The use of anti-ulcer agents and the risk of chronic kidney disease: a meta-analysis

Purpose

We conducted a meta-analysis to explore the association between the use of different anti-ulcer agents and the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and decline in glomerular filtration rate (GFR) in various study populations.

Methods

PubMed, Embase, and the Cochrane Library were searched for relevant entries up to July 1, 2017. The primary outcomes of the meta-analysis were risk ratios (RRs) of CKD, ESRD, and decline in GFR. We also investigated the heterogeneity of the meta-analysis by subgroup analysis and meta-regression analysis.

Results

A total of 662,624 individuals were enrolled in five trials. Compared with non-PPI users, PPI users had a higher trend of CKD (RR?=?1.16, 95% CI 1.07–1.25, P?<?0.001), especially ESRD (RR?=?1.81, 95% CI 1.59–2.06, P?<?0.001). There was an elevated risk of adverse renal outcome among participants receiving PPI and not H2RA (CKD: RR?=?1.28, 95% CI 1.24–1.33, P?<?0.001; ESRD: RR?=?1.39, 95% CI 1.17–1.64, P?<?0.001; GFR: RR?=?1.31, 95% CI 1.26–1.36, P?<?0.001). However, H2RA users were not associated with CKD when compared with non-H2RA users (RR?=?1.02, 95% CI 0.83–1.25, P?=?0.855). In subgroup analysis, the average age of individuals and drug dosage had no influence on the risk of CKD, while duration of PPI exposure from 31 to 720 days is a potential factor in progression to ESRD (P?<?0.001).

Conclusions

Chronic PPI use, but not H2RAs, is associated with deterioration in kidney function.

     

Sagittal abdominal diameter and Framingham risk score in non-dialysis chronic kidney disease patients

Background

Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that abdominal obesity is a risk factor for cardiovascular mortality. We investigated the link between sagittal abdominal diameter (SAD) and Framingham risk score in non-dialysis CKD patients.

Methods

In a cross-sectional study, we enrolled 307 prevalent non-dialysis CKD patients (175 males, aged 50.7?±?17.04 years). SAD and Framingham risk score were measured.

Results

Framingham cardiovascular disease risk score was independently predicted by SAD (P?<?0.01), GFR (P?<?0.01) and diabetic history (P?<?0.05). Adjusted R² of the model was 0.178. SAD could be independently predicted by BMI (P?<?0.01), diabetic history (P?<?0.01), GFR (P?<?0.01) and age (P?<?0.01). Adjusted R² of the model was 0.409. Using receiver operating characteristic (ROC) curve, a cutoff SAD value of 16.55 cm was determined with sensitivity of 63.7%, specificity of 58.3%.

Conclusion

Elevated SAD is significantly associated with increased Framingham risk score in non-dialysis CKD patients. SAD can be predicted by patients’ BMI, diabetic history, renal function and age. Further investigation is needed to explore the potential benefits of central obesity lowering therapy in this patient group.

     

Zoledronic acid in children with osteogenesis imperfecta and Bruck syndrome: a 2-year prospective observational study

Summary

Treatment with zoledronic acid (ZA) over 2 years, among 33 children with osteogenesis imperfecta (OI) and five Bruck syndrome cases, showed reduction in fracture rates, pain, and improvement in bone mineral density (BMD) and motor milestones of development. This is the first study reporting the use of bisphosphonates in patients with Bruck syndrome (BS).

Introduction

OI and BS are genetic disorders that result in bone fragility and reduced BMD. There is little literature describing the efficacy and safety of ZA in this population. In this study, we assess the response to treatment with ZA at six monthly intervals in Egyptian children with OI and BS for a period of 2 years.

Methods

Thirty-three patients with OI and five patients with BS were treated with 0.1 mg/kg ZA intravenously every 6 months for 2 years during which they were followed up using different parameters. A clinical severity score (CSS) was applied to the patients before and 2 years after the start of therapy. Comparison of disease severity and response to ZA treatment between autosomal-dominant (AD) and autosomal-recessive (AR) OI patients was also done.

Results

After 6 months of treatment, OI and BS patients showed a significant increase in BMD Z-scores (P?<?0.003 in the spine and P?<?0.004 in the hip), together with a significant drop in fracture rate (P?<?0.001), relief of pain (P?<?0.001), and improvement in ambulation (P?<?0.001). CSS was significantly reduced after 2 years of treatment in both OI and BS patients. AR-OI patients were more severely affected than AD-OI patients and showed more significant improvement.

