Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

No long-term survival benefit with sustained-release 5-fluorouracil implants in patients with stages Ⅱ and Ⅲ gastric cancer

BACKGROUND The prognosis of gastric cancer in an advanced stage remains poor. The exact efficacy of the use of intraoperative sustained-release chemotherapy with 5-fluorouracil(5-FU) in advanced-stage gastric cancer is still unelucidated.AIM To explore the long-term survival benefit of using sustained-release 5-FU implants in stage Ⅱ and stage Ⅲ gastric cancer patients.METHODS Patients with gastric cancer in a locally advanced stage and who underwent an R0 radical resection between Jan 2014, to Dec 2016, in this single institution were included. Patients with pathological diagnoses other than adenocarcinoma were excluded. All included patients were grouped according to whether intraoperative sustained-release(SR) chemotherapy with 5-FU was used or not(NSR). The primary end-point was 5-year overall survival. Kaplan–Meier method with logrank test was used to analyze the overall survival of patients and Cox analysis was used to analyze prognosis factors of these patients.RESULTS In total, there were 563 patients with gastric cancer with locally advanced stage, who underwent an R0 radical resection. 309 patients were included in the final analysis. 219(70.9%) were men, with an average age of 58.25 years. Furthermore, 56(18.1%) received neoadjuvant chemotherapy, and 191(61.8%) were in TNM stage Ⅲ. In addition, 158 patients received intraoperative sustainedrelease chemotherapy with 5-FU and were included in the SR group, while the other 161 patients were included in the NSR group. The overall complication rate was 12.94% in the whole group and 10.81%, 16.46% in SR and NSR groups, respectively. There were no significant differences between the two groups in overall survival and complication rate(P > 0.05). The multivariate cox analysis indicated that only N Stage and neoadjuvant therapy were independent influencing factors of survival.CONCLUSION Intraoperative sustained-release chemotherapy usage with 5-FU, did not improve the survival of patients who underwent an R0 radical resection in locally advanced stage of gastric cancer.

Thirty-one patients with primary hepatocellular carcinoma survived for more than 5 years after hepatectomy

Objective: To investigate the factors affecting progno- sis of patients with primary hepatocellular carcinoma (PHC) after resection. Methods: From 1976 to 1992, 213 patients with PHC treated with hepatectomy were followed up for more than 5 years. Thirty-one of the patients who had sur- vived for more than 5 years were compared with 56 patients who had survived for less than 5 years. Results: Early detection of tumor, radical resection, number of tumors, capsule formation, operation safe distance, presence of portal tumor embolus, pre- sence of cirrhosis and tumor size were important fac- tors affecting the prognosis of patients with PHC. The proportion of small liver cancer in the patients who had survived for more than 5 years was greatly larger than that in the control group. Conclusions: Early detection of tumor and radical re- section are of value in raising the 5-year survival rate. Much remains to be investigated about the rela- tionship between safe margin distance and prognosis of patients with PHC.

浙江省台州市胆囊癌5年相对生存率(2014-2018年):基于周期法分析

目的本研究旨在提供浙江省台州市胆囊癌最新5年相对生存率总体及分层数据。方法选择浙江省台州市4个具有高质量数据的肿瘤登记处2004—2018年期间诊断为胆囊癌并随访至2018年12月31日的病例及其随访信息。采用周期法分析2014—2018年胆囊癌总体及按诊断年龄、性别、地区分层的5年相对生存率,并评估15年期间(2004—2018年)的5年相对生存率的变化趋势。结果2004—2018年期间台州市4个肿瘤登记处胆囊癌患者共计914例。2014—2018年5年相对生存率为29.1%,分层分析显示,男性患者5年相对生存率明显低于女性患者(24.3%vs 30.2%),并呈现明显的年龄梯度:5年相对生存率从35.7%(≤54岁组)逐步下降到25.8%(>74岁组);城镇患者5年相对生存率高于农村患者(30.4%vs 28.3%)。15年期间(2004—2018年)胆囊癌患者5年相对生存率的总体及分层(性别、诊断年龄和城乡)数据均呈明显上升趋势。结论本研究发现浙江省台州市胆囊癌患者5年相对生存率(2004—2018年)已达29.1%,并且最近15年期间的5年相对生存率呈现明显上升趋势,为制订胆囊癌预防和控制政策及干预措施提供了重要依据。

