Prognostic value of the ratio of carcinoembryonic antigen concentration to maximum tumor diameter in patients with stage II colorectal cancer

BackgroundRecently, a study from our center indicated that the ratio of preoperative carcinoembryonic antigen (CEA) concentration to maximum tumor diameter (DMAX) may be a prognostic marker for patients with rectal cancer. Therefore, the study aimed to evaluate whether this ratio (CEA/DMAX) has prognostic value for patients with stage II colorectal cancer (CRC).MethodsA prospectively maintained database was searched for patients with pathologically confirmed stage II CRC who underwent surgery between January 2010 and March 2019. Patients were stratified according to the mean CEA/DMAX value into low and high CEA/DMAX groups. Kaplan-Meier, univariable, and multivariable Cox regression analyses were used to evaluate whether the CEA/DMAX could predict overall survival (OS) and disease-free survival (DFS). Nomograms were constructed in terms of the results of multivariable Cox regression analyses.ResultsThe study included 2,499 patients with stage II CRC. The mean CEA/DMAX value was 2.33 (ng/mL per cm). Kaplan-Meier analyses revealed that, relative to the low CEA/DMAX group, the high CEA/DMAX group had significantly poorer OS (67.31% vs. 85.02%, P<0.001) and DFS (61.41% vs. 77.10%, P<0.001). The multivariable Cox regression analysis revealed that CEA/DMAX independently predicted OS (hazard ratio: 2.58, 95% confidence interval: 1.51–4.38, P<0.001) and DFS (hazard ratio: 1.97, 95% confidence interval: 1.38–2.83, P<0.001). Two simple-to-use nomograms comprising CEA/DMAX, age, T stage, and lymphovascular invasion were developed to predict 1-, 3-, and 5-year rates of OS and DFS among patients with stage II CRC. The nomograms had good performance based on the concordance index, receiver operating characteristic (ROC) curve analysis, and calibration curves. Subgroup analyses further confirmed that a high CEA/DMAX was associated with poor OS and DFS among patients with stage II colon cancer and among patients with stage II rectal cancer (both P<0.05).ConclusionsAmong patients with stage II CRC, a high CEA/DMAX independently predicted poor OS and DFS, and the predictive abilities were also observed in subgroup analyses of patients with stage II colon cancer or rectal cancer. Furthermore, we developed two nomograms that had good accuracy for predicting the prognosis of stage II CRC.     

Pretreatment nomogram for prostate-specific antigen recurrence after radical prostatectomy or external-beam radiation therapy for clinically localized prostate cancer.

PURPOSE: To present nomograms providing estimates of prostate-specific antigen (PSA) failure-free survival after radical prostatectomy (RP) or external-beam radiation therapy (RT) for men diagnosed during the PSA era with clinically localized disease. PATIENTS AND METHODS: A Cox regression multivariable analysis was used to determine the prognostic significance of the pretreatment PSA level, 1992 American Joint Committee on Cancer (AJCC) clinical stage, and biopsy Gleason score in predicting the time to posttherapy PSA failure in 1,654 men with T1c,2 prostate cancer managed with either RP or RT. RESULTS: Pretherapy PSA, AJCC clinical stage, and biopsy Gleason score were independent predictors (P < .0001) of time to posttherapy PSA failure in patients managed with either RP or RT. Two-year PSA failure rates derived from the Cox regression model and bootstrap estimates of the 95% confidence intervals are presented in the format of a nomogram stratified by the pretreatment PSA, AJCC clinical stage, biopsy Gleason score, and local treatment modality. CONCLUSION: Men at high risk (> 50%) for early (< or = 2 years) PSA failure could be identified on the basis of the type of local therapy received and the clinical information obtained as part of the routine work-up for localized prostate cancer. Selection of these men for trials evaluating adjuvant systemic and improved local therapies may be justified.     

