BACKGROUND Magnetic resonance imaging(MRI)and endoscopic ultrasonography(EUS)are recommended in combination for screening pancreatic cancer in high-risk individuals.However,in clinical practice,MRI and EUS are increas...BACKGROUND Magnetic resonance imaging(MRI)and endoscopic ultrasonography(EUS)are recommended in combination for screening pancreatic cancer in high-risk individuals.However,in clinical practice,MRI and EUS are increasingly utilized for pancreatic surveillance during routine health examinations.AIM To investigate the feasibility of these imaging modalities for screening in low-risk individuals.METHODS This retrospective study included patients at low risk for pancreatic cancer who underwent MRI or EUS at two health evaluation centers between March 2019 and December 2024.Basic characteristics,laboratory data,and imaging results were collected.RESULTS A total of 3364 low-risk individuals underwent pancreatic screening:1553(46.1%)received MRI,and 1811 underwent EUS.No significant differences were observed in age or sex distribution between the groups.In imaging screening,EUS demonstrated a higher detection rate of abnormal pancreatic lesions(12.8%vs 2.6%;P<0.001).MRI detected more cystic lesions than did EUS(P<0.001).EUS identified smaller nodular lesions compared to MRI(9.2 mm vs 18.0 mm;P=0.044).The MRI group had a higher number of confirmed intraductal papillary mucinous neoplasms(P=0.031),whereas the EUS group identified more suspected branch-duct intraductal papillary mucinous neoplasms(P<0.001).Pancreatic adenocarcinoma was found in three patients(0.08%),with no significant difference in detection rates between EUS and MRI(0.11%vs 0.06%;P=0.656).CONCLUSION In low-risk individuals,MRI and EUS offer comparable effectiveness for pancreatic cancer surveillance.The choice of imaging strategy for health evaluation depends on cost considerations and degree of invasiveness.展开更多
Purpose:While the mental health impact of a prostate cancer diagnosis,including low-risk prostate cancer,is well-documented,the effect of pre-existing anxiety and/or depression on adherence to active surveillance prot...Purpose:While the mental health impact of a prostate cancer diagnosis,including low-risk prostate cancer,is well-documented,the effect of pre-existing anxiety and/or depression on adherence to active surveillance protocols in low-risk prostate cancer patients remains unclear.This study assessed the association between prior anxiety and/or depression and active surveillance adherence in men with low-risk prostate cancer.Methods:We conducted a retrospective,multicenter study involving 426 men diagnosed with low-risk prostate cancer who were recommended active surveillance as the primary management strategy.Active surveillance adherence was defined by completion of both a prostate-specific antigen test and a prostate biopsy within 18 months of diagnosis.Premature treatment was identified as definitive treatment,either through radiation therapy or radical prostatectomy.Results:Men with a prior mental health diagnosis were significantly less likely to adhere to active surveillance than those without such a diagnosis(27.6%vs.49.5%,p=0.006).These individuals had lower adherence rates for prostate-specific testing(58.6%vs.73.4%)and biopsy(27.6%vs.50.0%)and were more likely to abandon active surveillance in favor of immediate treatment(39.7%vs.25.0%,p=0.005).No significant differences were observed between patients with both anxiety and depression versus those with a single diagnosis.Conclusions:Pre-existing anxiety and/or depression is associated with reduced active surveillance adherence and a greater likelihood of premature treatment in men with low-risk prostate cancer.These findings highlight the importance of addressing psychiatric factors in lowrisk prostate cancer management and suggest avenues for future research.展开更多
