建立预测阴茎鳞状细胞癌区域淋巴结转移风险的列线图

目的 根据阴茎癌原发灶的病理指标,建立预测阴茎鳞状细胞癌区域淋巴结转移风险的列线图. 方法 收集1990-2005年73例阴茎鳞状细胞癌患者资料,患者均接受阴茎肿瘤切除和区域淋巴结清扫术.免疫组化法检测分子指标(p53、Ki-67、E-cadherin和MMP-9)的表达水平.采用Logistic回归模型建立列线图.预测淋巴结转移的变量包括年龄、分期、分级、蛋白表达水平(p53、Ki-67、E-cadherin和MMP-9)和脉管侵犯.其中年龄为连续变量,分期、分级、蛋白表达水平和脉管侵犯为分类变量. 结果 肿瘤分级、p53表达水平和脉管侵犯是预测区域淋巴结转移的独立预后因素(P<0.05),回归系数分别为3.97、2.12和2.37,OR值分别为52.99、8.33和10.70.用于预测淋巴结转移风险的列线图显示出良好的一致系数(0.92)和良好的校准. 结论 基于阴茎鳞状细胞癌原发灶的病理特征,构建预测区域淋巴结转移风险的列线图,不仅有助于个体化的判断肿瘤转移的风险,并且有助于与患者的交流和治疗选择.     

铜死亡相关基因在肝细胞癌中的表达及其临床意义

背景与目的：肝细胞癌（HCC）是一种全球常见的恶性肿瘤，具有高复发率和高病死率。铜死亡是一种新型的程序性细胞死亡，涉及肿瘤细胞的增殖和生长、血管生成和转移。因此，本研究探讨铜死亡相关基因（CRGs）在HCC中的表达与预后的关系，并建立预后相关的列线图模型以及分析CRGs与HCC免疫细胞浸润的关系。方法：使用R语言“limma”包对TCGA数据库下载的HCC组织与正常组织的数据中CRGs进行差异表达分析；“clusterProfiler”包进行GO和KEGG分析；单因素Cox回归分析筛选与预后相关的CRGs,LassoCox回归分析构建HCC中CRGs相关预后评分模型；“ggsurvplot”包以总生存（OS）为结局绘制Kaplan-Meier生存曲线；“survival ROC”包绘制ROC曲线评估预后评分的准确性；“regplot”和“rms”包绘制列线图和校准曲线；利用TIMER数据库分析CRGs的表达与6种免疫细胞丰度之间的关系。结果：与正常组织相比，HCC组织19个CRGs中的16个有差异表达（上调：PDHB、PDHA1、MTF1、LIPT1、LIPT2、LIAS、GLS、DL...     

经皮肾镜取石术后尿脓毒血症的相关危险因素及预测模型

目的：对经皮肾镜取石术（percutaneous nephrolithotomy,PCNL）治疗上尿路结石术后发生尿脓毒血症的围手术期相关因素进行分析,根据其中的独立危险因素,建立预测术后尿脓毒血症风险的列线图模型。方法：回顾性分析2013年1月至2016年12月北京大学第三医院泌尿外科405例接受一期PCNL患者的临床资料。根据术后是否发生尿脓毒血症将患者分为两组,通过单因素和多因素Logistic回归分析评价患者发生尿脓毒血症的独立风险因素,根据回归系数绘制相应的列线图预测模型。结果： 405例患者PCNL手术均获成功,其中32例（7.9%）术后发生尿脓毒血症,多因素Logistic回归分析结果显示,与术后尿脓毒血症相关的独立风险因素包括：糖尿病史（OR=4.511,P=0.001）、较高结石负荷（OR=2.588,P=0.043）、较长手术时间（OR=2.353,P=0.036）、较高灌注速度（OR=5.862,P<0.001）以及感染性结石成分（OR=2.677,P=0.036）。列线图模型在建模样本中的一致性系数（concordance index,C-index）为0.834,在验证样本中的C index为0.802,表现出良好的符合度。结论：糖尿病史、较高结石负荷、较长手术时间、较高术中灌注速度以及感染性结石成分是一期PCNL治疗上尿路结石术后尿脓毒血症的独立风险因素,根据上述临床独立风险因素建立的列线图有助于预测术后尿脓毒血症的风险。     

Augmenting prostate magnetic resonance imaging reporting to incorporate diagnostic recommendations based upon clinical risk calculators

Risk calculators have offered a viable tool for clinicians to stratify patients at risk of prostate cancer (PCa) and to mitigate the low sensitivity and specificity of screening prostate specific antigen (PSA). While initially based on clinical and demographic data, incorporation of multiparametric magnetic resonance imaging (MRI) and the validated prostate imaging reporting and data system suspicion scoring system has standardized and improved risk stratification beyond the use of PSA and patient parameters alone. Biopsy-naïve patients with lower risk profiles for harboring clinically significant PCa are often subjected to uncomfortable, invasive, and potentially unnecessary prostate biopsy procedures. Incorporating risk calculator data into prostate MRI reports can broaden the role of radiologists, improve communication with clinicians primarily managing these patients, and help guide clinical care in directing the screening, detection, and risk stratification of PCa.     

膀胱癌的Nomograms预测模型

膀胱癌的自然病史存在显著变异性,这使得对个体患者进行预后评估显得十分重要.Nomograms模型较其他模型具有更高的预测准确性和应用简便性,它可以提供准确的个体化风险评估,方便临床决策.Nomograms模型被认为是预测膀胱癌患者预后的最准确、最具鉴别力的预测工具,具有广阔的发展前景.然而,这种模型也有其自身的不足,这...     

Models predicting non-sentinel node involvement also predict for regional recurrence in breast cancer patients without axillary treatment

Background

Non-SN prediction models are frequently used in clinical decision making to identify patients that may not need axillary treatment, but these models still need to be validated by follow-up data. Our purpose was the validation of non-sentinel node (SN) prediction models in predicting regional recurrences in patients without axillary treatment.

Methods

We followed a cohort of 486 women with favorable primary tumor characteristics and pN0(i+)(sn) or pN1mi(sn) for median 4.5 years. None of the patients underwent axillary treatment. Based on four published non-SN prediction models, the threshold allowing separation into low versus high-risk on non-SN involvement was set at 10%.

Results

Overall 5-year regional recurrence rate was 3.0% (SE, ±0.1%). Using the Tenon scoring system, 438 low-risk patients had a 5-year regional recurrence rate of 2.3% (±0.8%), and 48 high-risk patients a recurrence rate of 10.1% (±0.4%). The MSKCC nomogram identified 300 low-risk patients with a recurrence rate of 2.8% (±1.1%), versus 166 high-risk patients with a rate of 3.4% (±0.5%) (20 patients not assessable). The Stanford nomogram identified 21 high-risk patients without recurrence, and 465 low-risk patients with a 3.2% (±0.9%) recurrence rate. A Dutch model discriminated between 384 low-risk patients with a recurrence rate of 2.2% (±0.8%) and 102 high-risk patients with a rate of 6.3% (±2.9%).

Conclusion

The Tenon scoring system outperformed the other models as it identified the largest subgroup of patients with low recurrence rate. In patients resembling our cohort we would recommend axillary treatment if they had a Tenon score above 3.5.