Problems of the preoperative prediction of the pathological stage in prostate cancer

The pathological stage of the tumor is the most influential prognostic factor for progression after radical prostatectomy. However, as many as 50% of men undergoing radical prostatectomy are found to have extraprostatic disease in the pathological specimen. Accurate identification of the risks of disease extension and of disease recurrence prior to radical prostatectomy would thus be useful in counseling men presenting with clinically localized prostate cancer. Nomograms may help patients and physicians make more informed treatment decisions based on the probability of pathological stage. Partin and co-workers popularized the use of a pretreatment nomogram based on PSA (prostate specific antigen), clinical stage (TNM stage) and biopsy Gleason score to predict the pathological stage of localized prostate cancer. However, it may not be directly applicable to Japanese males, and the interpretation and comparison of data sets should be done with caution and careful consideration. Although attempts have been made to establish a nomogram for Japanese patients, been tried, it is still based on the data for a small number of patients. More data from a greater number of patients and validation analysis are essential. Recently, artificial neural networks (ANN) have been shown to be effective in predicting pathologic stage in men with clinically localized prostate cancer. The use of ANNs is a relatively new concept and the data is based on Western people; thus, the data analysis for Japanese patients is necessary. The present paper mainly outlines the usefulness and problems for the preoperative prediction of the pathological stage in prostate cancer by nomograms and artificial neural networks.     

Clinical pretreatment risk factors and Ga-67 scintigraphy early during treatment for prediction of outcome of patients with aggressive non-Hodgkin lymphoma

BACKGROUND: Clinical pretreatment risk factors indicate the severity of disease in patients with aggressive non-Hodgkin lymphoma (NHL). Ga-67 scintigraphy during treatment is an early indicator of treatment-related features of lymphoma cells. The ability of risk factors and Ga-67 to predict disease outcome was compared in 139 patients with aggressive NHL. METHODS: Pretreatment clinical risk factors and Ga-67 scintigraphy performed after one cycle and at mid-treatment were evaluated for their correlation with response rate and as predictors of 5-year failure-free survival (FFS). Univariate analysis was performed to determine the ability of pretreatment risk factors and Ga-67 early during treatment to predict FFS. Subsequently, multivariate analysis was performed on the variables with significant univariate results using the Cox proportional hazards method. The predictive value of risk factors and Ga-67 scintigraphy was calculated to determine their suitability in selecting patients with poor outcome. RESULTS: Response rate correlated with stage of disease (P < 0.01) and the international prognostic index (IPI) score (P < 0.05). Five-year FFS was predicted by stage of disease (P < 0.004), performance status (P < 0.02), and the IPI score (P < 0.01). Response rate correlated with results of Ga-67 scintigraphy after one cycle of chemotherapy (P < 0.001) and at mid-treatment (P < 0.001). Five-year FFS was predicted by Ga-67 after one cycle of chemotherapy (P < 0.0004) and at mid-treatment (P < 0.0001). Positive Ga-67 after the first cycle of treatment predicted 64% of patients who had failure of treatment. A positive study at mid-treatment predicted 77% of patients who had treatment failure. Cox analysis showed Ga-67 after one course (P < 0.0012) and at mid-treatment (P < 0.0002) as being the most significant variables in predicting FFS. CONCLUSIONS: Ga-67 scintigraphy demonstrates early the effect of treatment in patients with aggressive NHL. It is a better predictor than pretreatment risk factors of both response rate and FFS. Positive Ga-67 early during treatment may be used as an independent test in selecting patients who will not respond favorably to current protocol treatment for early therapeutic modifications.     

Combining the Prostate Cancer Risk Index (PRIX) with the Presence of Secondary Circulating Prostate Cells to Predict the Risk of Biochemical Failure after Radical Prostatectomy for Prostate Cancer

Introduction: The use of pre- and post-surgery variables has been used to create nomograms in order to identifypatients at high risk of treatment failure. The PRIX nomogram is one such device; we compare the PRIX nomogramwith the presence of secondary circulating prostate cells to predict those men who will undergo treatment failure.Methods and Patients: Men who underwent radical prostatectomy for prostate cancer entered the study. The PRIXscore was calculated from the total serum PSA pre-surgery, the biopsy Gleason score and clinical stage. Circulatingprostate cells were detected from venous blood one month after surgery, using differential gel centrifugation and standardimmunocytochemistry with anti-PSA. A test was considered positive when 1 CPC/blood sample was detected. Patientswere followed up for five years and biochemical failure was defined as a serum PSA >0.2ng/ml. Kaplan-Meier andCox proportional models were used to calculate survival curves. Results: 321 men participated, of whom 131 (40.8%)underwent biochemical failure within 5 years. A higher PRIX score was associated with increased failure risk, as wasthe presence of CPCs. The predictive power of CPCs was significantly higher than the PRIX score. Combining thetwo methods, for equal PRIX scores, scores but CPC positive had a worse biochemical failure free survival than menwith high PRIX scores but CPC negative. For men with PRIX scores of ≥4 the use of CPC detection did not aid in theclinical decision making process. For those with PRIX scores of 0 and 1, CPC detection identified men with a high riskof treatment failure. Conclusions: The combined PRIX/CPC score improved the predictive values of men at high riskof biochemical failure. Both are simple systems that could be incorporated in a general hospital. Further multicenterstudies are warranted to confirm these results.     

