ABSTRACT
【Objective】 To construct an easy-to-use individual survival prognostic tool based on competing risk analyses to predict the risk of 1-, 2- and 3- year recurrence for patients with non-muscle invasive bladder cancer (NMIBC). 【Methods】 The follow-up data of 419 NMIBC patients were obtained. The patients were randomly divided into training cohort (n=293) and validation cohort (n=126). The variables included age at diagnosis, sex, history of smoking, tumor number, tumor size, histolo-gic grade, pathological stage, and bladder perfusion drug. The cumulative incidence function (CIF) of recurrence was estimated using all variables in the training cohort and potential prognostic variables were determined with Gray’s test. The Fine-Gray subdistribution proportional hazard approach was used as a multivariate competitive risk analysis to identify independent pro-gnostic variables. A competing risk nomogram was developed to predict the recurrence. The performance of the competing risk model was evaluated with the area under the receiver operating characteristic curve (AUC), calibration curve, and Brier score. 【Results】 Five independent prognostic factors including age, number of tumors, tumor size, histologic grade and pathological stage were used to construct the competing risk model. In the validation cohort, the AUC of 1-, 2- and 3- year recurrence were 0.895 (95%CI: 0.831-0.959), 0.861(95%CI: 0.774-0.948) and 0.827(95%CI: 0.721-0.934), respectively, indicating that the model had a high predictive performance. 【Conclusion】 We successfully constructed a competing risk model to predict the risk of 1-, 2- and 3-year recurrence for NMIBC patients. It may help clinicians to improve the postoperative management of patients.
ABSTRACT
【Objective】 To investigate the effects of preoperative lipid metabolism level on the postoperative prognosis of non-muscular invasive bladder cancer (NMIBC). 【Methods】 Clinical data of NMIBC patients who underwent surgical treatment in our hospital during Mar.2014 and May 2021 were retrospectively analyzed. Based on receiver operating characteristic (ROC) curve, the optimal cutoff values of all lipid metabolism indicators were determined and patients were classified accordingly. The independent risk factors for postoperative recurrence were identified with Cox regression model. The survival was analyzed with Kaplan-Meier, and recurrence-free survival (RFS) was compared using log-rank tests. A recurrence risk prediction model was established based on the high-density lipoprotein (HDL) and other clinic pathological factors and the accuracy of prediction was evaluated with the area under the ROC curve (AUC). 【Results】 Cox multivariate analysis showed HDL, tumor number, tumor size and histological grade were independent risk factors for recurrence (P<0.05). Kaplan-Meier analysis showed that RFS was significantly longer in the high-HDL group than in the low-HDL group (P<0.001). Incorporating HDL, tumor number, tumor size, histological grade, and tumor stage into the recurrence risk model, the AUC was 0.706, and internal cross validation showed the AUC was 0.711. 【Conclusion】 Preoperative HDL is an independent risk factor affecting the RFS of patients with NMIBC, and combining it with clinic pathological factors will improve the prediction of tumor recurrence.
ABSTRACT
OBJECTIVE: To observe the time distribution characteristic of silica nanoparticles in rats after one-time intratracheal infusion. METHODS: Specific pathogen free male Wistar rats were randomly divided into one control group and7 experimental groups according to different time of intratracheal infusion( 1,3,5,7,14,21 and 28 days),6 rats in each group. The experiment groups were intratracheally instilled with 1. 0 mL silica nanoparticle suspension( mass concentration 50. 00 g/L). The control group was not given any treatment. Rats were sacrificed and their organ tissue samples such as serum,lung,spleen,liver and kidney were collected at different time points. The silicon levels of tissues were determined by inductively coupled plasma optical-emission spectrometry. The histology of rat's lungs was observed by optical microscope and the location of silica in lungs was observed by polarization microscope. RESULTS: After exposure to silica nanoparticles for 1-7 days,the changes of rats' lung tissue was mainly exudative inflammation. The changes of lung was proliferative inflammatory lesions after 14-28 days of exposure to silica nanoparticles. The visible nodules of cells were observed in the lung tissue in 28 days experiment group. The distribution of silica nanoparticles was observed obviously in the lung tissues of rats of 1 day experiment group under the polarizing microscopy. The tendency decreased with the increase of observation time. Silica nanoparticles were rarely seen 21 and 28 days after intratracheal infusion in rats. The silicon levels of serum,lung and spleen tissues reached the peak in 1 day after silica nanoparticles instillation,then dropped in 3-7 days( serum) or 3-14 days( lung and spleen tissues) and went back to that of the control group's. The level of silicon in the livers and kidneys of rats in the experimental groups showed no significant increase in the level of 1-5 day after the instillation( P > 0. 05),and showed significant increase in the level of 7 day( P < 0. 05). The level reached its peak on time points of 14 and 21 days after the instillation,and subsequently decreased,and didn't returned to normal till the 28 th day. The silicon levels of the lungs,spleens,livers and kidneys were all higher in rats than that of serum( P < 0. 05). The silicon levels of the lungs and spleens were higher than that of the livers and kidneys after instillation for1-5 days( P < 0. 05). The silicon levels of the lungs and spleens were both lower than that of the livers and kidneys after instillation for 14-28 days( P < 0. 05). CONCLUSION: Silica nanoparticles can cause lung injury when instilled intratracheally in rats. After instillation,silica nanoparticles were mainly distributed in the lungs and spleens after 1-5 days and distributed in the livers and kidneys after 14-28 days.