Proportional Hazards Model Multivariate Analysis Research Articles

MP80-12 ASSOCIATION BETWEEN HIGH PREOPERATIVE SERUM TOTAL TESTOSTERONE LEVELS IN OBESITY PATIENTS AND PSA RECURRENCE AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AMONG JAPANESE POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP80-12 ASSOCIATION BETWEEN HIGH PREOPERATIVE SERUM TOTAL TESTOSTERONE LEVELS IN OBESITY PATIENTS AND PSA RECURRENCE AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AMONG JAPANESE POPULATION Yutaka Horiguchi, Kiichi Hagiwara, Noboru Sakamoto, Fumio Tsukuda, Toshikazu Okaneya, and Shoji Koga Yutaka HoriguchiYutaka Horiguchi More articles by this author , Kiichi HagiwaraKiichi Hagiwara More articles by this author , Noboru SakamotoNoboru Sakamoto More articles by this author , Fumio TsukudaFumio Tsukuda More articles by this author , Toshikazu OkaneyaToshikazu Okaneya More articles by this author , and Shoji KogaShoji Koga More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although a relationship between prostate cancer pathology and prognosis and serum total testosterone (TT) has been studied, previous evidences were contradictory. Also, there are few reports on the relationship between TT and oncologic outcomes after robotic-assisted laparoscopic radical prostatectomy (RARP). While, the influence of a high body mass index (BMI) on prostate cancer risk has been suggested. Therefore, we prospectively investigated the relationship between preoperative TT and postoperative PSA recurrence (BCR) in patients who underwent RARP. METHODS: A total of 1060 prostate biopsies were performed in our hospital between July 2015 and November 2020. Of 666 patients diagnosed with prostate cancer, 238 underwent RARP. The study cohort were 233 patients who had been followed up for more than 6 months after surgery. TT measurements were performed at 6:00 early morning on admission to all patients for prostate biopsy. A BCR was defined as postoperative PSA ≥0.2 ng/mL. RESULTS: The median age, serum PSA level, and TT at diagnosis were 70 (41 - 80) years, 8.56 (3.23 - 113.86) ng/mL, and 4.15 (0.73 - 10.70) ng/mL, respectively. RARP was performed at a mean of 2.5 (1.2 - 6.3) months after biopsy, and the mean postoperative follow-up period was 47 (6 - 86) months. Median TT level 12 months after RARP was 114% of preoperative TT in randomely evaluated 30 patients. BCR was observed in 54 patients (23.2%) at an average of 17 (0 - 65) months after surgery and salvage radiation and/or androgen deprivation therapy were applied. On Cox proportional hazard model multivariate analysis, significant preoperative predictors of BCR were biopsy Grade Group (bGG) ≥4 (Hazard ratio (HR) 3.3, p<0.0001), clinical stage T classification (cT) ≥ 3 (HR 2.3, p=0.003), and PSA density (PSAD) ≥ 0.25 (HR 2.2, p=0.014). When the patients are stratified by BMI ≥ 26.0 (n=57, 24.5% of study cohort, median TT: 3.51 ng/mL), bGG and cT lost their significance; instead, TT ≥ 3.78 ng/mL (HR 3.9, p=0.021) and PSAD ≥ 0.25 (HR 5.0, p=0.035) were significant predictors. When a risk of BCR was classified according to these 2 factors, only 1 of 17 patients (5.8%) in the low-risk (0 factor) group had BCR, whereas 9 of 14 (64.3%) patients in the high-risk (2 factors) group had BCR (Log-rank test, p<0.001). CONCLUSIONS: Preoperative TT was a significant independent factor for predicting BCR after RARP in patients with BMI ≥ 26.0 among Japanese population, indicating its usefulness when considering the treatment options prior to RARP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1156 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yutaka Horiguchi More articles by this author Kiichi Hagiwara More articles by this author Noboru Sakamoto More articles by this author Fumio Tsukuda More articles by this author Toshikazu Okaneya More articles by this author Shoji Koga More articles by this author Expand All Advertisement PDF downloadLoading ...

