Adjuvant chemotherapy use and outcomes of patients with high‐risk versus low‐risk stage II colon cancer
Aalok KumarHagen F. KenneckeDaniel J. RenoufHoward J. LimSharlene GillRyan WoodsCaroline SpeersWinson Y. Cheung
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BACKGROUND Adjuvant chemotherapy (AC) is frequently considered in patients with stage II colon cancer who are considered to be at high risk. However, to the authors' knowledge, the survival benefits associated with AC in these patients remain largely unproven. In the current study, the authors sought to examine the use of AC in patients with AJCC stage II colon cancer and to compare the impact of AC on outcomes in patients with high‐risk versus low‐risk disease in a population‐based setting. METHODS Patients with stage II colon cancer who were evaluated at 1 of 5 regional cancer centers in British Columbia from 1999 to 2008 were analyzed. Kaplan‐Meier and Cox regression methods were used to correlate high‐risk versus low‐risk status and receipt of AC with recurrence‐free survival (RFS), disease‐specific survival (DSS), and overall survival (OS). RESULTS A total of 1697 patients were identified: 1286 (76%) with high‐risk and 411 (24%) with low‐risk disease, among whom 373 (29%) and 51 (12%),respectively, received AC. Individuals with high‐risk disease treated with AC were younger (median age, 62 years vs 72 years; P <.001) and had better Eastern Cooperative Oncology Group performance status (0/1: 47% vs 33%; P = .001). For high‐risk patients, AC was associated with improved OS (hazard ratio [HR], 0.65; 95% confidence interval [95% CI], 0.50‐0.83 [ P = .001]). However, no significant benefits with regard to RFS or DSS were observed. Subgroup analyses revealed that AC in patients with T4 disease was associated with significantly improved RFS (HR, 0.63; 95% CI, 0.42‐0.95 [ P = .03]), DSS (HR, 0.59; 95% CI, 0.37‐0.93 [ P = .02]), and OS (HR, 0.50; 95% CI, 0.33‐0.77 [ P = .002]). For patients with low‐risk disease, AC was associated with inferior RFS (HR, 2.18; 95% CI, 1.00‐4.79 [ P = .05]) and DSS (HR, 3.01; 95% CI, 1.10‐8.23 [ P = .03]). CONCLUSIONS In this population‐based analysis, AC was associated with an OS advantage in high‐risk patients, most likely due to patient selection. RFS, DSS, and OS benefits were mainly observed in patients with T4 disease, suggesting a limited role for AC in patients deemed to be high risk by non‐T4 features. Cancer 2015;121:527–534. © 2014 American Cancer Society .Cite
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Controversy exists concerning the necessary margin of excision for cutaneous melanoma 2 mm or greater in thickness.
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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Ground-glass opacity
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The prognostic role of survivin in colorectal carcinoma remains controversial. This meta-analysis aimed to explore the association between survivin expression and survival outcomes in patients with colorectal carcinoma. A comprehensive literature search for relevant studies published up to April 2013 was performed using PubMed, MEDLINE and ISI Web of Science. Only articles in which survivin was detected by immunohistochemical staining were included. This meta-analysis was done using STATA and Review Manager. A total of 1784 patients from 14 studies were included in the analysis. Our results showed that survivin overexpression in patients with colorectal carcinoma was significantly associated with poor overall survival (hazard ratio, 1.505; 95% confidence interval, 1.197–1.893; P = 0.000) and disease-free survival (hazard ratio, 2.323; 95% confidence interval, 1.687–3.199; P = 0.000). The results indicated that a significant relationship between survivin expression and overall survival was also exhibited in studies with an Asian country (hazard ratio, 1.684; 95% confidence interval, 1.477–1.921), patient number >100 (hazard ratio, 1.604; 95% confidence interval, 1.371–1.877), the cut-off level <50% (hazard ratio, 1.449; 95% confidence interval, 1.045–2.010), the percentage of survivin overexpression >50% (hazard ratio, 1.528; 95% confidence interval, 1.056–2.211) and the hazard ratio estimated (hazard ratio, 1.643; 95% confidence interval, 1.262–2.139). Moreover, upregulation of survivin was associated with stages (III/IV vs. I/II: odds ratio, 1.08; 95% confidence interval, 0.80–1.46), the depth of invasion (T3/T4 vs. T1/T2: odds ratio, 1.79; 95% confidence interval 0.67–4.74), lymph node metastasis (positive vs. negative: odds ratio, 1.49; 95% confidence interval, 0.99–2.26), distant metastasis (positive vs. negative: odds ratio, 2.37; 95% confidence interval, 0.99–5.72) and grade of differentiation (well/moderate vs. poor: odds ratio, 1.02; 95% confidence interval, 0.43–2.41), but without significance. The present meta-analysis indicated that upregulation of survivin was associated with poor prognosis in patients with colorectal carcinoma.
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Background: The ideal aortic valve substitute in young and middle-aged adults remains unknown. We sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving a mechanical aortic valve replacement (AVR). Methods: From 1990 to 2014, 258 patients underwent a Ross procedure and 1444 had a mechanical AVR at a single institution. Patients were matched into 208 pairs through the use of a propensity score. Mean age was 37.2±10.2 years, and 63% were male. Mean follow-up was 14.2±6.5 years. Results: Overall survival was equivalent (Ross versus AVR: hazard ratio, 0.91, 95% confidence interval, 0.38–2.16; P =0.83), although freedom from cardiac- and valve-related mortality was improved in the Ross group (Ross versus AVR: hazard ratio, 0.22; 95% confidence interval, 0.034–0.86; P =0.03). Freedom from reintervention was equivalent after both procedures (Ross versus AVR: hazard ratio, 1.86; 95% confidence interval, 0.76–4.94; P =0.18). Long-term freedom from stroke or major bleeding was superior after the Ross procedure (Ross versus AVR: hazard ratio, 0.09; 95% confidence interval, 0.02–0.31; P <0.001). Conclusions: Long-term survival and freedom from reintervention were comparable between the Ross procedure and mechanical AVR. However, the Ross procedure was associated with improved freedom from cardiac- and valve-related mortality and a significant reduction in the incidence of stroke and major bleeding. In specialized centers, the Ross procedure represents an excellent option and should be considered for young and middle-aged adults undergoing AVR.
Ross procedure
Stroke
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