AIM To establish the Karnofsky performance status(KPS) categories which would facilitate the interconversion of the KPS scale to the Eastern Cooperative Oncology Group(ECOG) performance status(PS) scale.METHODS This w...AIM To establish the Karnofsky performance status(KPS) categories which would facilitate the interconversion of the KPS scale to the Eastern Cooperative Oncology Group(ECOG) performance status(PS) scale.METHODS This was a retrospective analysis of all patients attending the lung cancer clinic at a tertiary care center over a 5-year period(September 2009 to August 2014). All patients were assessed with both KPS and ECOG PS scales at each visit. Correlation between KPS and ECOG PS was assessed using Spearman's correlation coefficient. KPS categories equivalent to ECOG PS scores were compared using hit rate and weighted kappa(κw).RESULTS A total of 1501 patients were assessed over the study period, providing 5844 paired KPS and ECOG PS assessments. The study cohort had a mean(standard deviation; SD) age of 58.4(10.8) years, with the majority being current or ex-smokers(76.9%) and males(82.3%). Non-small cell lung cancer was the most common histological type(n = 1196, 79.7%) with the majority having advanced(stage ⅢB/Ⅳ) disease(83.4%). Mean baseline KPS and ECOG PS scores were 77.6(SD = 14.4) and 1.5(SD = 1) respectively. The most frequent KPS score was 80(29%), and the most frequent ECOG PS score was 1(43%). The overall correlation between KPS and ECOG PS was good(Spearman r =-0.84, P < 0.0001) but ranged from-0.727 to-0.972 between visits. KPS categories derived from our cohort [10-40(ECOG 4), 50-60(ECOG 3), 70(ECOG 2), 80-90(ECOG 1), 100(ECOG 0)] performed better [hit rate 78.1%, κw = 0.749(0.736-0.762) P < 0.0001] than those suggested in the past literature.CONCLUSION The current study provides the largest set of paired KPS-ECOG assessments to date. We suggest that the KPS categories 10-40, 50-60, 70, 80-90, and 100 are equivalent to ECOG PS categories of 4, 3, 2, 1, and 0 respectively.展开更多
BACKGROUND Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart,liver and kidney transplants.However,information on how functional status,before and after tra...BACKGROUND Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart,liver and kidney transplants.However,information on how functional status,before and after transplant impacts post-transplant survival outcomes is lacking.AIM To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults.METHODS We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022.The primary outcome was mortality.Using the Karnofsky Performance Status,functional impairment was categorized as severe,moderate and normal.Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression.RESULTS The median age was 41 years,majority(53.4%)were women.Severe impairment was present in 28.3%of recipients.The median survival time was 906.6 days.The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively.Recipients with severe impairment had a 56%higher risk of mortality at one year[Hazard ratio(HR)=1.56;95%CI:1.23–1.98;P<0.001]and 58%at five years(HR=1.58;95%CI:1.24–2.00;P<0.001)compared to patients with no functional impairment.Recipients with worse functional status after transplant also had poor survival outcomes.CONCLUSION Pre-and post-transplant recipient functional status is an important prognostic indicator for short-and long-term intestinal transplant outcomes.展开更多
Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in C...Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.展开更多
Objective This study aimed to investigate the effects of vitamin B12 mixed oral liquid in the treatment of radiation-induced esophagitis in patients with esophageal cancer.Methods Seventy-five patients with esophageal...Objective This study aimed to investigate the effects of vitamin B12 mixed oral liquid in the treatment of radiation-induced esophagitis in patients with esophageal cancer.Methods Seventy-five patients with esophageal cancer who met the enrollment criteria were randomly divided into the vitamin B12 mixed oral liquid group(39 patients in the study group)and the gentamicin mixed oral liquid group(36 patients in the control group).The effects of the two treatment methods on esophagitis grading,pain degree,body weight loss,and Karnofsky performance status(KPS)score in patients with radiation esophagitis were observed.Results In the control group,grade 1 radiation esophagitis