Introduction: Cancer staging has historically been based solely on the anatomic extent of the tumor (T), spread to lymph nodes (N), and the presence of distant metastases (M). More recently biologic factors have been added to modify TNM stage groups to provide more accurate prognosis for patients.
Areas covered: The American Joint Committee on Cancer (AJCC) updated breast cancer staging in 2016 to include T, N, M, tumor grade and expression of estrogen and progesterone receptors and HER2. Addition of these factors changed the stage group for a large fraction of cases compared to prior TNM stage groupings. This updated ‘prognostic stage’ provides more robust and precise prognosis information.
Expert opinion: Inclusion of biological information in staging changes the meaning and the use of stage in clinical practice. This paper reviews the evidence supporting these changes, limitations affecting staging, and discusses the implications for clinical practice and the future of breast cancer staging. 相似文献
BACKGROUND: Chronic kidney disease patients who are resistant to erythropoietin (EPO) treatment may suffer from malnutrition and/or inflammation. METHODS: In a cross-sectional study of haemodialysis patients, we investigated the relationship between the natural logarithm of the weekly EPO dose normalized for post-dialysis body weight and outcome measures of nutrition and/or inflammation [BMI, albumin and C reactive protein (CRP)] by means of multiple linear regression analysis. On the basis of the decile distribution of weekly EPO doses, we also evaluated four groups of patients: untreated, hyper-responders, normo-responders and hypo-responders. RESULTS: Six hundred and seventy-seven adult haemodialysis patients were recruited from five Italian centres. BMI and albumin were lower in the hypo-responders than in the other groups (21.3+/-3.8 vs 24.4+/-4.7 kg/m(2), P<0.001; and 3.8+/-0.6 vs 4.1+/-0.4 g/dl, P<0.001), whereas the median CRP level was higher (1.9 vs 0.8 mg/dl, P = 0.004). The median weekly EPO dose ranged from 30 IU/kg/week in the hyper-responsive group to 263 IU/kg/week in the hypo-responsive group. Transferrin saturation linearly decreased from the hyper- to hypo-responsive group (37+/-15 to 25+/-10%, P = 0.003), without any differences in transferrin levels. Ferritin levels were lower in the hypo-responsive than in the other patients (median 318 vs 445 ng/ml, P = 0.01). At multiple linear regression analysis, haemoglobin, BMI, albumin, CRP and serum iron levels were independently associated with the natural logarithm of the weekly EPO dose (R(2) = 0.22). CONCLUSIONS: Our findings support a clear association between EPO responsiveness and nutritional and inflammation variables in haemodialysis patients; iron deficiency is still a major cause of hypo-responsiveness. 相似文献
Objective: To evaluate the effects of a new timing strategy of band adjustment on the short-term outcome of obese women operated
with adjustable silicone gastric banding. Subjects: The outcome of 30 women without binge-eating disorder operated with laparoscopic
adjustable silicone gastric banding with a wider intraoperatory band calibration (LAP-BAND) was compared to that of 30 body
mass index-matched women without binge-eating disorder previously operated with adjustable silicone gastric banding (ASGB)
applied by laparotomy with the usual intraoperatory band calibration. The patients were evaluated 3, 6 and 12 months after
surgery. Measurements: (1) weight loss; (2) total daily energy intake; (3) percent as liquid, soft or solid food; (4) vomiting
frequency; (5) rate of postoperative percutaneous band adjustments; (6) rate of band-related complications. Results: Both
the weight loss and the daily energy intake did not differ between patients with LAP-BAND and patients with ASGB. After surgery,
the patients with LAP-BAND ate more solid food and less liquid food than the patients with ASGB. Vomiting frequency was higher
in patients with ASGB than in patients with LAP-BAND. The total number of percutaneous band adjustments was higher in women
with LAP-BAND than in women with ASGB. Band inflation because of weight stabilization was performed in six (20.0%) women with
ASGB and in 19 (63.3%) women with LAP-BAND. Neostoma stenosis occurred in one women with ASGB, but in none of the women with
LAP-BAND. One patient with LAP-BAND presented band slippage. Conclusions: The wider intraoperatory band calibration performed