Objective:To observe the effect of different doses and frequencies of roxadustat on low-risk patients with myelodysplastic syndromes(MDS).Methods:This study was conducted using a comparative treatment observation appr...Objective:To observe the effect of different doses and frequencies of roxadustat on low-risk patients with myelodysplastic syndromes(MDS).Methods:This study was conducted using a comparative treatment observation approach.Low-risk MDS patients admitted to our hospital from February 2022 to February 2023 were selected,excluding patients with a history of severe drug allergies or known allergies to roxadustat.A total of 60 patients were included and randomly divided into observation group A(20 cases,100 mg,twice weekly),observation group B(20 cases,50 mg,once daily),and observation group C(20 cases,150 mg,twice weekly).Patient recovery,adverse reaction rate,and hemoglobin recovery time were compared and statistically analyzed.Results:The recovery rate of group B in the observation group was significantly higher than that in the other two groups,and the incidence of adverse reactions and the time to Hb recovery were also better in group B than in the other two groups(p<0.05).Conclusion:Low-dose,high-frequency(50 mg,once daily)administration can effectively improve the hemoglobin level of low-risk MDS patients and help improve their general survival.展开更多
Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer ...Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate cancer treated with radical prostatectomy at our institution between 2000 and 2012. Patients with neoadjuvant treatments were excluded. We retrospectively reviewed the clinical and pathological outcomes for patients with VLR or LR prostate cancers that were classified by NCCN guidelines. Results: We identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137 patients with LR (p = 0.56). However, none of the 19 patients >65 years old with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer, 14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04 and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR and LR had similarly favorable outcomes, but patients >65 years old with VLR had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our results support the treatment strategy of the NCCN that patients with VLR cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including active surveillance and aggressive treatments—can be applied to the remaining patients with VLR or LR cancers.展开更多
Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cance...Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.展开更多
To reduce treatment-related side effects in low-risk prostate cancer(PCa),both focal therapy and deferred treatments,including active surveillance(AS)and watchful waiting(WW),are worth considering over radical prostat...To reduce treatment-related side effects in low-risk prostate cancer(PCa),both focal therapy and deferred treatments,including active surveillance(AS)and watchful waiting(WW),are worth considering over radical prostatectomy(RP).Therefore,this study aimed to compare long-term survival outcomes between focal therapy and AS/WW.Data were obtained and analyzed from the Surveillance,Epidemiology,and End Results(SEER)database.Patients with low-risk PCa who received focal therapy or AS/WW from 2010 to 2016 were included.Focal therapy included cryotherapy and laser ablation.Multivariate Cox proportional hazards models were used to compare overall mortality(OM)and cancer-specific mortality(CSM)between AS/WW and focal therapy,and propensity score matching(PSM)was performed to reduce the influence of bias and unmeasured confounders.A total of 19292 patients with low-risk PCa were included in this study.In multivariate Cox proportional hazards model analysis,the risk of OM was higher in patients receiving focal therapy than those receiving AS/WW(hazard ratio[HR]=1.35,95%confidence interval[CI]:1.02–1.79,P=0.037),whereas no significant difference was found in CSM(HR=0.98,95%CI:0.23–4.11,P=0.977).After PSM,the OM and CSM of focal therapy and AS/WW showed no significant differences(HR=1.26,95%CI:0.92–1.74,P=0.149;and HR=1.26,95%CI:0.24–6.51,P=0.782,respectively).For patients with low-risk PCa,focal therapy was no match for AS/WW in decreasing OM,suggesting that AS/WW could bring more overall survival benefits.展开更多
Prostate cancer(PCa)is the second-most common cancer among men.Both active surveillance or watchful waiting(AS/WW)and focal laser ablation(FLA)can avoid the complications caused by radical treatment.How to make the ch...Prostate cancer(PCa)is the second-most common cancer among men.Both active surveillance or watchful waiting(AS/WW)and focal laser ablation(FLA)can avoid the complications caused by radical treatment.How to make the choice between these options in clinical practice needs further study.Therefore,this study aims to compare and analyze their effects based on overall survival(OS)and cancer-specific survival(CSS)to obtain better long-term benefits.We included patients with low-risk PCa