Annual Hazard Research Articles

Characteristics and prognosis of distant metastasis after primary treatment for early-stage extranodal nasal-type natural killer/T-cell lymphoma from the China Lymphoma Collaborative Group database.

This study aimed to investigate the characteristics and prognosis of distant metastasis (DM) after primary treatment for early-stage extranodal nasal-type natural killer (NK)/T-cell lymphoma (ENKTCL). A total of 1619 patients from the China Lymphoma Collaborative Group database were retrospectively reviewed. The cumulative incidence of DM was assessed using Fine and Gray's competing risk analysis. The correlation between DM sites was evaluated using phi coefficients, while DM sites were classified using hierarchical clustering. Regression analysis was used to assess the linear correlation between DM-free survival (DMFS) and overall survival (OS). The 5-year cumulative DM rate was 26.2%, with the highest annual hazard rate being in the first year (14.9%). The most frequent DM sites were the skin and soft tissues (SSTs, 32.4%) and distant lymph nodes (LNs, 31.3%). DM sites were categorized into four subgroups of distinct prognosis - distant LN, SST, extracutaneous site, and lymphoma-associated hemophagocytic lymphohistiocytosis. SST or distant LN, solitary metastasis, and late-onset DM demonstrated a relatively favorable prognosis. Contemporary chemotherapy significantly decreased DM rates and improved DMFS. Decreased DM rates were further associated with increased OS probabilities. Our findings improve the understanding of the variable clinical behaviors of early-stage ENKTCL based on four distinct DM sites and thus provide guidance for future therapeutic decisions, metastatic surveillance, and translational trial design.

Sinonasal Inverted Papilloma-Associated and De Novo Squamous Cell Carcinoma: A Tale of Two Cities or Not.

Sinonasal squamous cell carcinoma (SNSCC) can arise as either inverted papilloma-associated SCC (IP-SCC) or as de novo SCC (DN-SCC). It is controversial as to whether survival differences between IP-SCC and DN-SCC exist. Between January 2000 and December 2016, 234 patients with SNSCC were analyzed retrospectively, including 68 with IP-SCC and 166 with DN-SCC. Propensity score matching (PSM) was performed to balance baseline characteristics. The Kaplan-Meier method and Cox proportional hazard model were used to determine risk factors on survival outcomes. The median follow-up time was 98.4 months. Before PSM, lymph node metastasis was noted to be lower in patients with IP-SCC. After PSM, the 5-year DFS, DSS and OS between IP-SCC and DN-SCC were 43.0% vs. 44.5% (p = 0.701), 49.2% vs. 56.2% (p = 0.753), and 48.2% vs. 52.9% (p = 0.978). The annual hazards of local failure, respectively, peaked at 28.4% and 27.8% for IP-SCC and DN-SCC within 12 months after treatment. Afterward, the hazards gradually decreased and the hazard for IP-SCC was always higher before approaching null. This study provides novel evidence to support the clinical utility of improved distinction between IP-SCC and DN-SCC. Further studies are necessary to validate these findings before considering escalation of IP-SCC.

Linac-based stereotactic radiosurgery for brain arteriovenous malformations

PurposeLinac stereotactic radiosurgery (SRS) is gaining popularity as a form of radiation treatment for cerebral arteriovenous malformations (AVMs) since the theory of combined radiosurgical and endovascular treatment poses much uncertainty and due to significant technical progress for SRS. This study focuses on how to evaluate obliteration and re-bleeding rates, and to determine factors and adverse effects influencing obliteration after linac-based SRS for cerebral AVMs.Material and methodsFrom a statistical record of 71 patients, 31 had partial embolisation, five surgery and 29 had no prior treatment. Using Kaplan–Meier survival and life table analyses, actuarial obliteration and annual bleeding hazard rates were calculated after SRS.ResultsAfter a follow up of 1, 2 and 3 years the actual obliteration rates were 22, 59 and 66%, respectively whereby it was noted that prior embolization had no effect on the obliteration rate. Annual bleeding hazard rates were further analyzed after stereotactic radiosurgery to be 2.1% and 1.4% for the first and second year respectively. Asymptomatic abnormalities were detected after imaging in 33.9% of patients. A dose of less than 18 Gy significantly reduced the obliteration probability.ConclusionSRS is a therapeutic option for intracerebral AVM. In general, there is a low rate of morbidity and a high probability of nidus obliteration.

