ABSTRACT
Objective:To explore the relevant prognostic factors and construct a nomogram to predict the relapse-free survival of cervical chordoma.Methods:Data of 48 patients with cervical chordoma treated by operation from November 1994 to June 2018 were retrospectively analyzed, including 28 males and 20 females, aged 48.5±15.4 years (range 5-70 years). Data extraction comprised patients age, gender, Karnofsky performance status scale (KPS), duration of preoperative symptoms, location, involved segments, preoperative Frankel score, diagnostic biopsy method, adjuvant radiotherapy, surgical option and complications. Follow-up was conducted at 3, 6, 12 months after surgery and annually, X-Ray/CT/MRI were used to evaluate the progress of disease. Univariate analysis was performed using Kaplan-Meier survival analysis and Log Rank test to identify prognostic factors relevant to relapse-free survival, and multivariate Cox regression analysis was used in multivariate analysis, then R 3.6.2 was used to construct a nomogram.Results:Mean follow-up time was 66.6±51.1 months (range 14-228 months), 35 cases relapsed up to follow-up time, the cumulative 1-year, 3-year and 5-year relapse-free survival were 70.8%, 42.1% and 30.9%. Univariate analysis showed that diagnostic biopsy method ( P=0.016), adjuvant radiation therapy ( P=0.027), surgical option ( P<0.001) were relevant to relapse-free survival of cervical chordoma. Multivariate Cox regression analysis showed that surgical option (intralesional resection after extracapsular separation vs. directly intralesional resection), HR=0.209, 95% CI (0.076, 0.575) had significant impacts on relapse-free survival of cervical chordoma. A nomogram with c-index of 0.760 to predict 1-year, 3-year and 5-year relapse-free survival was conducted basing on age, gender, location, involved segments, diagnostic biopsy method, adjuvant radiation therapy, surgical option. Conclusion:Aspiration biopsy, intralesional resection after extracapsular separation and adjuvant radiation therapy could prolong the relapse-free survival of cervical chordoma. The nomogram in this study could predict 1-year, 3-year and 5-year relapse-free survival of cervical chordoma with relatively good accuracy.
ABSTRACT
Objective To assess the difference in left atrial properties between elderly and younger control subjects and the role of left atrium remodeling in patients of different ages with atrial fibrillation.Methods A total of 194 patients with non-valvular atrial fibrillation were enrolled from September 2014 to June 2016.Based on age,patients were divided into an elderly group (≥60 years,n=129) and a younger group (＜60 years,n=65).We evaluated remodeling parameters for the left atrium using an Ultrasound Cardiography (UCG) system in 125 elder subjects,together with 64 control subjects.All remodeling parameters were recorded,including left atrial diameter (LAD),left atrial square (LAS),left atrial pressure (LAP) and left ventricular end-diastolic dimension (LVEDD).Results The elderly group had more female patients and more patients with persistent atrial fibrillation.Meanwhile,scores of CHA2DS2Vsc and levels of N-terminal pro-brain natriuretic peptide (NT-ProBNP) were significantly increased in elderly patients (both P＜0.05).Moreover,the elderly group was associated with increased values of LAD and LAS[(39.1±4.4)mm vs.(37.1±5.3)mm,P＜0.01;and(23.3±4.5)cm2 vs.(21.4±4.8)cm2,P＜0.01;respectively],compared with those in the control group.Spearman's correlation analysis showed that LAD,LAS and LAP were all markedly related to age (r=0.213,P＜0.05;r=-0.175,P＜0.05;r=0.170,P＜0.05;respectively),persistent onset of atrial fibrillation (r=0.401,P＜0.05;r=0.446,P＜0.05;r=0.160,P＜0.05;respectively),and impaired heart function,measured by left ventricular ejection fraction (r=-0.4371,P＜0.05;r=-0.403,P＜0.05;r=-0.364,P＜0.05;respectively) and NT-ProBNP (r=0.485,P＜0.01;r=0.483,P＜ 0.01;r =0.293,P＜ 0.01;respectively).Conclusions Left atrial remodeling properties measured by the UCG system in the elderly with non-valvular atrial fibrillation are more serious than those in mid-aged and young subjects.As a convenient and accurate assessment of remodeling parameters,the UCG system is an excellent option for measuring left atrial remodeling in the elderly population.