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BACKGROUND@#Autophagy related genes (ARGs) regulate lysosomal degradation to induce autophagy, and are involved in the occurrence and development of a variety of cancers. The expression of ARGs in tumor tissues has a great prospect in predicting the survival of patients. The aim of this study was to construct a prognostic risk score model for lung adenocarcinoma (LUAD) based on ARGs.@*METHODS@#5,786 ARGs were obtained from GeneCards database. Gene expression profiles and clinical data of 395 LUAD patients were collected from The Cancer Genome Atlas (TCGA) database. All ARGs expression data were extracted, and The ARGs differentially expressed were identified by R software. Survival analysis of differentially expressed ARGs was performed to screen for ARGs with prognostic value, and functional enrichment analysis was performed. The least absolute selection operator (LASSO) regression and Cox regression model were used to construct a prognostic risk scoring model for ARGs. The receiver operating characteristic (ROC) curve was drawn to obtain the optimal cut-off value of risk score. According to the cut-off value, the patients were divided into high-risk group and low-risk group. The area under curve (AUC) and the Kaplan-Meier survival curve was plotted to evaluate the model performance, which was verified in external data sets. Finally, univariate and multivariate Cox regression analysis was applied to evaluate the independent prognostic value of the model, and its clinical relevance was analyzed.@*RESULTS@#Survival analysis, Lasso regression and Cox regression analysis were used to construct a LUAD prognostic risk score model with five ARGs (ADAM12, CAMP, DKK1, STRIP2 and TFAP2A). The survival time of patients with low-risk score in this model was significantly better than that of patients with high-risk score (P<0.001). The model showed good prediction performance for LUAD in both the training set (AUCmax=0.78) and two external validation sets (AUCmax=0.88). Risk score was significantly associated with the prognosis of LUAD patients in univariate and multivariate Cox regression analyses, suggested that risk score could be a potential independent prognostic factor for LUAD. Correlation analysis of clinical characteristic showed that high risk score was closely associated with high T stage, high tumor stage and poor prognosis.@*CONCLUSIONS@#We constructed a LUAD risk score model consisting of five ARGs, which can provide a reference for predicting the prognosis of LUAD patients, and may be used in combination with tumor node metastasis (TNM) staging for prognosis prediction of LUAD patients in the future.
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Objective To explore the influencing factors of readmission in coronary heart disease patients with heart failure by constructing a multilevel Cox regression model. Methods A total of 1 433 coronary heart disease patients with heart failure were consecutively enrolled, from two hospitals in Shanxi Province from January, 2014 to December, 2017. Patients’ medical records (including baseline data, examination and treatment) were recorded and patients were followed up. The median follow-up period was 23 months. Univariate Cox regression analysis and mutivariate Cox regression analysis were used to screen the independent variables. Two-level Cox regression model was used to analyze the influencing factors. Results Rehospitalization occurred in 436(30.4%) cases. Two-level Cox regression model showed that advanced age(HR=1.010, 95% CI:1.001-1.019, P=0.032), male(HR=1.234, 95% CI: 1.009-1.509, P=0.040), physical labor(HR=1.458, 95% CI: 1.036-2.050, P=0.030),urban medical insurance (HR=1.513, 95% CI: 1.120-2.043, P=0.007), and prolonged QRS interval (HR=1.004, 95% CI:1.001-1.008, P=0.018) were independent risk factors for readmission coronary heart disease patients with heart failure. High urine specific gravity(HR=0.000, 95% CI:0.000-0.059, P=0.021) was a protective factor. Conclusions The age, gender, occupation, urban medical insurance, QRS intervall, and urine specific gravity are influencing factors of readmission in coronary heart disease patients with heart failure. Strengthening clinical nursing and monitoring and perfecting social security system can reduce the occurrence of patients’ rehospitalization.