Conclusion

Zoledronic acid proved to be safe and effective in the treatment of OI and BS. The biannual infusion protocol was convenient to patients. There was a positive correlation between disease severity and benefits of the treatment. The use of the CSS proved to be of value in the assessment of the degree of severity in OI, and with some modifications, it was a valuable tool for the assessment of response to treatment.

     

Vitamin D supplementation improves endothelial dysfunction in patients with non-dialysis chronic kidney disease

Purpose

Hypovitaminosis D is common in chronic kidney disease (CKD) and is associated with endothelial dysfunction and cardiovascular events. This study aimed to investigate the effects of vitamin D supplementation on endothelial dysfunction in non-dialysis CKD patients.

Materials and methods

Seventy-one non-dialysis CKD patients with low vitamin D (serum 25(OH)D < 30 ng/mL) were recruited. Patients received oral cholecalciferol 50,000 units once a week for 12 weeks. Changes in endothelial function by brachial artery flow-mediated dilation (FMD), soluble vascular cell adhesion molecule-1 (sVCAM-1), and sE-selectin were studied.

Results

There was a significant increase in serum levels of 25(OH)D after cholecalciferol supplementation (33.7 ± 12.1 vs. 13.2 ± 5.4 ng/mL, P < 0.001). Multivariable regression analysis showed that higher proteinuria (β = ? 0.548, P < 0.001) and lower levels of 25(OH)D (β = 0.360, P < 0.001) at baseline were related to lower 25(OH)D level after supplementation. FMD increased significantly from 4.4 ± 1.3 to 5.1 ± 1.5% (P < 0.001), and soluble endothelial biomarkers decreased: sVCAM-1 from 926.9 ± 158.0 to 867.0 ± 129.0 ng/mL (P < 0.001), and sE-selectin 69.7 ± 15.8 to 63.3 ± 14.7 ng/mL (P < 0.001).

Conclusions

Vitamin D supplementation can improve endothelial dysfunction in pre-dialysis CKD patients.

     

Greater Curvature Plication with Duodenal–Jejunal Bypass: a Novel Metabolic Surgery for Type 2 Diabetes Mellitus

Objective

The study investigated the use of great curvature plication with duodenal–jejunal bypass (GCP-DJB) in a type 2 diabetic with obesity rat model.

Methods

Twenty-two Sprague-Dawley rats were given a high fat and sugar diet with subsequent intraperitoneal injection of a small dosage of streptozotocin (30 mg/kg) and randomly assigned to either GCP-DJB (n?=?12) or Sham surgery (n?=?10). Body weight, peripheral blood glucose, and fasting serum insulin were assayed, and insulin resistance index (IRI) was calculated, before and at 1, 2, 4, and 8 weeks after surgery.

Results

No differences were found in the preoperative characteristics of the two groups (P?>?0.05). At week 1, the body weights decreased significantly, but there was no significant difference between the two groups (P?>?0.05).The fasting blood glucose was significantly lower in the GCP-DJB than in the Sham group (P?<?0.05), serum insulin levels were higher (P?<?0.05), and IRI began to decline (P?<?0.05). From 2 to 8 weeks, the body weight of Sham group gradually recovered and continued to rise, while the GCP-DJB group remained at a relatively lower state. Compared to the Sham group, the body weight, fasting blood glucose as well as IRI of GCP-DJB rats had significantly decreased (P?<?0.05). But, the fasting insulin concentrations had significantly increased (P?<?0.05).

Conclusion

This novel GCP-DJB procedure established a stable animal model for the study of metabolic surgery to treat type 2 diabetes mellitus (T2DM).

     

Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes

Purpose

With the increasing number of primary total hip arthroplasties (THA) being performed, the frequency of revision surgery is also expected to increase. We analysed the immediate in-hospital complications and epidemiologic data of 3,469 revision and 18,186 primary THA cases.

Methods

The National Hospital Discharge Survey (NHDS) was evaluated between 2001 and 2010 for patients who underwent revision and primary THA. Patients were identified and included in our retrospective study based on ICD-9 procedure codes.

