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Objective@#To investigate the influencing factors of smoking tendency of adolescents and to analyze the influence of e-cigarette on smoking tendency of teenagers and the possible interaction, to provide evidence for tobacco control measures.@*Methods@#Stratified multistage cluster probability sampling method was used to select 6 178 students from junior middle school, high school and vocational high school students in Shanghai for questionnaire survey from September to October 2019. Students with smoking tendency were taken as case group, adolescents with same sex and similar age(within 1 year) were mathed in 1∶3 ratio. A total of 631 adolescents with smoking tendency and 1 870 non-smoking tendency were included in the study. Conditional Logistic regression was used to analyze the influencing factors and possible interactions.@*Results@#After adjusting gender, age and other covariates, conditional Logistic analysis results showed that the smoking tendency of middle school students was associated with factors such as their friends smoking, trying cigarettes and trying e-cigarettes. The OR value and 95%CI were 3.26(2.47-4.29), 5.90(3.76-9.24), and 3.28(2.11-5.10), respectively. The interaction analysis results showed that the OR value and 95%CI of the multiplying interaction between friends smoking and trying e-cigarettes, trying smoking and trying e-cigarettes were 8.62(4.90-15.17) and 12.01(6.02-23.95), respectively. There was no additive interaction.@*Conclusion@#Tobacco control interventions, such as e-cigarette harm publicity and peer education, can help to change teenagers smoking tendency and further reduce their tobacco use rate.
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Objective@#To explore the clinical significance of serum squamous cell carcinoma antigen (SCC-Ag) in early cervical squamous cell carcinoma.@*Methods@#The clinicopathological data and follow-up information of 1435 patients with stage ⅠA2-ⅡA cervical squamous cell carcinoma were collected. The correlation between serum SCC-Ag level and clinicopathological feature and prognosis were analyzed. The best cut-off of serum SCC-Ag for predicting pelvic lymph node metastasis and survival of cervical squamous cell carcinoma patients were also identified.@*Results@#The result of univariate analysis showed that The International Federation of Gynecology and Obstetrics (FIGO) staging, tumor size, depth of cervical stromal invasion, lymphovascular space involvement, pelvic lymph node metastasis, common iliac lymph node metastasis and para-aortic lymph node metastasis were significantly related with serum SCC-Ag level (all P<0.05). The result of multivariate logistic regression analysis showed that tumor size, depth of cervical stromal invasion, pelvic lymph node metastasis and common iliac lymph node metastasis were the independent risk factors of preoperative serum SCC-Ag>2.65 ng/ml (all P<0.001). Multivariate Cox regression analysis showed that lymphovascular space involvement, SCC-Ag>3.15 ng/ml, common iliac lymph node metastasis and tumor size >4 cm were the independent prognostic risk factors (all P<0.05). The univariate analysis showed that, the tumor size, FIGO stage, depth of cervical stromal invasion and SCC-Ag level were significantly related with the recurrence of 1 096 patients without postoperative high risk factors (all P<0.05). Multivariate logistic regression analysis showed that FIGO stage (OR=1.671) and SCC-Ag>2.65 ng/ml (OR=4.490) were the independent risk factors for recurrence (both P<0.05). The best cut off of SCC-Ag for predicting early postoperative cervical lymph node metastasis of cervical squamous cell carcinoma was 2.65 ng/ml, the sensitivity was 60.8%, the specificity was 71.8%. The best cut off of SCC-Ag for predicting prognosis of cervical squamous cell carcinoma was 3.15 ng/ml, the sensitivity was 53.5%, the specificity was 71.1%.@*Conclusions@#Preoperative serum squamous cell carcinoma antigen is an independent prognostic risk factor of survival of patients with early cervical squamous cell carcinoma, and is significantly related with recurrence of patients without postoperative high-risk factors. It can be used as a reference factor for postoperative adjuvant radiotherapy.