Prediction of sites of recurrence in gastric carcinoma using immunohistochemical parameters

BACKGROUND AND OBJECTIVES: To improve prognosis of patients with gastric cancer, it is important to detect recurrences at an early stage following surgery. If the site of recurrence can be predicted, recurrent disease can be easier detected at an early stage. However, this is difficult to achieve using normal clinicopathological factors. We aimed to predict sites of recurrence in patients with advanced gastric carcinoma who underwent curative resection. METHODS: Expressions of vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-ss1, and p53, together with density of microvessels (MVs), and dendritic cell (DC) infiltration were examined by immunohistochemistry to evaluate their relationships with recurrence patterns in patients with advanced gastric carcinoma (n = 92). RESULTS: All immunohistochemical parameters closely correlated with prognosis (TGF-ss1, P = 0.008; VEGF, P < 0.001; p53, P = 0.028; MV, P < 0.001; DC, P < 0.001). Multivariate analysis showed that DC infiltration (P = 0.02; HR, 2.52; 95%CI, 1.16-5.48), MV density (P = 0.023; HR, 2.48; 95%CI, 1.13-5.44), VEGF expression (P = 0.002; HR, 3.27; 95%CI, 1.52-7.05), and lymph node metastasis (P < 0.0001; HR, 2.09; 95%CI, 1.49-2.93) were independent prognostic factors. A multivariate logistic regression analysis indicated that DC infiltration (P = 0.004; Odds ratio, 4.25; 95%CI, 1.51-11.96) and lymph node metastasis (P = 0.01; Odds ratio, 3.37; 95%CI, 1.31-8.66) provided significant estimates of relative risks for development of peritoneal recurrence. Upon development of hematogenous recurrence, VEGF expression significantly indicated relative risks (P < 0.001; Odds ratio, 7.26; 95%CI, 1.41-37.3). Moreover, p53 expression closely correlated with lymph node recurrence (P = 0.042; Odds ratio, 11; 95%CI, 1.26-95.7). CONCLUSIONS: Assessment of immunohistochemical parameters can predict sites of recurrence in gastric carcinomas, and thus contributes to improve prognosis.     

Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer

The majority of breast cancers are diagnosed in postmenopausal women. Competing comorbidities, particularly cardiovascular disease (CVD), should be considered when individualizing adjuvant therapies for these women. We compared the 10-year predicted breast cancer recurrence risk with CVD risk among postmenopausal women with hormone receptor-positive (HR+), non-metastatic breast cancer. CVD risk factor data were prospectively collected from postmenopausal women with stage I-III, HR+?breast cancer initiating adjuvant aromatase inhibitor therapy. We compared predicted 10-year CVD risk, including the composite index heart age, computed from modified Framingham risk score, with predicted 10-year risk of breast cancer recurrence using Adjuvant! Online. We created multivariable logistic regression models to estimate the odds ratios (OR) and 95% confidence intervals (CI) for greater CVD risk than breast cancer recurrence risk. Among 415 women, mean age and heart age were 60 and 67?years, respectively. Overall, 43% of women had a predicted 10-year CVD risk equivalent to breast cancer recurrence risk and 37% had CVD risk higher than breast cancer recurrence risk. Predicted CVD risk was higher than breast cancer recurrence risk for stage I disease (OR: 6.1, 95% CI: 3.4-11.2) or heart age >65 (OR: 12.4, 95% CI: 7.0-22.6). The majority of postmenopausal women with HR+ early breast cancer had a predicted 10-year CVD risk that was equivalent to or higher than breast cancer recurrence risk. Physicians should weigh competing risks and offer early screening and cardiac prevention strategies for women at a greater risk for CVD.     