Long non-coding RNA CERS6-AS1 plays a prognostic role in promoting the progression of gastric cancer

ABSTRACT This study aims to investigate the potential clinical function of long non-coding RNA CERS6-AS1 (lncRNA CERS6-AS1) integrated miR-567 in gastric cancer. The expression of CERS6-AS1 in gastric cancer tissues was detected through RT-qPCR in contrast to the normal tissues. The correlation between the expression of lncRNA CERS6-AS1 and the characteristics of clinical data was analyzed. Kaplan-Meier curve was used to assess the survival analysis, while Cox proportional hazards model multivariate analysis was performed to evaluate the prognostic risk factors of gastric cancer to verify the prognostic possibility of CERS6-AS1. The expression of CERS6-AS1 in different gastric cancer cells was detected, being the development of gastric cancer cells after knockdown CERS6-AS1 studied using CCK-8, Transwell migration, and invasion detection methods. The targeting effect and interaction between CERS6-AS1 and miR-567 through biological analysis and luciferase activity detection. The expression of lncRNA CERS6-AS1 was elevated in gastric cancer tissues and cells. The results of this study demonstrate that the condition of gastric cancer patients was related to the expression of CERS6-AS1, and therefore CERS6-AS1 might be a prognostic factor for the progression of gastric cancer. In addition, the ability of gastric cancer cells to proliferate, migrate and invade could be reduced by knockdown CERS6-AS1. After CERS6-AS1 knockdown, the expression level of miR-567 in gastric cancer tissues decreased, while the expression level of miR-567 increased. In conclusion, lncRNA CERS6-AS1 might promote the progression of gastric cancer and had the potential as a prognostic marker of gastric cancer.

Glutathione combined with mecobalamin in the treatment of chemotherapy-induced peripheral neuropathy in multiple myeloma: a retrospective clinical study.

This study sought to examine the use of glutathione combined with mecobalamin in the prevention and treatment peripheral neuropathy (PN) in multiple myeloma (MM) patients, observe its effectiveness and safety, and explore the risk factors and prognostic factors of chemotherapy-induced peripheral neuropathy (CIPN). Patients in the study group were administered 2.4 g of glutathione intravenously once daily 2-3 days before chemotherapy, combined with 500 µg of mecobalamin administered intravenously once every other day until the end of the chemotherapy cycle. Patients who did not use this regimen were selected as a control group. Differences in adverse reactions, treatment efficiency, progression-free survival (PFS), and overall survival (OS) between the two groups were retrospectively analyzed. PFS and OS curves were plotted using the Kaplan-Meier method. The univariate analysis rates were compared using the χ2 test. The multivariate analysis was performed by a logistic regression analysis. The proportional hazard regression model was used for the univariate and multivariate proportional hazards model analyses. The incidence of PN, especially grade 2 and 3 PN, was more decreased in the study group than the control group. The history of diabetes (P=0.032) and the method of bortezomib injection (P=0.043) was found to affect the PN grade. The multivariate logistic regression analysis showed that diabetes was an independent risk factor of PN in MM patients [odds ratio (OR) =3.484, P=0.020]. The Proportional hazards model multivariate analysis showed that extramedullary disease (EMD) [hazard ratio (HR) =2.373, P=0.006] and elevated lactic dehydrogenase (LDH) (HR =1.934, P=0.009) were independent prognostic factors for MM patients. Glutathione combined with mecobalamin significantly reduced the incidence and severity of CIPN in MM patients, and did not increase the adverse reactions of patients with MM. Diabetes and bortezomib intravenously increased the incidence and severity of PN in patients with MM.

Significance of boost radiotherapy in early invasive ductal breast cancer with ductal carcinoma in situ component under negative surgical margins.