Results

The number of primary and revision THAs increased steadily from 2001 to 2010. The revision burden decreased for the same studied period (r?=?–0.92) to reach 13.9 % in 2010. The South region had higher revision burden of 17.4 % (p?<?0.001). The primary THA group was more likely to be obese, morbidly obese, and have hypertension (p?<?0.001). The revision THA group had an increased rate of blood transfusions (p?<?0.001), deep venous thrombosis (p?=?0.008), post-operative sepsis (p?<?0.001), and wound complications (p?<?0.001). The in-hospital mortality rate was also higher for the revision THA group (0.6 % versus 0.2 %, p?<?0.001).

Conclusions

The revision burden has undergone a steady decrease over the ten years studied and the reason for this is likely multifactorial. The South region had a significantly higher revision burden when compared to the rest of the United States. Larger hospitals tend to perform relatively more revisions. Revision THA patients are associated with longer hospital stay, higher complications rate, and higher in-hospital mortality rate.

     

Posttraumatische Syringomyelie

Background

Posttraumatic syringomyelia (PTS) can occur as a rare complication after traumatic spinal cord injury (tSCI) and in cases of delayed diagnosis could lead to disastrous deterioration of both motor and sensory neurological functions.

Objective

To determine influencing factors causing PTS after tSCI.

Material and methods

In a monocentric retrospective two-arm study all patients who were readmitted as inpatients due to increasing neurological impairment caused by PTS (n?=?107) in the period between 1 October 1997 and 31 December 2012 were compared with a randomised group of tSCI patients without PTS (n?=?1590) over the same time period.

Results

Included in the study were 107 patients with an average age of 30.25 years (86 male and 21 female). The most frequent clinical symptoms were changes in sensitivity, pain perception and muscle strength. Within the PTS group, patients older than 30 years had a shorter interval between the onset of SCI and the diagnosis of PTS (p?<?0.001). Both the study and control groups showed a significant age difference at the time of the accident (p?<?0.001). In addition, the number of completely paraplegic (American Spinal Injury Association impairment scale AIS type A) patients was significantly higher within the PTS group (p?<?0.001) and they also had remission to pedestrians significantly less frequently (p?<?0.001). In addition, in a group comparison significantly different neurological levels of paralysis (p?<?0.001) were observed at the time of discharge. Further results showed that younger patients with complete SCI lesions had a higher risk of developing PTS.

Conclusion

The PTS is a rare but severe complication of tSCI, frequently followed by increasing impairment of sensibility, motor function and the autonomic nervous system. As the prognosis of the disease is highly influenced by the time point of the diagnosis, in suspected cases immediate presentation at a specialized center for paraplegic patients is necessary.

     

Risk of total/subtotal meniscectomy for respective medial and lateral meniscus injury: correlation with tear type,duration of complaint,age, gender and ACL rupture in 6034 Asian patients

Background

To evaluate the risk factor associated with total or subtotal meniscectomy for respective medial and lateral meniscus injury.

Methods

The data of all the meniscus injured patients undergoing arthroscopy in our institute between January 15th, 2000 and December 31st, 2008 was collected and 6034 patients with 7241 injured menisci met the inclusion criteria. The mean patient age was 33.6?±?14.9 years and there were 4785 males and 2456 females with 3568 medial and 3673 lateral menisci. The decision tree approach was applied to investigate the correlation of the tear type, the duration of complaint, age, gender, ACL rupture and total/subtotal meniscectomy for respective medial and lateral meniscus.

Results

The tear type was associated with both medial (χ2?=?70.901, P?<?0.001) and lateral (χ2?=?268.019, P?<?0.001) total/subtotal meniscectomy. The strongest risk of total/subtotal meniscectomy of both medial and lateral meniscus tear was shown for the complex tear followed by the longitudinal, oblique, horizontal and radial tear of the medial meniscus and followed by horizontal, longitudinal, radial and oblique tear of the lateral meniscus. The risk of total/subtotal medial meniscectomy was significantly elevated for the patients with complex tear and the age of ≤40 years old (χ2?=?21.028, P?<?0.001) and those with the oblique, horizontal or radial tear accompanied by ACL rupture (χ2?=?6.631, P?=?0.01). Besides, the duration of complaint was also associated with total/subtotal meniscectomy of the medial longitudinal tear with ACL rupture (χ2?=?17.155, P?<?0.001). On the other side, the risk of total/subtotal lateral meniscectomy was significantly elevated for the complex tear of the female patients (χ2?=?5.877, P?=?0.015) with no ACL rupture (χ2?=?50.501, P?<?0.001). The ACL rupture was associated with a decreased risk of total/subtotal meniscectomy for all the types of the lateral meniscus (complex: χ2?=?50.501, P?<?0.001; horizontal: χ2?=?20.897, P?<?0.001; oblique: χ2?=?27.413, P?<?0.001; longitudinal and radial: χ2?=?110.85, P?<?0.001).