Long term risk of distant metastasis in women with non-metastatic breast cancer and survival after metastasis detection: a population-based linked health records study.

To estimate the long term risk of distant metastases (DM) for women with initial diagnoses of non-metastatic breast cancer; to estimate breast cancer-specific and overall survival for women with DM. Population-based health record linkage study. Women diagnosed with localised or regional primary breast cancer recorded in the NSW Cancer Registry, 2001-2002. Time from breast cancer diagnosis to first DM, time from first DM to death from breast cancer. time to death from any cause. 6338 women were diagnosed with non-metastatic breast cancer (localised, 3885; regional, 2453; median age, 59 years [IQR, 49-69 years]). DM were recorded (to 30 September 2016) for 1432 women (23%; median age, 62 years [IQR, 51-73 years]). The 14-year cumulative DM incidence was 22.2% (95% CI, 21.1-23.2%; localised disease: 14.3% [95% CI, 13.2-15.4%]; regional disease: 34.7% [95% CI, 32.8-36.6%]). Annual hazard of DM was highest during the second year after breast cancer diagnosis (localised disease: 2.8%; 95% CI, 2.3-3.3%; regional disease: 9.1%; 95% CI, 7.8-10.3%); from year five it was about 1% for those with localised disease, from year seven about 2% for women with regional disease at diagnosis. Five years after diagnosis, the 5-year conditional probability of DM was 4.4% (95% CI, 3.7-5.1%) for women with localised and 10.4% (95% CI, 9.1-12.0%) for those with regional disease at diagnosis. Median breast cancer-specific survival from first DM record date was 28 months (95% CI, 25-31 months); the annual hazard of breast cancer death after the first DM record declined from 36% (95% CI, 33-40%) during the first year to 14% (95% CI, 11-18%) during the fourth year since detection. DM risk declines with time from diagnosis of non-metastatic breast cancer, and the annual risk of dying from breast cancer declines with time from initial DM detection. These findings can be used to inform patients at follow-up about changes in risk over time since diagnosis and for planning health services.

RADIOLOGICAL HEALTH RISK EVALUATION OF DOMESTIC SOURCES OF WATER IN SELECTED LEAD MINING COMMUNITIES OF NASARAWA STATE, NORTH CENTRAL, NIGERIA

Mining activities is one of the causals of water pollution in recent times that could potentiate a great risk to human who depends on these water sources for domestic uses in Adudu, Abuni and Kanje mining communities of Nasarawa State. This research aimed to determine the quantity of radionuclides viz 238U, 232Th and 40K in surface and groundwater samples of these communities. The concentrations of the radionuclides were measured using Gamma-ray spectroscopy and the radiological hazard indices such as Radium Equivalent (Raeq), Dose Rate (DR), Annual Effective Dose Equivalent (AEDE), Hazard Index (Hi), Representative Radioactivity (Iy) and Excessive Life Cancer Risk (ELCR) were evaluated and used to analyze the data. 238U was found in 12 out of the 27 analyzed water samples with their concentrations within the WHO standard. The concentration of 232Th found in the sampled water sources were higher than the recommended limit except for samples B5 and S2. However, 40K was found in most water samples analyzed although the concentration was below the authorized standard. The evaluated radiological health hazard parameters (Raeq, DR, AEDE, AEDE, HI, Iy and ELCR) were generally below world average and WHO standard values for domestic water. Thus, this study showed that the concentrations of radionuclides in these sources of water pose no radiological health risk to the community dwellers and the presence of the radionuclides are due to the geologic and mineral composition of the study area rather than mining activities.

