Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refine...Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refined staging system for PDAC.Methods:Data were collected from the China Pancreas Data Center(CPDC)for patients with resected PDAC in 2016 and 2017,and cancer-specific survival(CSS)was evaluated using the Kaplan-Meier method and log-rank test.Univariate and multivariate analyses based on Cox regression were performed to identify prognostic factors.The recursive partitioning analysis(RPA),Kaplan-Meier method,and log-rank test were performed on the training dataset to generate a proposed modification for the 8 th TNM staging system utilizing the preoperative carbohydrate antigen(CA)19-9 level.Validation was performed for both staging systems in the validation cohort.Results:A total of 1,676 PDAC patients were retrieved,and the median CSS was significantly different between the 8 th TNM groupings,with no significant difference in survival between stage IB and IIA.The analysis of T and N stages demonstrated a better prognostic value in the N category.Multivariate analysis showed that the preoperative serum CA19-9 level was the strongest prognostic indicator among all the independent risk factors.All patients with CA19-9>500 U/mL had similar survival,and we proposed a new staging system by combining IB and IIA and stratifying all patients with high CA19-9 into stage III.The modified staging system had a better performance for predicting CSS than the 8 th AJCC staging scheme.Conclusions:The 8 th AJCC staging system for PDAC is suitable for a Chinese cohort of resected patients,and the N category has a better prognostic value than the T category.Our modified staging system has superior accuracy in predicting survival than the 8 th AJCC TNM staging system.展开更多
ECG monitoring in daily life is an important means of treating heart disease. To make it easier for the medical to monitor the ECG of their patients outside the hospital, we designed and developed an ECG monitoring an...ECG monitoring in daily life is an important means of treating heart disease. To make it easier for the medical to monitor the ECG of their patients outside the hospital, we designed and developed an ECG monitoring and alarming system based on Android smart phone. In our system, an ECG device collects the ECG signal and transmits it to an Android phone. The Android phone detects alarms which come from the ECG devices. When alarms occur, Android phone will capture the ECG images and the details about the alarms, and sends them to the cloud Alarm Server (AS). Once received, AS push the messages to doctors’ phone, so the doctors could see the ECG images and alarm details on their mobile phone. In our system, high resolution ECG pictures are transmitted to doctors’ phone in a user-friendly way, which can help doctors keep track of their patient’s condition easily.展开更多
Objective: To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification o...Objective: To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification of the 8th edition American Joint Committee on Cancer (AJCC) staging system. Methods: A cohort of 185 patients with PDAC who underwent surgical resection in the General Surgery Department of Peking University First Hospital from January 2010 to December 2017 was enrolled retrospectively. The clinicopathological characteristics and survival data were analyzed to find out risk factors correlated to DFS. The survival curves were calculated according to the 8th edition of AJCC staging system. Results:Among the 185 PDAC patients, 125 (67.6%) with pancreatic head carcinoma underwent pancreatoduodenectomy or total pancreatectomy, and 60 (32.4%) with tumors located in the pancreatic body and tail underwent distal pancreatectomy and splenectomy. R0 resection was achieved in 97 patients (52.4%), and the R1 and R2 resections rate was 44.9% and 2.7%, respectively. One hundred five patients (56.8%) received postoperative adjuvant chemotherapy. The median overall survival (OS) was 21 (95% confidence interval [CI] 17.7–24.3) months, and median DFS was 15 (95% CI 13.6–16.5) months. Univariate analysis showed that AJCC T and N staging, status of resection margin, grade of tumor differentiation, perineural invasion, intravascular cancer embolus, combined vascular resection, neutrophil-to-lymphocyte ratio (NLR)≥2, carcinoembryonic antigen ≥5ng/mL, carbohydrate antigen 19-9 (CA 19-9)≥400U/mL, and without postoperative adjuvant chemotherapy were correlated with shorter DFS. Furthermore, AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy were independent risk factors for DFS. Both the DFS and OS curves were well separated by stage using the 8th staging classification. Conclusions: The 8th edition of AJCC T, primary tumor;N, regional lymph nodes;M, distant metastasis staging system could predict the prognosis of PDAC accurately. Patients with AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy, have a significantly higher risk of tumor recurrence and shorter DFS after surgery. R0 resection and adjuvant chemotherapy could significantly prolong the DFS of PDAC patients.展开更多