Conclusion

Analyzing data from a big sample available in an Asian patient database, we found different risk factors associated with total/subtotal meniscectomy for respective medial and lateral meniscus. Identifying patients at high risk for total/subtotal meniscectomy may allow for interventions after meniscus injury.

     

A Multi-institutional Analysis of Duodenal Neuroendocrine Tumors: Tumor Biology Rather than Extent of Resection Dictates Prognosis

Introduction

Duodenal neuroendocrine tumors (NETs) are rare neoplasms with poorly defined management. We sought to evaluate the outcomes of patients undergoing resection of duodenal NETs.

Methods

Using a multi-institutional database, 146 patients who underwent resection for duodenal NETs between 1993 and 2015 were identified. Data on clinicopathologic characteristics and outcomes were collected and analyzed.

Results

Local surgical resection (LR) was performed in 57 (39.0 %) patients, while 50 (34.3 %) patients underwent pancreaticoduodenectomy (PD) and 39 (26.7 %) patients an endoscopic resection (ER). Factors associated with worse RFS included advanced tumor grade and metastasis at diagnosis (both P?<?0.05) but not procedure type (P?>?0.05). Among patients who had at least one lymph node examined (n?=?85), 50 (58.8 %) had a metastatic lymph node; lymph node metastasis (P?=?0.04) and advanced tumor grade (P?=?0.04) were more common among patients with tumors >1.5 cm. Median length-of-stay was longer for PD versus LR (P?<?0.001). PD patients were at increased risk for severe postoperative complications (P?=?0.01).

Conclusion

Recurrence of duodenal NETs was dependent on tumor biology rather than procedure type. PD was associated with a longer hospital stay and higher risk of perioperative complications. For patients with tumors ≤1.5 cm, LR or ER may be appropriate with PD reserved for larger lesions and those not amenable to a more local approach.

     

The Prognostic Value of Varying Definitions of Positive Resection Margin in Patients with Colorectal Cancer Liver Metastases

Background

Varying definitions of resection margin clearance are currently employed among patients with colorectal cancer liver metastases (CRLM). Specifically, a microscopically positive margin (R1) has alternatively been equated with an involved margin (margin width?=?0 mm) or a margin width <?1 mm. Consequently, patients with a margin width of 0–1 mm (sub-mm) are inconsistently classified in either the R0 or R1 categories, thus obscuring the prognostic implications of sub-mm margins.

Methods

Six hundred thirty-three patients who underwent resection of CRLM were identified. Both R1 definitions were alternatively employed and multivariable analysis was used to determine the predictive power of each definition, as well as the prognostic implications of a sub-mm margin.

Results

Five hundred thirty-nine (85.2%) patients had a margin width ≥?1 mm, 42 had a sub-mm margin width, and 52 had an involved margin (0 mm). A margin width ≥?1 mm was associated with improved survival vs. a sub-mm margin (65 vs. 36 months; P?=?0.03) or an involved margin (65 vs. 33 months; P?<?0.001). No significant difference in survival was detected between patients with involved vs. sub-mm margins (P?=?0.31). A sub-mm margin and an involved margin were both independent predictors of worse OS (HR 1.66, 1.04–2.67; P?=?0.04, and HR 2.14, 1.46–3.16; P?<?0.001, respectively) in multivariable analysis. Importantly, after combining the two definitions, patients with either an involved margin or a sub-mm margin were associated with worse OS in multivariable analysis (HR 1.94, 1.41–2.65; P?<?0.001).

Conclusions

Patients with involved or sub-mm margins demonstrated a similar inferior OS vs. patients with a margin width >?1 mm. Consequently, a uniform definition of R1 as a margin width <?1 mm should perhaps be employed by future studies.

