BACKGROUND The Khorana risk score(KRS)has poor predictive value for cancer-associated thrombosis in a single tumor type but is associated with early all-cause mortality from cancer.Evidence for the association between...BACKGROUND The Khorana risk score(KRS)has poor predictive value for cancer-associated thrombosis in a single tumor type but is associated with early all-cause mortality from cancer.Evidence for the association between KRS and all-cause mortality in Japanese patients with gastric and colorectal cancer is limited.AIM To investigate whether KRS was independently related to all-cause mortality in Japanese patients with gastric and colorectal cancer after adjusting for other covariates and to shed light on its temporal validity.METHODS Data from Dryad database were used in this study.Patients in the Gastroen-terology Department of Sapporo General Hospital,Sapporo,Japan,were enrolled.The starting and ending dates of the enrollment were January 1,2008 and January 5,2015,respectively.The cutoff date for follow-up was May 31,2016.The inde-pendent and dependent(target)variables were the baseline measured using the KRS and final all-cause mortality,respectively.The KRS was categorized into three groups:Low-risk group(=0 score),intermediate-risk group(1-2 score),and high-risk group(≥3 score).RESULTS Men and patients with Eastern Cooperative Oncology Group Performance Status(ECOG PS)≥2 displayed a higher 2-year risk of death than women and those with ECOG PS 0-1 in the intermediate/high risk group for KRS.The higher the score,the higher the risk of early death;however,the relevance of this independent prediction decreased with longer survival.The overall survival of each patient was recorded via real-world follow-up and retrospective observations,and this study yielded the overall relationship between KRS and all-cause mortality.CONCLUSION The prechemotherapy baseline of KRS was independently associated with all-cause mortality within 2 years;however,this independent predictive relationship weakened as survival time increased.展开更多
Background:Globally,colorectal cancer(CRC)imposes a substantial burden on healthcare systems and confers considerable medical expenditures.We aimed to evaluate the global and regional burden in epidemiological trends ...Background:Globally,colorectal cancer(CRC)imposes a substantial burden on healthcare systems and confers considerable medical expenditures.We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC.Methods:We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index(HDI).Trends of age-standardized rates of incidence and mortality in 60 countries(2000–2019)were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019.The association between exposure to country-level lifestyle,metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression.Results:CRC incidence and mortality varied greatly in the 60 selected countries,and much higher incidence and mortality were observed in countries with higher HDIs,and vice versa.From 2000 to 2019,significant increases of incidence and mortality were observed for 33 countries(average annual percent changes[AAPCs],0.24–3.82)and 18 countries(AAPCs,0.41–2.22),respectively.A stronger increase in incidence was observed among males(AAPCs,0.36–4.54)and individuals<50 years(AAPCs,0.56–3.86).Notably,15 countries showed significant decreases in both incidence(AAPCs,0.24 to2.19)and mortality(AAPCs,0.84 to2.74).A significant increase of incidence among individuals<50 years was observed in 30 countries(AAPCs,0.28–3.62).Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking,higher level of cholesterol level,higher level of unemployment,and a poorer healthcare system.Conclusions:Some high-HDI countries showed decreasing trends in CRC incidence and mortality,whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends,especially in males and populations≥50 years,which require targeted preventive health programs.展开更多