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Objective To explore the prognosis and risk factors for cervical cancer in elderly patients. Methods Clinical data of 337 elderly patients (≥ 65 years old )admitted into Zhejiang Cancer Hospital from June 2008 to June 2013 were retrospectively analyzed.Clinical data and the follow-up information were collected. The correlation of prognosis with age ,performance status score , International Federation of Gynecology and Obstetrics (FIGO )staging ,tumor size ,pathological type , treatment and comorbidities were analyzed. Results Among 337 elderly patients ,the 5-year overall survival(OS )rates for patients with stage Ⅰ,Ⅱ,Ⅲ,Ⅳ were 81.8% ,62.3% ,53.5% and 0.0% , respectively (χ2=63.414 ,P=0.000) ;local recurrence rate was 33.5% ;the 5-year OS rate of patients with and without comorbidities were 54.0% and 70.0% ,respectively(χ2=8.907 ,P=0.003).Among 119 cervical cancer patients with stage ⅠA-ⅡA ,5-year OS for surgery group and radiotherapy group were 83.5% and 55.0% ,respectively(χ2=13.161 ,P=0.000).Among 218 advanced cervical cancer patients ,the 5 year OS for chemoradiotherapy and radiotherapy groups were 69.7% and 51.9% , respectively(χ2=4.030 ,P=0.045). The acute toxicity reactions of radiotherapy and chemoradiotherapy groups were as follows. The incidences of acute grades 3-4 hematological toxicity were 9.7% and 42.4% in radiotherapy group and chemoradiotherapy groups respectively (χ2=21.362 ,P=0.000) ,and the incidences of acute grade 3 gastrointestinal toxicity were 5.9% and 9.1% (χ2=0.086 ,P=0.769)in radiotherapy group and chemoradiotherapy group ,respectively.No grade 4 gastrointestinal toxicity was found.Multivariate Cox regression analysis showed that age ,PS score , FIGO staging ,pathological type ,treatment and comorbidities were influencing factors for prognosis in elderly patients with cervical cancer (P＜0.05). Conclusions Elderly cervical cancer patients have a good tolerance to treatment. The comorbidity is one of negatively influencing factors for prognosis. The efficacy of definitive radiotherapy is inferior to surgery in elderly patients with early stage cervical cancer due to the high proportion of comorbidities.Concurrent chemoradiotherapy can improve the prognosis of middle and advanced cervical cancer in elderly patients.
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Objective To study the difference between intensity-modulated radiation therapy (IMRT) and three dimensional conformal radiation therapy (3D-CRT) for pelvic radiation of post-operative treatment with gynecologic malignant tumor. Methods A prospective investigation study was conducted on 183 patients of post-operative patients with whole pelvic radiation therapy of cervical cancer or endometrial cancer in Zhejiang Cancer Hospital [IMRT group (n=85) and 3D-CRT group (n=98)] from Oct. 2015 to Oct. 2016. The two groups received same dose (45 Gy in 25 fractions). Comparison of two groups with radiation dosimetry:the score according to the Radiation Therapy Oncology Group (RTOG) acute radiation injury grading standards before and after radiotherapy reaction, the score from functional assessment of cancer therapy scale-cervix (FACT-Cx) scale and expanded prostate cancer index composite for clinical practice (EPIC-CP) scale were also analyzed. Results (1) There were no significant effect with age, culture level, family economic condition and ratio of radiochemotherapy between two groups (all P>0.05). (2) Dosimetric comparison for IMRT vs 3D-CRT:the average dose of planning target volume (PTV) decreased(46.1 ± 0.4) vs(46.4 ± 0.5)Gy, V45 dose percentage increased(95.2 ± 1.0)%vs (93.3 ± 2.0)%, intestinal bag dose of V40 decreased(24.4 ± 6.8)%vs (36.5 ± 15.9)%, rectal V40 dose percentage decreased(73.9 ± 12.3)%vs (85.4 ± 8.4)%, and lower rectal V45 dose percentage(32.8 ± 13.4)%vs (71.5 ± 13.7)%, bladder V40 dose percentage decreased(55.5 ± 13.0)% vs (84.4 ± 13.0)%. Bone marrow V20 lower:(67.9 ± 5.4)% vs (79.5 ± 6.6)%, V10 lower:(82.1 ± 6.0)% vs (86.3 ± 6.6)%; there were significant differences (all P0.05). (3) Acute radiation injury classification for IMRT vs 3D-CRT:big or small intestine:Ⅱ-Ⅲreaction [13%(11/85) vs 24% (24/98); χ2=3.925, P=0.048], there was significant difference. Bladder: Ⅲ reaction [19% (16/85) vs 26% (25/98); χ2=1.171, P=0.279], there was no significant difference. Radiochemotherapy of bone marrow suppression:Ⅲ-Ⅳreaction (14/20), the incidence rate [26%(14/54) vs 31%(20/65);χ2=0.339, P=0.562], the difference was not statistically significant. (4) Quality of life scale by FACT-Cx scale in IMRT vs 3D-CRT:there were no significant difference before radiotherapy (82 ± 16 vs 85 ± 16;t=1.279, P=0.203), while there was significant difference after radiotherapy (76 ± 14 vs 71 ± 18;t=-2.160, P=0.032). EPIC-CP scale score:before radiotherapy they were (16±7 vs 15±6;t=-0.174, P=0.862) ,but after radiotherapy (18±7 vs 22± 7; t=3.158, P=0.002), there was significant difference between them. Before and after radiotherapy, the increased EPIC-CP scale of the IMRT group vs 3D-CRT group were 3 ± 4 and 6 ± 4, the 3D-CRT group was significantly higher, the difference was statistically significant (t=5.500, P=0.000). Conclusion IMRT has shown that there are a significant benefit for the post-operative patients with cervical cancer and endometrial cancer compared to 3D-CRT.
