scholarly journals Learning curve for minimally invasive oesophagectomy of oesophageal cancer and survival analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yunpeng Zhao ◽  
Lei Shan ◽  
Chuanliang Peng ◽  
Bo Cong ◽  
Xiaogang Zhao
Keyword(s):  
Regression Analysis ◽  
Survival Analysis ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Short Term ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Minimally Invasive Oesophagectomy

Abstract Purpose Minimally invasive oesophagectomy is a technically demanding procedure, and the learning curve for this procedure should be explored. A survival analysis should also be performed. Methods A total of 214 consecutive patients who underwent minimally invasive oesophagectomy were retrospectively reviewed. To evaluate the development of thoracoscopic-laparoscopic oesophagectomy and compare mature minimally invasive oesophagectomy and open oesophagectomy, we comprehensively studied the clinical and surgical parameters. The cumulative sum (CUSUM) plot was used to evaluate the learning curve for systemic lymphadenectomy. Cox proportional hazards regression analysis was performed to explore the clinical factors affecting survival. Results The bleeding volume, operation time, and postoperative mortality within 3 months significantly decreased after 20 patients. The rise point for node dissection was visually determined to occur at patient 57 in the CUSUM plots. Patients who underwent mature thoracoscopic-laparoscopic oesophagectomy had better surgical data and short-term benefits than patients who underwent an open procedure. Cox proportional hazards regression analysis showed that the maximum diameter of the tumour cross-sectional area and the number of positive nodes significantly influenced survival. Conclusions The results suggest that thoracoscopic-laparoscopic oesophagectomy has short-term benefits. There was no evidence that it was associated with a significantly better prognosis for patients with oesophageal cancer. ClinicalTrials Gov ID: NCT04217239; January 2, 2020 retrospectively registered.

Learning Curve for Minimally Invasive Oesophagectomy of Esophageal Cancer and contrast with Open Oesophagectomy

2020 ◽  
Author(s):  
Yunpeng Zhao ◽  
Fanshuo Zeng ◽  
Zongbao Mou ◽  
Xuefeng Liang ◽  
Bo Cong ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Short Term ◽  
Open Procedure ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Minimally Invasive Oesophagectomy

Abstract Purpose: Minimally invasive oesophagectomy is a technically demanding procedure; thus, the learning curve of this procedure should be explored. Then the relatively mature minimally invasive oesophagectomy procedure should be contrasted with the open procedure. Methods: 214 consecutive patients underwent minimally invasive oesophagectomy were retrospectively reviewed. To evaluate the development of thoracoscopic-laparoscopic oesophagectomy and compare the mature minimally invasive oesophagectomy and open oesophagectomy (OE), we comprehensively studied the clinical and surgical parameters. The cumulative sum (CUSUM) plot was used to study the learning curve for systemic lymphadenectomy. Cox proportional hazards regression analysis was performed to evaluate the clinical factors affecting survival. Results: The bleeding volume, operation time, and postoperative mortality within 3 months significantly decreased after 20 patients. The rise point for the lymph nodes dissection number was visually determined to be at patient 57 in the CUSUM plots. Patients who underwent relatively mature thoracoscopic-laparoscopic oesophagectomy had better surgical data and short-term benefits than patients who underwent an open procedure. Cox proportional hazards regression analysis showed that the maximum diameter of the tumour cross-sectional area and the number of positive nodes had a significant influence on survival. Conclusions: The short-term benefits of thoracoscopic-laparoscopic oesophagectomy were suggested. There was no evidence that it is associated with a significantly better prognosis for patients with oesophageal cancer.

Serum FGF21 Is Associated with Future Cardiovascular Events in Patients with Coronary Artery Disease

Cardiology ◽  
2018 ◽  
Vol 139 (4) ◽  
pp. 212-218 ◽  
Author(s):  
Yun Shen ◽  
Xueli Zhang ◽  
Yiting Xu ◽  
Qin Xiong ◽  
Zhigang Lu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Artery Disease

Objectives: To investigate whether serum fibroblast growth factor 21 (FGF21) levels can be used to predict the future development of major adverse cardiovascular events (MACEs). Methods: This study included 253 patients who received subsequent follow-up, and complete data were collected for 234 patients. Independent predictors of MACEs were identified by using the Cox proportional-hazards regression analysis. The prognostic value of FGF21 levels for MACEs was evaluated by Kaplan-Meier survival analysis. Results: Of 229 patients finally enrolled in the analysis, 27/60 without coronary artery disease (CAD) at baseline experienced a MACE, and 132/169 patients with CAD at baseline experienced a MACE. Among patients with CAD at baseline, serum FGF21 levels were significantly higher in patients with MACEs (p < 0.05) than in patients without MACEs. Kaplan-Meier survival analysis showed patients with a higher serum FGF21 had a significantly lower event-free survival (p = 0.001) than those with a lower level. Further Cox proportional-hazards regression analysis, including the traditional risk factors for cardiovascular disease, showed that serum FGF21 was an independent predictor of MACE occurrence. Conclusions: In patients with CAD at baseline, an elevated serum FGF21 level was associated with the development of a MACE in the future.

scholarly journals Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

2014 ◽  
Vol 58 (12) ◽  
pp. 7468-7474 ◽  
Author(s):  
W. Picard ◽  
F. Bazin ◽  
B. Clouzeau ◽  
H.-N. Bui ◽  
M. Soulat ◽  
...  
Keyword(s):  
Septic Shock ◽  
Renal Failure ◽  
Regression Analysis ◽  
Severe Sepsis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Adjusted Relative Risk ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Increased Risk

ABSTRACTTo assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ± 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk = 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.