     

Positive Lymph Node Ratio as an Indicator of Prognosis and Local Tumor Clearance in N3 Gastric Cancer

Background

Nodal metastasis is an important clinical issue in gastric cancer patients. This study was designed to investigate the clinical usefulness of the positive lymph node ratio (PLNR), which reflects both metastatic and retrieved lymph node numbers, in patients with pN3 gastric cancer.

Methods

We retrospectively analyzed the records of 138 consecutive pN3 patients who underwent curative gastrectomy with lymphadenectomy from 2000 to 2012.

Results

A PLNR of 0.4 was proved to be the best cutoff value to stratify the prognosis of patients with pN3 gastric cancer (P?<?0.001). Univariate and multivariate analyses revealed that older age, larger tumor size (≥10 cm), and PLNR?≥?0.4 [P?<?0.001, HR 3.1 (95 % CI 1.7–5.4)] were independent prognostic factors in pN3 gastric cancer. Regarding the recurrence, patients with PLNR <0.4 had a significantly lower rate of lymph node recurrence than those with PLNR ≥0.4 (P?=?0.020). There was no significant difference in the lymph node recurrence rate between N3a and N3b patients in the PLNR <0.4 group [P?=?0.546, 11.6 % (7/60) vs. 12.5 (1/8)], indicating a better local control regardless of pN3 subgroups.

Conclusions

PLNR is useful to stratify the prognosis and evaluate the extent of local tumor clearance in pN3 gastric cancer.

     

Impaired skeletal health and neuromuscular function among amphetamine users in clinical treatment

Summary

This study examined musculoskeletal health in amphetamine users, compared with healthy age-matched controls. We show that amphetamine users have reduced bone mass at several skeletal sites and attenuated maximal muscle strength and force development capacity in the lower extremities.

Introduction

Amphetamine use may cause poor bone quality and elevated risk of osteoporosis. The purpose of this study was to investigate whether amphetamine users exhibit reduced regional and whole body bone mineral density (BMD), altered bone metabolism, and how muscle function may relate to the patient groups’ skeletal health.

Methods

We assessed hip, lumbar spine and whole body BMD, and trabecular bone score (TBS) by dual x-ray absorptiometry (DXA), and bone metabolism markers in serum and maximal strength and force development capacity in 36 amphetamine users (25 men, 30?±?7 years; 11 women 35?±?10 years) and in 37 healthy controls (23 men, 31?±?9 years; 14 women, 35?±?7 years).

Results

Whole body BMD was lower in amphetamine users (8 % in males and 7 % females, p?<?0.01), as were BMD at the total hip and sub-regions of the hip (9–11 % in men and 10–11 % in women, p?<?0.05). Male users had 4 % lower TBS (p?<?0.05) and higher serum level of type 1 collagen amino-terminal propeptide (p?<?0.01). This coincided with reduced lower extremity maximal strength of 30 % (males, p?<?0.001) and 25 % (females, p?<?0.05) and 27 % slower muscular force development in males compared to controls (p?<?0.01).

Conclusions

These findings demonstrate that amphetamine users suffer from a generalized reduction in bone mass, which was associated with attenuated maximal muscle strength and force development capacity in the lower extremities.

     

Platelet Counts and Liver Enzymes After Gastric Bypass Surgery

Background

Obesity is associated with chronic inflammation, liver steatosis and increased liver enzymes such as gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT), markers for non-alcoholic fatty liver disease (NAFLD) and liver fat content. Increased platelet counts (PCs) are a biomarker reflecting inflammation and the degree of fibrosis in NAFLD. We investigated alterations in PCs, GGT, ALT, C-reactive protein (CRP) and ferritin after Roux-en-Y gastric bypass (RYGBP).

Methods

One hundred twenty-four morbidly obese non-diabetic patients were evaluated before (baseline) and 12 months after (follow-up) RYGBP.