from the Surveillance Epidemiology and End Results database of 2010–2016.Multivariate Cox proportional hazard analyses were conducted for OS and CSS in the two groups.To eliminate bias,this study applied a series of sensitivity analyses.Moreover,Kaplan–Meier curves were plotted to obtain survival status.A total of 18841 patients with low-risk PCa were included,with a median of 36-month follow-up.According to the multivariate Cox proportional hazard regression,the FLA group presented inferior survival benefits in OS than the AS/WW group(hazard ratio[HR]:2.13,95%confidence interval[CI]:1.37–3.33,P<0.05).After adjusting for confounders,the result persisted(HR:1.69,95%CI:1.02–2.81,P<0.05).According to the results of the sensitivity analysis,the inverse probability of the treatment weighing model indicated the same result in OS.In conclusion,AS/WW and FLA have the advantage of fewer side effects and the benefit of avoiding overtreatment compared with standard treatment.Our study suggested that AS/WW provides more survival benefits for patients with low-risk PCa.More relevant researches and data will be needed for further clarity.展开更多
Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment f...Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retrospective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through December 31, 2014 who were treated with either active surveillance, radical prostatectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06;p-value = 0.1794;and p-value = 1.00;respectively). Adjusting for age at diagnosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value Conclusions: We found no association between travel distance and treatment choice for low-risk prostate cancer. Treatment choice was associated with institution which may suggest institutional bias in patterns of care.展开更多
Background Transcatheter aortic valve replacement(TAVR)for the treatment symptomatic severe aortic stenosis(AS)is indicated in patients with intermediate or higher surgical risk.Latest trials showed TAVR,and surgical ...Background Transcatheter aortic valve replacement(TAVR)for the treatment symptomatic severe aortic stenosis(AS)is indicated in patients with intermediate or higher surgical risk.Latest trials showed TAVR,and surgical aortic valve replacement(SAVR)perform similarly at 1-year for the composite outcomes of mortality,stroke and rehospitalization.We performed a comprehensive meta-analysis to compare individual outcomes at 1-year for TAVR compared to SAVR in low-risk patients.Methods Pub Med,Embase,and Cochrane central were searched for all the randomized controlled trials(RCTs)that reported 1-year comparative outcomes of TAVR and surgical aortic valve replacement(SAVR).Our conclusions are based upon the random-effects model using Der Simonian-Laird estimator.Results Data from 4 trials and 2887 randomized patients showed that TAVR had lower rates of all-cause mortality,cardiovascular mortality,and atrial fibrillation compared to SAVR at 1-year follow-up(P<0.05 for all).Also,TAVR was also associated with a significantly higher risk of permanent pacemaker implantation and moderate-severe paravalvular leak(P<0.05).Conclusions The latest randomised trial data demonstrates that in short-term,TAVR is safe and effective in reducing all-cause mortality or stroke.Longer follow-up of RCTs is needed to determine the durability of clinical benefits in TAVR over SAVR in low-risk patients.展开更多
Background Low-risk neuroblastomas have favorable biologic characteristics.Children Oncology Group (COG) proposed that surgical resection of the primary tumor was sufficient.We evaluated the long-term prognosis of sur...Background Low-risk neuroblastomas have favorable biologic characteristics.Children Oncology Group (COG) proposed that surgical resection of the primary tumor was sufficient.We evaluated the long-term prognosis of surgery alone for patients with low-risk neuroblastoma in China.Methods A total of 34 patients with low-risk neuroblastoma were treated in our center between Jan 2009 and Dec 2013.The medical records of these patients were reviewed.Results The primary lesion was located in the adrenal gland in 19 patients,the retroperitoneum in 5,the posterior mediastinum in 9 and the neck in 1.The tumor diameters and volumes were 1.80-10.0 cm (average 5.5 ±2.3 cm) and 1.28-424.10 cm3 (average 58.81 ± 92.00 cm3),respectively.The stages of the patients were as follows:stage Ⅰ in 25,stage Ⅱ in 7,and stage