Chronic disease and its therapeutic drugs may effect on the postoperative 5-year survival rate of lung cancer patients

In this study, we aimed to investigate the influencing factors of postoperative 5-year survival rate in non small-cell lung cancer（NSCLC） patients with stage I–III. We enrolled 220 patients who underwent surgical operation and survived longer than 3 months, with histologically confirmed adenocarcinoma or squamous cell carcinoma from Jan. 2009 to Dec. 2009. Multiple variables, like age, gender, smoking, alcohol, obesity, family history of cancer, diabetes, hypertension, antidiabetic drugs, tumor staging, pathology, treatments, surgical side as well as lipid levels, were selected. We found that tumor staging was associated with 5-year survival rate of stage I–III NSCLC patients by univariate analysis. Furthermore, diabetes mellitus, hypertension and surgical side were associated with the overall survival of NSCLC patients with stage I, stageⅡand stage III, respectively. In conclusion, the status of chronic disease had potential effect on the postoperative 5-year survival rate of lung cancer patients.

Rare long-term survivors of pancreatic adenocarcinoma without curative resection

Long-term outcome data in pancreatic adenocarcinoma are predominantly based on surgical series, as resection is currently considered essential for longterm survival. In contrast, five-year survival in nonresected patients has rarely been reported. In this report, we examined the incidence and natural history of ≥ 5-year survivors with non-resected pancreatic adenocarcinoma. All patients with pancreatic adenocarcinoma who received oncologic therapy alone without surgery at our institution between 1995 and 2009 were identified. Non-resected ≥ 5-year survivors represented 2%(11/544) of all non-resected patients undergoing treatment for pancreatic adenocarcinoma, and 11%(11/98) of ≥ 5-year survivors. Nine patients had localized tumor and 2 metastatic disease at initial diagnosis. Disease progression occurred in 6 patients, and the local tumor bed was the most common site of progression. Six patients suffered from significant morbidities including recurrent cholangitis, second malignancy, malnutrition and bowel perforation. A rare subset of patients with pancreatic cancer achieve longterm survival without resection. Despite prolonged survival, morbidities unrelated to the primary cancer were frequently encountered and a close follow-up is warranted in these patients. Factors such as tumor biology and host immunity may play a key role in disease progression and survival.

Comparison of three data mining methods in predicting 5-year survival of colorectal cancer patients

The prediction of colorectal cancer(CRC) survivability has always been a challenging research issue. Considering the importance of predicting CRC patients’ survival rates, we compared the performance of three data mining methods: decision trees(DTs), artificial neural networks(ANNs) and support vector machines(SVMs), for predicting 5-year survival of CRC patients to assist clinicians in making treatment decisions. The CRC dataset used to build the prediction model comes from the surveillance, epidemiology, and end results(SEER) program. The 5-fold cross-validation and random forest algorithm were respectively utilized for measuring the model predictive accuracy and the importance of features. Experimental results show that the predictive accuracy of ANNs(0.73) and SVMs(0.75) were higher than that of DTs, and they also have the best result in the area under the receiver operating characteristic(ROC) curve(area under curve(AUC)=0.82). This result may indicate high predictive power of ANNs and SVMs for predicting 5-year survival of CRC patients.