Results

Body mass index (BMI) was reduced from 43.5 kg/m² (baseline) to 31.1 kg/m² (follow-up), and p?<?0.001 and weight declined from 126.2 to 89.0 kg. PCs decreased from 303?×?10⁹ to 260?×?10⁹/l, p?<?0.001. GGT was reduced from 0.63 to 0.38 μkat/l, p?<?0.001. ALT decreased from 0.69 to 0.59 μkat/l, p?=?0.006. CRP was lowered from 7.3 to 5.4 mg/l p?<?0.001 and ferritin from 106 to 84 μg/l p?<?0.001. The alterations in PCs correlated with the changes in CRP (r?=?0.38, p?=?0.001), BMI (r?=?0.25, p?=?0.012), weight (r?=?0.24, p?=?0.015) and inversely correlated with ferritin (r?=?21, p?=?0.036).

Conclusions

PCs, GGT and ALT (markers for NAFLD), and CRP and ferritin (markers for inflammation) decreased in morbidly obese after RYGBP. The decrease in PCs correlated with alterations in CRP, BMI, weight and ferritin. The lowering of liver enzymes may reflect a lowered liver fat content and decreased general inflammation.

     

Overexpression of Sox3 is Associated with Diminished Prognosis in Esophageal Squamous Cell Carcinoma

Background

Esophageal squamous cell carcinoma (ESCC) is a lethal malignancy lacking valid prognostic biomarkers. As a member of the High Mobility Group domain-containing DNA-binding proteins, Sox3 has been reported to induce oncogenic transformation of chicken embryo fibroblasts. However, the expression and prognostic value of Sox3 in ESCC remain unclear.

Methods

A total of 30 pairs of ESCC with a corresponding non-neoplastic esophageal epithelium (NE) specimen were investigated for Sox3 expression using RT-PCR and western blot analysis. Tissue microarrays containing 118 ESCC and 30 NE samples were detected for Sox3 expression using immunohistochemical staining. The relationship of Sox3 staining with various clinicopathological characteristics and survival of patients was statistically analyzed.

Results

Sox3 expression in ESCC was 3.1- and 2.7-fold higher than in NE at mRNA (P < 0.001) and protein level (P < 0.001), respectively. Positive staining of Sox3 was observed in 77.1 % of the ESCC and 16.7 % of the NE samples (P < 0.001). High expression of Sox3 was significantly correlated with the regional lymph nodes metastasis (RLNM) (P = 0.022) and advanced TNM stage (P = 0.011). Moreover, high expression of Sox3 was significantly associated with poor overall survival (P < 0.001) and recurrence-free survival (P < 0.001) in ESCC patients. Both Sox3 expression (P < 0.001) and RLNM (P = 0.002) were independent prognostic factors for patients with ESCC.

Conclusions

Sox3 might play a positive role in tumor development and could serve as an independent predictor of poor prognosis for ESCC.

     

Predictive Value of CEA for Survival in Stage I Rectal Cancer: a Population-Based Propensity Score-Matched Analysis

Background

The aim of the study was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall- and cancer-specific survival in stage I rectal cancer.

Methods

Stage I rectal cancer patients were identified in the Surveillance, Epidemiology, and End Results database between 2004 and 2011. The impact of an elevated preoperative CEA level (C1-stage) compared with a normal CEA level (C0-stage) on overall and cancer-specific survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods.

Results

Overall, 1932 stage I rectal cancer patients were included, of which 328 (17 %) patients had C1-stage. The 5-year overall and cancer-specific survival for patients with C0-stage were 85.7 % (95 % CI 83.2–88.2 %) and 94.7 % (95 % CI 93.1–96.3 %), versus 76.8 % (95 % CI 70.9–83.1 %) and 88.1 % (95 % CI 83.3–93.2 %) for patients with C1-stage (P?<?0.001 and P?=?0.001). The negative impact of C1-stage on overall and cancer-specific survival was confirmed by risk-adjusted Cox proportional hazard regression analysis (hazard ratio [HR]?=?1.57, 95 % CI?=?1.15–2.16, P?=?0.007 and 2.04, 95 % CI?=?1.25–3.33, P?=?0.006), and after propensity score matching (overall survival [OS]: HR?=?1.46, 95 % CI?=?1.02–2.08, P?=?0.044 and cancer-specific survival [CSS]: HR?=?3.28, 95 % CI?=?1.78–6.03, P?<?0.001).

Conclusion

This is the first population-based investigation of a large cohort of exclusively stage I rectal cancer patients providing compelling evidence that elevated preoperative CEA level is a strong predictor of worse overall and cancer-specific survival.