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Objective To investigate the prevalence rate of nosocomial infections and the use of antibacterial agents in Zhejiang Cancer Hospital.Methods The cross-sectional survey on nosocomial infections was conducted among inpatients in Zhejiang Cancer Hospital on August 11,2011 and June 19,2012.The differences in prevalence rates of nosocomial infections,purposes of antibacterial agents use (for treatment,for prevention,or for both treatment and prevention),methods of medication (single or combined medication),and pathogen detections between 2011 and 2012 were analyzed with x2 test.Results There were 854 and 886 patients enrolled in the study in 2011 and 2012,and the prevalence rates of nosocomial infections were 5.27％ (45/854) and 5.08％ (45/886),respectively (x2 =0.186,P ＞ 0.05).Lower respiratory tract infection was the most common nosocomial infections both in 2011 and 2012,which accounted for 28.89％ and 36.96％ of all infections,respectively; and there was no significant difference in infection sites between 2011 and 2012 (x2 =1.415,P＞0.05).Totally 154 out of 854 patients (18.03％)in 2011 and 186 out of 886 patients (20.99％) in 2012 received antibacterial agents,and single medication was the most common.There were no significant differences in the purposes and methods of medication between 2011 and 2012 (x2 =1.994 and 3.042,P ＞ 0.05).Pathogen detections were performed in 56 out of 59 patients (94.92％) and 57 out of 65 patients (87.69％) who received antibacterial agents for treatment in 2011 and 2012,respectively.The most common pathogens were Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumanni.Conclusion The prevalence rate of nosocomial infection in Zhejiang Cancer Hospital is of the satisfactory level,which is due to the good management of antibacterial agents use.
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Toll like receptors (TLRs) are the most characteristic of pathogen recognition receptors.TLR signal pathway affects the outcome of cervical HPV infection,and plays double roles of promoting or inhibiting tumor in immune regulation for the process from high-risk HPV infection to cervical cancer.The polymorphism of TLR gene is closely related to the occurrence of cervical cancer.
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Treatment of gynaeeological cancer frequently results in the loss of ovarian function and menopausal syndrome.The most effective treatment is hormone replacement therapy (HRT).According to the current studies,HRT does not increase the risk of recurrence or death in patients with early stage endometrial cancer and uterine leiomyosarcomas. The safety of HRT in ovarian cancer patients is inconclusive. Cervical squamous cell carcinoma, vaginal cancer and vulvar cancer are not contraindications for HRT. Estrogen replacement therapy (ERT) is contraindicated for low-grade endometrial stromal sarcomas. Therefore,after integrated risk assessment and discussion,patients with severe menopausal symptoms can be treated with HRT to improve the quality of life.
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Objective To study the association between endometrioid uterine carcinomas and metabolic syndrome (MS). Methods A retrospective study was conducted on 123 patients who were admitted in Department of Gynecology Oncology, Zhejiang Cancer Hospital (study group) and 90 healthy women (control group) with matching age from Jan. 2005 to Mar. 2009. The general conditions[including age, whether menopausal, body mass index (BMI)];the risk factors for MS [including waist circumference,fasting plasma glucose, triglycerides(TG), high-density lipoprotein (HDL) and systolic and diastolic blood pressure]were analyzed. The clinical stage, histological type, and pathology differentiated degree of study group with or without MS were also analyzed by univariate analysis and Cox proportional hazards models.Results (1) The univariate survival analysis shown that there were no significant difference with age in two groups[(54.3±0.6) vs. (54.2±0.9) years;P>0.05], while the rate of menopausal, BMI(≥25 kg/m~2), the cases coupled with MS, the size of waist circumference (> 80 cm), the level of fasting plasma glucose (≥5.6 mmol/L),TG(> 1.7 mmol/L)and abnormal systolic and diastolic blood pressure in study group were higher than those in control group (67.5% vs. 48. 9%, 45.5% vs. 23.3%, 43.9% vs.18.9%, 50.4% vs. 27.8%, 53.7% vs. 21.1%, 40.7% vs. 21.1% and 40.7% vs. 25.6%,respectively, all P <0.05). The percentage of HDL(< 1.30 mmol/L) was higher in study group than that in control granp(63. 4% vs. 32. 2%, P <0.05). (2) There were not significant difference for the clinical stage, pathological type, grades between patients with or without MS in study group (P > 0.05). (3) The Logistic multivariate survival analysis shown that central obesity, higher TG, lower HDL and abnormal plasma glucose were independent risk factors for endometrioid uterine carcinomas coupled with MS (P< 0.05). Conclusion Metabolic syndrome is marginally associated with an increased risk of endometrioid uterine carcinomas, which may be the new point to screen, prevention and treatment endometrioid uterine carcinomas.
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Chemotherapy cure rate of gestational trophoblastic tumor patients is high, and subsequent preghancy outcomes deserves attention. The gestational trophoblastic tumor parients after chemotherapy is recommended at least 1 year of contraception befor pregnancy, and their pregnancy outcomes are similar to those of general population. Recent siudies find that the interval between chemotherapy and the subsequent pregnancy affects preghancy outcomes. Careful prenatal monitoring is recommended in those patients who are pregnant within 6 months after chemotherapy. So, the gestational trophoblastic tumor patients after chemotherapy is recommended at least 1 year of contraception before pregnancy.