ABSTRACT
Precise management of kidney cancer requires the identification of prognostic factors. hPG80 (circulating progastrin) is a tumor promoting peptide present in the blood of patients with various cancers, including renal cell carcinoma (RCC). In this study, we evaluated the prognostic value of plasma hPG80 in 143 prospectively collected patients with metastatic RCC (mRCC). The prognostic impact of hPG80 levels on overall survival (OS) in mRCC patients after controlling for hPG80 levels in non-cancer age matched controls was determined and compared to the International Metastatic Database Consortium (IMDC) risk model (good, intermediate, poor). ROC curves were used to evaluate the diagnostic accuracy of hPG80 using the area under the curve (AUC). Our results showed that plasma hPG80 was detected in 94% of mRCC patients. hPG80 levels displayed high predictive accuracy with an AUC of 0.93 and 0.84 when compared to 18-25 year old controls and 50-80 year old controls, respectively. mRCC patients with high hPG80 levels (>4.5 pM) had significantly lower OS compared to patients with low hPG80 levels (<4.5 pM) (12 versus 31.2 months, respectively; p = 0.0031). Adding hPG80 levels (score of 1 for patients having hPG80 levels > 4.5 pM) to the six variables of the IMDC risk model showed a greater and significant difference in OS between the newly defined good-, intermediate- and poor-risk groups (p = 0.0003 compared to p = 0.0076). Finally, when patients with IMDC intermediate-risk group were further divided into two groups based on hPG80 levels within these subgroups, increased OS were observed in patients with low hPG80 levels (<4.5 pM). In conclusion, our data suggest that hPG80 could be used for prognosticating survival in mRCC alone or integrated to the IMDC score (by adding a variable to the IMDC score or by substratifying the IMDC risk groups), be a prognostic biomarker in mRCC patients.
ABSTRACT
Introduction: Mental health problems are common among students at university, representing a major public health concern. The internet and new technologies are widely used by students and represent a significant resource to them for mental health information and support. Aim: The aim of this systematic review is to summarize and critique studies of mental health-related digital use (including purposes, advantages, and barriers) by students worldwide, to support the implementation of future digital mental health interventions targeting university students. Methods: We searched for peer-reviewed articles published between January 2008 and May 2018 by using Pubmed, Google Scholar, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, research design, recruitment and sampling, data collection, analysis method, key findings, and mean quality score. Outcomes were synthetized through the textual narrative synthesis method. Results: Of the 1,487 titles and abstracts screened, 24 articles were critically reviewed. Sample sizes ranged from 19 to 6,034 participants. The two key findings were that students worldwide have a high need for mental health information and are prepared to use digital tools for their mental health and well-being. However, they are currently struggling to discern trustworthy information online and are expressing a desire for reliable devices handling their sensitive data. Conclusions: Through the description of patterns in university students' mental health-related digital use, this review outlines important features for potential web- and mobile-based interventions for promoting mental health and preventing mental illness at the university.