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Objective To establish a prediction model for 3-years recurrence after initial ischemic stroke by Cox proportional hazards regression and individual prognostic Index(PI)equation, and to evaluate its application value and external reality. Methods The inpatients with cerebral ischemic stroke hospitalized in Neurology Department in North China University of Science and Technology Affiliated Hospital were finally internalized between January 2013 and December 2013.Follow-up study on recurrence was carried out between January 2016 and December 2016.The recurrence prediction model was constructed by the Cox proportional hazards regression model.During January 2016 and December 2016,data of patients with ischemic stroke were prospectively continuously collected.And PI equation was used to verify its external reality in ischemic stroke patients. Results A total of 184 cases had stroke recurrence during the follow-up period.The Cox proportional hazards regression model analysis showed that age(RR=1.303,95% CI:1.019-1.666),history of heart disease(RR=1.788,95% CI:1.127-2.836),hypertension(RR=1.897,95% CI:1.097-3.280),diabetes(RR= 1.674,95% CI:1.015-2.760)and total cholesterol(RR= 2.136,95% CI:1.396-3.266)were the independent risk factors for stroke recurrence.The established recurrence model was correlated with individual PI equation,which was PI = 0.265X1+ 0.581X2+ 0.640X3+ 0.515X4+0.759X5.By the validation study of PI equation to predict stroke recurrence among patients admitted later, the sensitivity was 0.719,specificity was 0.769,and accuracy was 0.800. Conclusions Age,history of heart disease,hypertension,diabetes,and total cholesterol are independent risk factors for recurrence of ischemic stroke.And the PI for predicting stroke recurrence within 3 years after initial stroke is successfully established,which is good and helpful for predicting ischemic stroke recurrence.
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Objective To investigate the relationship between serum uric acid levels and long-term prognosis in patients with neurologically asymptomatic carotid atherosclerotic.Methods Six hundred and thirty-seven cases of carotid atherosclerosis treated in Wulanchabu Central Hospital from January 2013 to January 2017 were enrolled in the study.The clinical data of the patients were collected and the patients were divided into four groups according to the serum uric acid level.Kaplan-Meier method was used to calculate the survival rate of all deaths and cardiovascular diseases in each group,and the survival curve was drawn.Log-rank test was applied to compare the survival curve.Multivariate Cox proportional hazards model was used to assess the risk of serum uric acid levels in the prognosis of patients.Results The differences of hypertension, smoking history, hyperlipidemia,serum uric acid(SUA)and serum homocysteine were statistically significant among the four groups(P<0.05).There were significant differences in all-cause death(P=0.000)and cardiovascular-cause death(P=0.000)among the four groups.Cox regression analysis showed that serum acid was an independent risk factor of all-cause mortality(RR=1.262,95%CI:1.084-2.119,P=0.025)and cardiovascular-cause mortality in patients with neurologically asymptomatic carotid atherosclerosis(RR=1.364,95%CI:1.063-1.750,P=0.013).Conclusion Elevated serum uric acid level is an independent risk factor for patients with neurologically asymptomatic carotid atherosclerosis,which can increase the rate of all-cause mortality and mortality of cardiovascular disease,and has a significant impact on long-term prognosis.
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Objective Few studies are reported on the clinical characteristics of glioma-related epilepsy (GRE).Postoperative recurrence of epilepsy in some patients seriously affects their recovery.We aimed to explore the duration, frequency and type of the epileptic seizure as well as possible factors for postoperative recurrence of epilepsy.Methods We recorded the frequency and duration of epileptic seizures, analyzed the recurrence-related factors using the Cox regression model, and investigated the risk factors of recurrent epilepsy.Results The postoperative recurrence of epilepsy was found in 24 (26.97%) of the 89 cases, which, compared with the 65 non-recurrence cases, had a significantly longer seizure duration (7[3-10] vs 5[2-9] min, P2 cm) (HR=2.867, 95% CI: 1.210-6.795), brain wave type (HR=2.501, 95% CI: 1.058-5.914), and preoperative frequency of epileptic seizure (>6 times/mo) (HR=5.100, 95% CI: 2.437-10.677).Conclusion Postoperative recurrence of epilepsy is associated with the clinical pathological parameters, and the changes of the frequency and duration of epileptic seizures before and after surgery may provide some new theoretical reference for the treatment and prognosis of the disease.