Ⅳs in 2.All patients were in the low-risk group according to COG risk stratification criteria.No patients showed MYCN amplification.The primary tumors of all patients were completely resected.Nine adrenal tumors were completely resected by laparoscopy.All patients were successfully followed for 66-115 (average 89.71 ± 16.17) months.Recurrence was observed in 4 patients.In addition to one local recurrence,another three recurrences were metastases.The lesions were effectively controlled in all patients with recurrences.All patients survived,including 28 cases of tumor-free survival;the 4-year overall and event-free survival rates were both 100%.Conclusions Surgery alone is a safe and effective treatment strategy for low-risk neuroblastoma.Recurrent lesions may be controlled and treated by rescue chemotherapy and surgery.展开更多
Background:The current standard of care for non-bulky diffuse large B-cell lymphoma(DLBCL)patients with an International Prognostic Index(IPI)of 0 is four cycles of rituximab plus cyclophosphamide,doxorubicin,vincrist...Background:The current standard of care for non-bulky diffuse large B-cell lymphoma(DLBCL)patients with an International Prognostic Index(IPI)of 0 is four cycles of rituximab plus cyclophosphamide,doxorubicin,vincristine and prednisone(R-CHOP)but whether the same efficacy can be achieved with reduced chemotherapy regimen of four cycles for non-bulky DLBCL patients with an IPI of 1 remains unclear.This study compared four cycles versus six cycles of chemotherapy in non-bulky low-risk DLBCL patients with negative interim positron emission tomography with computed tomography(PET-CT,Deauville 1-3),irrespective of age and other IPI risk factors(IPI 0-1).Methods:This was an open-label,randomized,phaseⅢ,non-inferiority trial.Patients aged 14-75 years with newly diagnosed low-risk DLBCL,according to IPI,achieving PET-CT confirmed complete response(CR)after four cycles of R-CHOPwere randomized(1:1)between four cycles of rituximab(4R-CHOP+4R arm)or two cycles of R-CHOP plus two cycles of rituximab(6R-CHOP+2R arm).The primary endpoint was 2-year progression-free survival(PFS),conducted in the intention-to-treat population.Safety was assessed in patients with at least one cycle of assigned treatment.The non-inferiority margin was-8%.Results:A total of 287 patients were included in the intention-to-treat analysis,the median follow-up was 47.3 months,and the 2-year PFS rate was 95%(95%confidence interval[CI],92%to 99%)and 94%(95%CI,91%to 98%)for the 4R-CHOP+4R and 6R-CHOP+2R arm.The absolute difference in 2-year PFS between the two arms was 1%(95%CI,-5%to 7%),supporting the non-inferiority of 4R-CHOP+4R.Grade 3-4 neutropenia was lower in the last four cycles of rituximab alone in the 4R-CHOP+4R arm(16.7%versus 76.9%),with decreased risk of febrile neutropenia(0.0%versus 8.4%)and infection(2.1%versus 14.0%).Conclusions:For newly diagnosed low-risk DLBCL patients,interim PET-CT after four cycles of R-CHOP was effective in identifying patients with Deauville 1-3 who would have a good response and Deauville 4-5 patients who might have high-risk biological features or develop resistance.Reducing the standard six cycles to four cycles of chemotherapy had comparable clinical efficacy and fewer adverse events in low-risk,non-bulky DLBCL with interim PET-CT confirmed CR.展开更多
目的分析中国1990—2023年下腰痛疾病负担的变化趋势和归因危险因素,预测2030年下腰痛的相关疾病负担。方法基于2023年全球疾病负担研究(Global Burden of Disease,GBD)数据库,分析中国下腰痛人群1990—2023年的发病率、患病率、伤残损...目的分析中国1990—2023年下腰痛疾病负担的变化趋势和归因危险因素,预测2030年下腰痛的相关疾病负担。方法基于2023年全球疾病负担研究(Global Burden of Disease,GBD)数据库,分析中国下腰痛人群1990—2023年的发病率、患病率、伤残损失寿命年(years lived with disability,YLDs)和归因危险因素的特点及变化趋势,评估疾病负担的年龄与性别差异,通过自回归积分滑动平均模型与年龄-时期-队列模型对2030年疾病负担进行双模型联合预测。结果从1990年至2023年,中国下腰痛发病人数、患病人数、YLDs均呈上升趋势,分别由2998.91万例、6863.63万例、773.24万人年上升至4138.36万例、9532.40万例、1063.59万人年;发病率、患病率、YLDs率亦呈上升趋势,分别从2543.31/10万、5820.89/10万、655.77/10万上升至2892.65/10万、6663.01/10万、743.43/10万;然而年龄标准化发病率、患病率、YLDs率呈下降趋势,分别从2859.73/10万、6636.60/10万、740.83/10万下降至2164.80/10万、4929.78/10万、551.92/10万。下腰痛疾病负担呈现出女性明显高于男性且随年龄增加逐渐升高的特征(高峰为50~59岁)。归因分析示,吸烟、职业因素和高身体质量指数(body mass index,BMI)是导致YLDs增加的主要因素且存在性别差异。双模型显示,2023—2030年下腰痛的年龄标准化发病率、患病率和YLDs率将从2023年后呈逐年下降趋势。结论中国下腰痛疾病负担显示,1990—2023年中国人群的下腰痛负担逐年加重,吸烟、职业因素和高BMI是主要危险因素。预计到2030年,下腰痛的疾病负担将有所下降,但绝对疾病负担仍将维持高位,应关注疾病负担更重的中老年群体尤其是女性群体,并积极针对这些可控风险因素采取体质量控制与控烟管理等针对性措施。展开更多
