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Prognostic models for locally advanced cervical cancer: external validation of the published models
David Lora,Agustín Gómez de la Cámara,Sara Pedraza Fernández,Rafael Enríquez de Salamanca,José Fermín Pérez-Regadera Gómez 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5
Objective: To externally validate the prognostic models for predicting the time-dependentoutcome in patients with locally advanced cervical cancer (LACC) who were treated withconcurrent chemoradiotherapy in an independient cohort. Methods: A historical cohort of 297 women with LACC who were treated with radicalconcurrent chemoradiotherapy from 1999 to 2014 at the 12 de Octubre University Hospital(H12O), Madrid, Spain. The external validity of prognostic models was quantified regardingdiscrimination, calibration, measures of overall performance, and decision curve analyses. Results: The review identified 8 studies containing 13 prognostic models. Different(International Federation of Gynecology and Obstetrics [FIGO] stages, parametriuminvolvement, hydronephrosis, location of positive nodes, and race) but related cohorts withvalidation cohort (5-year overall survival [OS]=70%; 5-year disease-free survival [DFS]=64%;average age of 50; and over 79% squamous cell) were evaluated. The following models exhibitedgood external validity in terms of discrimination and calibration but limited clinical utility: theOS model at 3 year from Kidd et al.'s study (area under the receiver operating characteristiccurve [AUROC]=0.69; threshold of clinical utility [TCU] between 36% and 50%), the models ofDFS at 1 year from Kidd et al.'s study (AUROC=0.64; TCU between 24% and 32%) and 2 yearsfrom Rose et al.'s study (AUROC=0.70; TCU between 19% and 58%) and the distant recurrencemodel at 5 years from Kang et al.'s study (AUROC=0.67; TCU between 12% and 36%). Conclusion: The external validation revealed the statistical and clinical usefulness of 4prognostic models published in the literature.
( Constanza Ciriza De Los-rios ),( Fernando Canga Rodriguez-valcarcel ),( David Lora Pablos ),( Javier De La Cruz Bertolo ),( Isabel Castel De Lucas ),( Gregorio Castellano Tortajada ) 대한소화기기능성질환·운동학회 2015 Journal of Neurogastroenterology and Motility (JNM Vol.21 No.3
Background/Aims: The body position can influence esophageal motility data obtained with high-resolution manometry (HRM). To examine whether the body position influences HRM diagnoses in patients with esophageal dysphagia and gastroesophageal reflux disease (GERD). Methods: HRM (Manoscan) was performed in 99 patients in the sitting and supine positions; 49 had dysphagia and 50 had GERD assessed by 24-hour pH monitoring. HRM plots were analyzed according to the Chicago classification. Results: HRM results varied in the final diagnoses of the esophageal body (EB) in patients with dysphagia (P = 0.024), the result being more distal spasm and weak peristalsis while sitting. In patients with GERD, the HRM diagnoses of the lower esophageal sphincter (LES), the esophagogastric junction (EGJ) morphology, and EB varied depending on the position; (P = 0.063, P = 0.017, P = 0.041 respectively). Hypotensive LES, EGJ type III (hiatal hernia), and weak peristalsis were more frequently identified in the sitting position. The reliability (kappa) of the position influencing HRM diagnoses was similar in dysphagia and GERD (LES diagnosis: dysphagia 0.32 [0.14-0.49] and GERD 0.31 [0.10-0.52], P = 0.960; EB diagnosis: dysphagia 0.49 [0.30-0.69] and GERD 0.39 [0.20-0.59], P = 0.480). The reliability in EGJ morphology studies was higher in dysphagia 0.81 (0.68-0.94) than in GERD 0.55 (0.37-0.73), P = 0.020. Conclusions: HRM results varied according to the position in patients with dysphagia and GERD. Weak peristalsis was more frequently diagnosed while sitting in dysphagia and GERD. Hypotensive LES and EGJ type III (hiatal hernia) were also more frequently diagnosed in the sitting position in patients with GERD. (J Neurogastroenterol Motil 2015;21:370-379)