant cSCC were older age,male sex,white race,recipient and donor human leukocyte antigen(HLA)mismatch level,malignancy at listing,diagnosis with restrictive myopathy or hypertrophic myopathy,heart re-transplant,and induction therapy with OKT3 or daclizumab.The multivariate model was used to predict the 5-,8-and 10-year incidence of cSCC and respectively provided AUC of 0.79,0.78 and 0.77 in the derivation set and 0.80,0.78 and 0.77 in the validation set.The risk scoring system assigned each patient with a risk score within the range of 0-11,based on which they were stratified into 4 different risk groups.The predicted and observed 5-year probability of developing cSCC match well among different risk groups.In addition,the log-rank test indicated significantly different cSCCfree survival across different groups.CONCLUSION A risk prediction model for cSCC among heart-transplant recipients has been generated for the first time.It offers a c-statistic of≥0.77 in both derivation and validation sets.展开更多
Objective： To investigate the risk factors of bone metastases in breast carcinoma. Methods： By cross sectional study, the data of 225 breast cancer patients who were inpatients in four hospitals in Hangzhou were ana...Objective： To investigate the risk factors of bone metastases in breast carcinoma. Methods： By cross sectional study, the data of 225 breast cancer patients who were inpatients in four hospitals in Hangzhou were analyzed. All patients underwent total body bone scan with single photon emission computed tomography （SPECT） at least once during 1995 to 2000. Results： All patients were followed-up to 294 months after operation, bone metastases were found in 113 cases, suspected bone metastases 3 cases, with a bone metastases rate of 50.9% （113/222）. Multivariate analysis by Cox＇s proportional hazards regression model showed that there were four risk factors of bone metastases in breast cancer： （1） clinical stage, Ⅰ～Ⅳ stages with a hazard ratio of bone metastases of 1.945, 95% confidence interval 1.396～2.710; （2） number of invaded axillary lymph nodes, with a hazard ratio of 1.039, 95% confidence interval 1.0142～1.068; （3） skeletal complications （yes vs. no）, with a hazard ratio of bone metastases of 1.722, 95% confidence interval 1.060～2.796; （4） age at the time of surgery or diagnosis, with a hazard ratio of 2.048, 95% confidence interval 1.123～3.876 for patients of age 40～50 y versus patients bellow 40 y of age and 2.837, 95% confidence interval 1.473～5.465 for patients of age above 50 y versus patients of ages between 40 and 50. Kaplan-Meier curves showed that for patients with more than 5 invasive axillary lymph nodes, compared with those with 1～5, the bone metastasis rates increased significantly （x^2 =6.3319, P=0.012）. Conclusion： The clinical stage, number of metastatic axillary lymph nodes, age at the time of operation and skeletal complications are essential risk factors of bone metastases.展开更多
BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hyd...BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrations<20 ng/mL(defined as vitamin D deficiency),39%had serum 25(OH)D concentrations between 20 to 29 ng/mL(insufficiency),and 31%had serum 25(OH)D concentrations≥30 ng/mL(sufficiency).Prevalence of MetS was 28.4%.During a mean of 18 years follow-up,vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality.Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and allcause mortality.There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality.Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.展开更多
文摘Starting with the Aalen （1989） version of Cox （1972） ＇regression model＇ we show the method for construction of ＂any＂ joint survival function given marginal survival functions. Basically, however, we restrict ourselves to model positive stochastic dependences only with the general assumption that the underlying two marginal random variables are centered on the set of nonnegative real values. With only these assumptions we obtain nice general characterization of bivariate probability distributions that may play similar role as the copula methodology. Examples of reliability and biomedical applications are given.
