Establishment of a prognostic scoring model for regional recurrent nasopharyngeal carcinoma after neck dissection

Objective:The main aim of this study was to establish a scoring model to predict risk of progression and survival in patients with regionally recurrent nasopharyngeal carcinoma(NPC).Methods:Three hundred and forty-eight patients subjected to neck dissection from 2003 to 2017 were included for study.Clinicopathologic information for each patient was analyzed.Independent prognostic factors were selected using the Cox proportional hazards model and incorporated into the scoring model.Concordance index(C-index)and calibration curves were used to verify discrimination and calibration,respectively and the results validated using bootstrap resampling.Results:Microscopic positive lymph node>2[hazard ratio(HR),2.19;95%confidence interval(CI),1.30–3.68;P=0.003],extranodal extension(HR,2.75;95%CI,1.69–4.47;P<0.001),and lower neck involvement(HR,1.78;95%CI,1.04–3.04;P=0.034)were identified from multivariate analysis as independent factors for overall survival(OS).A qualitative 4-point scale was generated to stratify patients into 4 risk groups for predicting OS and progression-free survival(PFS).The novel scoring model demonstrated enhanced discrimination(C-index=0.69;95%CI,0.62–0.76)relative to the original recurrent tumor-node-metastasis(rTNM)staging system(C-index=0.56;95%CI,0.50–0.62),and was internally validated with a bootstrap-adjusted C-index of 0.70.The calibration curve showed good agreement between predicted probabilities and actual observations.Conclusions:The scoring system established in this study based on a large regionally recurrent NPC cohort fills a gap regarding assessment of risk and prediction of survival outcomes after neck dissection in this population and could be further applied to identify high-risk patients who may benefit from more aggressive intervention.

Continuously Quantifying Oral Chemicals Based on Flexible Hybrid Electronics for Clinical Diagnosis and Pathogenetic Study

Simultaneous monitoring of diverse salivary parameters can reveal underlying mechanisms of intraoral biological processes and offer profound insights into the evolution of oral diseases.However,conventional analytical devices with bulky volumes,rigid formats,and discrete sensing mechanisms deviate from the requirements of continuous biophysiological quantification,resulting in huge difficulty in precise clinical diagnosis and pathogenetic study.Here,we present a flexible hybrid electronic system integrated with functional nanomaterials to continuously sense Ca^(2+),pH,and temperature for wireless real-time oral health monitoring.The miniaturized system with an island-bridge structure that is designed specifically to fit the teeth is only 0.4g in weight and 31.5×8.5×1.35 mm^(3) in dimension,allowing effective integration with customized dental braces and comfort attachment on teeth.Characterization results indicate high sensitivities of 30.3 and 60.6 mV/decade for Ca^(2+)and pH with low potential drifts.The system has been applied in clinical studies to conduct Ca^(2+)and pH mappings on carious teeth,biophysiological monitoring for up to 12 h,and outcome evaluation of dental restoration,providing quantitative data to assist in the diagnosis and understanding of oral diseases.Notably,caries risk assessment of 1o human subjects using the flexible system validates the important role of saliva buffering capacity in caries pathogenesis.The proposed flexible system may offer an open platform to carry diverse components to support both clinical diagnosis and treatment as well as fundamental researchfororaldiseases and induced systemicdiseases.