Estrogen receptor-negative/progesterone receptor-positive and her-2-negative breast cancer might no longer be classified as hormone receptor-positive breast cancer.

The single progesterone receptor (PR)-positive phenotype (estrogen receptor (ER)-/PR + , sPR positive) is an infrequent and independent biological entity. However, the prognosis of patients with sPR-positive and her-2-negative phenotype is still controversial, and it is not always easy to decide treatment strategies for them. Patients during 2010-2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method was used to evaluatecancer-specificsurvival (CSS). The propensity score matching (PSM) method was used to balance differences of characteristics in groups. The Life-Table method was used to calculate 5-year CSS rates and the annual hazard rate of death (HRD). A total of 97,527 patients were included, and only 745 (0.76%) patients were sPR-positive phenotype. The majority of sPR-positive breast cancer were basal-like subtype. Survival analysis showed that the sPR-positive breast cancer had similar prognosis comparing to double hormonal receptor-negative (ER-/PR-, dHoR-negative) breast cancer, and had the highest HRD during the initial 1-2years of follow-up, then maintained the HRD of almost zero during the late years of follow-up. The patients with sPR-positive and her-2-negative breast cancer, similar to dHoR-negative breast cancer, had a worse survival, and could benefit from chemotherapy significantly. However, the escalating endocrine therapy was not recommended for sPR-positive patients. The patients with sPR positive should be excluded from future clinical trials concerning endocrine therapy.

Natural Radioactivity and Radiological Implications of Stream Sediments at Wadi Aidib Area, South Eastern Desert, Egypt

Wadi Aidib lies at the extreme southern part of the Eastern Desert, Egypt, between 22o15'- 22o21' N and Longitudes 36o20'-36o30' E. Landsat ETM+ false color composite image (bands 3, 2, 1) was used for regional discrimination for different rock types and provide an excellent base map for the study area, morphological features of the stream deposits of the study area were known from Landsat ETM images, in addition to several field observations. The studied stream sediments accumulate in the form of alluvial fans. They are mainly composed of sands, gravels, boulders and contain some heavy valuable minerals which are derived from metavolcanics, metasediments, quartz diorite, biotite and alkali feldspar granites. Heavy liquid separation and magnetic separation techniques in addition to microscopic examination for the studied stream sediment samples were applied to identify the heavy minerals in these sediments. These minerals are represented by magnetite, ilmenite, rutile, garnet, zircon, monazite and Green silicates. The distribution of some elements in the study area is clear that they are concentrated near the outcrops of granites. The radionuclide concentrations were measured in different stations using a calibrated gamma-ray portable detector (RS 230) and the heavy minerals causing radioactivity were separated by heavy liquids and determined by binuclear and environmental scanning electron microscopes. Uranium ranges between 5.25 and 32.05 ppm with an average of 16.63 ppm, Th between 4.4 and 17 ppm with 11.34 ppm as an average and potassium fall between 1.8 and 5.15% with an average of 3.4 %. Correlation between soil radioactivity and its mineralogical content indicate that the high radionuclides contents are mainly attributed to the presence monazite which is the principal source of both uranium and thorium. Uranium high concentrations could be related to the metamict zircon. Absorbed Dose Rate (D), annual effective dose equivalent radium equivalent activity, external and internal hazard index, in addition to activity gamma index caused by gamma emitting natural radionuclide are determined from the obtained values of 238U, 232Th and 40K. Fairly, some of the studied stations do not satisfy the universal standards. 40K plays the main and most important role in dose rate contribution.