accounted for 27.8%of the total patients,grade 2 accounted for 41.7%,and grades 3 and 4 accounted for 30.6%.In the vitamin B12 treatment group,grade 1 radiation esophagitis accounted for 66.7%of the total patients,grade 2 accounted for 25.6%,and grades 3 and 4 accounted for 7.7%;there was a significant difference between the vitamin B12 treatment group and control group(P<0.01).Similarly,pain caused by radiation esophagitis was significantly improved in the vitamin B12 group compared with the control group(P<0.05).After treatment,the average weight loss of the control group was(2.18±0.36)kg,while that of the vitamin B12 treatment group was(0.90±0.43)kg(P<0.05).The KPS scores of the vitamin B12 group were higher than those of the control group,which were 86.2±1.2 and 85.6±1.5,respectively,but there was no statistical difference(P>0.05).Conclusion Vitamin B12 mixed oral liquid can effectively reduce the severity of radiation esophagitis,relieve pain,improve patients’quality of life,and increase treatment compliance.展开更多
Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with ML...Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n = 51) or TDT (n = 22) placement from 2012 to 2017. The success rates of placement, clinical outcomes after decompression, complications, the time to resuming enteral nutrition (EN), Karnofsky performance status (KPS) scoring and the following-up therapeutic options were investigated. Results Technical success were achieved in 100% of patients in both groups. The clinical success rates were 98.0%(50/51) for SEMS and 95.5%(21/22) for TDT. No perforation was found in any group, while 3.9%(2/51) in the SEMS and 18.2%(4/22) in TDT group experienced displacement (P = 0.26). It took 2.1 IQR (0~2) days and 3 IQR (2~5) days to resume EN in the SEMS and TDT groups, respectively (P < 0.001). The KPS scores were significantly higher in patients implanted with SEMS (70, IQR 50~80) than in those with TDT (35, IQR 30~50)(P < 0.001). In the SEMS group, 37.3%(19/51) of patients underwent stenting as a bridge to surgery, 9.8%(5/51) for chemotherapy only and 52.9%(27/51) for palliation, while 40.9%(9/22), 0 and 59.1%(13/22) underwent placement for these reasons in the TDT group, respectively. The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation, while only 31.6%(6/19) of those in the SEMS group needed a stoma (P = 0.080). In addition, anastomotic leakage was only found in the TDT group (2/9)(P = 0.10). Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO. However, SEMS placement is associated with earlier EN, fewer complications, and benefits for the postoperative quality-of-life.展开更多
文摘AIM To establish the Karnofsky performance status(KPS) categories which would facilitate the interconversion of the KPS scale to the Eastern Cooperative Oncology Group(ECOG) performance status(PS) scale.METHODS This was a retrospective analysis of all patients attending the lung cancer clinic at a tertiary care center over a 5-year period(September 2009 to August 2014). All patients were assessed with both KPS and ECOG PS scales at each visit. Correlation between KPS and ECOG PS was assessed using Spearman's correlation coefficient. KPS categories equivalent to ECOG PS scores were compared using hit rate and weighted kappa(κw).RESULTS A total of 1501 patients were assessed over the study period, providing 5844 paired KPS and ECOG PS assessments. The study cohort had a mean(standard deviation; SD) age of 58.4(10.8) years, with the majority being current or ex-smokers(76.9%) and males(82.3%). Non-small cell lung cancer was the most common histological type(n = 1196, 79.7%) with the majority having advanced(stage ⅢB/Ⅳ) disease(83.4%). Mean baseline KPS and ECOG PS scores were 77.6(SD = 14.4) and 1.5(SD = 1) respectively. The most frequent KPS score was 80(29%), and the most frequent ECOG PS score was 1(43%). The overall correlation between KPS and ECOG PS was good(Spearman r =-0.84, P < 0.0001) but ranged from-0.727 to-0.972 between visits. KPS categories derived from our cohort [10-40(ECOG 4), 50-60(ECOG 3), 70(ECOG 2), 80-90(ECOG 1), 100(ECOG 0)] performed better [hit rate 78.1%, κw = 0.749(0.736-0.762) P < 0.0001] than those suggested in the past literature.CONCLUSION The current study provides the largest set of paired KPS-ECOG assessments to date. We suggest that the KPS categories 10-40, 50-60, 70, 80-90, and 100 are equivalent to ECOG PS categories of 4, 3, 2, 1, and 0 respectively.