     

Prognostic role of decreased E-cadherin expression in patients with upper tract urothelial carcinoma: a multi-institutional study

Purpose

To assess the role of E-cadherin as prognostic biomarker in upper tract urothelial carcinoma (UTUC) in a large multi-institutional cohort of patients.

Methods

Immunohistochemistry technique was used to evaluate E-cadherin expression in 678 patients with unilateral, sporadic UTUC treated with RNU. E-cadherin expression was considered decreased if 10 % or more cells had decreased expression (<90 %).

Results

Decreased E-cadherin expression was observed in 353 patients (52.1 %) and was associated with advanced pathological stage (P < 0.001), higher grade (P < 0.001), lymph node metastasis (P = 0.006), lymphovascular invasion (P < 0.001), concomitant carcinoma in situ (P < 0.001), multifocality (P = 0.004), tumor necrosis (P = 0.020) and sessile architecture (P < 0.001). Within a median follow-up of 30 months (interquartile range 15–57), 171 patients (25.4 %) experienced disease recurrence and 150 (21.9 %) died from UTUC. In univariable analyses, decreased E-cadherin expression was significantly associated with worse recurrence-free survival (P < 0.001) and cancer-specific survival CSS (P = 0.006); however, in multivariable analyses, it was not (P = 0.74 and 0.84, respectively). The lack of independent prognostic value of E-cadherin remained true in all subgroup analyses.

Conclusion

In UTUC patients treated with RNU, decreased E-cadherin expression is associated with features of biologically and clinically aggressive disease and worse outcome in univariable, but not multivariable, analyses. If E-cadherin’s association with factors of advanced disease is confirmed on UTUC biopsy specimens, it could be used to help in the clinical decision-making regarding kidney-sparing approaches and/or neo-adjuvant chemotherapy.

     

Decreased Skeletal Muscle Volume Is a Predictive Factor for Poorer Survival in Patients Undergoing Surgical Resection for Pancreatic Ductal Adenocarcinoma

Background

The aim of this study was to investigate the impact of decreased skeletal muscle (SM) volume on survival outcomes in patients undergoing surgical resection for pancreatic ductal adenocarcinoma (PDAC).

Methods

Between March 2000 and February 2015, 323 patients who underwent upfront surgical resection for PDAC were identified from the Mayo Clinic SPORE in Pancreatic Cancer. Body composition data, including SM area, subcutaneous adipose tissue area, and visceral adipose tissue area were calculated using an abdominal computed tomography (CT) image at the third lumbar spinal level. The body composition data were normalized by patients’ height (e.g., SM index, cm²/m²) and analyzed as continuous variables. Clinicopathological findings and body composition data at initial diagnosis were evaluated for association with overall survival and recurrence-free survival.

Results

Because the median SM index was significantly different between males vs. females (49.9 cm²/m² [range, 32.0–70.3] vs. 39.4 cm²/m² [range, 29.2–66.2], P?<?0.001), it was standardized for each sex and used for further analyses. Parameters independently associated with a shorter overall survival were a larger tumor size (P?=?0.007), a greater tumor extent (P?=?0.037), a higher carbohydrate antigen 19–9 level (P?<?0.001), and a smaller sex-standardized SM index (P?=?0.011). Parameters independently associated with a shorter recurrence-free survival were female sex (P?=?0.029), a larger tumor size (P?<?0.001), a higher carbohydrate antigen 19–9 level (P?=?0.001), and a smaller sex-standardized SM index (P?=?0.007).

Conclusions

A smaller sex-standardized SM index is a predictive factor for shorter overall and recurrence-free survival in PDAC patients undergoing surgery.

     

Factors associated with urinary incontinence in middle-aged women: a population-based household survey

Introduction and hypothesis

The objective was to determine the prevalence of urinary incontinence (UI) and factors associated in a sample of Brazilian middle-aged women.

Methods

A cross-sectional study was conducted between September 2012 and June 2013 with 749 women. UI was defined as any complaint of involuntary loss of urine. The independent variables were sociodemographic data and health-related habits and problems. Statistical analysis was carried out using Chi-squared test and Poisson regression.