文摘In the applications of COX regression models, we always encounter data sets t<span>hat contain too many variables that only a few of them contribute to the</span> model. Therefore, it will waste much more samples to estimate the “noneffective” variables in the inference. In this paper, we use a sequential procedure for constructing<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "="">the fixed size confidence set for the “effective” parameters to the model based on an adaptive shrinkage estimate such that the “effective” coefficients can be efficiently identified with the minimum sample size. Fixed design is considered for numerical simulation. The strong consistency, asymptotic distributions and convergence rates of estimates under the fixed design are obtained. In addition, the sequential procedure is shown to be asymptotically optimal in the sense of Chow and Robbins (1965).</span></span></span>
文摘BACKGROUND Cox health behavior interventions combined with psychological care have the potential to improve recovery outcomes and psychological well-being in patients with hypertensive cerebral hemorrhage accompanied by mental disorders.AIM To explore the impact of combining the Cox Health Behavior Interaction Model with multifaceted psychological nursing in patients with hypertensive intracerebral hemorrhage(ICH)complicated by mental disorders and to provide a reference for the nursing intervention in patients with hypertensive ICH.METHODS Overall,128 patients with hypertensive ICH complicated by mental disorders who were admitted to the Affiliated Hospital of Nantong University between January 2022 and December 2024 were divided into groups using a random number table.The control group(n=64)received multifaceted psychological nursing,and the observation group(n=64)received the Cox Health Behavior Interaction Model intervention based on multifaceted psychological nursing.The mental state,psychological resilience,self-efficacy,and quality of life of the two groups were compared.RESULTS Post-intervention,the mental states of anxiety and depression in the observation group(38.82±3.67 points and 35.14±2.75 points,respectively)were lower than those in the control group(46.96±5.12 points and 41.36±3.71 points,respectively),and the psychological resilience levels(tenacity,self-improvement,and optimism)were higher than those in the control group(P<0.05).Postintervention,the General Self-Efficacy Scale score in the observation group(31.75±2.75 points)was higher than that in the control group(26.76±2.93 points),and the physical health-and social and mental health-related quality of life were both higher than those in the control group(P<0.05).CONCLUSION Combining the Cox Health Behavior Interaction Model with multifaceted psychological nursing for patients with hypertensive ICH and mental disorders relieves anxiety and depression and improves resilience,self-efficacy,and quality of life.
文摘Modeling HIV/AIDS progression is critical for understanding disease dynamics and improving patient care. This study compares the Exponential and Weibull survival models, focusing on their ability to capture state-specific failure rates in HIV/AIDS progression. While the Exponential model offers simplicity with a constant hazard rate, it often fails to accommodate the complexities of dynamic disease progression. In contrast, the Weibull model provides flexibility by allowing hazard rates to vary over time. Both models are evaluated within the frameworks of the Cox Proportional Hazards (Cox PH) and Accelerated Failure Time (AFT) models, incorporating critical covariates such as age, gender, CD4 count, and ART status. Statistical evaluation metrics, including Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), log-likelihood, and Pseudo-R2, were employed to assess model performance across diverse patient subgroups. Results indicate that the Weibull model consistently outperforms the Exponential model in dynamic scenarios, such as younger patients and those with co-infections, while maintaining robustness in stable contexts. This study highlights the trade-off between flexibility and simplicity in survival modeling, advocating for tailored model selection to balance interpretability and predictive accuracy. These findings provide valuable insights for optimizing HIV/AIDS management strategies and advancing survival analysis methodologies.
文摘This study has provided a starting point for defining and working with Cox models in respect of multivariate modeling. In medical researches, there may be situations, where several risk factors potentially affect patient prognosis, howbeit, only one or two might predict patient’s predicament. In seeking to find out which of the risk factors contribute the most to the survival times of patients, there was the need for researchers to adjust the covariates to realize their impact on survival times of patients. Aside the multivariate nature of the covariates, some covariates might be categorical while others might be quantitative. Again, there might be cases where researchers need a model that has <span style="font-family:Verdana;">the capability of extending survival analysis methods to assessing simulta</span><span style="font-family:Verdana;">neously the effect of several risk factors on survival times. This study unveiled the Cox model as a robust technique which could accomplish the aforementioned cases.</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">An investigation meant to evaluate the ITN-factor vis-à-vis its </span><span style="font-family:Verdana;">contribution towards death due to Malaria was exemplified with the Cox model. Data were taken from hospitals in Ghana. In doing so, we assessed hospital in-patients who reported cases of malaria (origin state) to time until death or censoring (destination stage) as a result of predictive factors (exposure to the malaria parasites) and some socioeconomic variables. We purposefully used Cox models to quantify the effect of the ITN-factor in the presence of other risk factors to obtain some measures of effect that could describe the rela</span><span style="font-family:Verdana;">tionship between the exposure variable and time until death adjusting for</span><span style="font-family:Verdana;"> other variables. PH assumption holds for all three covariates. Sex of patient was insignificant to deaths due to malaria. Age of patient and user status </span></span><span style="font-family:Verdana;">were</span><span style="font-family:Verdana;"> both significant. The magnitude of the coefficient (0.384) of ITN user status depicts its high contribution to the variation in the dependent variable.</span>
基金supported by the Hebei Provincial Program for the Subjects with High Scholarship and Creative Research Potential,China.