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Objective To investigate the risk factors and establish the Cox's regression model and the personal prognosis index for the recurrence of ischemic stroke in 3-year follow-up.methods 1058 patients were retrospectively reviewed consecutively diagnosed with ischemic stroke admitted to the Neurology Department of the Hebei united University Affiliated Hospital from January 1,2013 to December 31,2013.Cases were followed up since the onset of ischemic stroke.The follow-up was finished in January 1,2016.Kaplan-Meier methods were used for recurrence rate description.Monovariant and multivariate Cox's proportional hazard regression model were used to analyze risk factors associated with recurrence.Thus,a recurrence model was set up.Result sDuring the period of follow-up,184 cases relapsed.The 1-year recurrence rate was 29.9 person-year,2-year recurrence rate was 46.6 person-year,3-year recurrence rate was 52.7 person-year.Monovariant and multivariant Cox's proportional hazard regression model showed that the independent risk factors associated with recurrence were age(X1)(RR=1.303;95%CI:1.019~1.666)history of heart disease(X2)(RR=1.788;95%CI:1.127~2.836),hypertension(X3)(RR=1.897;95%CI:1.097~3.280),diabetes(X4)(RR=1.674;95%CI:1.015~2.760),total cholesterol(X5)(RR=2.136;95%CI:1.396~3.266).The personal prognosis index(PI)of recurrence model was as the following: PI=0.265X1+0.581X2+0.640X3+0.515X4+0.759X5.Conclusion sAge,history of heart disease,hypertension,disease progression,and total cholesterol are the independent risk factors associated with recurrence of ischemic stroke.The recurrence model and the personal prognosis index equation are successful constructed.
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Objective To investigate the relationship between serum uric acid levels and long-term prognosis in patients with neurologically asymptomatic carotid atherosclerotic.Methods Six hundred and thirty-seven cases of carotid atherosclerosis treated in Wulanchabu Central Hospital from January 2013 to January 2017 were enrolled in the study.The clinical data of the patients were collected and the patients were divided into four groups according to the serum uric acid level.Kaplan-Meier method was used to calculate the survival rate of all deaths and cardiovascular diseases in each group,and the survival curve was drawn.Log-rank test was applied to compare the survival curve.Multivariate Cox proportional hazards model was used to assess the risk of serum uric acid levels in the prognosis of patients.Results The differences of hypertension, smoking history, hyperlipidemia,serum uric acid(SUA)and serum homocysteine were statistically significant among the four groups(P<0.05).There were significant differences in all-cause death(P=0.000)and cardiovascular-cause death(P=0.000)among the four groups.Cox regression analysis showed that serum acid was an independent risk factor of all-cause mortality(RR=1.262,95%CI:1.084-2.119,P=0.025)and cardiovascular-cause mortality in patients with neurologically asymptomatic carotid atherosclerosis(RR=1.364,95%CI:1.063-1.750,P=0.013).Conclusion Elevated serum uric acid level is an independent risk factor for patients with neurologically asymptomatic carotid atherosclerosis,which can increase the rate of all-cause mortality and mortality of cardiovascular disease,and has a significant impact on long-term prognosis.
