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
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
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
In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of tre...In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.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
An enduring debate in research revolves around the association between elevated endogenous testosterone levels and prostate cancer. This systematic review is intended to assess the present understanding of the role of...An enduring debate in research revolves around the association between elevated endogenous testosterone levels and prostate cancer. This systematic review is intended to assess the present understanding of the role of endogenous testosterone in the diagnosis and treatment of low- and intermediate-risk prostate cancer. Our search strategy was the following: (endogenous testosterone) AND (((low risk) OR (intermediate risk)) AND ((diagnosis) OR (treatment))) AND (prostate cancer);that was applied to PubMed, Web of Science, and Scopus databases to identify pertinent articles. Two investigators performed an independent selection following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The preliminary investigation detected 105 records, and 81 records remained after eliminating duplicates. Following the review of titles and abstracts, 71 articles were excluded. A comprehensive examination of the full text was conducted for 10 articles, excluding 3 of them. After revising the references of eligible articles, other 3 articles were included. We finally identified 10 suitable studies, including three main topics: (1) association between endogenous testosterone and European Association of Urology (EAU) risk classes;(2) association between endogenous testosterone density and the tumor load;and (3) association of endogenous testosterone with tumor upgrading and tumor upstaging. Actual literature about the impact of endogenous testosterone on low- and intermediate-risk prostate cancer is not numerous, but appears to be still conflicting. More investigations are needed to increase the consistency of the literature’s results.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
Human papillomaviruses(HPVs) have been detected in cervical cancer cells and skin papilloma cells, which have a variety of types, including low-risk and high-risk types. HPV genome replication requires the host cell&#...Human papillomaviruses(HPVs) have been detected in cervical cancer cells and skin papilloma cells, which have a variety of types, including low-risk and high-risk types. HPV genome replication requires the host cell's DNA synthesis machinery, and HPVs encode proteins that maintain differentiated epithelial cells in a replication-competent state. HPV types are tissue-specific and generally produce different types of lesions, either benign or malignant. This review examines different HPV types and their associated diseases and presents therapeutic options for the treatment of HPV-positive diseases.展开更多
Objective: To investigate the influence of the new coronavirus epidemic on tumor radiotherapy patients in Zigong City, and provide radiotherapy feasibility and safety in other prefecture-level or low-risk areas. Metho...Objective: To investigate the influence of the new coronavirus epidemic on tumor radiotherapy patients in Zigong City, and provide radiotherapy feasibility and safety in other prefecture-level or low-risk areas. Methods: Retrospective Collection of data from January 31, 2020, in our hospital, this time period is an epidemic group. The control group was data from January 31, 2019-May 31, in our hospital. Patient data includes gender, age, tumor type, hospitalization fee, average hospitalization day, radiotherapy completion, treatment destination, and other information. Results: The patients with epidemic groups and control groups were 320 and 237, respectively, and the radiotherapy patients increased by 25.9%, increasing patients mainly from other departures outside the tumor department underperformance reform intervention. The epidemic group of brain and breast tumor patients were 39 and 37, respectively, with statistical differences (P < 0.05) compared to the control group (25 and 16 respectively). The number of tumor radiotherapy patients in other parts increased, but there was no statistical difference (P > 0.05). Inpatient costs, the average hospitalization day, radiotherapy completion, the purpose of treatment, and other data epidemic groups and control groups have no statistical difference (P > 0.05). Conclusion: The number of COVID-2019 epidemic interventions has increased the number of cancer radiotherapy patients in our hospital, and the epidemic situation has no effect on hospitalization, the average hospitalization day, radiotherapy, and the like. Optimizing the process of clinical treatment, strict prevention and control measures can ensure timely and safe radiotherapy in low-risk areas.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
How do you pick stocks in China? Which sectors in the Ashare market have the greatest investment potential? What problems would China's stock market face if the economy contracts? These are questions Xinhua Financ...How do you pick stocks in China? Which sectors in the Ashare market have the greatest investment potential? What problems would China's stock market face if the economy contracts? These are questions Xinhua Finance's Money Journal recently put to the man responsible for Franklin Templeton Investments' fund management business in China,India and Brazil. Stephen H. Dover, Managing Director and International Chief Investment Officer for Franklin Templeton Advisors, the largest listed fund management company in...展开更多