Analysis of the Radiological, Mineralogical and Long-Term Sustainability of Several Commercial Aswan Granites Used as Building Materials

The widespread usage of granite in the building sector motivated us to conduct this research and examine the material’s sustainability in terms of the investigated characteristics. The purpose of this paper is to discuss the statistical analysis results for the mineralogical impact on radiological hazards indices, such as the equivalent of radium, absorbed gamma dose rate, annual effective dose, internal and external hazard indices, as well as the gamma-ray index, that were calculated to estimate the environmental risks associated with these granites used as building materials, to protect the public from excessive radioactivity exposure. We focused primarily on statistical significance at a 95% confidence level. We employed a non-parametric test (Kruskal–Wallis Test) rather than a one-way ANOVA, to determine the statistical significance of the samples due to the lack of homogeneity or normality among them. To assess the difference between the samples, we used the Mann–Whitney Test on each pair of samples. Additionally, Pearson correlation coefficients for all the mineralogical results are computed. The presence of K-rich minerals (Kefeldspars, biotite) and accessories such as uranophane, uranothorite, allanite, xenotime, fergusonite, aeschynite, zircon, cassiterite, apatite, and sphene, which are mostly found in granitic rocks, determines the level of natural radioactivity of the investigated granites. Most of the rock samples analyzed have indicators of radioactive dangers that are within the acceptable level range, indicating that they are suitable for use as building materials. On the other hand, some samples have environmental criteria that are higher than international standards, indicating that they are unsuitable for use as construction materials.

Time‐dependent seismic resilience of aging repairable structures considering multiple damage states

AbstractEarthquakes are among the natural hazards threatening the serviceafbility, functionality, and safety of engineering structures significantly. Posthazard structures may suffer from different damage states and correspondingly different functionality losses/recovery processes in the aftermath of hazardous events. This paper proposes a measure for structural time‐dependent seismic resilience considering multiple damage states. Its specific case (i.e., considering damage–no damage scenario) reduces to the existing resilience measure in the literature. The time‐variant fragility curves and the generalized seismic capacities are used to determine the damage states conditional on the peak ground motion (PGA). The proposed measure is applicable for both of the following two cases: (1) the earthquake occurrence rate and the magnitude of PGA conditional on earthquake occurrence are known; (2) the probability distribution of annual maximum PGA is known. In terms of the latter, the annual seismic hazard function can be used to describe the seismic load uncertainty. A numerical example is presented to demonstrate the applicability of the proposed resilience measure. It is shown that the proposed measure can be used to quantitatively guide structural design to meet the target resilience level.

Radiological risk assessment in sediment of Namal Lake, Mianwali, Pakistan.

This study is concentrated on the radiological risk assessment of sixteen surface sediment samples recovered from Namal Lake, District Mianwali, Punjab, Pakistan. The activity of 137Cs, 40K, 226Ra, 228Ra, and 232Th was carried out with the help of a high purity germanium detector (HPGe) in the sediment, varied in the ranges of > 0.02-3.73 ± 1.31, 98.32 ± 21.45-341.02 ± 58.67, 18.34 ± 2.16-34.23 ± 4.34, 1.62 ± .30-2.34 ± .52, and 0.14 ± 0.10-2.34 ± 0.59Bqkg-1 with average values 0.74 ± 0.29, 237.26 ± 37.97, 25.06 ± 4.74, 1.97 ± 0.39, and 1.73 ± 0.33Bqkg-1, respectively. The measured concentrations in the current study have been compared with other earlier studies in the world. The data was also used for determining the other useful parameters like radium equivalent activity, absorbed dose rate, annual effective dose rate, and external and internal hazards index to assess the radiological risk assessment for the environment around the study area. The ERICA Tool software was also applied for radiological risk assessment for lake fish due to the radioactivity present in the lake sediments. It was concluded from the results of ERICA tool that the risk quotient in this study is less than one indicating that no toxic effects of radioactivity for Namal Lake fish.

