Coronary heart disease incidence and competing risks： an important issue

The estimation of lifetime morbid events is not a rare presentation of relatively old and of more recent epidemi- ological investigations, accompanied by evaluating rates, risks and predictors （more in general determinants or risk factors）. However, when the follow-up period is very long and Kaplan-Meier survival curves are adopted, or Kaplan- Meier-based more complex models such as Cox＇s analysis are used, clinical （or epidemiological） reality may well be distorted since by these survival methods risks tend to be overestimated, whereas survival tends to be reduced.

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

基线CT对晚期转移性胃癌患者预后预测价值的初步研究

目的探讨基线CT对晚期转移性胃癌患者无进展生存期(PFS)和总生存期(OS)的预测价值。方法回顾性分析2019年1月至2020年5月上海瑞金医院85例伴有腹膜或肝脏转移的晚期胃癌患者的临床和影像学资料。收集患者临床因素,包括体力状况(PS)评分、病灶部位、肿瘤指标;收集影像学因素,包括原发灶最长径、最大截面积及CT值、病灶强化是否均匀、CT血管壁外侵犯评分(ctEMVI)、转移淋巴结最大短径、胃周淋巴结是否融合及坏死、有无融合的大块淋巴结、肝脏转移灶最大截面积及CT值、腹膜转移CT评分、腹膜转移结节最大直径。以Kaplan-Meier生存曲线和log-rank检验分析指标的组间预后差异。单因素和多因素Cox比例风险回归模型用于确定PFS和OS的独立风险因素。结果原发灶最大截面积、平扫CT值、延迟期CT值和延迟期CT比值高、低风险组患者的PFS生存曲线差异有统计学意义(P<0.05),原发灶最大截面积高、低风险组患者的PFS和OS生存曲线差异有统计学意义(P<0.05)。单因素分析中,原发灶最大截面积、平扫CT值、延迟期CT值、延迟期CT比值及转移淋巴结最大短径是PFS的风险因素(P<0.05);PS评分、CA724、原发灶最大截面积、肝脏转移灶最大截面积和腹膜转移CT评分是OS的风险因素(P<0.05)。多因素分析中,原发灶最大截面积、平扫CT值是晚期胃癌患者PFS的独立风险因素(HR=0.41、2.50,P=0.009、0.006);PS评分、CA724、腹膜转移CT评分是患者OS的独立风险因素(HR=46.78、6.26、92.92,P=0.026、0.009、0.007)。结论基线CT上原发灶大小、病灶CT值以及腹膜转移CT评分可作为单部位远处转移不可切除晚期胃癌患者生存的独立风险因素,基线CT对于晚期胃癌患者具有一定的生存预测价值。