A nonlinear mathematical model is proposed and analyzed to study the dynamics of 2009 HIN1 flu epidemic in a homogeneous population with constant immigration of susceptibles. The effect of contact tracing and quaranti...A nonlinear mathematical model is proposed and analyzed to study the dynamics of 2009 HIN1 flu epidemic in a homogeneous population with constant immigration of susceptibles. The effect of contact tracing and quarantine （isolation） strategies in reduc- ing the spread of H1N1 flu is incorporated. The model monitors the dynamics of five sub-populations （classes）, namely susceptible with high infection risk, susceptible with reduction of infection risk, infective, quarantined and recovered individuals. The model analysis includes the determination of equilibrium points and carrying out their stability analysis in terms of the threshold parameter R0. Moreover, the numerical simulation of the proposed model is also performed by using fourth order Runge-Kutta method along with the sensitivity analysis of the endemic equilibrium point. The analysis and numeri- cal simulation results demonstrate that the maximum implementation of contact tracing and quarantine strategies help in reducing endemic infective class size and hence act as effective intervention strategy to control the disease. This gives a theoretical interpreta- tion to the practical experiences that the early contact tracing and quarantine strategies are criticMly important to control the outbreak of epidemics.展开更多
This work examines a mathematical model of COVID-19 among two subgroups:low-risk and high-risk populations with two preventive measures;non-pharmaceutical interventions including wearing masks,maintaining social dista...This work examines a mathematical model of COVID-19 among two subgroups:low-risk and high-risk populations with two preventive measures;non-pharmaceutical interventions including wearing masks,maintaining social distance,and washing hands regularly by the low-risk group.In addition to the interventions mentioned above,highrisk individuals must take extra precaution measures,including telework,avoiding social gathering or public places,etc.to reduce the transmission.Those with underlying chronic diseases and the elderly(ages 60 and above)were classified as high-risk individuals and the rest as low-risk individuals.The parameter values used in this study were estimated using the available data from the Johns Hopkins University on COVID-19 for Brazil and South Africa.We evaluated the effective reproduction number for the two countries and observed how the various parameters affected the effective reproduction number.We also performed numerical simulations and analysis of the model.Susceptible and infectious populations for both low-risk and high-risk individuals were studied in detail.Results were displayed in both graphical and table forms to show the dynamics of each country being studied.We observed that non-pharmaceutical interventions by highrisk individuals significantly reduce infections among only high-risk individuals.In contrast,non-pharmaceutical interventions by low-risk individuals have a significant reduction in infections in both subgroups.Therefore,low-risk individuals’preventive actions have a considerable effect on reducing infections,even among high-risk individuals.展开更多
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In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.
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An enduring debate in research revolves around the association between elevated endogenous testosterone levels and prostate cancer. This systematic review is intended to assess the present understanding of the role of endogenous testosterone in the diagnosis and treatment of low- and intermediate-risk prostate cancer. Our search strategy was the following: (endogenous testosterone) AND (((low risk) OR (intermediate risk)) AND ((diagnosis) OR (treatment))) AND (prostate cancer);that was applied to PubMed, Web of Science, and Scopus databases to identify pertinent articles. Two investigators performed an independent selection following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The preliminary investigation detected 105 records, and 81 records remained after eliminating duplicates. Following the review of titles and abstracts, 71 articles were excluded. A comprehensive examination of the full text was conducted for 10 articles, excluding 3 of them. After revising the references of eligible articles, other 3 articles were included. We finally identified 10 suitable studies, including three main topics: (1) association between endogenous testosterone and European Association of Urology (EAU) risk classes;(2) association between endogenous testosterone density and the tumor load;and (3) association of endogenous testosterone with tumor upgrading and tumor upstaging. Actual literature about the impact of endogenous testosterone on low- and intermediate-risk prostate cancer is not numerous, but appears to be still conflicting. More investigations are needed to increase the consistency of the literature’s results.
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.
基金Supported by a grant from the National Natural Science Foundation of China(No.81260301)
文摘Human papillomaviruses(HPVs) have been detected in cervical cancer cells and skin papilloma cells, which have a variety of types, including low-risk and high-risk types. HPV genome replication requires the host cell's DNA synthesis machinery, and HPVs encode proteins that maintain differentiated epithelial cells in a replication-competent state. HPV types are tissue-specific and generally produce different types of lesions, either benign or malignant. This review examines different HPV types and their associated diseases and presents therapeutic options for the treatment of HPV-positive diseases.