文摘OBJECTIVE To retrospectively analyze clinical data of patientsfrom our hospital who underwent radical surgery for esophagealcarcinoma and for adenocarcinoma of the gastric cardia,as well asto investigate prognostic factors affecting the long-term survival ofthe patients.METHODS Data from the patients eligible for our study,admitted to the 4th Hospital of Hebei Medical University fromJanuary 1996 to December 2004,were randomized,and 12distinctive clinicopathologic factors influencing the survival rateof those who underwent radical surgery for esophageal carcinomaor carcinoma of the gastric cardia were collected.Univariate andmultivariate analysis of these individual variables were performedusing the Cox proportional hazard model.RESULTS It was shown by univariate analysis that age,tumorsize,pathologic type,lymph node status,TNM staging,depthof infiltration and encroachment into local organs,etc.,were thefactors that markedly influenced the prognosis of patients(P<0.01).Multivariate analysis showed that pathologic type,numberof the lymph node metastases,involvement of local organs,andTNM staging were independent prognostic factors(P<0.05).CONCLUSION The independent factors influencing theprognosis of patients with esophageal cancer and carcinoma ofthe gastric cardia include pathologic type,number of lymph nodemetastases,involvement of local organs and TNM staging.Themain prognostic factors affecting the patient's survival are patientage,tumor size and depth of infiltration.In addition,patients withinvolvement of the local organs have a worse prognosis,and theyshould be closely followed up.
文摘Penalized empirical likelihood inferential procedure is proposed for Cox＇s pro- portional hazards model with adaptive LASSO（ALASSO）. Under reasonable conditions, we show that the proposed method has oracle property and the limiting distribution of a penal- ized empirical likelihood ratio via ALASSO is a chi-square distributions. The advantage of penalized empirical likelihood is illustrated in testing hypothesis and constructing confidence sets by simulation studies and a real example.
文摘<strong>Background: </strong><span style="font-family:""><span style="font-family:Verdana;">One of the main objectives of hospital managements is to control the length of stay (LOS). Successful control of LOS of inpatients will result in reduction in the cost of care, decrease in nosocomial infections, medication side effects, and better management of the limited number of available patients’ beds. The length of stay (LOS) is an important indicator of the efficiency of hospital management by improving the quality of treatment, and increased hospital profit with more efficient bed management. The purpose of this study was to model the distribution of LOS as a function of patient’s age, and the Diagnosis Related Groups (DRG), based on electronic medical records of a large tertiary care hospital. </span><b><span style="font-family:Verdana;">Materials and Methods: </span></b><span style="font-family:Verdana;">Information related to the research subjects were retrieved from a database of patients admitted to King Faisal Specialist Hospital and Research Center hospital in Riyadh, Saudi Arabia between January 2014 and December 2016. Subjects’ confidential information was masked from the investigators. The data analyses were reported visually, descriptively, and analytically using Cox proportional hazard regression model to predict the risk of long-stay when patients’ age and the DRG are considered as antecedent risk factors. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Predicting the risk of long stay depends significantly on the age at admission, and the DRG to which a patient belongs to. We demonstrated the validity of the Cox regression model for the available data as the proportionality assumption is shown to be satisfied. Two examples were presented to demonstrate the utility of the Cox model in this regard.</span></span>
文摘Cox Proportional Hazard model is a popular statistical technique for exploring the relationship between the survival time of neonates and several explanatory variables. It provides an estimate of the study variables’ effect on survival after adjustment for other explanatory variables, and allows us to estimate the hazard (or risk) of death of newborn in NICU of hospitals in River Nile State-Sudan for the period (2018-2020). Study Data represented (neonate gender, mode of delivery, birth type, neonate weight, resident type, gestational age, and survival time). Kaplan-Meier method is used to estimate survival and hazard function for survival times of newborns that have not completed their first month. Of 700 neonates in the study area, 25% of them died during 2018-2020. Variables of interest that had a significant effect on neonatal death by Cox Proportional Hazard Model analysis were neonate weight, resident type, and gestational age. In Cox Proportional Hazard Model analysis all the variables of interest had an effect on neonatal death, but the variables with a significant effect included, weight of neonate, resident type and gestational age.