γ-H2AX as a novel prognostic marker in patients with non-small lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17553-e17553
Author(s):  
Dimitrios Matthaios ◽  
Panagiotis Hountis ◽  
Grigorios Trypsianis ◽  
Athanasios Zissimopoulos ◽  
Demosthenes Bouros ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Regression Analysis ◽  
Proportional Hazards ◽  
Prognostic Indicator ◽  
Cox Proportional Hazards ◽  
Independent Effect ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression

e17553 Background: Phosphorylation of the H2AX histone is an early indicator of DNA double-strand breaks and of the resulting DNA damage response. In the present study we assessed the expression of γ-Η2ΑΧ in a cohort of 96 patients with non-small cell lung carcinoma and evaluated its role as a prognostic indicator in resectable NCSLC patients. Methods: 96 parafin-embedded specimens of non-small lung cancer patients were examined. All patients underwent radical thoracic surgery of primary tumor (lobectomy or pneumonectomy) and regional lymph nodes dissection. γ-Η2ΑΧ expression was assessed by standard immunohistochemistry.Multivariate Cox proportional hazards regression analysis, using a backward selection approach, were performed to explore the independent effect of variables on survival. All tests were two tailed and statistical significance was considered for p values <0.05. Results: Follow-up was available for all patients; mean duration of follow-up was 27.50 ± 14.07 months (range 0.2-57 months, median 24 months). Sixty-three patients (65.2%) died during the follow-up period. The mean survival time was 32.2 ± 1.9 months (95% CI = 28.5 to 35.8 months; median 30.0 months); one, two and three-year survival rates were 86.5 ± 3.5%, 57.3 ± 5.1% and 37.1 ± 5.4% respectively. Low γ-H2AX expression was associated with a significant better survival as compared with those having high γ-H2AX expression (23.2 months for high γ-Η2ΑΧ expressin vs 35.3 months for low γ-H2AX expression, p=0.009; HR=1.95, 95% CI=1.15-3.30). Further investigation with multivariate Cox proportional hazards regression analysis revealed that high expression of γ-H2AX remained independent prognostic factors of worse overall survival (HR=2.15, 95% CI=1.22-3.79, p=0.026). Conclusions: Our study is the first study to demonstrate that overexpression of γ-Η2ΑΧ is an independent prognostic indicator of worse overall survival in patients with non-small lung cancer. Further studies are needed to confirm our results.

scholarly journals High PD-L1 Expression Associates with Low T-Cadherin Expression and Poor Prognosis in HPV-Negative Head and Neck Squamous Cell Carcinoma

2021 ◽  
Author(s):  
Qiuju Wang ◽  
Yanzhen Zhao ◽  
Yan Chen ◽  
Yibo Chen ◽  
Xiaoyu Song ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Regression Analysis ◽  
Protein Expression ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression

Abstract PurposeT-cadherin is an immunoglobulin-like adhesion molecule which acts as a tumor suppressor gene, programmed cell death ligand 1 (PD-L1) is a cell surface protein that involves in the suppression of the immune system. This study aimed at exploring the correlation between T-cadherin and PD-L1, as well as their prognostic value in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC). MethodsIn this study, immunohistochemical staining was used to determine the protein expression of T-cadherin and PD-L1 in 104 tissue specimens of HPV-negative HNSCC. Spearman linear correlation analysis was used to determine the association between protein expression of T-cadherin and PD-L1. Kaplan-Meier analysis was used to plot overall survival (OS) and disease-free survival (DFS) curves. Cox proportional hazards regression analysis was used to conduct univariate and multivariate analysis. ResultsThe results showed a large negative association between protein expression of T-cadherin and PD-L1 (r=-0.775, P<0.01), expression of T-cadherin and PD-L1 were associated with OS (P=0.021 and 0.034, respectively) and DFS (P=0.012 and 0.016, respectively) in patients with HPV-negative HNSCC. Cox proportional hazards regression analysis revealed that expression of T-cadherin and PD-L1 were independent prognostic predictors for OS and DFS in patients with HPV-negative HNSCC. The worst prognosis was observed in patients with T-cadherin negative/PD-L1 positive.ConclusionIn conclusion, expression of T-cadherin and PD-L1 were inversely correlated and were independent prognostic factors for patients with HPV-negative HNSCC.

scholarly journals P1335MALNUTRITION, INFLAMMATION, AND ANEMIA SYNERGISTICALLY IMPACT VASCULAR ACCESS FAILURE IN PATIENTS WITH FIRST-TIME ARTERIOVENOUS FISTULA FORMATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Masaki Hara ◽  
Naozumi Saiki ◽  
Hiroki Suzuki ◽  
Masamitsu Ubukata ◽  
Rin Asao ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Risk Score ◽  
Vascular Access ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Risk Scores ◽  
Fistula Formation ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
First Time