Abstract 32: Post Stroke Suicide In Georgia, 2011-2018: Identifying High Risk Groups

Background: Disability can impact stroke survivors’ quality of life and mental health and may lead to suicide. Identifying and treating people at risk is one of the strategies listed by the Centers for Disease Control and Prevention to reduce suicide. The objectives of this study were to estimate the burden of suicide among stroke survivors in Georgia, identify predisposing factors, determine when patients are more likely to die of suicide, and examine suicide circumstances. Methods: Clinically diagnosed ischemic stroke (IS) patients from the Georgia Coverdell Acute Stroke Registry were linked with the Georgia Violent Death Reporting System (GVDRS) and death data for a retrospective cohort study. We applied survival analysis to estimate the annual suicide rate and cox proportional hazard model to identify high risk groups for suicide among stroke survivors. For those who died by suicide, circumstances were analyzed descriptively. Results: A total of 68,122 IS patients, from 2011 to 2018, were included. The median follow-up period was 40 months, and 70 suicide deaths were observed with a suicide rate of 28.3/100,000 person-years. About two-thirds of the suicides happened within 2 years of the stroke incident. Whites (HR=3.4), males (HR=10.8), young adults (HR=2.8), patients with depression (HR=3.8), and those who left hospitals against medical advice (HR=5.6) were more likely to die by suicide compared to blacks, females, older adults, patients without depression, and those who were discharged home respectively. Depression was reported in 36% of deaths, of which 25% had a past medical history of depression at hospital admission for stroke or were discharged with an antidepressant prescription. Firearms were used in 86.4% of the suicides. Conclusion: Ischemic stroke survivors have a 30% higher risk of death by suicide compared to the general Georgia population. This increased risk is mainly among males, patients with depression, and those who left hospitals against medical advice. More than four out of five suicides are by firearm; therefore, it is reasonable to make screening for suicide and counseling on firearm safety for patients and caregivers be a part of the discharge process and post discharge follow-up.

Radiogeochemistry, uranium migration, and radiogenic heat of the granite gneisses in parts of the southwestern Basement Complex of Nigeria

The radiogeochemistry of granite gneisses in Akunu-Akoko (AK) and Ayere (AY) areas of the southwestern Basement Complex of Nigeria was studied using gamma-ray spectrometry, and geostatistical analysis and modeling. This study was aimed at determining the concentrations of radionuclides (K, U, and Th) in these rocks, as well as alteration scenarios, nature and rates of uranium migration (UM), levels of radiological hazards, and rate of radiogenic heat production (RHP). The interquartile (lowest Q1 < highest Q2 < highest Q3) elemental concentrations for 40K, 238U, and 232Th were 0.23 < 3.75<4.06%; 1.00 < 4.20<5.40 ppm; and 4.10 < 16.10<30.20 ppm, respectively, within the minimum and maximum limits of BDL (below detection limit) to 5.23%, BDL–9.70 ppm, and 0.40–60.20 ppm. The average activity concentrations of 40K, 238U, and 232Th with values of 629.28, 38.58, and 49.96 Bqkg−1, respectively, were above their crustal averages in the order of AK3<AK2<AK3<AY3<AY1<AY2. Variability in K-eU-eTh content and alteration in the rocks were affirmed by radioelement ratios and F-parameter. The high radionuclide concentrations may be attributed to high levels of radioactive materials, as well as trace and rare earth elements. Low radionuclide concentration in rocks is due to weathering, metamorphism, and 12–86% outward UM. The absorbed dose rate (ADR) average of 75.09 nGyh−1 was within the allowable range, with regression R-squared (R2) prediction values of 25–92% from the radionuclides. The average radium activity was below the permissible limit of 370 Bqkg−1, and the annual effective doses, hazard indices, gamma activity, and activity utilization index were all far below the safe limit of 1 mSvy−1. However, gonad equivalent and excess lifetime cancer risk were above their permissible limits. RHP average of 1.89 μWm−3 above the crustal range of 0.8–1.2 μWm−3 will considerably contribute to the heat flux in the areas. Based on the prediction accuracy of the R2 results, 36–86% of RHP rates in the rocks are achievable from the radionuclides.