文摘BACKGROUND Magnetic resonance imaging(MRI)and endoscopic ultrasonography(EUS)are recommended in combination for screening pancreatic cancer in high-risk individuals.However,in clinical practice,MRI and EUS are increasingly utilized for pancreatic surveillance during routine health examinations.AIM To investigate the feasibility of these imaging modalities for screening in low-risk individuals.METHODS This retrospective study included patients at low risk for pancreatic cancer who underwent MRI or EUS at two health evaluation centers between March 2019 and December 2024.Basic characteristics,laboratory data,and imaging results were collected.RESULTS A total of 3364 low-risk individuals underwent pancreatic screening:1553(46.1%)received MRI,and 1811 underwent EUS.No significant differences were observed in age or sex distribution between the groups.In imaging screening,EUS demonstrated a higher detection rate of abnormal pancreatic lesions(12.8%vs 2.6%;P<0.001).MRI detected more cystic lesions than did EUS(P<0.001).EUS identified smaller nodular lesions compared to MRI(9.2 mm vs 18.0 mm;P=0.044).The MRI group had a higher number of confirmed intraductal papillary mucinous neoplasms(P=0.031),whereas the EUS group identified more suspected branch-duct intraductal papillary mucinous neoplasms(P<0.001).Pancreatic adenocarcinoma was found in three patients(0.08%),with no significant difference in detection rates between EUS and MRI(0.11%vs 0.06%;P=0.656).CONCLUSION In low-risk individuals,MRI and EUS offer comparable effectiveness for pancreatic cancer surveillance.The choice of imaging strategy for health evaluation depends on cost considerations and degree of invasiveness.
文摘Purpose:While the mental health impact of a prostate cancer diagnosis,including low-risk prostate cancer,is well-documented,the effect of pre-existing anxiety and/or depression on adherence to active surveillance protocols in low-risk prostate cancer patients remains unclear.This study assessed the association between prior anxiety and/or depression and active surveillance adherence in men with low-risk prostate cancer.Methods:We conducted a retrospective,multicenter study involving 426 men diagnosed with low-risk prostate cancer who were recommended active surveillance as the primary management strategy.Active surveillance adherence was defined by completion of both a prostate-specific antigen test and a prostate biopsy within 18 months of diagnosis.Premature treatment was identified as definitive treatment,either through radiation therapy or radical prostatectomy.Results:Men with a prior mental health diagnosis were significantly less likely to adhere to active surveillance than those without such a diagnosis(27.6%vs.49.5%,p=0.006).These individuals had lower adherence rates for prostate-specific testing(58.6%vs.73.4%)and biopsy(27.6%vs.50.0%)and were more likely to abandon active surveillance in favor of immediate treatment(39.7%vs.25.0%,p=0.005).No significant differences were observed between patients with both anxiety and depression versus those with a single diagnosis.Conclusions:Pre-existing anxiety and/or depression is associated with reduced active surveillance adherence and a greater likelihood of premature treatment in men with low-risk prostate cancer.These findings highlight the importance of addressing psychiatric factors in lowrisk prostate cancer management and suggest avenues for future research.
文摘Objective:To observe the effect of different doses and frequencies of roxadustat on low-risk patients with myelodysplastic syndromes(MDS).Methods:This study was conducted using a comparative treatment observation approach.Low-risk MDS patients admitted to our hospital from February 2022 to February 2023 were selected,excluding patients with a history of severe drug allergies or known allergies to roxadustat.A total of 60 patients were included and randomly divided into observation group A(20 cases,100 mg,twice weekly),observation group B(20 cases,50 mg,once daily),and observation group C(20 cases,150 mg,twice weekly).Patient recovery,adverse reaction rate,and hemoglobin recovery time were compared and statistically analyzed.Results:The recovery rate of group B in the observation group was significantly higher than that in the other two groups,and the incidence of adverse reactions and the time to Hb recovery were also better in group B than in the other two groups(p<0.05).Conclusion:Low-dose,high-frequency(50 mg,once daily)administration can effectively improve the hemoglobin level of low-risk MDS patients and help improve their general survival.