Nomograms for survival prediction in patients undergoing liver resection for hepatitis B virus related early stage hepatocellular carcinoma

BackgroundThe long-term outcomes of patients who underwent liver resection (LR) for early-stage hepatitis B virus (HBV)-related hepatocellular carcinomas (HCCs) are difficult to predict. This study aimed to develop two nomograms to predict postoperative disease-free survival (DFS) and overall survival (OS), respectively.MethodsData on a primary cohort of 1328 patients who underwent LR for HBV-related HCCs within Milan criteria at the Eastern Hepatobiliary Surgery Hospital (EHBH) from 2000 to 2006 were used to develop the nomograms by the Cox regression analyses. An internal validation cohort of 442 patients operated from 2006 to 2011 at the EHBH and an external validation cohort of 474 patients operated from 2007 to 2009 at the Zhongshan Hospital were used for validation studies. Discrimination and calibration were measured using concordance index (C-index), calibration plots and Kaplan–Meier curves.ResultsThe independent predictors of DFS or OS which included tumour stage factors, biomarker and HBV–DNA level were respectively incorporated into the two nomograms. In the primary cohort, the C-indexes of the models in predicting DFS and OS were 0.76 (95% confidence interval: 0.75–0.78) and 0.79 (0.77–0.81), respectively. The calibration curves fitted well. Both nomograms accurately stratify patients into four distinct incremental prognostic subgroups. The C-indexes of the nomogram for OS prediction was significantly higher than those of the six conventional staging systems (0.65–0.71, all P < 0.001). These results were verified by the internal and external validations.ConclusionThe proposed nomograms showed good prognostication for patients with early HBV-related HCCs after hepatectomy.     

Preoperative Serum Prostate-specific Antigen, Clinical Stage and Gleason Sum as Basis for Predicting Final Pathological Stage in Japanese Patients with Prostate Cancer

By logistic regression analysis and log-likelihood ratio chi-squaretest, the usefulness of preoperative variables (prostate specificantigen [PSA], clinical stage and biopsy Gleason sum) for predictingthe final pathological stage was assessed in 77 patients withclinically resectable prostate cancers. Pathologically, 32 (41.6%)had organ-confined disease. Extracapsular extension was foundin 41 (53.2%), seminal vesicle involvement in 30 (39.0%), positivepelvic lymph nodes in 10 (13.0%) and a positive surgical marginin 27 (35.1%). Each preoperative variable was found to be significantlyassociated with the final pathological stage. Any combinationof these variables was more predictive for extraprostatic disease,compared with each individual. variable. Extraprostatic spreadwas found more frequently in patients with lower serum PSA inthis Japanese elderly male population compared with North Americanmales. These preoperative variables considered in combinationmay provide valuable information for management decisions relatedto prostate cancer. Serum PSA alone cannot reliably predictpathological stage on an individual basis except in patientswith a PSA level of 20 ng/ml or greater. The high incidenceof extraprostatic spread at intermediate PSA underscores theimportance of selecting an ideal cutoff value for PSA-basedscreening in a Japanese male population.     

Individual prediction of lateral neck metastasis risk in patients with unifocal papillary thyroid carcinoma

IntroductionMuch controversy exists over whether to perform lateral neck dissection (LND) on patients with papillary thyroid carcinoma (PTC). This study aimed to build predictive nomograms that could individually estimate lateral neck metastasis (LNM) risk and help determine follow up intensity.Patients and methodsUnifocal PTC patients who underwent LND between April 2012 and August 2014 were identified. Clinical and pathological variables were retrospectively evaluated using univariate and stepwise multivariate logistic regression analysis. Variables that had statistical significance in final multivariate logistic models were chosen to build nomograms, which were further corrected using the bootstrap resampling method.ResultsIn all, 505 PTC patients were eligible for analysis. Among these, 178 patients (35.2%) had lateral neck metastasis. Two nomograms were generated: nomogram (c) and nomogram (c + p). Nomogram (c) incorporated four clinical variables: age, tumor size, tumor site, and extrathyroidal extension (ETE). It had a good discriminative ability, with a C-index of 0.79 (bootstrap-corrected, 0.78). Nomogram (c + p) incorporated two clinical variables and two pathological variables: tumor size, tumor site, extranodal extension (ENE), and number of positive nodes in the central compartment. Nomogram (c + p) showed an excellent discriminative ability, with a C-index of 0.86 (bootstrap-corrected, 0.85).ConclusionTwo predictive nomograms were generated. Nomogram (c) is a clinical model, whereas nomogram (c + p) is a clinicopathological model. Each nomogram incorporates only four variables and can give an accurate estimate of LNM risk in unifocal PTC patients, which may assist clinicians in patient counseling and decision making regarding LND.     