基金supported by grants from the National Natural Science Foundation of China(No.81672353 and 81871954)。
文摘Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refined staging system for PDAC.Methods:Data were collected from the China Pancreas Data Center(CPDC)for patients with resected PDAC in 2016 and 2017,and cancer-specific survival(CSS)was evaluated using the Kaplan-Meier method and log-rank test.Univariate and multivariate analyses based on Cox regression were performed to identify prognostic factors.The recursive partitioning analysis(RPA),Kaplan-Meier method,and log-rank test were performed on the training dataset to generate a proposed modification for the 8 th TNM staging system utilizing the preoperative carbohydrate antigen(CA)19-9 level.Validation was performed for both staging systems in the validation cohort.Results:A total of 1,676 PDAC patients were retrieved,and the median CSS was significantly different between the 8 th TNM groupings,with no significant difference in survival between stage IB and IIA.The analysis of T and N stages demonstrated a better prognostic value in the N category.Multivariate analysis showed that the preoperative serum CA19-9 level was the strongest prognostic indicator among all the independent risk factors.All patients with CA19-9>500 U/mL had similar survival,and we proposed a new staging system by combining IB and IIA and stratifying all patients with high CA19-9 into stage III.The modified staging system had a better performance for predicting CSS than the 8 th AJCC staging scheme.Conclusions:The 8 th AJCC staging system for PDAC is suitable for a Chinese cohort of resected patients,and the N category has a better prognostic value than the T category.Our modified staging system has superior accuracy in predicting survival than the 8 th AJCC TNM staging system.
文摘ECG monitoring in daily life is an important means of treating heart disease. To make it easier for the medical to monitor the ECG of their patients outside the hospital, we designed and developed an ECG monitoring and alarming system based on Android smart phone. In our system, an ECG device collects the ECG signal and transmits it to an Android phone. The Android phone detects alarms which come from the ECG devices. When alarms occur, Android phone will capture the ECG images and the details about the alarms, and sends them to the cloud Alarm Server (AS). Once received, AS push the messages to doctors’ phone, so the doctors could see the ECG images and alarm details on their mobile phone. In our system, high resolution ECG pictures are transmitted to doctors’ phone in a user-friendly way, which can help doctors keep track of their patient’s condition easily.
基金The study was supported in part by grants from the National Natural Science Foundation of China(81372605,81572339,and 81672353)Foundation of Capital Characteristic Clinic Project from the Beijing Science and Technology Commission,China(Z161100000516038)
文摘Objective: To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification of the 8th edition American Joint Committee on Cancer (AJCC) staging system. Methods: A cohort of 185 patients with PDAC who underwent surgical resection in the General Surgery Department of Peking University First Hospital from January 2010 to December 2017 was enrolled retrospectively. The clinicopathological characteristics and survival data were analyzed to find out risk factors correlated to DFS. The survival curves were calculated according to the 8th edition of AJCC staging system. Results:Among the 185 PDAC patients, 125 (67.6%) with pancreatic head carcinoma underwent pancreatoduodenectomy or total pancreatectomy, and 60 (32.4%) with tumors located in the pancreatic body and tail underwent distal pancreatectomy and splenectomy. R0 resection was achieved in 97 patients (52.4%), and the R1 and R2 resections rate was 44.9% and 2.7%, respectively. One hundred five patients (56.8%) received postoperative adjuvant chemotherapy. The median overall survival (OS) was 21 (95% confidence interval [CI] 17.7–24.3) months, and median DFS was 15 (95% CI 13.6–16.5) months. Univariate analysis showed that AJCC T and N staging, status of resection margin, grade of tumor differentiation, perineural invasion, intravascular cancer embolus, combined vascular resection, neutrophil-to-lymphocyte ratio (NLR)≥2, carcinoembryonic antigen ≥5ng/mL, carbohydrate antigen 19-9 (CA 19-9)≥400U/mL, and without postoperative adjuvant chemotherapy were correlated with shorter DFS. Furthermore, AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy were independent risk factors for DFS. Both the DFS and OS curves were well separated by stage using the 8th staging classification. Conclusions: The 8th edition of AJCC T, primary tumor;N, regional lymph nodes;M, distant metastasis staging system could predict the prognosis of PDAC accurately. Patients with AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy, have a significantly higher risk of tumor recurrence and shorter DFS after surgery. R0 resection and adjuvant chemotherapy could significantly prolong the DFS of PDAC patients.