文摘Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate cancer treated with radical prostatectomy at our institution between 2000 and 2012. Patients with neoadjuvant treatments were excluded. We retrospectively reviewed the clinical and pathological outcomes for patients with VLR or LR prostate cancers that were classified by NCCN guidelines. Results: We identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137 patients with LR (p = 0.56). However, none of the 19 patients >65 years old with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer, 14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04 and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR and LR had similarly favorable outcomes, but patients >65 years old with VLR had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our results support the treatment strategy of the NCCN that patients with VLR cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including active surveillance and aggressive treatments—can be applied to the remaining patients with VLR or LR cancers.
文摘Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.
基金supported by the National Key Research and Development Program of China(SQ2017YFSF090096)the National Natural Science Foundation of China(81770756)the Sichuan Science and Technology Program(2017HH0063)。
文摘To reduce treatment-related side effects in low-risk prostate cancer(PCa),both focal therapy and deferred treatments,including active surveillance(AS)and watchful waiting(WW),are worth considering over radical prostatectomy(RP).Therefore,this study aimed to compare long-term survival outcomes between focal therapy and AS/WW.Data were obtained and analyzed from the Surveillance,Epidemiology,and End Results(SEER)database.Patients with low-risk PCa who received focal therapy or AS/WW from 2010 to 2016 were included.Focal therapy included cryotherapy and laser ablation.Multivariate Cox proportional hazards models were used to compare overall mortality(OM)and cancer-specific mortality(CSM)between AS/WW and focal therapy,and propensity score matching(PSM)was performed to reduce the influence of bias and unmeasured confounders.A total of 19292 patients with low-risk PCa were included in this study.In multivariate Cox proportional hazards model analysis,the risk of OM was higher in patients receiving focal therapy than those receiving AS/WW(hazard ratio[HR]=1.35,95%confidence interval[CI]:1.02–1.79,P=0.037),whereas no significant difference was found in CSM(HR=0.98,95%CI:0.23–4.11,P=0.977).After PSM,the OM and CSM of focal therapy and AS/WW showed no significant differences(HR=1.26,95%CI:0.92–1.74,P=0.149;and HR=1.26,95%CI:0.24–6.51,P=0.782,respectively).For patients with low-risk PCa,focal therapy was no match for AS/WW in decreasing OM,suggesting that AS/WW could bring more overall survival benefits.
文摘Prostate cancer(PCa)is the second-most common cancer among men.Both active surveillance or watchful waiting(AS/WW)and focal laser ablation(FLA)can avoid the complications caused by radical treatment.How to make the choice between these options in clinical practice needs further study.Therefore,this study aims to compare and analyze their effects based on overall survival(OS)and cancer-specific survival(CSS)to obtain better long-term benefits.We included patients with low-risk PCa from the Surveillance Epidemiology and End Results database of 2010–2016.Multivariate Cox proportional hazard analyses were conducted for OS and CSS in the two groups.To eliminate bias,this study applied a series of sensitivity analyses.Moreover,Kaplan–Meier curves were plotted to obtain survival status.A total of 18841 patients with low-risk PCa were included,with a median of 36-month follow-up.According to the multivariate Cox proportional hazard regression,the FLA group presented inferior survival benefits in OS than the AS/WW group(hazard ratio[HR]:2.13,95%confidence interval[CI]:1.37–3.33,P<0.05).After adjusting for confounders,the result persisted(HR:1.69,95%CI:1.02–2.81,P<0.05).According to the results of the sensitivity analysis,the inverse probability of the treatment weighing model indicated the same result in OS.In conclusion,AS/WW and FLA have the advantage of fewer side effects and the benefit of avoiding overtreatment compared with standard treatment.Our study suggested that AS/WW provides more survival benefits for patients with low-risk PCa.More relevant researches and data will be needed for further clarity.