基金supported by a UICC International Cancer Technology Transfer Fellowship.
文摘Background: The Center of Molecular Immunology (CIM) is a center in Cuba devoted to the research, development and manufacturing of biotechnological products. CIMAvax?EGF is a vaccine for the treatment of non-small cell lung cancer patients (NSCL). Purpose: The aim of this work is to evaluate the effects of some potential prognostic factors on the overall survival of patients treated with CIMAvax?EGF vaccine, based on data collected in a phase II and a phase III clinical trials. Methods: The stratified Cox regression model is used to evaluate the effects of these prognostic factors, based on separate analysis for each trial, and on the combined data from both trials. Results: Patients with Performance status 0 or 1, with IV stage of tumor and male under 60 years obtain more benefit in terms of overall survival if they receive CIMAvax?EGF. Conclusions: Vaccinated group has a better performance if patients have a performance status 0 or 1, stage IV and age under 60 years. These prognostic factors influence overall survival in a positive way for those patients that received CIMAvax?EGF.
基金supported by the National Natural Science Foundation of China,Nos.82071426,81873784Clinical Cohort Construction Program of Peking University Third Hospital,No.BYSYDL2019002(all to DF)。
文摘Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.
基金Supported by the Gastric Cancer Laboratory and Pathology Department of Chinese Medical University,Shenyang,Chinathe Science and Technology Program of Shenyang,No. 1081232-1-00
文摘AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer and compared it with the Cox model.Three thousand and eighteen gastric cancer patients who received a gastrectomy between 1980 and 2004 were retrospectively evaluated.Clinic-pathological factors were included in a log-normal model as well as Cox model.The akaike information criterion (AIC) was employed to compare the efficiency of both models.Univariate analysis indicated that age at diagnosis,past history,cancer location,distant metastasis status,surgical curative degree,combined other organ resection,Borrmann type,Lauren's classification,pT stage,total dissected nodes and pN stage were prognostic factors in both log-normal and Cox models.RESULTS:In the final multivariate model,age at diagnosis,past history,surgical curative degree,Borrmann type,Lauren's classification,pT stage,and pN stage were significant prognostic factors in both log-normal and Cox models.However,cancer location,distant metastasis status,and histology types were found to be significant prognostic factors in log-normal results alone.According to AIC,the log-normal model performed better than the Cox proportional hazard model (AIC value:2534.72 vs 1693.56).CONCLUSION:It is suggested that the log-normal regression model can be a useful statistical model to evaluate prognostic factors instead of the Cox proportional hazard model.
文摘BACKGROUND Fibrinogen-to-albumin ratio(FAR)has been found to be of prognostic significance for several types of malignant tumors.However,less is known about the association between FAR and survival outcomes in hepatocellular carcinoma(HCC)patients.AIM To explore the association between FAR and prognosis and survival in patients with HCC.METHODS A total of 366 histologically confirmed HCC patients diagnosed between 2013 and 2018 in a provincial cancer hospital in southwestern China were retrospectively selected.Relevant data were extracted from the hospital information system.The optimal cutoff for baseline serum FAR measured upon disease diagnosis was established using the receiver operating characteristic(ROC)curve.Univariate and multivariate Cox proportional hazards models were used to determine the crude and adjusted associations between FAR and the overall survival(OS)of the HCC patients while controlling for various covariates.The restricted cubic spline(RCS)was applied to estimate the dose-response trend in the FAR-OS association.RESULTS The optimal cutoff value for baseline FAR determined by the ROC was 0.081.Multivariate Cox proportional hazards model revealed that a lower baseline serum FAR level was associated with an adjusted hazard ratio of 2.43(95%confidence interval:1.87–3.15)in the OS of HCC patients,with identifiable dose-response trend in the RCS.Subgroup analysis showed that this FAR-OS association was more prominent in HCC patients with a lower baseline serum aspartate aminotransferase or carbohydrate antigen 125 level.CONCLUSION Serum FAR is a prominent prognostic indicator for HCC.Intervention measures aimed at reducing FAR might result in survival benefit for HCC patients.