We hypothesize that there is a risk of ipsilateral breast tumor recurrence (IBTR) in surgical margin-free invasive ductal carcinoma (IDC) in the presence of ductal carcinoma in situ (DCIS) component affecting surgical margins in early stage. From 1990 to 2014, 343 patients with IDC in which the DCIS component constitute have received radiotherapy (RT) following breast-conserving surgery (BCS). All patients received whole breast irradiation with a prescribed dose of 50 Gy in 20 fractions (four times a week). This one-arm cohort with boost RT (253 patients) was compared for IBTR with a non-cohort group receiving no boost RT because of freedom from positive margins (90 patients). Median observation months were 98 (boost group) vs 119 (no boost group), respectively. The 15-year local recurrence-free survival (LRFS) rates were 98.5% and 85.6% in the boost and no boost groups, respectively (Cox proportional hazards model univariate analysis; p = 0.013, HR 0.13). Similarly, for other background factors, there was a significant difference in the LRFS between age groups. The 15-year LRFS rate was 91.8% in patients aged 45 years or younger and 94.6% in patients older than 46 years (p = 0.031, HR 0.21), respectively. Only these two factors were independently significant in Cox proportional hazards model multivariate analysis. IBTR risk in margin-free IDC with DCIS component was independently decreased by boost RT in the cohort setting. Tumor size, extensive intraductal component (EIC), boost dose, the presence of lymph node (LN) metastasis and hormonal therapy were not IBTR risk factors in this study.

Nutritional Factors Affecting the Mortality in Patients with Chronic Lung Disease

Abstract Objectives Malnutrition is frequently observed in patients with chronic lung disease, having important clinical outcome. Several factors have been identified in its development, such as age, disease severity, muscle dysfunction, reduced physical activity and dietary intake. This retrospective observational study investigated the nutritional factors that affect the mortality in patients with chronic lung disease. Methods The subjects of this study were hospitalized patients, consulted to dietetics and nutrition services team with history of treatment for lung diseases within the last three months. We collected data, anthropometric measurements, handgrip strength, dietary intake, nutritional status, blood samples, 90-day readmission and survival using an electrical medical record(EMR). Nutritional status was assessed using Consensus of Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. Statistical analysis was performed using SPSS, version 21. Results Total subjects were 76 patients (44 males, 32 females) and their mean age was 63.4, mean BMI 19.96 kg/m2, mean energy and protein intake 1395 kcal/day, 56.8 g/day, respectively. Only twenty-eight % of the patients was adequate nutrition status, thirty-four % died by the date of observation. Energy and protein intake of non-survivors were significantly lower than that of survivors (21.95 ± 7.43 kcal/kg vs. 30.37 ± 9.46 kcal/kg; P &amp;lt; 0.001, 0.90 ± 0.33 g vs. 1.22 ± 0.38 g; P = 0.001, respectively). But there was no significant difference in body weight, BMI, TSF, MAMC, HGS, nutritional status. In Cox proportional hazard model multivariate analysis, 90-day readmission was a variable that increased mortality (HR 3.760, 95% CI 1.594–8.867; P = 0.0025). On the other hand, energy intake ≥25 kcal/kg (HR 0.299, 95% CI 0.129–0.694; P = 0.005) and protein intake ≥0.8 g/kg (HR 0.179, 95% CI 0.073–0.436; P &amp;lt; 0.001) has been shown to be a variable that decreases mortality. Conclusions In patients with chronic lung disease, low energy and protein intake can have a negative impact on mortality, so adequate energy and protein intake in these patients are very important. Funding Sources No funding.

Follow-up study of children with gastroesophageal reflux disease

Objective To study the prognosis of gastroesophageal reflux disease (GERD) in children, and explore the factors which impacts on the prognosis of GERD. Methods One hundred and thirteen children with GERD were enrolled on the basis of positive result of 24-hour pH-monitoring between January 2007 and November 2011.The number of patients who were followed up was 87, and the parents of children were contacted with the telephone.The prognosis was evaluated by comparing the degree of patients' symptom relief, and the cumulative symptom relief rate was calculated by Kaplan-meier product limit method.The univariate Log-rank test and the COX proportional hazardmodel multivariate analysis were applied to detect the factors impacting on the prognosis, including age, gender, the regularity of treatment, reflux index, and Boix-Ochoa standard score, with esophageal hiatal hernia or without, receiving surgical treatment or not, the diet and lifestyle improved or not, receiving anti-acid treatment or not, as well as with allergies history or without. Results At last, 76 out of 87 children had symptom relieved.Survival curve showed the cumulative symptom relief rate at different time points, the median cumulative symptom relief rate reached 6 months, the final relief rate was close to 90.0%, and the continuous treatment time was 44 months.The study showed that 14.9% (13/87 cases) of children's growth and development were affected and the life and learning in 16.1% (14/87 cases) of children were impacted. Age (P=0.012, Wald=6.376) and the regularity of treatment (P=0.000, Wald=13.059) were the risk factors in the prognosis of GERD. Conclusions Age and the treatment regularity were the factors in the prognosis.The children aged more than 1-year old have poor prognosis compared with those less than 1-year old, and the irregular treatment is the risk factor in the prognosis. Key words: Gastroesophageal reflux disease; Prognosis; Symptom relief rate; Survival curve; COX proportional hazard model; Child

The risk of recurrent IgA nephropathy in a steroid-free protocol and other modifying immunosuppression.