文摘Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retrospective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through December 31, 2014 who were treated with either active surveillance, radical prostatectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06;p-value = 0.1794;and p-value = 1.00;respectively). Adjusting for age at diagnosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value Conclusions: We found no association between travel distance and treatment choice for low-risk prostate cancer. Treatment choice was associated with institution which may suggest institutional bias in patterns of care.
文摘Background Transcatheter aortic valve replacement(TAVR)for the treatment symptomatic severe aortic stenosis(AS)is indicated in patients with intermediate or higher surgical risk.Latest trials showed TAVR,and surgical aortic valve replacement(SAVR)perform similarly at 1-year for the composite outcomes of mortality,stroke and rehospitalization.We performed a comprehensive meta-analysis to compare individual outcomes at 1-year for TAVR compared to SAVR in low-risk patients.Methods Pub Med,Embase,and Cochrane central were searched for all the randomized controlled trials(RCTs)that reported 1-year comparative outcomes of TAVR and surgical aortic valve replacement(SAVR).Our conclusions are based upon the random-effects model using Der Simonian-Laird estimator.Results Data from 4 trials and 2887 randomized patients showed that TAVR had lower rates of all-cause mortality,cardiovascular mortality,and atrial fibrillation compared to SAVR at 1-year follow-up(P<0.05 for all).Also,TAVR was also associated with a significantly higher risk of permanent pacemaker implantation and moderate-severe paravalvular leak(P<0.05).Conclusions The latest randomised trial data demonstrates that in short-term,TAVR is safe and effective in reducing all-cause mortality or stroke.Longer follow-up of RCTs is needed to determine the durability of clinical benefits in TAVR over SAVR in low-risk patients.
文摘Background Low-risk neuroblastomas have favorable biologic characteristics.Children Oncology Group (COG) proposed that surgical resection of the primary tumor was sufficient.We evaluated the long-term prognosis of surgery alone for patients with low-risk neuroblastoma in China.Methods A total of 34 patients with low-risk neuroblastoma were treated in our center between Jan 2009 and Dec 2013.The medical records of these patients were reviewed.Results The primary lesion was located in the adrenal gland in 19 patients,the retroperitoneum in 5,the posterior mediastinum in 9 and the neck in 1.The tumor diameters and volumes were 1.80-10.0 cm (average 5.5 ±2.3 cm) and 1.28-424.10 cm3 (average 58.81 ± 92.00 cm3),respectively.The stages of the patients were as follows:stage Ⅰ in 25,stage Ⅱ in 7,and stage Ⅳs in 2.All patients were in the low-risk group according to COG risk stratification criteria.No patients showed MYCN amplification.The primary tumors of all patients were completely resected.Nine adrenal tumors were completely resected by laparoscopy.All patients were successfully followed for 66-115 (average 89.71 ± 16.17) months.Recurrence was observed in 4 patients.In addition to one local recurrence,another three recurrences were metastases.The lesions were effectively controlled in all patients with recurrences.All patients survived,including 28 cases of tumor-free survival;the 4-year overall and event-free survival rates were both 100%.Conclusions Surgery alone is a safe and effective treatment strategy for low-risk neuroblastoma.Recurrent lesions may be controlled and treated by rescue chemotherapy and surgery.
