ABSTRACT
The present study analyzed the predictive value of combined analysis of collapsin response mediator protein 4 (CRMP4) methylation levels and the Cancer of the Prostate Risk Assessment (CAPRA-S) Postsurgical score of patients who required adjuvant hormone therapy (AHT) after radical prostatectomy (RP). We retrospectively analyzed 305 patients with prostate cancer (PCa) who received RP and subsequent androgen deprivation therapy (ADT). Two hundred and thirty patients with clinically high-risk PCa underwent immediate ADT, and 75 patients with intermediate risk PCa underwent deferred ADT. CRMP4 methylation levels in biopsies were determined, and CAPRA-S scores were calculated. In the deferred ADT group, the values of the hazard ratios for tumor progression and cancer-specific mortality (CSM) in patients with ≥15% CRMP4 methylation were 6.81 (95% CI: 2.34-19.80) and 12.83 (95% CI: 2.16-26.10), respectively. Receiver-operating characteristic curve analysis indicated that CRMP4 methylation levels ≥15% served as a significant prognostic marker of tumor progression and CSM. In the immediate ADT group, CAPRA-S scores ≥6 and CRMP4 methylation levels ≥15% were independent predictors of these outcomes (uni- and multi-variable Cox regression analyses). The differences in the 5-year progression-free survival between each combination were statistically significant. Combining CAPRA-S score and CRMP4 methylation levels improved the area under the curve compared with the CRMP4 or CAPRA-S model. Therefore, CRMP4 methylation levels ≥15% were significantly associated with a poor prognosis and their combination with CAPRA-S score accurately predicted tumor progression and metastasis for patients requiring AHT after RP.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Androgen Antagonists/therapeutic use , Biomarkers, Tumor/blood , Hormone Replacement Therapy , Methylation , Muscle Proteins/metabolism , Neoplasm Grading , Neoplasm Metastasis , Neoplasm Staging , Prognosis , Progression-Free Survival , Prostatectomy , Prostatic Neoplasms/metabolism , Retrospective Studies , Risk Assessment , Treatment OutcomeABSTRACT
BACKGROUND:Currently, there is no explicit evidence-based medicine evidence to prove the merits or demerits of absorbable materials in the treatment of fractures of the lateral humeral condyle in children. OBJECTIVE:To evaluate the clinical efficacies of open reduction with absorbable material versus open reduction with Kirschner wire fixation for lateral condylar fracture of the humerus in children.METHODS:WanFang, VIP, CNKI, CBMdisc, EMbase, PubMed were retrieved for controlled trials concerning open reduction with absorbable material versus open reduction with Kirschner wire fixation for treating lateral condylar fracture of the humerus in children. After data extraction and quality evaluations, RevMan 5.3 software was used for systematic review. Postoperative functional recovery of the elbow joint, average hospitalization expenses, adverse events, delayed union, postoperative infection, nerve injury and deformity of the elbow were compared in patients undergoing different treatments. RESULTS AND CONCLUSION:A total of seven articles, involving 449 children with lateral condylar fracture of the humerus, were included for this Meta-analysis. Children in test group received open reduction with absorbable material, while those in control group were subjected to open reduction with Kirschner wire fixation. For treating lateral condylar fracture of the humerus in children, no significant inter-group difference existed in the aspects of postoperative functional recovery of the elbow joint [odds ratio (OR)=0.72, 95％ confidence interval (CI) (0.37, 1.41),P=0.34]; postoperative delayed union [OR=0.46, 95％CI(0.16, 1.30),P=0.14]; deformity of the elbow [OR=0.70, 95％CI (0.24, 2.10),P=0.53]. Less adverse events and postoperative infections were observed in the test group compared with the control group [OR=0.17, 95％CI (0.08, 0.38),P < 0.0001;OR=0.09, 95％CI (0.02, 0.38),P=0.001]. However, up to now, we knew of no comparable data concerning average hospitalization expenses and indicators for nerve injury between the two groups. To conclude, compared with Kirschner wire fixation, open reduction with absorbable material can achieve similar effects on lateral condylar fractures of the humerus, but has better effects to prevent adverse events and postoperative infection. Further investigation on large-scale, double-blind, high-quality randomized controlled trials is warranted for confirming our results.