Recurrent glomerulonephritis is an important cause of kidney allograft failure. The effect of immunosuppression on recurrent IgA nephropathy (IgAN) is unclear. We analyzed the impact of steroids and other immunosuppression on the risk of recurrent IgAN post-kidney transplantation. Between June 1989 and November 2008, 3311 kidney transplants were performed at our center. IgAN was the primary disease in 124 patients; of these, 75 (60.5%) patients received steroid-based immunosuppression (15 undergoing late steroid withdrawal), and 49 (39.5%) were maintained on steroid-free immunosuppression. Recurrent IgAN was diagnosed in 27 of 124 (22%) patients in clinically indicated kidney allograft biopsies over a median follow-up of 6.86 ± 5.4 yr. On cox proportional hazards model multivariate analysis, the hazard risk (HR) of IgAN recurrence was significantly higher in patients managed with steroid-free (HR 8.59: 3.03, 24.38, p < 0.001) and sirolimus-based (HR = 3.00:1.16, 7.75, p = 0.024) immunosuppression without antilymphocyte globulin induction (HR = 4.5: 1.77, 11.73, p = 0.002). Mycophenolate use was associated with a lower risk (HR = 0.42: 0.19, 0.95, p = 0.036), whereas cyclosporine did not have a significant impact on the risk of IgAN recurrence (p = 0.61). These results warrant future prospective studies regarding the role of steroids and other immunosuppression drugs in reducing recurrence of IgAN and other glomerulonephritis post-transplant.

Neuroendocrine differentiation is not a malignant index of non-small cell lung cancer

背景与目的非小细胞肺癌（Non-small cell lung cancer, NSCLC）中的神经内分泌（Neuroendocrine, NE）分化是否是恶性生物学行为与不良预后的指标，是否对化疗更敏感一直是人们关注与争论的问题。通过对NSCLC术后标本进行有关NE分化的回顾性研究，比较NE分化与NSCLC患者生存的关系，以探讨NSCLC中NE分化的临床意义。方法按入组标准共收集274例肺癌临床资料及标本，将标本制作成组织芯片，行CgA、Syn、NCAM、Leu-7、PGP9.5和MAP-2等NE抗体染色，同时行Ki-67染色了解核增殖指数。通过不同的评分组合分析NE分化对NSCLC的预后意义。结果不同NE评分对经手术治疗的NSCLC预后的影响均未达到统计学差异（1分、2分、≥3分vs 0分，P=0.527；0分vs ≥1分，P=0.791； < 2分vs≥2分，P=0.163； < 3分vs≥3分，P=0.293）。进一步将pTNM分期按Ⅰ期、Ⅱ期与Ⅲ期进行分层，单因素分析NE评分在各层对预后的影响，显示差异无统计学意义。围手术期化疗组不同NE评分同预后的比较无阳性结果（1分、2分、≥3分vs0分，P=0.692；0分vs≥1分，P=0.922； < 2分vs≥2分，P=0.264； < 3分vs≥3分，P=0.484）。结论NE分化体现了部分NSCLC具有NELT结构、功能上的特点，本组研究显示NE分化同NSCLC预后无关，并非其高恶性度的指标。

Evaluating the prognostic factors effective on the outcome of patients with glioblastoma multiformis: does maximal resection of the tumor lengthen the median survival?