in patients with LAP-BAND did not reduce the short-term efficacy of adjustable silicone gastric banding. This new timing strategy
of band adjustment required more postoperative percutaneous band inflations, but it improved the eating pattern of the patients
(low vomiting frequency and high intake of solid food). 相似文献
Male Sprague-Dawley rats injected (i.p.) at 1500h with L-acetyl-carnitine in doses of 10, 30 or 90 mg/kg exhibited a notable increase in their pineal and serum melatonin content 1 hr later. Likewise, L-acetyl-carnitine administered in the same dose range induced a significant increase of pineal and serum melatonin content in rats treated at 0100h, following exposure of 30 min to bright white light to suppress endogenous melatonin. Under in vitro experimental conditions, however, 60 min of coincubation of isolated rat pineal glands with L-acetyl-carnitine (10(-5) M) did not result in an elevation in melatonin accumulated in the incubation medium. These results demonstrate that, in vivo, L-acetyl-carnitine can exert a modulatory action on synthesis and release of melatonin, possibly by modifying noradrenergic transmission and signal transduction in the pineal gland. 相似文献
Neurological Sciences - Frontotemporal dementia is a clinicopathological syndrome caused by progressive degeneration of the frontal lobes, anterior temporal lobes or both. A wide spectrum of... 相似文献
OBJECTIVE: The present study tested the hypothesis that cortical electroencephalographic (EEG) rhythms. change across normal elderly (Nold), mild cognitive impairment (MCI), and Alzheimer's disease (AD) subjects as a function of the global cognitive level. METHODS: Resting eyes-closed EEG data were recorded in 155 MCI, 193 mild AD, and 126 age-matched Nold subjects. EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). EEG cortical sources were estimated by LORETA. RESULTS: Occipital delta and alpha 1 sources in parietal, occipital, temporal, and 'limbic' areas had an intermediate magnitude in MCI subjects compared to mild AD and Nold subjects. These five EEG sources presented both linear and nonlinear (linear, exponential, logarithmic, and power) correlations with the global cognitive level (as revealed by mini mental state examination score) across all subjects. CONCLUSIONS: Cortical EEG rhythms change in pathological aging as a function of the global cognitive level. SIGNIFICANCE: The present functional data on large populations support the 'transitional hypothesis' of a shadow zone across normality, pre-clinical stage of dementia (MCI), and AD. 相似文献
Bone scintigraphy plays a major role in the diagnosis of bone metastases. The clinical utility of new biochemical markers
of bone metabolism has recently been investigated in various bone diseases. This study evaluated the role of some bone metabolism
markers in comparison with bone scan in the follow-up of breast cancer patients. We studied 149 patients with breast cancer,
33 (22%) of whom had bone metastases. IRMAs were used for the evaluation of blood levels of osteocalcin, bone alkaline phosphatase
(BAP), the C-terminal propeptide of type I procollagen and the C-terminal cross-linked telopeptide of type I collagen (ICTP).
Multivariate regression analysis showed that menopausal status (P=0.007) and metastatic bone lesions (P=0.001) affected bone marker levels. When considering post-menopausal women, the only subset in which bone metabolism marker
behaviour could be reliably investigated, we found a high degree of overlap in marker distribution for scan-positive and scan-negative
patients. Discrimination between scan-negative and scan-positive patients based on the above markers, taken singly or jointly,
was assessed by means of logistic discriminant analysis. The best discrimination was achieved with BAP, closely followed by
ICTP. BAP and ICTP together gave a slight improvement over the use of the two markers separately. However, even in this case
the degree of discrimination was poor and its clinical utility was limited. In fact, to achieve a specificity of 95%, the
sensitivity of the test was about 20%; conversely, with a sensitivity of 95%, the specificity was below 10%. In conclusion,
based on our findings, we believe that blood levels of the investigated markers cannot replace bone scintigraphy in the follow-up
of breast cancer patients for the early detection of bone metastases.
Received 14 April and in revised form 5 July 1997 相似文献