Predictors of locoregional control in stage I/II oral squamous cell carcinoma classified by AJCC 8th edition

ObjectivesTo study the determinants of locoregional control (LRC) on stage I/II oral squamous cell carcinoma (OSCC) classified by AJCC 8th edition.MethodsRetrospective analysis from 296 patients of pT1-2N0 oral OSCC treated with surgery (wide local excision and selective neck dissection). Those receiving adjuvant therapy were excluded. Multivariate analysis was performed for impact of adverse pathological features (APFs) on LRC.ResultsIn stage I, LRC was impacted by perineural invasion (PNI) (HR 7.72, p = 0.010, 95% CI 1.64–36.26) and moderate/poor differentiation (MD/PD) (HR 3.04, p = 0.049, 95% CI 0.99–9.25). In stage II, LRC was impacted by depth of invasion (DOI) (HR 1.59, p = 0.014, 95% CI 1.099–2.32), PNI (HR = 2.86, p = 0.005, 95% CI 1.36–5.98). Combined MD/PD and PNI were associated with worse LRC than either feature individually (HR = 4.12, p < 0.001, 95% CI 2.16–7.85).ConclusionPNI and differentiation accurately predict LRC in AJCC 8th edition classified stage I/II OSCC. PNI was a stronger predictor of locoregional failure than DOI in stage II disease. By incorporating these parameters, we can improve precision in staging of early OSCC and identify potential candidates for treatment escalation to improve outcomes.     

Nomogram for the prediction of lymph node metastasis and survival outcomes in rectal neuroendocrine tumour patients undergoing resection

BackgroundThe current study analysed rectal neuroendocrine tumour (RNET) patients undergoing resection to identify predictive factors and construct nomograms for lymph node metastasis, cancer-specific survival (CSS) and overall survival (OS).MethodsRNET patients registered in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Multivariable logistic regression analysis was used to investigate the relationships between clinicopathological factors and lymph node metastasis. A multivariate competing risk model was applied to investigate factors independently associated with CSS. Through the Cox regression model, a multivariable analysis of OS was performed. Nomograms were established based on independent predictive factors. Calibration plots, receiver operating characteristic (ROC) curves and Brier scores were used to evaluate the predictive accuracy of the nomograms.ResultsIn this study, 1,253 RNET patients were included for further analysis. Tumour size ≥12 mm (P<0.001), T3/T4 stage (P<0.001) and M1 stage (P=0.001) were independently associated with lymph node metastasis. The performance of the nomogram was acceptable for predicting lymph node metastasis, with an area under the ROC curve (AUC) of 0.937 [95% confidence interval (CI): 0.874–1.000]. Calibration curves and the Hosmer-Lemeshow test revealed desirable model calibration (P=0.99996). The multivariate competing risk model analysis showed that grade II (P=0.017), tumour size ≥12 mm (P=0.007), AJCC TNM stage II (P=0.002), stage III (P<0.001) and stage IV (P<0.001) were significantly associated with worse CSS. In the competing risk nomogram model, the time-dependent AUC revealed good discriminatory ability of the model (time from 1 to 107 months, AUC >0.900), and the Brier score showed good accuracy of the nomogram, which was greater than that of the AJCC TNM stage. Multivariate Cox analysis showed that age >60 years (P=0.002), median income ≥$65,000 (P=0.013), AJCC TNM stage III (P=0.038) and AJCC TNM stage IV (P<0.001) were independently associated with worse OS. In the nomogram for the prediction of OS, the C-statistic was 0.703 (95% CI: 0.615–0.792), which was significantly better than that of the AJCC TNM stage (0.703 vs. 0.607, P=0.009). A calibration plot for the probability of survival demonstrated good calibration.ConclusionsThe present study is the first to establish nomograms with great discrimination and accuracy for the prediction of lymph node metastases, CSS and OS in RNET patients, which can be used to guide treatment decision-making and surveillance.     