Background The ETR that should be undertaken in patients with GBM remains controversial. This study aims to reiterate some independent predicting factors and to underscore the role and the ETR in increasing the survival of patients in the situation of developing countries, that is, without preoperative MRI or tractography. The authors submit additional information to be added to the list of CTRs in the management of malignant brain tumors. Methods The authors prospectively analyzed a cohort of 35 consecutive patients with histologically proven GBM who underwent tumor resection in surgically amenable areas for the first time at Sina Hospital, Tehran, between 2003 and 2005. Demographic data, volumetric measurements, and other characteristics identified on preoperative and immediate postoperative MR imaging as well as intraoperative and postoperative clinical data were collectively analyzed by SPSS for Windows, version 11.5 (SPSS, Chicago, Ill). Results Cox proportional hazards model multivariate analysis identified the following independent predictors of survival: Karnofsky performance scale ≥80 ( P = .01), ETR ( P = .01), tumor location in functionally silent prefrontal area ( P = .002) vs tumor location in corpus callosum ( P = .001), postoperative RT ( P = .004), and postoperative chemotherapy ( P = .001) Conclusion Maximal resection of the tumor volume is an independent variable associated with longer survival times in patient with GBM. Gross total resection should be performed whenever possible, although not at the expense of increased morbidity.

Prognostic Significance of Neuroendocrine Differentiation in Non-small Cell Lung Cancer Patients' Survival

Objective: To observe the relationship between non-small cell lung cancer with neuroendrocrine differentiation (NSCLC-NE) and patients' postoperative survival. Methods: During April 1997 to April 1999, 98 cases of lung cancer were surgically treated. The tumor specimens of the patients were stained by NE markers, i.e. neuron specific enolase (NSE) and synaptophysin (SY). The intensity of NE markers reaction was divided as "+", "++", "+++" scale groups. The same specimens were also examined under an electron microscope for the specific neuroendocrine granules. All enrolled patients were followed up for 36 months, and the longest follow-up time was 60 months. The COX proportional hazard model multivariate analysis was applied to observe the relationship between the NSCLE-NE and the patients' postoperative survival. Results: In 91 cases of NSCLC, 63.7% (58/91) were positive for NE stain reaction. Among them, 59.3% (54/91) were positive for NSE and 24.1% (22/91) for SY. 48.4% (44/91) were considered as NSCLC-NE by the combination of NE marker stain reaction and electron microscopic examination. COX proportional hazard model multivariate analysis showed that the NSCLC-NE patients' survival was significantly shortened (P=0.048). The following factors were related to NSCLC-NE patients' survival: lung cancer cell differentiation (P=0.006), clinical lung cancer stage (P=0.001), the NE markers reaction (P=0.054). Conclusion: NSCLE-NE is significantly related to the cancer cell differentiation and the patients' postoperative survival. The NE markers should be applied clinically as one of prognostic factors to evaluate the postoperative survival of NSCLC patients.

Prognostic significance of neuroendocrine differentiation in non-small cell lung cancer patients' survival

To observe the relationship between non-small cell lung cancer with neuroendocrine differentiation (NSCLC-NE) and patients' postoperative survival. During April 1997 to April 1999, ninety-eight patients with lung cancer who were surgical treated were enrolled in this study. The tumor specimens were stained by NE markers: neuron specific enolase (NSE) and synaptophysin (SY). The NE marker reactions were divided as +, ++ and +++ scale groups. The same specimens were also examined by electron microscope for the specific neuroendocrine granule. All enrolled patients were followed up to 36 months, and the maximum follow-up time was 60 months. The Cox proportional hazard model multivariate analysis was applied to observe the relationship between the NSCLC-NE and the patients' postoperative survival. Ninety-one cases were diagnosed as NSCLC. In these patients, 63.7% (58/91) were positive for NE stain. Among them, 59.3% (54/91) were NSE-positive, and 24.1%(22/91) were SY-positive. The specific NE granules were found by the electron microscope examination in 33.0%(30/91). Combination of NE marker stain reaction and electronic microscope examination results, 48.4% (44/91) were considered as NSCLC-NE. The Cox proportional hazard model multivariate analysis showed that the NSCLC-NE patients' survival was significantly reduced (P=0.048). The following factors were related to NSCLC-NE patients' survival: lung cancer cell differentiation (P=0.006), stages of the cancer (P=0.001), and the NE markers reaction (P=0.054). NSCLC-NE is significantly related to the cancer cell differentiation and the patients' postoperative survival. The NE markers should be applied clinically as one of prognostic factors to evaluate the postoperative survival for NSCLC patients.