基金Project supported by the National Natural Science Foundation of China(Nos.31471226 and 91440108)the Fundamental Research Funds for the Central Universities(Nos.WK2070000044 and WK2070000034),China
文摘Objective： In this study, we aimed to expand current knowledge of head and neck squamous cell carcinoma （HNSCC）-associated long noncoding RNAs （IncRNAs）, and to discover potential IncRNA prognostic biomarkers for HNSCC based on next-generation RNA-seq. Methods： RNA-seq data of 546 samples from patients with HNSCC were downloaded from The Cancer Genome Atlas （TCGA）, including 43 paired samples of tumor tissue and adjacent normal tissue. An integrated analysis incorporating differential expression, weighted gene co-expression networks, functional enrichment, clinical parameters, and survival analysis was conducted to discover HNSCC-associated IncRNAs. The function of CYTOR was verified by cell-based experiments. To further identify IncRNAs with prognostic significance, a multivariate Cox proportional hazard regression analysis was performed. The identified IncRNAs were validated with an independent cohort using clinical feature relevance analysis and multivariate Cox regression analysis. Results： We identified nine HNSCC-relevant IncRNAs likely to play pivotal roles in HNSCC onset and development. By functional enrichment analysis, we revealed that CYTOR might participate in the multistep pathological processes of cancer, such as ribosome biogenesis and maintenance of genomic stability. CY-I-OR was identified to be positively correlated with lymph node metastasis, and significantly negatively correlated with overall survival （OS） and disease free survival （DFS） of HNSCC patients. Moreover, CYTOR inhibited cell apoptosis following treatment with the chemotherapeutic drug diamminedichloroplatinum （DDP）. HCG22, the most dramatically down-regulated IncRNA in tumor tissue, may function in epidermis differentiation. It was also significantly associated with several clinical features of patients with HNSCC, and positively correlated with patient survival. CYTOR and HCG22 maintained their prognostic values in- dependent of several clinical features in multivariate Cox hazards analysis. Notably, validation either based on an independent HNSCC cohort or by laboratory experiments confirmed these findings. Conclusions： Our transcriptomic analysis suggested that dysregulation of these HNSCC-associated IncRNAs might be involved in HNSCC oncogenesis and progression. Moreover, CYTOR and HCG22 were confirmed as two independent prognostic factors for HNSCC patient survival, providing new insights into the roles of these IncRNAs in HNSCC as well as clinical applications.
基金Supported by National Natural Science Foundations of China(10271062,10571092)a grant from the Research Grants Council of the Hong Kong Special Administrative Region,China(Project No.HKU 7475/05H)
文摘In this paper we consider risk processes with two classes of business in which the two claim-number processes are dependent Cox processes. We first assume that the two claim-number processes have a two-dimensional Markovian intensity. Under this assumption, we not only study the sum of the two individual risk processes but also investigate the two-dimensional risk process formed by considering the two individual processes separately. For each of the two risk processes we derive an expression for the ruin probability, and then construct an upper bound for the ruin probability. We next assume that the intensity of the two claim-number processes follows a Markov chain. In this case, we examine the ruin probability of the sum of the two individual risk processes. Specifically, a differential system for the ruin probability is derived and numerical results are obtained for exponential claim sizes.
文摘Three hundred and eight patients with hepatocellular carcinoma underwent radical resection during 1975- 1991.The 1-,2-, 3-,4-,5-,and 10-year recurrent rates were 12.7%,28.7%,41.2%, 47.5%,54.1% and 64.4% respectively.By the end of March 1992,recurrence had occurred in 134 patients.Risk factors for recurrence were analyzed.Cox univariate analysts identified the following five factors to be correlated with increasing risk: high γ-GT,discovery by clinical,macronodular cirrhosis,minor resection and portal vein embolus.However,only high γ-GT,macronodular cirrhosis,and minor resection have been proved significant risk factors for recurrence in Cox multivariate analysis.Larger hepatic resection might reduce recurrence,intra-andlor post-operation comprehensive treatments are adevocated.
文摘Objective: To evaluate the major prognostic factors in patients with pancreatic carcinoma. Methods:113 cases of a particular disease were retrospectively analysed and 9 factors for prognosis were studied by multivaritate analysis with Cox proportional hazards survival model.Survival rate was calculated by Kaplan-Meier estimation. Results:In this group,survival time was 0.1 to 82 months,and the median survival time was 3 months.Overall survival rates at month 6,12,18,36 were 35.6%,20.3%,15.9% and 6.2%,respectively.Multivariate analyses revealed significant prognostic factors as follows:jaundice,metastasis,therapy method and synthetic therapy. Conclusion: The prognosis of pancreatic carcinoma is determined by various factors.Jaundice and metastasis are independent predictors of poor survival.Radical operation and synthetic therapy will improve the prognosis.