Survival of patients with gastric cancer surgically treated at the National Cancer Center of China from 2011 to 2018 according to stage at diagnosis

Objective:The postoperative survival rates of patients with gastric cancer at different stages treated at the National Cancer Center(NCC)of China have not been reported.Therefore,we evaluated the survival of patients with gastric cancer who underwent surgery at the NCC from 2011 to 2018 to provide baseline information for further studies.Methods:We identified 7,301 patients with primary gastric carcinoma who underwent surgery at the NCC be-tween January 2011 and May 2018;among these,5,008 patients were enrolled in this study.Follow up was completed on April 30,2020.We analyzed the 5-year survival according to the stage,sex,age,and other clini-copathological features.Results:Five-year survival rates of patients with pTNM stages ⅠA,ⅠB,ⅡA,ⅡB,ⅢA,ⅢB,ⅢC,and Ⅳ treated at the NCC were 94.9%,91.8%,86.5%,76.1%,61.1%,44.2%,29.7%,and 8.1%,respectively,which were similar to those reported in Japan during the same period.Five-year survival rates of patients with ypTNM stages I,II,III,and IV were 93.1%,63.2%,27.2%,and 0.0%,respectively.In multivariable analysis,age,signet ring cell carcinoma,adjuvant chemotherapy,and degree of differentiation were revealed as important prognostic factors.Conclusion:The survival rates of patients with gastric cancer treated at the NCC have been significantly improved,reaching the levels of Japan in the same period.

河南省2015-2019年恶性肿瘤5年相对生存率分析

目的利用人群肿瘤登记数据分析2015—2019年河南省恶性肿瘤5年相对生存率。方法提取河南省肿瘤登记数据库中诊断日期在2010年1月1日至2019年12月31日之间的恶性肿瘤病例,采用现时生存分析方法估计恶性肿瘤5年相对生存率,EdererⅡ方法计算期望生存率,感兴趣时期设定为2015—2019年,随访截至2019年12月31日。使用国际癌症生存标准年龄结构进行标化,标化生存率的组间比较采用Z检验。结果河南省2015—2019年恶性肿瘤总体5年相对生存率为43.3%。总体标化5年相对生存率为40.2%,其中女性高于男性(分别为45.9%和34.7%;Z=39.60,P<0.001),城市高于农村(分别为44.9%和39.1%;Z=12.97,P<0.001)。0~14岁儿童恶性肿瘤5年相对生存率为60.2%,15岁及以上患者5年相对生存率为43.5%。标化5年相对生存率>70%的恶性肿瘤有2种(甲状腺癌82.2%,乳腺癌71.6%),<30%的有4种(胰腺癌18.2%,肝癌19.6%,肺癌24.0%,胆囊癌26.6%)。结论河南省恶性肿瘤5年相对生存率相对滞后于全国平均水平,应继续加强肿瘤综合防控力度。

胸腔镜与传统手术对非小细胞肺癌远期疗效的影响

目的分析胸腔镜手术治疗中早期非小细胞肺癌(NSCLC)的远期疗效。方法回顾性分析131例NSCLS患者的临床资料,按治疗方法的不同分成VATS组和S组,VATS进行胸腔镜手术,S组进行传统开胸手术,分析两组5年生存期。结果 VATS较S组手术时间长、术中出血量少、留置胸管时间短、术后止痛时间短、术后住院时间短,差异有统计学意义(P<0.01),而清扫淋巴结个数差异无统计学意义(P>0.05);两组5年生存率差异无统计学意义(P>0.05)。结论 VATS手术时间较传统开胸手术时间长,但其对患者手术损伤较小,缩短术后恢复时间及住院时间,提高患者生活质量,但不能提高中早期NSCLC患者的5年生存期。

Meta-analysis of immunohistochemical expression of hypoxia inducible factor-1α as a prognostic role in gastric cancer

AIM: To conduct a meta-analysis to evaluate the prognostic role of hypoxia inducible factor-1&#x003b1; (HIF-1&#x003b1;) expression in gastric cancer.

