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盘点:2020年10月31日Lancet研究精选

2020-10-31 MedSci原创 MedSci原创

2020年10月31日Lancet研究精选

【1】根治性手术后立即进行辅助放疗对前列腺癌患者无事件生存率的影响
 
 
近日研究人员开展随机对照研究,比较根治性前列腺切除术后辅助放疗或早期补救放疗对局部或局部晚期前列腺癌患者的疗效。
 
成年的中高危,局限性或局部晚期前列腺癌患者参与研究,在根治性前列腺切除术后立即进行辅助放疗或早期补救放疗,检测患者出现进展事件,包括生化进展(前列腺特异性抗原[PSA]≥0.4ng/mL,并在完成任何术后放疗后上升)、临床或放射学进展、接受其他治疗、前列腺癌死亡或随机化后PSA水平高于2.0ng/ml的时间。研究的主要终点为无事件生存率。
 
3个队列,总计2153名患者完成研究,平均随访时间从60个月到78个月不等,最多随访132个月。1075名患者接受辅助放疗,1078名患者接受早期补救放疗。患者基线特相近,平均年龄在64-65岁之间,大多数患者(1671例[77.6%])的Gleason评分为7分。所有试验都被评估为具有较低的偏倚风险。研究发现,辅助放疗与早期抢救性放疗相比,无事件生存率方面没有显著改善(HR 0.95),5年无事件生存率(89%vs88%)仅提高1个百分点,总体结果在不同试验间保持一致。
 
【2】前列腺癌根治术后放疗策略对PSA进程的影响
 
 
前列腺癌根治术后放疗的最佳时机尚不确定。近日研究人员比较了辅助放疗与挽救性放疗治疗对患者前列腺特异性抗原(PSA)生化进程的影响。
 
RADICALS-RT研究中,招募了在根治性前列腺切除术后至少有一个生化进展危险因素(病理性T阶段3或4,Gleason评分7-10,阳性边缘,或术前PSA≥10 ng/mL)的患者。患者随机接受辅助放疗或根据PSA生化进展进行挽救放疗治疗策略(PSA≥0.1ng/mL或连续三次升高)。主要的观察指标是无远端转移,还报告了生化无进展生存率,无激素治疗,安全性和患者报告的结果。
 
1396名患者参与研究,699名(50%)接受抢救性放疗,697名(50%)接受辅助放疗。患者的中位年龄为65岁,中位随访时间为4.9年。辅助放疗组697名参与者中,649名(93%)在6个月内接受治疗,抢救放疗组699名参与者中有228人(33%)在随机分组后8年内接受放疗。辅助放疗组和挽救放疗组的5年生化无进展生存率分别为85%和88%(HR:1.10)。辅助放疗组5年后无需计划外激素治疗的比例为93%,而抢救放疗组为92%(HR:0.88)。辅助放疗组患者1年时自述尿失禁更严重(平均得分4.8 vs 4.0)。辅助放疗组6%的个体在2年内报告了3-4级尿道狭窄,而抢救放疗组为4%。
 
【3】SYNTAX II 2020评分为复杂冠状动脉疾病患者血运重建提供个性化选择依据
 
 
通常随机对照试验是检验新治疗方法疗效的金标准,通常以平均治疗效果作为主要终点及结论。但在临床实践中,由于患者的个体差异,根据总体平均疗效为具有患者制定治疗策略的方案往往不科学。近日研究人员试图开发一个个性化决策工具,以用于复杂冠状动脉疾病患者个体化的选择最佳血运重建策略。
 
SYNTAXES研究为一项多中心、随机对照试验。招募冠脉三支病变和左主干病变患者,随机接受经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)。研究组使用Cox回归模型制定可预测10年内死亡的临床预后指标,并在第二阶段将其与指定的治疗方法(PCI或CABG)和两个预先指定的疗效调节因子(根据疾病类型和解剖SYNTAX评分来确定)相结合。研究组开发相应的预测模型预测接受PCI或CABG患者5年内发生重大不良血管事件(定义为全因死亡、非致命性中风或非致命性心肌梗死的复合结局)的风险,之后通过交叉验证,来评估这一模型的预测效果。
 
在交叉验证中,新开发的SYNTAX评分II模型(SYNTAX II 2020)在两个治疗组中均显示了良好的10年全因死亡(PCI组C指数为0.73, CABG组C指数为0.73)和5年重大不良心血管事件(0.65和0.71)预测能力。在外部验证中,SYNTAX II 2020评分显示出有效的判别能力,并能很好地预测5年重大不良心血管事件(PCI组C指数为0.67, CABG组C指数为0.62)。在试验人群中,预测显示CABG相对于PCI的治疗受益更多,且实际临床结果证实了这一预测。
 