Nomograms provide improved accuracy for predicting survival after radical cystectomy.

AIMS: To develop multivariate nomograms that determine the probabilities of all-cause and bladder cancer-specific survival after radical cystectomy and to compare their predictive accuracy to that of American Joint Committee on Cancer (AJCC) staging. METHODS: We used Cox proportional hazards regression analyses to model variables of 731 consecutive patients treated with radical cystectomy and bilateral pelvic lymphadenectomy for bladder transitional cell carcinoma. Variables included age of patient, gender, pathologic stage (pT), pathologic grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status (pN), neoadjuvant chemotherapy (NACH), adjuvant chemotherapy (ACH), and adjuvant external beam radiotherapy (AXRT). Two hundred bootstrap resamples were used to reduce overfit bias and for internal validation. RESULTS: During a mean follow-up of 36.4 months, 290 of 731 (39.7%) patients died; 196 of 290 patients (67.6%) died of bladder cancer. Actuarial all-cause survival estimates were 56.3% [95% confidence interval (95% CI), 51.8-60.6%] and 42.9% (95% CI, 37.3-48.4%) at 5 and 8 years after cystectomy, respectively. Actuarial cancer-specific survival estimates were 67.3% (62.9-71.3%) and 58.7% (52.7-64.2%) at 5 and 8 years, respectively. The accuracy of a nomogram for prediction of all-cause survival (0.732) that included patient age, pT, pN, LVI, NACH, ACH, and AXRT was significantly superior (P=0.001) to that of AJCC staging-based risk grouping (0.615). Similarly, the accuracy of a nomogram for prediction of cancer-specific survival that included pT, pN, LVI, NACH, and AXRT (0.791) was significantly superior (P=0.001) to that of AJCC staging-based risk grouping (0.663). CONCLUSIONS: Multivariate nomograms provide a more accurate and relevant individualized prediction of survival after cystectomy compared with conventional prediction models, thereby allowing for improved patient counseling and treatment selection.     

Defining prostate cancer risk after radical prostatectomy

Prostate cancer encompasses a wide spectrum of tumor phenotypes with differing prognoses and a part of these patients are at risk of experiencing tumor recurrence after initial treatment. This review discusses the parameters that determine PCa risk for failure after radical prostatectomy and also focuses on the ability of currently available post-treatment nomograms to predict treatment outcomes, and probability of treatment failure. The use of predictive nomograms may be therefore helpful in the complex decision making process.     

Impact of deprivation and rural residence on treatment of colorectal and lung cancer

For common cancers, survival is poorer for deprived and outlying, rural patients. This study investigated whether there were differences in treatment of colorectal and lung cancer in these groups. Case notes of 1314 patients in north and northeast Scotland who were diagnosed with lung or colorectal cancer in 1995 or 1996 were reviewed. On univariate analysis, the proportions of patients receiving surgery, chemotherapy and radiotherapy appeared similar in all socio-economic and rural categories. Adjusting for disease stage, age and other factors, there was less chemotherapy among deprived patients with lung cancer (odds ratio 0.39; 95% confidence intervals 0.16 to 0.96) and less radiotherapy among outlying patients with colorectal cancer (0.39; 0.19 to 0.82). The time between first referral and treatment also appeared similar in all socio-economic and rural groups. Adjusting for disease stage and other variables, times to lung cancer treatment remained similar, but colorectal cancer treatment was quicker for outlying patients (adjusted hazard ratio 1.30; 95% confidence intervals 1.03 to 1.64). These findings suggest that socio-economic status and rurality may have a minor impact on modalities of treatment for colorectal and lung cancer, but do not lead to delays between referral and treatment.     