提高院外心脏骤停患者出院存活率:深圳宝安实践

目的心脏骤停(CA)是严重威胁人民群众生命健康的重大公共卫生问题之一。为提高院外心脏骤停(OHCA)患者出院存活率,深圳市宝安区进行了探索与实践。方法①创新急诊急救服务,构建社会急救体系、院前急救体系、院内急诊体系和重症监护治疗体系“四环一体化”急诊医疗服务体系的院外生存链;②创建了“党建引领、政府主导、部门协同、专业指引、科技支撑、社会参与”全覆盖的社会急救(培训)体系建设模式暨“宝安模式”,制定了宝安区社会急救(培训)体系建设成效的评价指标;③建立了宝安区心脏骤停注册登记系统、社会应急救护培训管理系统;④提升急诊急救专业人员救治技能与心肺脑复苏质量;⑤扎实推进“5分钟社会救援圈”建设,填补“急救空窗期”。结果宝安区公众急救技能培训率9.18%、OHCA旁观者CPR实施率26.11%、OHCA患者AED使用率4.78%、OHCA患者30 d存活率6.31%、30 d内出院存活率4.44%。结论通过上述措施,能显著提高OHCA患者出院存活率。

NLRC5在宫颈癌中的表达及与宫颈癌患者预后的相关性研究

目的探讨宫颈癌组织及癌旁组织NLRC5(NOD-like receptor family caspase recruitment domain family-containing 5)的表达情况与宫颈癌患者预后的相关性。方法选择2013年1月—2016年6月在安徽医科大学第二附属医院进行诊治的宫颈癌患者,共60例,收集宫颈癌手术的癌组织和癌旁组织,采用免疫组化的方法检测宫颈癌组织及癌旁组织中NLRC5的表达并分析其与宫颈癌患者预后的相关性。结果在宫颈癌组织中,NLRC5的阳性表达低于癌旁组织[15(25.00)%vs.50(83.33%),P<0.05]。对宫颈癌组织内NLRC5表达与患者临床病理特征进行分析,发现NLRC5的阴性表达与宫颈癌的浸润深度和肿瘤大小相关(χ^(2)=11.769、5.926,均P<0.05),NLRC5的表达与年龄、病理类型、有无淋巴结转移等没有相关性(均P>0.05)。绘制宫颈癌的生存预后Kaplan-Meier曲线,发现NLRC5阴性表达患者生存期较阳性表达的患者短(P<0.05)。对宫颈癌预后的相关因素进行单因素或Cox多因素分析,发现NLRC5阴性表达、淋巴结转移、浸润深度是宫颈癌预后的独立影响因素(均P<0.05)。结论与癌旁组织比较,在宫颈癌组织中NLRC5呈现低表达,同时,NLRC5阴性表达是影响宫颈癌患者预后的独立危险因素,这一发现有可能作为宫颈癌诊治的新靶点。

2002-2016年上海市杨浦区肝癌流行现况与生存分析

【目的】分析2002—2016年上海市杨浦区肝癌发病和死亡的流行趋势和生存情况。【方法】收集上海市杨浦区户籍人口肿瘤登记系统中2002—2016年肝癌发病与死亡的数据,获取公安部门公布的每年户籍人口数,用世界标准人口构成计算标化肝癌发病率与死亡率,分析肝癌总体、性别和年龄别的发病率和死亡率趋势。用寿命表法计算生存率,log-rank检验分析不同性别肝癌患者的5年生存率的差异和诊断时期别。【结果】2002—2016年杨浦区肝癌的发病率与死亡率整体呈现下降趋势,去除人口老龄化的影响,标化后的发病率年度变化百分比(APC)为−3.10%(P<0.01),标化后的死亡率APC为−3.44%(P<0.01)。经Z检验,男性的发病率和死亡率均显著高于女性(P<0.01)。从年龄分析,肝癌发病率从40岁开始上升明显,死亡率从50岁开始明显升高。4007名肝癌患者已追踪随访5年,5年生存率为12.45%,生存期中位数为281.48 d。男性肝癌患者5年生存率高于女性,有显著性差异(P<0.01)。46.58%的肝癌患者诊断时已为Ⅳ期,Ⅰ期比例仅占13.46%,男女各期别之间的比例无统计学差异(P=0.85)。【结论】2002—2016年杨浦区肝癌发病率与死亡率总体呈现缓慢下降趋势,男性的发病率与死亡率高于女性。中老年是肝癌发病与死亡的主要人群,5年生存率较低,诊断时的期别多为中晚期。