文摘Objective: To investigate the influence of the new coronavirus epidemic on tumor radiotherapy patients in Zigong City, and provide radiotherapy feasibility and safety in other prefecture-level or low-risk areas. Methods: Retrospective Collection of data from January 31, 2020, in our hospital, this time period is an epidemic group. The control group was data from January 31, 2019-May 31, in our hospital. Patient data includes gender, age, tumor type, hospitalization fee, average hospitalization day, radiotherapy completion, treatment destination, and other information. Results: The patients with epidemic groups and control groups were 320 and 237, respectively, and the radiotherapy patients increased by 25.9%, increasing patients mainly from other departures outside the tumor department underperformance reform intervention. The epidemic group of brain and breast tumor patients were 39 and 37, respectively, with statistical differences (P < 0.05) compared to the control group (25 and 16 respectively). The number of tumor radiotherapy patients in other parts increased, but there was no statistical difference (P > 0.05). Inpatient costs, the average hospitalization day, radiotherapy completion, the purpose of treatment, and other data epidemic groups and control groups have no statistical difference (P > 0.05). Conclusion: The number of COVID-2019 epidemic interventions has increased the number of cancer radiotherapy patients in our hospital, and the epidemic situation has no effect on hospitalization, the average hospitalization day, radiotherapy, and the like. Optimizing the process of clinical treatment, strict prevention and control measures can ensure timely and safe radiotherapy in low-risk areas.
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How do you pick stocks in China? Which sectors in the Ashare market have the greatest investment potential? What problems would China's stock market face if the economy contracts? These are questions Xinhua Finance's Money Journal recently put to the man responsible for Franklin Templeton Investments' fund management business in China,India and Brazil. Stephen H. Dover, Managing Director and International Chief Investment Officer for Franklin Templeton Advisors, the largest listed fund management company in...
文摘A nonlinear mathematical model is proposed and analyzed to study the dynamics of 2009 HIN1 flu epidemic in a homogeneous population with constant immigration of susceptibles. The effect of contact tracing and quarantine （isolation） strategies in reduc- ing the spread of H1N1 flu is incorporated. The model monitors the dynamics of five sub-populations （classes）, namely susceptible with high infection risk, susceptible with reduction of infection risk, infective, quarantined and recovered individuals. The model analysis includes the determination of equilibrium points and carrying out their stability analysis in terms of the threshold parameter R0. Moreover, the numerical simulation of the proposed model is also performed by using fourth order Runge-Kutta method along with the sensitivity analysis of the endemic equilibrium point. The analysis and numeri- cal simulation results demonstrate that the maximum implementation of contact tracing and quarantine strategies help in reducing endemic infective class size and hence act as effective intervention strategy to control the disease. This gives a theoretical interpreta- tion to the practical experiences that the early contact tracing and quarantine strategies are criticMly important to control the outbreak of epidemics.
文摘This work examines a mathematical model of COVID-19 among two subgroups:low-risk and high-risk populations with two preventive measures;non-pharmaceutical interventions including wearing masks,maintaining social distance,and washing hands regularly by the low-risk group.In addition to the interventions mentioned above,highrisk individuals must take extra precaution measures,including telework,avoiding social gathering or public places,etc.to reduce the transmission.Those with underlying chronic diseases and the elderly(ages 60 and above)were classified as high-risk individuals and the rest as low-risk individuals.The parameter values used in this study were estimated using the available data from the Johns Hopkins University on COVID-19 for Brazil and South Africa.We evaluated the effective reproduction number for the two countries and observed how the various parameters affected the effective reproduction number.We also performed numerical simulations and analysis of the model.Susceptible and infectious populations for both low-risk and high-risk individuals were studied in detail.Results were displayed in both graphical and table forms to show the dynamics of each country being studied.We observed that non-pharmaceutical interventions by highrisk individuals significantly reduce infections among only high-risk individuals.In contrast,non-pharmaceutical interventions by low-risk individuals have a significant reduction in infections in both subgroups.Therefore,low-risk individuals’preventive actions have a considerable effect on reducing infections,even among high-risk individuals.