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Objective To explore the association between the change of daily living activities and the suymtoms of depression in Chinese middle-age and elderly people.Methods People without symptoms on depression,emotional or spiritual diseases or memories related diseases in baseline survey (2011),those who were aged ≥45 years in the China Health and Retirement Longitudinal Survey (CHARLS) with two waves from 2011 to 2013 were invited to participate in this CHARLS study.Information related to demographic characteristics and health status of the subjects were collected through household-interview.Depression symptom was assessed with the Center for Epidemiological Studies of Depression (CES-D10) scale.Activities of daily living function was assessed by both Basic Activities of Daily Living (BADL) and Instrument Activities of Daily Living (IADL) scales.Symptoms of depression was compared and the differences in various BADL/IADL changing groups were analyzed with Log-rank test.Association between the changes of daily living activities and depression symptom was analyzed by Cox regression model.Results Results from the log-rank test showed that the differences of depression symptom hazard ratio were statistically significant in different BADL/IADL changing groups.Results from the Cox regression analysis showed that the BADL/IADL in the deteriorating groups was associated with the higher hazard ratio of depression symptom (P＜0.01),with the HR value (95％CI) for BADL and IADL deteriorate groups as 1.45 (1.20-1.76) and 1.64 (1.36-1.98),respectively,when comparing to the ‘stablized'group.This phenomenon appeared an urban-rural difference.Statistical significances on IADL also happened in both urban and rural areas while BADL only occurred in rurals.Conclusion There appeared an association between the change of daily living activities and depression symptom in Chinese middle-age and elderly people.Difference between IADL and BADL was also noticed between urban and rural areas.
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Objective To explore the association between the change of daily living activities and the suymtoms of depression in Chinese middle-age and elderly people.Methods People without symptoms on depression,emotional or spiritual diseases or memories related diseases in baseline survey (2011),those who were aged ≥45 years in the China Health and Retirement Longitudinal Survey (CHARLS) with two waves from 2011 to 2013 were invited to participate in this CHARLS study.Information related to demographic characteristics and health status of the subjects were collected through household-interview.Depression symptom was assessed with the Center for Epidemiological Studies of Depression (CES-D10) scale.Activities of daily living function was assessed by both Basic Activities of Daily Living (BADL) and Instrument Activities of Daily Living (IADL) scales.Symptoms of depression was compared and the differences in various BADL/IADL changing groups were analyzed with Log-rank test.Association between the changes of daily living activities and depression symptom was analyzed by Cox regression model.Results Results from the log-rank test showed that the differences of depression symptom hazard ratio were statistically significant in different BADL/IADL changing groups.Results from the Cox regression analysis showed that the BADL/IADL in the deteriorating groups was associated with the higher hazard ratio of depression symptom (P＜0.01),with the HR value (95％CI) for BADL and IADL deteriorate groups as 1.45 (1.20-1.76) and 1.64 (1.36-1.98),respectively,when comparing to the ‘stablized'group.This phenomenon appeared an urban-rural difference.Statistical significances on IADL also happened in both urban and rural areas while BADL only occurred in rurals.Conclusion There appeared an association between the change of daily living activities and depression symptom in Chinese middle-age and elderly people.Difference between IADL and BADL was also noticed between urban and rural areas.
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Aims: Controlled clinical trials collect huge amounts of high quality data. It is a waste of information to evaluate these data only for the efficacy and safety of the investigational medication. We propose extended evaluations of large trials for scientific purposes, especially to find the most important risk factors of the disease or variables which are associated with risk to have the disease. Methodology: The SPICE study is a controlled, randomised, completely masked trial that has investigated the efficacy of the Crataegus product WSÒ 1442 in 2681 randomised patients with congestive heart failure (CHF). It was initiated and sponsored by Dr. Willmar Schwabe Pharmaceuticals. Results have already been published. We asked the sponsor to send us the data for an extended evaluation which was performed with a multivariate Cox regression model to find risk factors for the composite endpoint cardiac death, non-fatal myocardial infarction or hospitalisation due to progressive heart failure. Results: Most important risk factors are lower New York Heart Association (NYHA) function class, younger age and higher left ventricular ejection fraction. Patients had less cardiac events when taking glycosides, antiarrhythmics, nitrates, diuretics, beta blockers and calcium antagonists, so patients with a high number of cardiovascular medication have a poorer prognosis. Three scenarios for the interpretation of cardioactive medications as “risk” are presented. We assume that symptoms leading to the indication of a specific cardioactive medication are the risk. This risk is only partly balanced by medication intake. In general, the intake of cardioactive medication is associated with the risk to have the disease. Conclusion: An extended evaluation of large clinical studies finds out what is important for the outcome besides specific efficacy of the investigational drug. This is usually not the scope of pharmaceutical companies, but useful for science, doctors and patients.
