ABSTRACT
Objective:To compare the risk assessment capability of model for end-stage liver disease (MELD), glasgow-blatchford score (GBS), and the AIMS65 scoring system for liver cirrhosis patients with esophageal and gastric variceal bleeding (EGVB).Methods:A retrospective analysis was made on data of 182 cirrhosis patients with EGVB admitted to the Department of Gastroenterology, General Hospital of Tianjin Medical University from January 1, 2015 to March 1, 2018. According to the MELD, GBS and AIMS65 scoring system, the corresponding scores of each patient were calculated to evaluate the ability of the three scoring systems to correctly classify EGVB as a " high-risk patient" . The receiver operating characteristic curve was drawn to compare the predictive value of three scoring systems for different clinical outcomes (blood transfusion, rebleeding, and death). The area under curve (AUC)>0.7 was believed to have higher accuracy.Results:The clinical outcomes of 182 patients included blood transfusion in 113 (62.1%) cases, rebleeding in 31 (17.0%) cases, and death of 11 (6.0%) cases. The MELD score was 7-25, GBS was 3-16, and AIMS65 score was 0-3. There were 4 (2.2%) patients with MELD score < 9, 139 (76.4%) patients with AIMS65 score 0-1, including 68 patients with AIMS65 score of 0 and 71 patients with AIMS65 score of 1. The AUC of MELD, GBS and AIMS65 for predicting blood transfusion was 0.514 (95% CI: 0.439-0.589), 0.681 (95% CI: 0.608-0.748), and 0.669 (95% CI: 0.596-0.737), respectively. When predicting rebleeding, the AUC of MELD, GBS and AIMS65 was 0.525 (95% CI: 0.449-0.599), 0.528 (95% CI: 0.453-0.602) and 0.580 (95% CI: 0.505-0.652), respectively. When predicting in-hospital mortality, the AUC of MELD, GBS and AIMS65 was 0.642 (95% CI: 0.567-0.711), 0.581 (95% CI: 0.505-0.653) and 0.786 (95% CI: 0.719-0.843), respectively. AIMS65 was superior to MELD ( P=0.083 6) and GBS ( P=0.047 0). Conclusion:GBS can correctly classify cirrhosis patients with EGVB as " high-risk group" , and is better than AIMS65 and MELD scoring system. MELD, GBS and AIMS65 all have poor accuracy in predicting blood transfusion and rebleeding, AIMS65 has a higher predictive value for death.
ABSTRACT
Objective To evaluate the predictive value of Admission-Rockall Score (aRS), Full-Rockall Score ( fRS ), Glasgow-Blatchford Score ( GBS ) and AIMS65 scoring systems for rebleeding, mortality, transfusion and clinical intervention of patients with acute nonvariceal upper gastrointestinal bleeding ( ANVUGIB). Methods A retrospective study was performed on the data of 294 ANVUGIB inpatients in the Department of Gastroenterology of Tianjin Medical University General Hospital from January 2015 to September 2016. Each patient was graded using the four scoring systems. The area under the receiver-operating characteristic curve ( AUC) about rebleeding, mortality, blood transfusion and clinical intervention was calculated using each system. Results For predicting rebleeding, fRS (AUC＝0. 696) and GBS (AUC＝0. 697) were both superior to aRS (AUC＝0. 609, P＜0. 05) and AIMS65 (AUC＝0. 571, P＜0. 05), and there was no significant difference on AUC between fRS and GBS (P＞0. 05). For predicting mortality, the AUC of aRS, fRS, GBS and AIMS65 were 0. 755, 0. 791, 0. 818, and 0. 780, respectively, and there were no significant differences (P＞0. 05). There were no significant differences in the predicting transfusion among four scoring systems, and the AUC was 0. 625, 0. 626, 0. 697 and 0. 658, respectively. Regarding clinical intervention treatment, fRS (AUC＝0. 661) was superior than that of aRS (AUC＝0. 520, P＜0. 05) and AIMS65 (AUC＝0. 545, P＜0. 05), and the AUC of GBS and three other scoring systems had no significant differences (P＞0. 05). Conclusion The four scoring systems are all with good predicting value on mortality of patients with ANVUGIB, while not on other aspects including rebleeding, transfusion and clinical intervention. fRS has a slightly better value on prediction of rebleeding and clinical intervention, and GBS is slightly better on prediction of rebleeding.
ABSTRACT
Background and purpose: Triple negative breast cancer (TNBC) is a high risk breast cancer characterized by the negative expression of estrogen receptor(ER), progesterone receptor (PR) and Her-2 that have no specific therapy. This study was to analyze clinical pathological characteristics, survival, and prognostic factors of patients with TNBC. Methods: Clinical and pathological as well as follow-up data of TNBC, treated at the Cancer Centre of Sun Yat-sen University from Jan. 2000 to Dec. 2003, were collected and analyzed. Results: A total number of 128 women were identified as having triple negative breast cancer. The median age of these patients was 46 years, and 60.9% of them had stage Ⅰ or Ⅱ disease. The majority of pathological types were invasive ductal carcinomas, and 78.1% of tumors were staged T1 or T2. And 48.4% of these patients were involved in lymph node. Event-free survival, local replase-free survival, distant metastasis-free survival and overall survival at five years were 71.1%, 84.3%, 75.8% and 83.6% respectively. Though lymph node metastasis, tumor masses, stage and lymph-vascular invasion were all found to be related to overall survival, however, only lymph node metastasis and tumor masses affected the overall survival as revealed by the Cox proportional hazard model analysis. Conclusion: Triple negative breast cancer has distinct clinical and pathological characteristics. The patients are usually young, with large masses, lymph node metastasis, family history of breast cancer and poor prognosis; lymph node metastasis and tumor mass are important prognostic factors.