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1.
Artigo em Inglês | MEDLINE | ID: mdl-28264462

RESUMO

The value of QuantiFERON in the diagnosis of tuberculosis disease and in the monitoring of the response to anti-tuberculosis treatment is unclear. The aims of this study were to evaluate the accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of tuberculosis and in the monitoring of the response to anti-tuberculosis treatment in patients with active pulmonary tuberculosis (PTB). Between January 2013 and December 2015, 133 cases with active PTB and 133 controls with no mycobacterial infection, matched by age (within 3 years) and by the week that they visited Tainan Chest Hospital, were enrolled in the study. Serial testing by QFT-GIT at baseline and after 2 and 6 months of treatment was performed. At these time points, a comparison of the performance of QFT-GIT with that of sputum culture status among study subjects was conducted. Compared to baseline, 116 (87.2%) cases showed a decreased response, whereas 17 (12.8%) showed persistent or stronger interferon-gamma (IFN-γ) responses at 2 months. PTB patients IFN-γ responses declined significantly from baseline to 2 months (median, 6.32 vs. 4.12; p < 0.005). The sensitivity values of the QFT-GIT test for the detection of pulmonary tuberculosis at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 74.4%, 78.2%, and 80.5%, respectively. The specificity values at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 66.2%, 63.9%, and 57.1%, respectively. Our results support the QFT-GIT assay as a potential tool for diagnosing tuberculosis and for monitoring the efficacy of anti-tuberculosis treatment.


Assuntos
Interferon gama/metabolismo , Kit de Reagentes para Diagnóstico , Escarro/metabolismo , Tuberculose Pulmonar/diagnóstico , Idoso , Antituberculosos/uso terapêutico , Bioensaio , Feminino , Ouro , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/metabolismo
2.
Asia Pac J Clin Oncol ; 12(2): e234-40, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24571424

RESUMO

AIMS: Neoadjuvant concurrent chemoradiotherapy (NCCRT) is currently the preferred treatment for rectal cancer of clinical stage II-III based on its efficacy in clinical trials. The population-based effectiveness of NCCRT is rarely reported on in the literature. The purpose of our study is to investigate the nationwide population-based effectiveness of NCCRT as compared with up-front proctectomy. METHODS: In this retrospective cohort study, we identified the study population by linking datasets including the cancer registry, death registry and other related files in Taiwan. We identified all patients with rectal adenocarcinoma of American Joint Committee on Cancer clinical stage II or III who were diagnosed in 2007 or 2008 and received either NCCRT or up-front proctectomy. We included patients' age, gender, residence, socioeconomic status and clinical stage as covariables. We used overall survival as the measure of effectiveness. The Cox proportional-hazards regression model was used for statistical analyses. We further conducted sensitivity analyses, one in only those who received optimal postoperative chemotherapy and one in two subgroups matched for propensity score. RESULTS: We included 1933 patients (NCCRT: 424; up-front proctectomy: 1509) in the study population. NCCRT was associated with improved survival as compared with up-front proctectomy (adjusted hazard ratio of death 0.656; 95% confidence interval 0.495-0.871). Our results were robust in the sensitivity analyses. CONCLUSION: We demonstrated that the use of neoadjuvant concurrent systemic therapy and radiotherapy is associated with better effectiveness in rectal adenocarcinoma of clinical stage II-III as compared with up-front proctectomy. Further studies are needed to elucidate the subgroups most likely to benefit and to clarify NCCRT's cost-effectiveness.


Assuntos
Neoplasias Retais/terapia , Adulto , Idoso , Quimiorradioterapia Adjuvante , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Retais/patologia , Estudos Retrospectivos , Taiwan
3.
Cancer Imaging ; 13(4): 458-65, 2013 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-24334433

RESUMO

RATIONALE AND OBJECTIVES: Although low-dose computed tomography (CT) is a recommended modality for lung cancer screening in high-risk populations, the role of other modalities, such as [(18)F]fluorodeoxyglucose-positron emission tomography (PET), is unclear. We conducted a systematic review to describe the role of PET in lung cancer screening. MATERIALS AND METHODS: A systematic review was conducted by reviewing primary studies focusing on PET screening for lung cancer until July 2012. Two independent reviewers identified studies that were compatible for inclusion/exclusion criteria. The analysis was restricted to English and included studies published since 2000. A descriptive analysis was used to summarize the results, and the pooled diagnostic performance of selective PET screening was calculated by weighted average using individual sample sizes. RESULTS: Among the identified studies (n = 3497), 12 studies were included for analysis. None of the studies evaluated the efficacy of primary PET screening specific to lung cancer. Eight studies focused on primary PET screening for all types of cancer; the detection rates of lung cancer were low. Four studies reported evidence of lung cancer screening programs with selective PET, in which the estimated pooled sensitivity and specificity was 83% and 91%, respectively. CONCLUSIONS: The role of primary PET screening for lung cancer remains unknown. However, PET has high sensitivity and specificity as a selective screening modality. Further studies must be conducted to evaluate the use of PET or PET/computed tomography screening for high-risk populations, preferably using randomized trials or prospective registration. ADVANCES IN KNOWLEDGE: Our meta-analysis indicates that PET has high sensitivity and specificity as a selective screening modality.


Assuntos
Detecção Precoce de Câncer , Fluordesoxiglucose F18 , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Humanos , Tomografia Computadorizada por Raios X
4.
Eur J Cardiothorac Surg ; 43(4): 783-6, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22864790

RESUMO

OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) is possibly associated with reduced acute pain and narcotics consumption when compared to open surgery, but little is known about the long-term effect. The goal of our study was to evaluate whether narcotics consumption is consistently lower after VATS for early stage non-small cell lung cancer (NSCLC), as compared to open surgery, during one-year follow-up. METHODS: This nationwide retrospective cohort study was conducted using data relating to cancer registry and national compulsory comprehensive claims in Taiwan. Our study cases were those newly diagnosed with clinical Stage I NSCLC, who underwent primary lung resection in the year 2007. The date of the admission during which index surgery was performed was used as the index date. We compared the use of narcotics, between the VATS and open surgery groups, over a period of one year following the index date. We defined narcotics as either Level 1 or 2 drugs as regulated in Taiwan. We also used an equiananalgesic dose chart to convert drug consumption into a uniform narcotics equivalent dose. Chi-square and t-tests were used for statistical analysis. RESULTS: We identified 329 cases (114 for VATS and 215 for open surgery). These two groups were balanced for most clinical variables. VATS was associated with lower narcotics consumption during the index admission (mean equivalent dose of intravenous morphine: 54.6 vs 71.4 mg) and this trend extended to the period covering the 2nd to 12th month after index date (73.8 vs 149.5mg). CONCLUSIONS: Narcotics consumption is consistently lower after VATS for early stage NSCLC, as compared to open surgery. Further prospective studies would be of great value in validating this finding.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Entorpecentes/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracotomia/métodos , Resultado do Tratamento
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