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Cao J, Zhang L, Zhou X. Constructing a prognostic tool for predicting the risk of non-adherence to antiplatelet therapy in discharged patients with coronary heart disease: a retrospective cohort study. PeerJ 2023; 11:e15876. [PMID: 37576506 PMCID: PMC10422952 DOI: 10.7717/peerj.15876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To investigate the incidence and influencing factors affecting the non-adherence behavior of patients with coronary heart disease (CHD) to antiplatelet therapy after discharge and to construct a personalized predictive tool. Methods In this retrospective cohort study, 289 patients with CHD who were admitted to the Department of Cardiology of The First Affiliated Hospital of the University of Science and Technology of China between June 2021 and September 2021 were enrolled. The clinical data of all patients were retrospectively collected from the hospital information system, and patients were followed up for 1 year after discharge to evaluate their adherence level to antiplatelet therapy, analyze their present situation and influencing factors for post-discharge adherence to antiplatelet therapy, and construct a nomogram model to predict the risk of non-adherence. Results Based on the adherence level to antiplatelet therapy within 1 year after discharge, the patients were divided into the adherence (n = 216) and non-adherence (n = 73) groups. Univariate analysis revealed statistically significant differences between the two groups in terms of variable distribution, including age, education level, medical payment method, number of combined risk factors, percutaneous coronary intervention, duration of antiplatelet medication, types of drugs taken at discharge, and CHD type (P < 0.05). Furthermore, multivariate logistic regression analysis revealed that, except for the medical payment method, all the seven abovementioned variables were independent risk factors for non-adherence to antiplatelet therapy (P < 0.05). The areas under the receiver operating characteristic curve before and after the internal validation of the predictive tool based on the seven independent risk factors and the nomogram were 0.899 (95% confidence interval [CI]: 0.858-0.941) and 0.89 (95% CI: 0.847-0.933), respectively; this indicates that the tool has good discrimination ability. The calibration curve and Hosmer-Lemeshow goodness of fit test revealed that the tool exhibited good calibration and prediction consistency (χ2 = 5.17, P = 0.739). Conclusion In this retrospective cohort study, we investigated the incidence and influencing factors affecting the non-adherence behavior of patients with CHD after discharge to antiplatelet therapy. For this, we constructed a personalized predictive tool based on seven independent risk factors affecting non-adherence behavior. The predictive tool exhibited good discrimination ability, calibration, and clinical applicability. Overall, our constructed tool is useful for predicting the risk of non-adherence behavior to antiplatelet therapy in discharged patients with CHD and can be used in personalized intervention strategies to improve patient outcomes.
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Affiliation(s)
- Jiaoyu Cao
- Department of Cardiology, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Lixiang Zhang
- Department of Cardiology, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Xiaojuan Zhou
- Department of Cardiology, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
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Akgül Ö, Ocak S, Gündoğdu SB, Yalaza M, Güldoğan CE, Tez M. Comparison of East and West Survival Nomograms in Turkish Gastric Cancer Patients Who Underwent Radical Surgery. Scand J Surg 2018; 107:308-314. [PMID: 29637843 DOI: 10.1177/1457496918766724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIM: The clinicopathological demonstrations of gastric cancer vary widely between Eastern and Western countries. Turkey is situated in Europe and Middle East which acts as a bridge between east and west. We aimed to validate the two popular nomograms of east and west origin by means of patients who underwent curative surgery for gastric cancer in our country. MATERIAL AND METHODS: Of the 202 patients diagnosed with gastric cancer between the years 2006 and 2013, 145 of these patients whose data were sufficient were included in the study. For all patients, demographic, laboratory, operative, and pathologic findings were documented. For each patient, prognostic factors were incorporated into the nomograms for estimating 5-year survival probability. RESULTS: For a Turkish cohort, the western nomogram showed a better discriminative capacity (AUC = 0.721, 95% confidence interval 0.637-0.806) and was better calibrated (the Hosmer-Lemeshow goodness-of-fit test p = 0.323), as compared to the eastern nomogram with AUC = 0.615, 95% confidence interval 0.522-0.708, and p = 0.077, respectively. CONCLUSION: Western nomogram was found to be more effective than eastern nomogram in prediction of estimating 5-year survival probability in patients with resectable gastric cancer in Turkish population.
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Affiliation(s)
- Ö Akgül
- 1 Department of Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - S Ocak
- 2 Department of Surgery, Samsun Education and Research Hospital, Samsun, Turkey
| | - S B Gündoğdu
- 1 Department of Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - M Yalaza
- 1 Department of Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - C E Güldoğan
- 3 Department of Surgery, Liv Hospital, Ankara, Turkey
| | - M Tez
- 1 Department of Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey
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van den Boorn HG, Engelhardt EG, van Kleef J, Sprangers MAG, van Oijen MGH, Abu-Hanna A, Zwinderman AH, Coupé VMH, van Laarhoven HWM. Prediction models for patients with esophageal or gastric cancer: A systematic review and meta-analysis. PLoS One 2018; 13:e0192310. [PMID: 29420636 PMCID: PMC5805284 DOI: 10.1371/journal.pone.0192310] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/22/2018] [Indexed: 02/06/2023] Open
Abstract
Background Clinical prediction models are increasingly used to predict outcomes such as survival in cancer patients. The aim of this study was threefold. First, to perform a systematic review to identify available clinical prediction models for patients with esophageal and/or gastric cancer. Second, to evaluate sources of bias in the included studies. Third, to investigate the predictive performance of the prediction models using meta-analysis. Methods MEDLINE, EMBASE, PsycINFO, CINAHL, and The Cochrane Library were searched for publications from the year 2000 onwards. Studies describing models predicting survival, adverse events and/or health-related quality of life (HRQoL) for esophageal or gastric cancer patients were included. Potential sources of bias were assessed and a meta-analysis, pooled per prediction model, was performed on the discriminative abilities (c-indices). Results A total of 61 studies were included (45 development and 16 validation studies), describing 47 prediction models. Most models predicted survival after a curative resection. Nearly 75% of the studies exhibited bias in at least 3 areas and model calibration was rarely reported. The meta-analysis showed that the averaged c-index of the models is fair (0.75) and ranges from 0.65 to 0.85. Conclusion Most available prediction models only focus on survival after a curative resection, which is only relevant to a limited patient population. Few models predicted adverse events after resection, and none focused on patient’s HRQoL, despite its relevance. Generally, the quality of reporting is poor and external model validation is limited. We conclude that there is a need for prediction models that better meet patients’ information needs, and provide information on both the benefits and harms of the various treatment options in terms of survival, adverse events and HRQoL.