Predicting age of ovarian failure after radiation to a field that includes the ovaries

PURPOSE: To predict the age at which ovarian failure is likely to develop after radiation to a field that includes the ovary in women treated for cancer. METHODS AND MATERIALS: Modern computed tomography radiotherapy planning allows determination of the effective dose of radiation received by the ovaries. Together with our recent assessment of the radiosensitivity of the human oocyte, the effective surviving fraction of primordial oocytes can be determined and the age of ovarian failure, with 95% confidence limits, predicted for any given dose of radiotherapy. RESULTS: The effective sterilizing dose (ESD: dose of fractionated radiotherapy [Gy] at which premature ovarian failure occurs immediately after treatment in 97.5% of patients) decreases with increasing age at treatment. ESD at birth is 20.3 Gy; at 10 years 18.4 Gy, at 20 years 16.5 Gy, and at 30 years 14.3 Gy. We have calculated 95% confidence limits for age at premature ovarian failure for estimated radiation doses to the ovary from 1 Gy to the ESD from birth to 50 years. CONCLUSIONS: We report the first model to reliably predict the age of ovarian failure after treatment with a known dose of radiotherapy. Clinical application of this model will enable physicians to counsel women on their reproductive potential following successful treatment.     

术前预后营养指数对胰十二指肠切除术后短期预后的预测价值

目的:探讨术前血清白蛋白（albumin,ALB）水平、预后营养指数对胰十二指肠切除术术后白蛋白变化的影响和短期预后的预测价值。方法:回顾性分析蚌埠医学院第一附属医院2018年09月至2019年09月收治的146例胰十二指肠切除术患者的一般资料及临床资料。分析评价术前白蛋白、预后营养指标与胰十二指肠切除术后白蛋白水平及下降率的相关性，通过受试者工作特征曲线(receiver operating characteristic curve,ROC)下的面积计算出术后90天死亡事件发生的预后营养指数（prognostic nutrition index,PNI）最佳截止值，单因素分析PNI与临床病理资料的相关性，多因素分析采用Logistic回归分析。术后90天的死亡率的相关因素及预测效能采用诺模图及校正曲线展示。结果:术前ALB水平与术后ALB下降率呈正相关关系（r＝0.340,P＜0.001），术前PNI与术后ALB水平及术后ALB下降率也呈正相关关系（r＝0.489，P＜0.001；r＝0.287，P=0.001），单因素及多因素分析表明病理分期、术前系统性免疫炎症指数（systemic immune-inflammation index,SII）、术后ALB水平、术后ALB下降率等因素是术前PNI的独立影响因素（P＜0.05）。诺模图及校正曲线进一步表明PNI可以预测术后90天死亡的风险。结论:术前ALB水平越高可能导致术后ALB降低更明显；术前PNI可以良好地预测胰十二指肠术后90天死亡事件发生的概率。     

Predicting clinical end points: treatment nomograms in prostate cancer

Due to the generally indolent nature of prostate cancer, patients must decide among a wide range of treatments, which will significantly affect both quality of life and survival. Thus, there is a need for instruments to aid patients and their physicians in decision analysis. Nomograms are instruments that predict outcomes for the individual patient. Using algorithms that incorporate multiple variables, nomograms calculate the predicted probability that a patient will reach a clinical end point of interest. Nomograms tend to outperform both expert clinicians and predictive instruments based on risk grouping. We outline principles for nomogram construction, including considerations for choice of clinical end points and appropriate predictive variables, and methods for model validation. Currently, nomograms are available to predict progression-free probability after several primary treatments for localized prostate cancer. There is need for additional models that predict other clinical end points, especially survival adjusted for quality of life.     

四肢纤维肉瘤患者预后诺模图的开发和验证

目的:开发诺模图来预测原发于四肢纤维肉瘤患者的总体生存率(OS)和癌症特异性生存率(CSS)。方法:根据SEER数据库,收集原发于四肢纤维肉瘤病例。采用Cox比例风险回归模型对病例预后进行分析,获得独立的预测因素。这些独立的预测因子被整合在一起,形成了预测5年和10年OS及CSS的诺模图。使用R软件通过一致性指数(C-index指数）、ROC曲线和校准曲线图来评估诺模图的性能。结果:在OS的单因素和多因素分析中,年龄、病理分级、肿瘤大小和手术被确定为独立的危险因素。 在CSS的单变量和多变量分析中,病理分级、肿瘤大小和肿瘤分期被确定为独立的危险因素。 这些特征均整合在诺模图中以预测5年和10年OS和CSS,C指数分别为0.812和0.857。通过5年和10年OS和CSS的概率的C-index指数和AUG曲线显示,诺模图预测和观察结果之间具有很好的一致性。结论:诺模图可以准确地预测四肢纤维肉瘤患者的OS和CSS,并有助于个性化的预后评估和个性化的临床决策。