目的:在肿瘤幸存者中,良好预后与心血管疾病死亡风险增加相关。本研究的目的是探讨不同肿瘤分期的结直肠肿瘤患者的累积死亡率和心血管疾病死亡风险。方法:我们从Surveillance, Epidemiology, and End Results (SEER)数据库中检索1975~2...目的:在肿瘤幸存者中,良好预后与心血管疾病死亡风险增加相关。本研究的目的是探讨不同肿瘤分期的结直肠肿瘤患者的累积死亡率和心血管疾病死亡风险。方法:我们从Surveillance, Epidemiology, and End Results (SEER)数据库中检索1975~2014年、年龄超过15岁的结直肠肿瘤幸存者。心血管疾病的累积死亡率通过竞争风险模型进行估计。我们计算了结直肠肿瘤死亡患者中心血管疾病死亡的比例。将心血管疾病的标准化死亡率(Standardized mortality ratio, SMR)与美国普通人群进行比较。结果:共纳入353,273例患者,其中早期患者147,465例(41.7%),中期患者141,541例(40.1%),晚期患者64,267例(18.2%)。心血管疾病是所有患者的第二位死亡原因,是早期患者的第一位死亡原因。早期患者确诊后八年心血管疾病累积死亡率高于结直肠肿瘤(12.17%比11.76%,P Objective: Favorable prognoses are associated with an increased risk of death from cardiovascular disease (CVD) among cancer survivors. The objective of this study is to explore cumulative mortality and risk of death from cardiovascular disease in patients with colorectal cancer by tumor stages. Methods: We retrieved colorectal cancer survivors aged 15 years or older between 1975 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative mortality from cardiovascular disease was estimated by competitive risk models. We calculated the proportions of death from cardiovascular disease among dead patients with colorectal cancer. Standardized mortality ratios (SMRs) for cardiovascular disease were estimated compared to the general US population. Results: A total of 353,273 patients were included, with 147,465 (41.7%) in the early stage, 141,541 (40.1%) in the middle stage, and 64,267 (18.2%) in the late stage. Cardiovascular disease was the second leading cause of death in all patients and the first leading cause of death in patients with localized disease. The cumulative mortality from cardiovascular disease was higher than that from colorectal cancer eight years after diagnosis in patients with localized disease (12.17% vs. 11.76%, P < 0.001). Among patients with different tumor stages, the proportion of deaths due to cardiovascular diseases gradually exceeds those due to colorectal cancer (overall: 30.57% vs 29.73% at the seventh year;early stage: 30.91% vs 29.90% at the fifth year;middle stage: 34.14% vs 23.73% at the ninth year;advanced stage: 28.83% vs 17.12% at the twelfth year). Compared with the general U.S. population, the standardized mortality ratio (SMR) for cardiovascular mortality among colorectal cancer patients is higher within one year after diagnosis (early stage: SMR is 1.12, and 95%CI is 1.07~1.17;middle stage: SMR is 1.13, and 95%CI is 1.08~1.18;advanced stage: SMR is 1.84, and 95%CI is 1.72~1.96), with younger patients at higher risk of death from cardiovascular diseases (early stage: SMR is 1.23, and 95%CI is 0.90~1.64;middle stage: SMR is 1.38, and 95%CI is 1.02~1.83;advanced stage: SMR is 4.19, and 95%CI is 2.87~5.91). Conclusions: Although cardiovascular disease possessed the highest cumulative mortality in colorectal cancer patients with localized disease, the risks of death from cardiovascular disease were greater than that from colorectal cancer among all tumor stages with time after diagnosis.展开更多
Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortal...Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.展开更多
Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In a...Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition,we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13- year period (1990- 2003) at the Asan Medical Center was performed. The mean involved body surface area was 49± 17% . All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8± 5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5% , 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR)=0.425; 95% CI, 0.011- 2.368), whereas corticosteroid therapy showed no such difference (SMR=1.004; 95% CI, 0.369- 2.187).展开更多
文摘目的:在肿瘤幸存者中,良好预后与心血管疾病死亡风险增加相关。本研究的目的是探讨不同肿瘤分期的结直肠肿瘤患者的累积死亡率和心血管疾病死亡风险。方法:我们从Surveillance, Epidemiology, and End Results (SEER)数据库中检索1975~2014年、年龄超过15岁的结直肠肿瘤幸存者。心血管疾病的累积死亡率通过竞争风险模型进行估计。我们计算了结直肠肿瘤死亡患者中心血管疾病死亡的比例。将心血管疾病的标准化死亡率(Standardized mortality ratio, SMR)与美国普通人群进行比较。结果:共纳入353,273例患者,其中早期患者147,465例(41.7%),中期患者141,541例(40.1%),晚期患者64,267例(18.2%)。心血管疾病是所有患者的第二位死亡原因,是早期患者的第一位死亡原因。早期患者确诊后八年心血管疾病累积死亡率高于结直肠肿瘤(12.17%比11.76%,P Objective: Favorable prognoses are associated with an increased risk of death from cardiovascular disease (CVD) among cancer survivors. The objective of this study is to explore cumulative mortality and risk of death from cardiovascular disease in patients with colorectal cancer by tumor stages. Methods: We retrieved colorectal cancer survivors aged 15 years or older between 1975 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative mortality from cardiovascular disease was estimated by competitive risk models. We calculated the proportions of death from cardiovascular disease among dead patients with colorectal cancer. Standardized mortality ratios (SMRs) for cardiovascular disease were estimated compared to the general US population. Results: A total of 353,273 patients were included, with 147,465 (41.7%) in the early stage, 141,541 (40.1%) in the middle stage, and 64,267 (18.2%) in the late stage. Cardiovascular disease was the second leading cause of death in all patients and the first leading cause of death in patients with localized disease. The cumulative mortality from cardiovascular disease was higher than that from colorectal cancer eight years after diagnosis in patients with localized disease (12.17% vs. 11.76%, P < 0.001). Among patients with different tumor stages, the proportion of deaths due to cardiovascular diseases gradually exceeds those due to colorectal cancer (overall: 30.57% vs 29.73% at the seventh year;early stage: 30.91% vs 29.90% at the fifth year;middle stage: 34.14% vs 23.73% at the ninth year;advanced stage: 28.83% vs 17.12% at the twelfth year). Compared with the general U.S. population, the standardized mortality ratio (SMR) for cardiovascular mortality among colorectal cancer patients is higher within one year after diagnosis (early stage: SMR is 1.12, and 95%CI is 1.07~1.17;middle stage: SMR is 1.13, and 95%CI is 1.08~1.18;advanced stage: SMR is 1.84, and 95%CI is 1.72~1.96), with younger patients at higher risk of death from cardiovascular diseases (early stage: SMR is 1.23, and 95%CI is 0.90~1.64;middle stage: SMR is 1.38, and 95%CI is 1.02~1.83;advanced stage: SMR is 4.19, and 95%CI is 2.87~5.91). Conclusions: Although cardiovascular disease possessed the highest cumulative mortality in colorectal cancer patients with localized disease, the risks of death from cardiovascular disease were greater than that from colorectal cancer among all tumor stages with time after diagnosis.
文摘Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.
文摘Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition,we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13- year period (1990- 2003) at the Asan Medical Center was performed. The mean involved body surface area was 49± 17% . All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8± 5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5% , 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR)=0.425; 95% CI, 0.011- 2.368), whereas corticosteroid therapy showed no such difference (SMR=1.004; 95% CI, 0.369- 2.187).