目的初步验证英国结直肠医师协会结直肠癌术后风险评估模型(The colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland,ACPGBI-CCM)的准确性,探讨其与临床风险预测指标间的关系。方法回顾性分析...目的初步验证英国结直肠医师协会结直肠癌术后风险评估模型(The colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland,ACPGBI-CCM)的准确性,探讨其与临床风险预测指标间的关系。方法回顾性分析2007年4月至2007年7月期间四川大学华西医院肛肠外科治疗组收治的诊断明确的结直肠癌患者。通过ACPGBI-CCM为每一位纳入研究的患者计算死亡率预测值,并以死亡率预测值中位数为界,将纳入患者分为低风险组与高风险组,比较2组间不同风险因子的差异;然后对评估指标进行分层分析,探讨其与术后死亡率预测值的关系。结果研究期间本治疗组共收治了99例诊断明确的结直肠癌患者,其中有67例符合纳入条件,平均年龄60.09岁,男34例,女33例;右半结肠癌15例,左半结肠癌9例,直肠癌43例;Dukes分期:A期0例,B期37例,C期24例,D期6例。术后30d内的实际死亡例数为0。ACPGBI-CCM预测的死亡率为0.77%～25.75%,中位值为3.36%,以预测死亡率≤3.36%为低风险组(34例),预测死亡率>3.36%为高风险组(33例),高风险组的死亡率预测值明显高于低风险组〔(8.86±4.51)%vs(1.76±0.68)%,P<0.01〕。高风险组与低风险组间患者年龄、内科合并症、术前有无化疗、ASA分级、术中肿瘤是否切除及手术持续时间差异均有统计学意义(P<0.01);2组间肿瘤并发症、Dukes分期、TNM分期及术后疼痛差异也均有统计学意义(P<0.05);2组间性别、既往腹部手术史、肿瘤距肛缘位置、肿瘤部位、分化程度、术后住院时间及总住院时间差异均无统计学意义(P>0.05)。进一步对各风险评估指标进行分析,发现不同年龄、有无内科合并症、术前化疗、不同ASA分级及肿瘤是否切除会导致不同的死亡率,其差异具有统计学意义(P<0.01);不同Dukes分期和分化程度会引起不同的死亡率,其差异亦有统计学意义(P<0.05);而不同的性别、有无既往腹部手术史、肿瘤并发症、不同TNM分期及不同肿瘤部位之间死亡率风险预测值差异均无统计学意义(P>0.05)。结论ACPGBI-CCM的临床适用性在单一大容量的医疗中心研究中得到肯定,但其预测效果会高估死亡率,这可能是由于地域和人文差异带来的结果。进一步分析发现,合并症、是否行新辅助治疗或辅助治疗可能是结直肠癌患者术后生存质量的独立预测因子,这需要进一步的临床分层次研究来证实。展开更多
文摘BACKGROUND The Khorana risk score(KRS)has poor predictive value for cancer-associated thrombosis in a single tumor type but is associated with early all-cause mortality from cancer.Evidence for the association between KRS and all-cause mortality in Japanese patients with gastric and colorectal cancer is limited.AIM To investigate whether KRS was independently related to all-cause mortality in Japanese patients with gastric and colorectal cancer after adjusting for other covariates and to shed light on its temporal validity.METHODS Data from Dryad database were used in this study.Patients in the Gastroen-terology Department of Sapporo General Hospital,Sapporo,Japan,were enrolled.The starting and ending dates of the enrollment were January 1,2008 and January 5,2015,respectively.The cutoff date for follow-up was May 31,2016.The inde-pendent and dependent(target)variables were the baseline measured using the KRS and final all-cause mortality,respectively.The KRS was categorized into three groups:Low-risk group(=0 score),intermediate-risk group(1-2 score),and high-risk group(≥3 score).RESULTS Men and patients with Eastern Cooperative Oncology Group Performance Status(ECOG PS)≥2 displayed a higher 2-year risk of death than women and those with ECOG PS 0-1 in the intermediate/high risk group for KRS.The higher the score,the higher the risk of early death;however,the relevance of this independent prediction decreased with longer survival.The overall survival of each patient was recorded via real-world follow-up and retrospective observations,and this study yielded the overall relationship between KRS and all-cause mortality.CONCLUSION The prechemotherapy baseline of KRS was independently associated with all-cause mortality within 2 years;however,this independent predictive relationship weakened as survival time increased.
基金the Natural Science Foundation of Beijing Municipality(No.7202169)the Beijing Nova Program of Science and Technology(No.Z191100001119065)the CAMS Innovation Fund for Medical Sciences(No.2017-I2M-1-006).
