Analysis of in-hospital morbidity and mortality of colorectal cancer and accuracy of POSSUM models for mortality risk / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To develop the modified P-POSSUM equation and the modified Cr-POSSUM equation and compare their performances with POSSUM in forecasting in-hospital morbidity and mortality of colorectal cancer.</p><p><b>METHODS</b>Data of 903 patients undergone operation of colon and rectal cancers from 1992 to 2005 in our department were enrolled in this study. ROC curve was applied to judge the differentiation ability of each score. Model goodness-or-fit was tested by the Hosmer-Lemeshow statistic and subgroup analysis was performed by the ratio of observed to expected deaths (O:E ratio). A 70:30 percent split-sample validation technique was adopted for model development and testing. Stepwise logistic regression was used to develop the modified P-POSSUM and the modified Cr-POSSUM. Their performance in validating sample, colonic cancer sample, rectal cancer sample, elective surgery sample, emergency surgery sample, curative surgery sample and palliative surgery sample was tested by ROC curve, Hosmer-Lemeshow statistic and O:E ratio.</p><p><b>RESULTS</b>The modified P-POSSUM showed good discrimination in all samples except the emergency surgery and palliative surgery. The predicted mortality of modified P-POSSUM was very close to the observed mortality. However, the modified Cr-POSSUM showed good discrimination in all samples except the palliative surgery. The predicted mortality was higher than the observed mortality, but still within the 95% confidence interval (CI) of the observed mortality. Both the modified models offered better accuracy than the P-POSSUM.</p><p><b>CONCLUSION</b>The modified P-POSSUM and the modified Cr-POSSUM model provide an accurate prediction of inpatient mortality in Chinese colorectal cancer patients.</p>

Multicenter randomized control trial on safety of domestic idarubicin for acute leukemia / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the safety of domestically produced idarubicin in the treatment of acute leukemia by a multicenter randomized control trial.</p><p><b>METHODS</b>This trial was carried out in the hemotologica department of five hospitals throughout China, with hospitalized patients who suffered from acute myelogenous leukemia ( AML except M3 type) , acute lymphocytic leukemia ( ALL) , chronic myelogenous leukemia-blast (CML-blast) , totally 155 patients. Those with severely cardial, hepatic or renal disfunction or those who had ever treated with > or = 200 mg/m(2) idarubicin were excluded from the trial. All patients signed the letter of consent as required by the Ethics Committee of our government. In this study, 155 leukemia patients were randomly grouped into: 1. test group treated using domestic idarubicin, 2. control group using imported idarubicin. The acute myelogenous leukemia regimen included idarubicin 8 mg/m(2), dl -3 plus cytosine arabinoside 100 mg/m(2), dl - 7 for 1-2 cycles. The regimen for acute lymphocytic leukemia was idarubicin 8 mg/m2, dl - 3; vincristine 2 mg/mr, dl; cyclophosphamide 750 mg/m2, dl ; plus prednisone 60 mg/m(2),dl - 14 for 1-2 cycles.</p><p><b>RESULTS</b>Clinical response rate of the tested group treated with domestic idarubicin and control group treated with imported idarubicin was 78. 1% (50/64) vs. 76.9% (50/65) without any statistically significant difference between the two groups(P >0. 05). Grade Ill - IV hematological toxicity rate of the domestic idarubicin group and imported idarubicin group was 74. 0% vs. 73. 1% , respectively (P = 0. 73). Drug-related death was observed in 3 of 77 patients in the domestic idarubicin group (3.9%) due to cerebral hemorrage or septic infection. The incidence of non-hematological toxicities in domestic idarubicin group and imported idarubicin group was 84. 4% vs. 79. 5% for nausea or vomiting, 70. 1% vs. 71. 8% for infection, 42. 9% vs. 41. 0% for mucositis, 33. 8% vs. 33. 3% for alopecia, 28.6% vs. 28. 2% for serum glutamicoxalacetic transaminase abnormalitis, 16. 9% vs. 10. 3% for cardiac toxicity, all without statistically significant differences between these two groups (P > 0. 05). Discontinuation of treatment due to non-hematological toxicity was not neccessary.</p><p><b>CONCLUSION</b>Domestic idarubicin is comparable to imported counterpart in efficiency and safety for the treatment of acute leukemia. The most severe side effects of domestic idarubicin is hematological toxicity, which should be closely observed and treated in time, while its non-hematological toxicity is tolerable.</p>