Factors Affecting Human Damage in Heavy Rains and Typhoon Disasters.

Floods due to heavy rains or typhoons are frequent annual hazards in Japan. This study aims to reduce disaster fatalities and contribute to disaster risk reduction. This retrospective observational study analyzed fatalities caused by heavy rains or typhoons. In Japan, 578 fatalities, related to seven occurrences of heavy rains and 16 typhoons, occurred between 2016 and 2020. Moreover, 13,195 houses collapsed due to hazards. Furthermore, 334 (73.2%) of the 456 fatalities were > 60 years old. Heavy rains caused more local area destruction due to floods and landslides than typhoons although wind- and disaster-related mortalities were found to be caused by typhoons. Human damage was eminent in older people because of their vulnerabilities and possibly dangerous behavior. Many fatalities were due to floods (46.9%) and landslides (44.1%). Indoor and outdoor mortalities due to heavy rains or typhoons were 157 (55.9%) and 124 (44.1%), respectively, and 24 (21.8%) of 124 outdoor mortalities occurred in vehicles. The number of recent flood mortalities in Japan correlates with the number of destroyed houses. Analyzing the victim's locations in the 2020 Kumamoto Heavy Rain using hazard and inundation maps suggested the difficulty of ensuring the safety of people living in dangerous areas. This study showed the characteristics of flood damage by heavy rains and typhoons in Japan and reports that flood damage is increasing because of the hazard size and community aging. Disaster risk reduction, disaster education, and evacuation safety plans for the elderly using hazard maps were important for strengthening disaster resilience.

Effect of postmastectomy radiotherapy on pT1-2N1 breast cancer patients with different molecular subtypes

ObjectiveTo clarify the effect of postmastectomy radiotherapy (PMRT) on pT1-2N1 breast cancer patients with different molecular subtypes. MethodsWe retrospectively analyzed the data of 5442 patients with pT1-2N1 breast cancer treated using modified radical mastectomy in 11 hospitals in China. Univariate, multivariate, and propensity score matching (PSM) analyses were used to evaluate the effect of PMRT on locoregional recurrence (LRR). ResultsWith a median follow-up duration of 63.8 months, the 5-year LRR rates were 4.0% and 7.7% among patients treated with and without PMRT, respectively (p < 0.001). PMRT was independently associated with reduced LRR after adjustments for confounders (p < 0.001). After grouping the patients according to the molecular subtype of cancer and conducting PSM, we found that the 5-year LRR rates among patients treated with and without PMRT (in that order) were as follows: luminal HER2-negative cancer, 1.9% and 6.5% (p < 0.001); luminal HER2-positive cancer, 3.8% and 13.7% (p = 0.041); HER2-overexpressing cancer, 10.2% and 15.5% (p = 0.236); and triple-negative cancer, 4.6% and 15.9% (p = 0.002). Among patients with HER2-overexpressing and triple-negative cancers, the LRR hazard rate displayed a dominant early peak, and was extremely low after 5 years. However, patients with luminal cancer continued to have a long-lasting high annual LRR hazard rate during follow-up. ConclusionPMRT significantly reduced the LRR risk in patients with pT1-2N1 luminal and triple-negative breast cancers, but had no effect on the LRR risk in patients with HER2-overexpressing cancer. Patients with different molecular subtypes displayed different annual LRR patterns, and the late recurrence of the luminal subtype suggests the necessity of long-term follow-up to evaluate the efficacy of PMRT.

Radioactivity, Metals Pollution and Mineralogy Assessment of a Beach Stretch from the Ionian Coast of Calabria (Southern Italy).

