Conditional survival probability of distant-metastatic hepatocellular carcinoma: A population-based study

BACKGROUND The prognosis of many patients with distant metastatic hepatocellular carcinoma(HCC)improved after they survived for several months.Compared with tradi-tional survival analysis,conditional survival(CS)which takes into account changes in survival risk could be used to describe dynamic survival probabilities.AIM To evaluate CS of distant metastatic HCC patients.METHODS Patients diagnosed with distant metastatic HCC between 2010 and 2015 were extracted from the Surveillance,Epidemiology and End Results database.Univariate and multivariate Cox regression analysis were used to identify factors for overall survival(OS),while competing risk model was used to identify risk factors for cancer-specific survival(CSS).Six-month CS was used to calculate the probability of survival for an additional 6 mo at a specific time after initial diagnosis,and standardized difference(d)was used to evaluate the survival differences between subgroups.Nomograms were constructed to predict CS.Positiveα-fetoprotein expression,higher T stage(T3 and T4),N1 stage,non-primary site surgery,non-chemotherapy,non-radiotherapy,and lung metastasis were independent risk factors for actual OS and CSS through univariate and multivariate analysis.Actual survival rates decreased over time,while CS rates gradually increased.As for the 6-month CS,the survival difference caused by chemotherapy and radiotherapy gradually disappeared over time,and the survival difference caused by lung metastasis reversed.Moreover,the influence of age and gender on survival gradually appeared.Nomograms were fitted for patients who have lived for 2,4 and 6 mo to predict 6-month conditional OS and CSS,respectively.The area under the curve(AUC)of nomograms for conditional OS decreased as time passed,and the AUC for conditional CSS gradually increased.CONCLUSION CS for distant metastatic HCC patients substantially increased over time.With dynamic risk factors,nomograms constructed at a specific time could predict more accurate survival rates.

Road traffic injury mortality and morbidity by country development status, 2011- 2017

Purpose:This research examined road traffic injury mortality and morbidity disparities across of country development status,and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 e to halve the number of global deaths and injuries from road traffic accidents by 2020.Methods:Data for road traffic mortality,morbidity,and socio-demographic index(SDI)were extracted by country from the estimates of the Global Burden of Disease study,and the implementation of the three types of national actions(legislation,prioritized vehicle safety standards,and trauma-related post-crash care service)were extracted from the Global Status Report on Road Safety byWorld Health Organization.We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.Results:Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017(by 7.52%e16.08%).Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period,while age-adjusted morbidity generally increased as SDI increased.Subgroup analysis by road user yielded similar results,but with two major differences during the study period of 2011 to 2017:(1)pedestrians in the high SDI countries experienced the lowest mortality(1.68e1.90 per 100,000 population)and morbidity(110.45e112.72 per 100,000 population for incidence and 487.48e491.24 per 100,000 population for prevalence),and(2)motor vehicle occupants in the high SDI countries had the lowest mortality(4.07e4.50 per 100,000 population)but the highest morbidity(428.74e467.78 per 100,000 population for incidence and 1025.70e1116.60 per 100,000 population for prevalence).Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries.Lower income nations comprise the heaviest burden of global road traffic injuries and deaths.Conclusion:Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement,prioritized vehicle safety standards and trauma-related postcrash care services.