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1830876, encodeId=1e9c18308e6ae, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 28 06:12:14 CST 2021, time=2021-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=896546, encodeId=85ca89654687, content=SYNTAX II 2020评分显示出有效的判别能力,并能很好地预测5年重大不良心血管事件(PCI组C指数为0.67, CABG组C指数为0.62)。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae205385871, createdName=Lexi, createdTime=Tue Nov 03 10:46:32 CST 2020, time=2020-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895853, encodeId=4497895853d5, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00074131254, createdName=13c30453m58暂无昵称, createdTime=Sat Oct 31 13:17:25 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034021, encodeId=fb03103402195, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sat Oct 31 13:12:14 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895852, encodeId=6f15895852bf, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f972237247, createdName=12137876m69(暂无昵称), createdTime=Sat Oct 31 12:43:10 CST 2020, time=2020-10-31, status=1, ipAttribution=)]
    2021-08-28 howi
  2. [GetPortalCommentsPageByObjectIdResponse(id=1830876, encodeId=1e9c18308e6ae, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 28 06:12:14 CST 2021, time=2021-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=896546, encodeId=85ca89654687, content=SYNTAX II 2020评分显示出有效的判别能力,并能很好地预测5年重大不良心血管事件(PCI组C指数为0.67, CABG组C指数为0.62)。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae205385871, createdName=Lexi, createdTime=Tue Nov 03 10:46:32 CST 2020, time=2020-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895853, encodeId=4497895853d5, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00074131254, createdName=13c30453m58暂无昵称, createdTime=Sat Oct 31 13:17:25 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034021, encodeId=fb03103402195, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sat Oct 31 13:12:14 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895852, encodeId=6f15895852bf, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f972237247, createdName=12137876m69(暂无昵称), createdTime=Sat Oct 31 12:43:10 CST 2020, time=2020-10-31, status=1, ipAttribution=)]
    2020-11-03 Lexi

    SYNTAX II 2020评分显示出有效的判别能力,并能很好地预测5年重大不良心血管事件(PCI组C指数为0.67, CABG组C指数为0.62)。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1830876, encodeId=1e9c18308e6ae, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 28 06:12:14 CST 2021, time=2021-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=896546, encodeId=85ca89654687, content=SYNTAX II 2020评分显示出有效的判别能力,并能很好地预测5年重大不良心血管事件(PCI组C指数为0.67, CABG组C指数为0.62)。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae205385871, createdName=Lexi, createdTime=Tue Nov 03 10:46:32 CST 2020, time=2020-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895853, encodeId=4497895853d5, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00074131254, createdName=13c30453m58暂无昵称, createdTime=Sat Oct 31 13:17:25 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034021, encodeId=fb03103402195, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sat Oct 31 13:12:14 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895852, encodeId=6f15895852bf, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f972237247, createdName=12137876m69(暂无昵称), createdTime=Sat Oct 31 12:43:10 CST 2020, time=2020-10-31, status=1, ipAttribution=)]
    2020-10-31 13c30453m58暂无昵称

    学习学习学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1830876, encodeId=1e9c18308e6ae, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 28 06:12:14 CST 2021, time=2021-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=896546, encodeId=85ca89654687, content=SYNTAX II 2020评分显示出有效的判别能力,并能很好地预测5年重大不良心血管事件(PCI组C指数为0.67, CABG组C指数为0.62)。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae205385871, createdName=Lexi, createdTime=Tue Nov 03 10:46:32 CST 2020, time=2020-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895853, encodeId=4497895853d5, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00074131254, createdName=13c30453m58暂无昵称, createdTime=Sat Oct 31 13:17:25 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034021, encodeId=fb03103402195, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sat Oct 31 13:12:14 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895852, encodeId=6f15895852bf, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f972237247, createdName=12137876m69(暂无昵称), createdTime=Sat Oct 31 12:43:10 CST 2020, time=2020-10-31, status=1, ipAttribution=)]
    2020-10-31 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1830876, encodeId=1e9c18308e6ae, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Aug 28 06:12:14 CST 2021, time=2021-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=896546, encodeId=85ca89654687, content=SYNTAX II 2020评分显示出有效的判别能力,并能很好地预测5年重大不良心血管事件(PCI组C指数为0.67, CABG组C指数为0.62)。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae205385871, createdName=Lexi, createdTime=Tue Nov 03 10:46:32 CST 2020, time=2020-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895853, encodeId=4497895853d5, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00074131254, createdName=13c30453m58暂无昵称, createdTime=Sat Oct 31 13:17:25 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034021, encodeId=fb03103402195, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sat Oct 31 13:12:14 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=895852, encodeId=6f15895852bf, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f972237247, createdName=12137876m69(暂无昵称), createdTime=Sat Oct 31 12:43:10 CST 2020, time=2020-10-31, status=1, ipAttribution=)]
    2020-10-31 12137876m69(暂无昵称)

    好文章

    0

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