In the present article, a case study is reported regarding an investigation carried out in order to assess radioactivity concentration, heavy metals pollution and mineralogy of a beach stretch extending from Soverato to Squillace municipalities of the Ionian coast of Calabria, South of Italy, a popular tourist destination, especially in summer. The analysis of radionuclides contents was performed by using a High Purity Germanium (HPGe) gamma-ray detector, in order to quantify the average specific activity of 226Ra, 232Th and 40K natural radionuclides and 137Cs anthropogenic radioisotope. The absorbed dose rate and the annual effective dose equivalent radiological hazard indices were also estimated. Furthermore, X-ray Fluorescence (XRF) spectrometry measurements were carried out for the quantitative elemental analysis of the sand, in order to investigate any possible chemical pollution by heavy metals. For this aim, different indices such as Enrichment Factor (EF), Geoaccumulation Index (Igeo), Contamination Factor (CF) and Pollution Load Index (PLI) were applied to estimate the level of toxicity imposed on the ecosystem by the detected heavy metals. Finally, in order to identify the crystalline mineral components of the investigated sand samples, X-ray Diffraction (XRD) and Micro-Raman Scattering (MRS) measurements were carried out.

Slowing on quantitative EEG is associated with transition to dementia in mild cognitive impairment.

Electroencephalographic (EEG) abnormalities are greater in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) than in MCI due to Alzheimer's disease (MCI-AD) and may anticipate the onset of dementia. We aimed to assess whether quantitative EEG (qEEG) slowing would predict a higher annual hazard of dementia in MCI across these etiologies. MCI patients (n = 92) and healthy comparators (n = 31) provided qEEG recording and underwent longitudinal clinical and cognitive follow-up. Associations between qEEG slowing, measured by increased theta/alpha ratio, and clinical progression from MCI to dementia were estimated with a multistate transition model to account for death as a competing risk, while controlling for age, cognitive function, and etiology classified by an expert consensus panel.Over a mean follow-up of 1.5 years (SD = 0.5), 14 cases of incident dementia and 5 deaths were observed. Increased theta/alpha ratio on qEEG was associated with increased annual hazard of dementia (hazard ratio = 1.84, 95% CI: 1.01-3.35). This extends previous findings that MCI-LB features early functional changes, showing that qEEG slowing may anticipate the onset of dementia in prospectively identified MCI.

Postresection Period-Specific Hazard of Recurrence as a Framework for Surveillance Strategy in Patients with Hepatocellular Carcinoma: A Multicenter Outcome Study

Introduction: In spite of the high frequency of recurrence of hepatocellular carcinoma (HCC) after resection, little evidence exists to directly help to plan a reasonable schedule for the frequency and intensity of postoperative surveillance for recurrence. Methods: 1,918 consecutive patients with Child-Turcott-Pugh class A who had T1- or T2-staged HCCs detected by active surveillance and underwent curative resection for their tumors at 3 teaching hospitals in Korea, followed by recurrence screening at 6-monthly or shorter intervals. To set an evidence-based timetable for postoperative surveillance, we investigated the annual hazard rate of recurrence through postoperative year 10 in patients undergoing hepatectomy for HCC, and the clinical and morphological phenotypes associated with early versus late recurrence. Results: The estimated hazard rate for recurrence peaked during year 0–1 (21.7%), with a subsequent gradual decrease through 5 years, followed by stabilization at <7.0% until year 10, except in the case of cirrhotics, who had a rate of 10.5% during year 4–5. Multivariate time-to-recurrence analysis by recurrence period revealed that serum alpha-fetoprotein ≥200 ng/mL, larger size of tumor, tumor multiplicity, microvascular invasion, capsular invasion, and higher METAVIR fibrosis stage were significantly related to disease recurrence within 5 years after resection, while cirrhosis (METAVIR F4) alone was related to disease recurrence beyond 5 years (Ps < 0.05). Post-relapse overall survival was better in the latter group (p = 0.033). Conclusions: Our chronological and morphological insights into recurrence after resection of primary HCCs may help implement an optimal intensity of surveillance for recurrence.