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Affiliation(s)
- H. G. van den Boorn
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - E. G. Engelhardt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - J. van Kleef
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M. A. G. Sprangers
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M. G. H. van Oijen
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A. H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - V. M. H. Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - H. W. M. van Laarhoven
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Chen S, Chen X, Nie R, Ou Yang L, Liu A, Li Y, Zhou Z, Chen Y, Peng J. A nomogram to predict prognosis for gastric cancer with peritoneal dissemination. Chin J Cancer Res 2018; 30:449-459. [PMID: 30210225 PMCID: PMC6129562 DOI: 10.21147/j.issn.1000-9604.2018.04.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To identify independent prognostic factors to be included in a nomogram to predict the prognosis of gastric cancer patients with peritoneal dissemination. Methods This is a retrospective study on 684 patients with a histological diagnosis of gastric cancer with peritoneal dissemination from the Sun Yat-sen University Cancer Center as the development set, and 62 gastric cancer patients from the Sixth Affiliated Hospital of Sun Yat-sen University as the validation group. Chi-square test and Cox regression analysis were used to compare the clinicopathological variables and the prognosis of gastric cancer patients with peritoneal dissemination. The Harrell’s concordance index (C-index) and calibration curve were determined for comparisons of predictive ability of the nomogram. Results Univariate and multivariate analyses showed that serum carcinoembryonic antigen (CEA) level (P=0.032), ascites grading (P=0.008), presence of extraperitoneal metastasis (P<0.001), seeding status (P=0.016) and performance status (P=0.009) were independent prognostic factors for gastric cancer patients with peritoneal dissemination in the development set. The nomogram model was constructed using these five factors. Internal validation showed that the C-index of the model was 0.641. For the external validation, the C-index of this model was 0.709. Conclusions We developed and validated a nomogram to predict the prognosis for gastric cancer patients with peritoneal dissemination. This nomogram may play an important clinical role in guiding palliative therapy for these types of patients, although it may need more data for optimization.
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Affiliation(s)
- Shi Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.,Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
| | - Xijie Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.,Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
| | - Runcong Nie
- Department of Gastropancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Liying Ou Yang
- Department of Intensive Care, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Aihong Liu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.,Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
| | - Yuanfang Li
- Department of Gastropancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhiwei Zhou
- Department of Gastropancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yingbo Chen
- Department of Gastropancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Junsheng Peng
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.,Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
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Treese C, Sanchez P, Grabowski P, Berg E, Bläker H, Kruschewski M, Haase O, Hummel M, Daum S. Poorly Differentiated Medullary Phenotype Predicts Poor Survival in Early Lymph Node-Negative Gastro-Esophageal Adenocarcinomas. PLoS One 2016; 11:e0168237. [PMID: 28030564 PMCID: PMC5193343 DOI: 10.1371/journal.pone.0168237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/28/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND 5-year survival rate in patients with early adenocarcinoma of the gastro-esophageal junction or stomach (AGE/S) in Caucasian patients is reported to be 60-80%. We aimed to identify prognostic markers for patients with UICC-I without lymph-node involvement (N0). METHODS Clinical data and tissue specimen from patients with AGE/S stage UICC-I-N0, treated by surgery only, were collected retrospectively. Tumor size, lymphatic vessel or vein invasion, grading, classification systems (WHO, Lauren, Ming), expression of BAX, BCL-2, CDX2, Cyclin E, E-cadherin, Ki-67, TP53, TP21, SHH, Survivin, HIF1A, TROP2 and mismatch repair deficiency were analyzed using tissue microarrays and correlated with overall and tumor related survival. RESULTS 129 patients (48 female) with a mean follow-up of 129.1 months were identified. 5-year overall survival was 83.9%, 5-year tumor related survival was 95.1%. Poorly differentiated medullary cancer subtypes (p<0.001) and positive vein invasion (p<0.001) were identified as risk factors for decreased overall-and tumor related survival. Ki-67 (p = 0.012) and TP53 mutation (p = 0.044) were the only immunohistochemical markers associated with worse overall survival but did not reach significance for decreased tumor related survival. CONCLUSION In the presented study patients with AGE/S in stage UICC-I-N0 had a better prognosis as previously reported for Caucasian patients. Poorly differentiated medullary subtype was associated with reduced survival and should be considered when studying prognosis in these patients.
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Affiliation(s)
- Christoph Treese
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Pedro Sanchez
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Patricia Grabowski
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- Department of Gastroenterology and Endocrinology, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
| | - Erika Berg
- Institute for Pathology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Hendrik Bläker
- Institute for Pathology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martin Kruschewski
- Department of General, Visceral and Thoracic Surgery, Städtisches Klinikum Solingen GmbH, Solingen, Germany
| | - Oliver Haase
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Michael Hummel
- Institute for Pathology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Severin Daum
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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