Abstract Background and Aims There are several reports that the initial (within one year) failure of vascular access (VA) is 2–53% in several countries. Malnutrition alone, inflammation alone, and anemia alone are factors that have a well-known relationship to VA failure. We believe that the relationship of these risk factors to VA failure is a complex one. Therefore, we evaluated whether the addition of these factors had a synergistic impact on VA failure. Method This longitudinal cohort study sought to confirm the effects of malnutrition, inflammation, and anemia on VA failure. We included 177 patients with chronic kidney disease (CKD) with first-time arteriovenous fistulas who were treated from January 2013 to December 2017. VA failure was defined as a new onset of VA obstruction or the need for percutaneous transluminal angioplasty. Albumin (Alb), C-reactive protein (CRP), and hemoglobin (Hb) were studied as indicators for malnutrition, inflammation, and anemia, respectively. Each highest (CRP) or lowest (Alb and Hb) interquartile range (IQR) group was assigned 1 point (as a risk score). The cumulative VA failure rate was analyzed by the Kaplan-Meier method, which stratified the study cohort into four groups according to the risk scores (0–3). We assessed whether the lowest IQR group of Hb and Alb, and the highest IQR group of CRP were associated with VA failure. To determine this, we used a univariable Cox proportional hazards regression analysis to calculate the hazard ratio (HR) and its 95% confidence interval (CI). A multivariable Cox proportional hazards regression analysis was used to evaluate the association between the risk score and VA failure, with adjustment for age, sex, presence or absence of diabetes mellitus, value of calcium phosphate products, preoperative vein diameter, and intraoperative vascular assessment scores. Results The average observational period was 1.6±1.4 years. The incidence of VA failure was 30.5% (54 patients). Cumulative VA failure was significantly higher in patients who had more than two risk scores, as compared to the patients who did not have any risk score (Figure). The univariate Cox regression analysis showed that Alb, CRP, and Hb were significantly associated with VA failure (HR, 2.00; 95% CI, 1.08–3.71 for Alb and HR, 2.21; 95% CI, 1.15–4.13 for CRP and HR, 1.96; 95% CI, 1.02–3.63 for Hb), respectively. The presence of more than two risk scores was significantly associated with VA failure (HR, 4.68; 95% CI, 1.07–18.5 for the patients with two risk scores and HR, 4.72; 95% CI, 1.32–17.2 for the patients with three risk scores). Conclusion Malnutrition, inflammation, and anemia independently and synergistically affect VA failure. In clinical settings, we need to be aware of the presence of malnutrition, inflammation, and anemia to better prevent VA failure.

scholarly journals A novel long non-coding RNA, AC012456.4, as a valuable and independent prognostic biomarker of survival in oral squamous cell carcinoma

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5307 ◽  
Author(s):  
Xuegang Hu ◽  
Zailing Qiu ◽  
Jianchai Zeng ◽  
Tingting Xiao ◽  
Zhihong Ke ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Survival Analysis ◽  
Oral Squamous Cell Carcinoma ◽  
Proportional Hazards ◽  
Prognostic Biomarker ◽  
Cox Proportional Hazards ◽  
Regression Analyses ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Kaplan Meier

Oral squamous cell carcinoma (OSCC) is a major malignant cancer of the head and neck. Long non-coding RNAs (lncRNAs) have emerged as critical regulators during the development and progression of cancers. This study aimed to identify a lncRNA-related signature with prognostic value for evaluating survival outcomes and to explore the underlying molecular mechanisms of OSCC. Associations between overall survival (OS), disease-free survival (DFS) and candidate lncRNAs were evaluated by Kaplan–Meier survival analysis and univariate and multivariate Cox proportional hazards regression analyses. The robustness of the prognostic significance was shown via the Gene Expression Omnibus (GEO) database. A total of 2,493 lncRNAs were differentially expressed between OSCC and control samples (fold change >2, p < 0.05). We used Kaplan–Meier survival analysis to identify 21 lncRNAs for which the expression levels were associated with OS and DFS of OSCC patients (p < 0.05) and found that down-expression of lncRNA AC012456.4 especially contributed to poor DFS (p = 0.00828) and OS (p = 0.00987). Furthermore, decreased expression of AC012456.4 was identified as an independent prognostic risk factor through multivariate Cox proportional hazards regression analyses (DFS: p = 0.004, hazard ratio (HR) = 0.600, 95% confidence interval(CI) [0.423–0.851]; OS: p = 0.002, HR = 0.672, 95% CI [0.523–0.863). Gene Set Enrichment Analysis (GSEA) indicated that lncRNA AC012456.4 were significantly enriched in critical biological functions and pathways and was correlated with tumorigenesis, such as regulation of cell activation, and the JAK-STAT and MAPK signal pathway. Overall, these findings were the first to evidence that AC012456.4 may be an important novel molecular target with great clinical value as a diagnostic, therapeutic and prognostic biomarker for OSCC patients.

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