Detecting of the Risk Indicator Parameters of Radioactive Nuclides Around the Stores of Fertilizer and Pesticides, Al Jazeera Agricultural Project Using the Germanium Detector

This study shows the assessment of radiation hazard parameters due to terrestrial radionuclide's in soil around the residential areas near the stores of fertilizer and pesticides, Al Jazeera agricultural project Radiation hazard parameters were was computed. These include excess lifetime cancer risk, annual gonadal dose equivalent hazard index, radium equivalent activity and external hazard. Obtained result indicates that some of the radiation hazard parameters, the average value excess lifetime cancer risk (ELCR) 0.12 × 10-3 μSv, were found to be lower than the UNSCEAR reported value of 0.29 × 10−3 μSv (UNSCEAR 2000), and that of average annual gonadal dose equivalent hazard index 214.59 µSVyear-1, the average value of AGDE in the region is the lower than worldwide average of 300 μSv/y (UNSCEAR 2000). the average radium equivalent Raeq (Bqkg-1) 64.3 Bqkg-1. The average external hazard index (Hex) 0.18, the calculated Hex values for all the samples were found to be below unity, which does not cause harm to the populations of the investigated region. Radiation hazard parameters due to terrestrial radionuclide's in the soil samples were compared to the international values reported by United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR, 2000) and previous studies on the region.

1018Long-term risk of distant metastasis and post-metastasis survival for breast cancer: health record linkage study

Abstract Background After early breast cancer (BC) treatment, women need information about long-term prognosis. In this population-based health record linkage study, we assessed the cumulative incidence of distant metastasis (DM) conditional on the DM-free interval; and BC-specific survival post-metastasis. Methods We included all women diagnosed with non-metastatic BC in the NSW Cancer Registry, 2001-2002. We used linked records from hospitals, dispensed medicines, radiotherapy services and death registrations and applied stringent criteria to determine time to first DM and BC death. Results 6338 women were included (BC: localised 3885, regional 2453). The 5-year cumulative incidence of DM was 7.4% (95% confidence interval 6.6-8.3) for localised BC; 22.8% (21.2-24.5) for regional BC. For women DM-free at 5 years, it was 5.7% (5.0-6.6); and 11.4% (10.0-13.0) to year 10, respectively. The annual hazard for BC death following localised BC remained lower than that for non-BC causes; for regional BC, it was similar to that for non-BC causes at 8 years. Following DM (N = 1492), BC-specific survival varied widely (median 25 months, interquartile range 6-127). The probability of surviving BC for ≥5 years was 32.0% (29.4-34.7) overall; and 47.1% (42.6-51.5) for those with a DM-free interval &amp;gt;5 years. Conclusions Women’s risk of DM improves over time since diagnosis; and post-metastasis survival is longer for women with later DM. Key messages Health record linkage methods can be used for conditional risk estimates to inform women who remain DM-free after early BC about their risk of DM in subsequent years; and post-metastasis survival.

Time-varying copula and average annual reliability-based nonstationary hazard assessment of extreme rainfall events

Due to global climate change and urbanization, more attention has been paid to decipher the nonstationary multivariate risk analysis from the perspective of probability distribution establishment. In this study, a multivariate nonstationary hazard assessment of annual extreme rainfall events, extracted from daily precipitation data observed at eight meteorological stations in Haihe River basin, China, was done in three phases: (1) Several statistical tests, such as nonparametric trend tests, log likelihood ratio (LR) tests and Change-point (CP) tests were applied to both the marginal distributions and the dependence structures to decipher different forms of nonstationarity; (2) estimation of the time-varying parameter for the marginal and joint probability distributions by maximum likelihood method; and (3) calculation of hydrologic design quantiles at different average annual reliability levels (ARR) during a certain design life period in terms of hazard assessment. According to the results, the attributes and their dependence structure belonging to several stations show nonstationarity because of existed trend in model parameter or change point. In the process of hazard assessment, the nonstationarity of dependence structure would produce less impact on ARR-based designed quantile estimation than the nonstationarity of marginal distribution on the one hand. On the other hand, it would add more uncertainty of quantile estimation for hydrologic design.