文摘BACKGROUND Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart,liver and kidney transplants.However,information on how functional status,before and after transplant impacts post-transplant survival outcomes is lacking.AIM To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults.METHODS We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022.The primary outcome was mortality.Using the Karnofsky Performance Status,functional impairment was categorized as severe,moderate and normal.Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression.RESULTS The median age was 41 years,majority(53.4%)were women.Severe impairment was present in 28.3%of recipients.The median survival time was 906.6 days.The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively.Recipients with severe impairment had a 56%higher risk of mortality at one year[Hazard ratio(HR)=1.56;95%CI:1.23–1.98;P<0.001]and 58%at five years(HR=1.58;95%CI:1.24–2.00;P<0.001)compared to patients with no functional impairment.Recipients with worse functional status after transplant also had poor survival outcomes.CONCLUSION Pre-and post-transplant recipient functional status is an important prognostic indicator for short-and long-term intestinal transplant outcomes.
基金This work was supported by the National Key Research to Han Ping Shi and Development Program(No.2017YFC1309200)National Natural Science Foundation of China(No.81673167 to Hong Xia Xu).
文摘Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.
基金Supported by a grant from the National Natural Sciences Foundation of China(No.81872471)
文摘Objective This study aimed to investigate the effects of vitamin B12 mixed oral liquid in the treatment of radiation-induced esophagitis in patients with esophageal cancer.Methods Seventy-five patients with esophageal cancer who met the enrollment criteria were randomly divided into the vitamin B12 mixed oral liquid group(39 patients in the study group)and the gentamicin mixed oral liquid group(36 patients in the control group).The effects of the two treatment methods on esophagitis grading,pain degree,body weight loss,and Karnofsky performance status(KPS)score in patients with radiation esophagitis were observed.Results In the control group,grade 1 radiation esophagitis accounted for 27.8%of the total patients,grade 2 accounted for 41.7%,and grades 3 and 4 accounted for 30.6%.In the vitamin B12 treatment group,grade 1 radiation esophagitis accounted for 66.7%of the total patients,grade 2 accounted for 25.6%,and grades 3 and 4 accounted for 7.7%;there was a significant difference between the vitamin B12 treatment group and control group(P<0.01).Similarly,pain caused by radiation esophagitis was significantly improved in the vitamin B12 group compared with the control group(P<0.05).After treatment,the average weight loss of the control group was(2.18±0.36)kg,while that of the vitamin B12 treatment group was(0.90±0.43)kg(P<0.05).The KPS scores of the vitamin B12 group were higher than those of the control group,which were 86.2±1.2 and 85.6±1.5,respectively,but there was no statistical difference(P>0.05).Conclusion Vitamin B12 mixed oral liquid can effectively reduce the severity of radiation esophagitis,relieve pain,improve patients’quality of life,and increase treatment compliance.
文摘Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n = 51) or TDT (n = 22) placement from 2012 to 2017. The success rates of placement, clinical outcomes after decompression, complications, the time to resuming enteral nutrition (EN), Karnofsky performance status (KPS) scoring and the following-up therapeutic options were investigated. Results Technical success were achieved in 100% of patients in both groups. The clinical success rates were 98.0%(50/51) for SEMS and 95.5%(21/22) for TDT. No perforation was found in any group, while 3.9%(2/51) in the SEMS and 18.2%(4/22) in TDT group experienced displacement (P = 0.26). It took 2.1 IQR (0~2) days and 3 IQR (2~5) days to resume EN in the SEMS and TDT groups, respectively (P < 0.001). The KPS scores were significantly higher in patients implanted with SEMS (70, IQR 50~80) than in those with TDT (35, IQR 30~50)(P < 0.001). In the SEMS group, 37.3%(19/51) of patients underwent stenting as a bridge to surgery, 9.8%(5/51) for chemotherapy only and 52.9%(27/51) for palliation, while 40.9%(9/22), 0 and 59.1%(13/22) underwent placement for these reasons in the TDT group, respectively. The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation, while only 31.6%(6/19) of those in the SEMS group needed a stoma (P = 0.080). In addition, anastomotic leakage was only found in the TDT group (2/9)(P = 0.10). Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO. However, SEMS placement is associated with earlier EN, fewer complications, and benefits for the postoperative quality-of-life.