文摘Background:Globally,colorectal cancer(CRC)imposes a substantial burden on healthcare systems and confers considerable medical expenditures.We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC.Methods:We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index(HDI).Trends of age-standardized rates of incidence and mortality in 60 countries(2000–2019)were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019.The association between exposure to country-level lifestyle,metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression.Results:CRC incidence and mortality varied greatly in the 60 selected countries,and much higher incidence and mortality were observed in countries with higher HDIs,and vice versa.From 2000 to 2019,significant increases of incidence and mortality were observed for 33 countries(average annual percent changes[AAPCs],0.24–3.82)and 18 countries(AAPCs,0.41–2.22),respectively.A stronger increase in incidence was observed among males(AAPCs,0.36–4.54)and individuals<50 years(AAPCs,0.56–3.86).Notably,15 countries showed significant decreases in both incidence(AAPCs,0.24 to2.19)and mortality(AAPCs,0.84 to2.74).A significant increase of incidence among individuals<50 years was observed in 30 countries(AAPCs,0.28–3.62).Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking,higher level of cholesterol level,higher level of unemployment,and a poorer healthcare system.Conclusions:Some high-HDI countries showed decreasing trends in CRC incidence and mortality,whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends,especially in males and populations≥50 years,which require targeted preventive health programs.
文摘目的初步验证英国结直肠医师协会结直肠癌术后风险评估模型(The colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland,ACPGBI-CCM)的准确性,探讨其与临床风险预测指标间的关系。方法回顾性分析2007年4月至2007年7月期间四川大学华西医院肛肠外科治疗组收治的诊断明确的结直肠癌患者。通过ACPGBI-CCM为每一位纳入研究的患者计算死亡率预测值,并以死亡率预测值中位数为界,将纳入患者分为低风险组与高风险组,比较2组间不同风险因子的差异;然后对评估指标进行分层分析,探讨其与术后死亡率预测值的关系。结果研究期间本治疗组共收治了99例诊断明确的结直肠癌患者,其中有67例符合纳入条件,平均年龄60.09岁,男34例,女33例;右半结肠癌15例,左半结肠癌9例,直肠癌43例;Dukes分期:A期0例,B期37例,C期24例,D期6例。术后30d内的实际死亡例数为0。ACPGBI-CCM预测的死亡率为0.77%～25.75%,中位值为3.36%,以预测死亡率≤3.36%为低风险组(34例),预测死亡率>3.36%为高风险组(33例),高风险组的死亡率预测值明显高于低风险组〔(8.86±4.51)%vs(1.76±0.68)%,P<0.01〕。高风险组与低风险组间患者年龄、内科合并症、术前有无化疗、ASA分级、术中肿瘤是否切除及手术持续时间差异均有统计学意义(P<0.01);2组间肿瘤并发症、Dukes分期、TNM分期及术后疼痛差异也均有统计学意义(P<0.05);2组间性别、既往腹部手术史、肿瘤距肛缘位置、肿瘤部位、分化程度、术后住院时间及总住院时间差异均无统计学意义(P>0.05)。进一步对各风险评估指标进行分析,发现不同年龄、有无内科合并症、术前化疗、不同ASA分级及肿瘤是否切除会导致不同的死亡率,其差异具有统计学意义(P<0.01);不同Dukes分期和分化程度会引起不同的死亡率,其差异亦有统计学意义(P<0.05);而不同的性别、有无既往腹部手术史、肿瘤并发症、不同TNM分期及不同肿瘤部位之间死亡率风险预测值差异均无统计学意义(P>0.05)。结论ACPGBI-CCM的临床适用性在单一大容量的医疗中心研究中得到肯定,但其预测效果会高估死亡率,这可能是由于地域和人文差异带来的结果。进一步分析发现,合并症、是否行新辅助治疗或辅助治疗可能是结直肠癌患者术后生存质量的独立预测因子,这需要进一步的临床分层次研究来证实。