基金Supported by National Science Foundation,No.CMMI-1728338.
文摘BACKGROUND Heart transplant recipients are at higher risk of developing skin cancer than the general population due to the long-term immunosuppression treatment.Cancer has been reported as one of the major causes of morbidity and mortality for patients after heart transplantation.Among different types of skin cancers,cutaneous squamous cell carcinoma(cSCC)is the most common one,which requires timely screening and better management.AIM To identify risk factors and predict the incidence of cSCC for heart transplant recipients.METHODS We retrospectively analyzed adult heart transplant recipients between 2000 and 2015 extracted from the United Network for Organ Sharing registry.The whole dataset was randomly divided into a derivation set(80%)and a validation set(20%).Uni-and multivariate Cox regression were done to identify significant risk factors associated with the development of cSCC.Receiver operating characteristics curves were generated and area under the curve(AUC)was calculated to assess the accuracy of the prediction model.Based on the selected risk factors,a risk scoring system was developed to stratify patients into different risk groups.A cumulative cSCC-free survival curve was generated using the Kaplan-Meier method for each group,and the log-rank test was done to compare the intergroup cSCC rates.RESULTS There were 23736 heart-transplant recipients during the study period,and 1827 of them have been reported with cSCC.Significant predictors of post-transplant cSCC were older age,male sex,white race,recipient and donor human leukocyte antigen(HLA)mismatch level,malignancy at listing,diagnosis with restrictive myopathy or hypertrophic myopathy,heart re-transplant,and induction therapy with OKT3 or daclizumab.The multivariate model was used to predict the 5-,8-and 10-year incidence of cSCC and respectively provided AUC of 0.79,0.78 and 0.77 in the derivation set and 0.80,0.78 and 0.77 in the validation set.The risk scoring system assigned each patient with a risk score within the range of 0-11,based on which they were stratified into 4 different risk groups.The predicted and observed 5-year probability of developing cSCC match well among different risk groups.In addition,the log-rank test indicated significantly different cSCCfree survival across different groups.CONCLUSION A risk prediction model for cSCC among heart-transplant recipients has been generated for the first time.It offers a c-statistic of≥0.77 in both derivation and validation sets.
文摘Objective： To investigate the risk factors of bone metastases in breast carcinoma. Methods： By cross sectional study, the data of 225 breast cancer patients who were inpatients in four hospitals in Hangzhou were analyzed. All patients underwent total body bone scan with single photon emission computed tomography （SPECT） at least once during 1995 to 2000. Results： All patients were followed-up to 294 months after operation, bone metastases were found in 113 cases, suspected bone metastases 3 cases, with a bone metastases rate of 50.9% （113/222）. Multivariate analysis by Cox＇s proportional hazards regression model showed that there were four risk factors of bone metastases in breast cancer： （1） clinical stage, Ⅰ～Ⅳ stages with a hazard ratio of bone metastases of 1.945, 95% confidence interval 1.396～2.710; （2） number of invaded axillary lymph nodes, with a hazard ratio of 1.039, 95% confidence interval 1.0142～1.068; （3） skeletal complications （yes vs. no）, with a hazard ratio of bone metastases of 1.722, 95% confidence interval 1.060～2.796; （4） age at the time of surgery or diagnosis, with a hazard ratio of 2.048, 95% confidence interval 1.123～3.876 for patients of age 40～50 y versus patients bellow 40 y of age and 2.837, 95% confidence interval 1.473～5.465 for patients of age above 50 y versus patients of ages between 40 and 50. Kaplan-Meier curves showed that for patients with more than 5 invasive axillary lymph nodes, compared with those with 1～5, the bone metastasis rates increased significantly （x^2 =6.3319, P=0.012）. Conclusion： The clinical stage, number of metastatic axillary lymph nodes, age at the time of operation and skeletal complications are essential risk factors of bone metastases.
文摘BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrations<20 ng/mL(defined as vitamin D deficiency),39%had serum 25(OH)D concentrations between 20 to 29 ng/mL(insufficiency),and 31%had serum 25(OH)D concentrations≥30 ng/mL(sufficiency).Prevalence of MetS was 28.4%.During a mean of 18 years follow-up,vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality.Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and allcause mortality.There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality.Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.