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Objective: To investigate the association between body height and risk of cancer incidence among adult men and women in Shanghai. Methods: Baseline information on body height and other factors relevant for cancer was obtained from Women's (1996-2000) and Men's Health Studies (2002-2006) in Shanghai. Participants with missing data on body height, or those lost to follow-up in one year after the study enrollment were excluded, leaving 74 709 women and 61 161 men for analysis. There were 4 031 incident cancers for women and 2 047 for men confirmed at the end of 2009. COX regression model was used to evaluate the HR s ( hazard ratios) and 95% CI (confidence interval) between height and cancers. Results: After adjustment for some potential confounding factors including age, weight, physical activity, energy intake, occupation, income and reproductive factors (for women only), HR s and 95% CI s for cancer incidence per 1 standard deviation (6 cm for both men and women) increment in body height were 1.04 (95% CI : 1.00-1.08) for total cancers, 1.18 (95% CI : 1.05-1.33) for stomach cancer, 1.34 (95% CI : 1.06-1.70) for kidney cancer and 1.05 (95% CI : 0.99-1.12) for breast cancer in women; and 1.06 (95% CI : 1.00-1.11) for total cancers, 1.11 (95% CI : 1.00-1.25) for lung cancer, 1.34 (95% CI : 1.02-1.75) for pancreatic cancer, 1.23 (95% CI : 1.01-1.49) for rectal cancer and 0.78 (95% CI : 0.66-0.94) for prostate cancer in men. Conclusion: A possible link between body height and cancer incidence in men and women is suggested. The association between body height and cancer incidence varies by cancer type. Copyright © 2012 by TUMOR.
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One of the epidemiological descriptor of a fatal infectious disease is the time it takes from infection to death or the survival period. The present study has focused on trend in survival and death of Iranian nonhemophiliac HIV patients from 1988 to 2002 and has estimated the nonparametric distribution of the survival function of HIV patients with respect to different variables of interest, like mode of transmission, gender and age at the time of diagnosis.
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Objective To explore the influencing factors on mild cognitive impairment among the community-based elderly population.Methods A‘n:m'matched case-control study was conducted to analyze the risk factors.COx regression model of survival analysis was selected to deal with non-geometric proportional matched data which was difficult to analyze by logistic regression modeI.Results Four hundred and twenty-three cases together with nine hundred and twenty-five controls were interviewed with an uniformed questionnaire.Through univariate and multivariate cox regression analysis,the odds ratio and 95%CJ of these risk factors appeared to be:physieal labor as 1.396(1.092-1.785);smoking as 1.551 (1.021-2.359);higher level of blood glucose as 1.354(1.102-1.664);HDL-C in the serum as 1.543 (1.232-1.932);LDL-C in the serum as 1.299(1.060-1.592);lower level of estrogen in the serum as 1.263(1.031-1.547);hypertension as 1.967(1.438-2.689);diabete:1.381(1.139-1.675);depressive disorder:1.406(1.110-1.780);cerebral thrombosis as 1.593(1.307-1.943);higher SBP as 1.331(1.129-1.569)and ApoEe4 carrier as 1.462(1.140-1.873)respectively.Odds ratio and 95%CI on protection factors appeared to be:reading newspaper frequently as 0.610(0.503-0.740);frequently doing housework as 0.804(0.665-0.973);frequently engaging in social activities as 0.617(0.502-0.757);reemployment after formal retirement as 0.759(0.636-0.906);having acumen olfaction as 0.900(0.845-0.958);having extrovert personality as 0.829(0.699-0.984);being decisive as 0.811(0.662-0.993).Conclusion The major measures to prevent MCI seemed to be including the following factors as:being intellectuals,engaging in healthy life style and decreasing the risk in developing hypertension,diabetes,depressive disorder and cerebrovascular disease.However.olfactory hypoesthesia,cowardice and haring introvert character,ApoEε4 carrier etc could be treated as early indications to signify MCI.