基金National Natural Science Foundation of China,Grant/Award Numbers:81830007,82130004,82170178,82200201,82070204National Key Research and Development Program of China,Grant/Award Number:2022YFC2502600+5 种基金Chang Jiang Scholars ProgramShanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support,Grant/Award Numbers:20152206,20152208Clinical Research Plan of Shanghai Hospital Development Center,Grant/Award Numbers:SHDC2020CR1032B,SHDC2022CRD033Multicenter Clinical Research Project by Shanghai Jiao Tong University School of Medicine,Grant/Award Number:DLY201601Collaborative Innovation Center of Systems BiomedicineSamuel Waxman Cancer Research Foundation。
文摘Background:The current standard of care for non-bulky diffuse large B-cell lymphoma(DLBCL)patients with an International Prognostic Index(IPI)of 0 is four cycles of rituximab plus cyclophosphamide,doxorubicin,vincristine and prednisone(R-CHOP)but whether the same efficacy can be achieved with reduced chemotherapy regimen of four cycles for non-bulky DLBCL patients with an IPI of 1 remains unclear.This study compared four cycles versus six cycles of chemotherapy in non-bulky low-risk DLBCL patients with negative interim positron emission tomography with computed tomography(PET-CT,Deauville 1-3),irrespective of age and other IPI risk factors(IPI 0-1).Methods:This was an open-label,randomized,phaseⅢ,non-inferiority trial.Patients aged 14-75 years with newly diagnosed low-risk DLBCL,according to IPI,achieving PET-CT confirmed complete response(CR)after four cycles of R-CHOPwere randomized(1:1)between four cycles of rituximab(4R-CHOP+4R arm)or two cycles of R-CHOP plus two cycles of rituximab(6R-CHOP+2R arm).The primary endpoint was 2-year progression-free survival(PFS),conducted in the intention-to-treat population.Safety was assessed in patients with at least one cycle of assigned treatment.The non-inferiority margin was-8%.Results:A total of 287 patients were included in the intention-to-treat analysis,the median follow-up was 47.3 months,and the 2-year PFS rate was 95%(95%confidence interval[CI],92%to 99%)and 94%(95%CI,91%to 98%)for the 4R-CHOP+4R and 6R-CHOP+2R arm.The absolute difference in 2-year PFS between the two arms was 1%(95%CI,-5%to 7%),supporting the non-inferiority of 4R-CHOP+4R.Grade 3-4 neutropenia was lower in the last four cycles of rituximab alone in the 4R-CHOP+4R arm(16.7%versus 76.9%),with decreased risk of febrile neutropenia(0.0%versus 8.4%)and infection(2.1%versus 14.0%).Conclusions:For newly diagnosed low-risk DLBCL patients,interim PET-CT after four cycles of R-CHOP was effective in identifying patients with Deauville 1-3 who would have a good response and Deauville 4-5 patients who might have high-risk biological features or develop resistance.Reducing the standard six cycles to four cycles of chemotherapy had comparable clinical efficacy and fewer adverse events in low-risk,non-bulky DLBCL with interim PET-CT confirmed CR.
文摘目的分析中国1990—2023年下腰痛疾病负担的变化趋势和归因危险因素,预测2030年下腰痛的相关疾病负担。方法基于2023年全球疾病负担研究(Global Burden of Disease,GBD)数据库,分析中国下腰痛人群1990—2023年的发病率、患病率、伤残损失寿命年(years lived with disability,YLDs)和归因危险因素的特点及变化趋势,评估疾病负担的年龄与性别差异,通过自回归积分滑动平均模型与年龄-时期-队列模型对2030年疾病负担进行双模型联合预测。结果从1990年至2023年,中国下腰痛发病人数、患病人数、YLDs均呈上升趋势,分别由2998.91万例、6863.63万例、773.24万人年上升至4138.36万例、9532.40万例、1063.59万人年;发病率、患病率、YLDs率亦呈上升趋势,分别从2543.31/10万、5820.89/10万、655.77/10万上升至2892.65/10万、6663.01/10万、743.43/10万;然而年龄标准化发病率、患病率、YLDs率呈下降趋势,分别从2859.73/10万、6636.60/10万、740.83/10万下降至2164.80/10万、4929.78/10万、551.92/10万。下腰痛疾病负担呈现出女性明显高于男性且随年龄增加逐渐升高的特征(高峰为50~59岁)。归因分析示,吸烟、职业因素和高身体质量指数(body mass index,BMI)是导致YLDs增加的主要因素且存在性别差异。双模型显示,2023—2030年下腰痛的年龄标准化发病率、患病率和YLDs率将从2023年后呈逐年下降趋势。结论中国下腰痛疾病负担显示,1990—2023年中国人群的下腰痛负担逐年加重,吸烟、职业因素和高BMI是主要危险因素。预计到2030年,下腰痛的疾病负担将有所下降,但绝对疾病负担仍将维持高位,应关注疾病负担更重的中老年群体尤其是女性群体,并积极针对这些可控风险因素采取体质量控制与控烟管理等针对性措施。
