BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical per...BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical perceptions.AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.RESULTS The PS rate after sphincter-saving surgery was 15.1%(59/391) in our study after a median follow-up of 47.3 mo(range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903(95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.展开更多
Autophagy,a cellular recycling process,plays a key role in maintaining genomic stability and regulating DNA damage repair.However,recent studies have challenged this consensus,suggesting that upregulation of autophagy...Autophagy,a cellular recycling process,plays a key role in maintaining genomic stability and regulating DNA damage repair.However,recent studies have challenged this consensus,suggesting that upregulation of autophagy may induce DNA damage and contribute to genomic instability.Notably,several investigations have demonstrated that autophagy-mediated DNA damage can occur through mechanisms involving the production of reactive oxygen species(ROS).Despite these findings,many questions remain unresolved regarding the controversial DNA-damaging effects of autophagy and its potential role in promoting genomic instability and intratumoral heterogeneity.A more comprehensive understanding of the mechanisms and implications of“autophagy-mediated DNA damage”will offer crucial insights into the development and progression of various diseases from different perspectives.A deeper insight into autophagy mechanisms will also help identify potential adverse effects of autophagy-targeted interventions and clarify the molecular basis of side effects observed in various therapies in the future.展开更多
基金Supported by the Taipei Medical University,No. TMU104-AE1-B35。
文摘BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical perceptions.AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.RESULTS The PS rate after sphincter-saving surgery was 15.1%(59/391) in our study after a median follow-up of 47.3 mo(range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903(95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.
基金supported by the National Science and Technology Council(NSTC 113-2320-B-006-016),Taiwan.
文摘Autophagy,a cellular recycling process,plays a key role in maintaining genomic stability and regulating DNA damage repair.However,recent studies have challenged this consensus,suggesting that upregulation of autophagy may induce DNA damage and contribute to genomic instability.Notably,several investigations have demonstrated that autophagy-mediated DNA damage can occur through mechanisms involving the production of reactive oxygen species(ROS).Despite these findings,many questions remain unresolved regarding the controversial DNA-damaging effects of autophagy and its potential role in promoting genomic instability and intratumoral heterogeneity.A more comprehensive understanding of the mechanisms and implications of“autophagy-mediated DNA damage”will offer crucial insights into the development and progression of various diseases from different perspectives.A deeper insight into autophagy mechanisms will also help identify potential adverse effects of autophagy-targeted interventions and clarify the molecular basis of side effects observed in various therapies in the future.