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Objective To study the clinical importance of TCM used in solidified therapy of colorectal cancer after radical resection. Method Prospective cohort study was applied to the trial, 84 cases in Xiyuan Hospital were selected to compare with 78 cases in western medicine hospital in the same time. The rates of relapse-metastasis and disease free survival of two groups were observed. Nine possible factors influencing disease-free survival were selected to analyze with COX regression model. Results 1-year, 2-year and 3-year relapse-metastasis rate of the teatment group were 0, 4.08% and 20% respectively, those were 5.12%, 22.91% and 36.11% in the control group. 1-year, 2-year and 3-year disease-free survival rate of teatment group were 100%, 95.91% and 80%, those were 94.87%, 77.08% and 63.88% in the control group. The main prognostic factors were lymph nodes metastasis and therapy. Conclusion TCM used in postoperative colorectal cancer could prevent relapse and metastasis.
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Objective To study the COX regression model of 28-day mortality in ARDS patients.Methods Four hundred and fifty-two ARDS patients from 2003 to 2005 was prospectively analyzed in a multi-center and random way. Results In the ARDS pathogeny,sepsis accounted for 41%,severe trauma and operation accounted for 36.3%,severe pancreatitis for 8.8%,and other for 13.9%.The 28-day mortality was 62.2%.Compared with the survived group,the number of dysfunction organs,age,APACHEII,PaCO_2,FiO_2,and A-aDO_2 were higher in the succumbed group,while PaO_2,PaO_2/FiO_2,and pH were lower.Conclusion The 28-day mortality was related with the number of dysfunction organs,age,GLASGOW score,and shock.
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Objective To analyze the factors influencing the long-term allograft survival in cadaver- ic renal transplantation.Methods Parameter data were obtained from 249 patients who received immuno- suppressive agents after renal transplantation.Health resources were evaluated for 1-5 years;and 14 relevant factors,including age,sex,therapeutic regimen choice and complications,etc were analyzed.Life table method and COX regression model were used to analyze the risk factors influencing the outcomes and to calculate the survival rates.Results Following renal transplantation,the survival rates of recipients who lived for 1,2 and 3 years were 72.6%,56.0% and 40.8%,respectively;and the rates of those who lived for 4 and 5 years both were 22.5%.The median survival time was 34.9 month.With the therapy prolonged,the survival benefit in MMF group was superior to that in AZA group,with the median survival time being 38.9 months 30.6 months,respectively.COX regression model showed that the main predictive factors were treatment regi- men(P=0.000),follow-up period(P=0.000),patient's compliance(P=0.000),acute rejection episode (P=0.020),sex(P=0.001)and hospitalization period(P=0.040).Conclusions Life table and COX regression model are useful methods for evaluating long-term outcome and influencing factors in renal trans- plant patients.
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This paper presents the application of Cox regression model in survival analysis of lung cancer for the first time in China.By using Cox model,a multivariate analysis was made on 191 patients with lung cancer treated by operation. Among the twenty three factors, only pathological sort, the size of tumor,lymph node metastases,type of operai ions, infiltra -ing across the end of tumor,and complications showed a high significance with prognostic relationship. Of those factors influecing postoperative survivaltime,lymph node metastases, is detrimental for patients, squamasum carcinoma and lobectomy are preferable. From survival curves of groups of different harzad groups,fit in the model and survival rale in the interclass was calculated, Therefore it showed advantages using Cox regression model in multivariate survival analysis