Results

The mean age was 52.5 (±4.4) years. The prevalence of UI was 23.6 %. Of these, 48 (6.4 %) had stress urinary incontinence, 59 (7.8 %) urinary urgency, and 70 (9.5 %) had mixed urinary incontinence. In the final statistical model, self-perception of health as fair/poor/very poor (PR: 1.90; 95 % CI, 1.45–2.49; P?<?0.001), ≥1 vaginal deliveries (PR: 1.84; 95 % CI, 1.35–2.50; P?<?0.001), higher body mass index (PR: 1.04; 95 % CI, 1.02–1.06; P?=?0.001), vaginal dryness (PR: 1.60; 95 % CI, 1.23–2.08; P?=?0.001), current or previous hormone therapy (PR: 1.38; 95 % CI, 1.06–1.81; P?=?0.019), pre-/perimenopause (PR: 1.42; 95 % CI, 1.06–1.91; P?=?0.021), and previous hysterectomy (PR: 1.41; 95 % CI, 1.03–1.92; P?=?0.031) were associated with a greater prevalence of UI. Current or previous use of soy products to treat menopausal symptoms was associated with a lower prevalence of UI (PR: 0.43; 95 % CI, 0.24–0.78; P?=?0.006).

Conclusions

Several factors are associated with UI in middle-aged Brazilian women. The results highlight the importance of carrying out interventions aimed at reducing modifiable factors.

     

Pre-treatment double- or triple-positive tumor markers are predictive of a poor outcome for patients undergoing radiofrequency ablation for hepatocellular carcinoma

Purposes

We evaluated the therapeutic effect of radiofrequency ablation (RFA) on hepatocellular carcinoma (HCC) according to the number of positive tumor markers.

Methods

The subjects of this study were 160 patients who underwent percutaneous and surgical RFA for HCC. Patients were divided into negative (n = 51), single- (n = 69), double- (n = 31), and triple-positive (n = 9) tumor marker groups according to the pre-treatment expression of these markers. We looked for any relationships among clinical parameters, outcomes, and tumor markers.

Results

The 3-year recurrence-free and overall survival rates of the negative, single-, double-, and triple-positive groups were 30, 19, 16, and 11 % (P = 0.02), and 94, 88, 67, and 37 % (P < 0.001), respectively. The 2-year local recurrence rates were 6.5, 0, 41.2, and 61.9 %, respectively (P < 0.001). Multivariate analysis revealed that a double- or triple-positive pre-treatment tumor marker profile was independently associated with local recurrence [hazard ratio (HR) 5.48, 95 % confidence interval (CI) 2.44–12.33, P < 0.001] and overall survival (HR 4.21, 95 % CI 1.89–9.37, P < 0.001).

Conclusion

RFA may not be suitable for patients with HCC who have pre-treatment expression of ≥two of these tumor markers.

     

The investigation of the survival time after recurrence in patients with pancreatic ductal adenocarcinoma for individualization of adjuvant chemotherapy

Purpose

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease; however, the frequency of recurrence can be reduced if curative surgery following adjuvant chemotherapy is applied. At present, adjuvant chemotherapy is uniformly performed in all patients, as it is unclear which tumor types are controlled best or worst. We investigated patients with recurrence to establish the optimum treatment strategy.

Methods

Of 138 patients who underwent curative surgery for PDAC, 85 developed recurrence. Comprehensive clinicopathological factors were investigated for their association with the survival time after recurrence (SAR).

Results

The median SAR was 12.6 months. Treatments for recurrence included best supportive care, GEM-based therapy and S-1. The performance status [hazard ratio (HR) 0.12, P?<?0.001], histological invasion of lymph vessels (HR 0.27, P?<?0.001), kind of treatment for recurrence (HR 5.0, P?<?0.001) and initial recurrence site (HR 2.9, P?<?0.001) were independent significant risk factors for the SAR. The initial recurrence sites were the liver (n?=?21, median SAR 8.8 months), lung (n?=?10, 14.9 months), peritoneum (n?=?6, 1.7 months), lymph nodes (n?=?6, 14.7 months), local site (n?=?17, 13.9 months) and multiple sites (n?=?25, 10.1 months). A shorter recurrence-free survival (<?1 year) and higher postoperative CA19-9 level were significantly associated with critical recurrence (peritoneal/liver).

Conclusions

Several risk factors for SAR were detected in this study. Further investigations are needed to individualize the adjuvant chemotherapy for each patient with PDAC.