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Robotic vs laparoscopic abdominoperineal resection for rectal cancer:A propensity score matching cohort study and metaanalysis

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1280-1290页

作者： Li Song Wen-Qiong Xu Zheng-Qiang Wei Gang Tang Department of Gastrointestinal Surgery Chengdu Fifth People's HospitalChengdu 610000Sichuan ProvinceChina Department of Nephrology Chengdu Fifth People's HospitalChengdu 610000Sichuan ProvinceChina Department of Gastrointestinal Surgery The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400000China Division of Biliary Tract Surgery Department of General SurgeryWest China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.

关键词： Robotic surgery Laparoscopic surgery Abdominoperineal resection Postoperative complications propensity score

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Clinical effect of laparoscopic radical resection of colorectal cancer based on propensity score matching

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World Journal of Gastrointestinal Surgery 2024年第1期16卷 124-133页

作者： Yang Liu Xian-Xue Wang Yu-Lin Li Wen-Tao He Hong Li Hua Chen Department of General Surgery Changde HospitalXiangya School of MedicineCentral South University(The First People’s Hospital of Changde City)Changde 415000Hunan ProvinceChina Department of Anesthesiology Changde HospitalXiangya School of MedicineCentral South University(The First People’s Hospital of Changde City)Changde 415000Hunan ProvinceChina

BACKGROUND The incidence of colorectal cancer(CRC)is increasing annually.Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice.AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching(PSM).METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital,Xiangya School of Medicine,Central South University(The First People’s Hospital of Changde City)were analyzed retrospectively.The control group included patients who underwent open surgery(n=43),and those who underwent laparoscopic surgery formed the observation group(n=57).The baseline information of both groups was equipoised using 1×1 PSM.Differences in the perioperative parameters,inflammatory response,immune function,degree of pain,and physical status between the groups were analyzed.RESULTS Thirty patients from both groups were successfully matched.After PSM,baseline data showed no statistically significant differences between the groups:(1)Periop-erative parameters:The observation group had a longer surgery time,less intra-operative blood loss,earlier first ambulation and first anal exhaust times,and shorter gastric tube indwelling time than the control group;(2)Inflammatory response:24 h after surgery,the levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)between groups were higher than preoperatively.IL-6,CRP,and TNF-αlevels in the observation group were lower than in the control group;(3)Immune function:At 24 h after surgery,counts of CD4-positive T-lymphocytes(CD4+)and CD4+/CD8-positive T-lymphocytes(CD8+)in both groups were lower than those before surgery,whereas CD8+was higher than that before surgery.At 24 h after surgery,both CD4+counts and CD4+/CD8+in the observation group were higher than those in the control group,whereas CD8+counts were lower;(4)Degree of pain:The visual analog scale scores in the observation group were lower than those in the control group at

关键词： Colorectal cancer Laparoscopic Open surgery Inflammatory reaction Immune function propensity score

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Comparison of the survival outcomes between primary and secondary muscle-invasive bladder cancer: a propensity score-matched study

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Chinese Medical Journal 2023年第9期136卷 1067-1073页

作者： Waichan Lok Jiapeng Zhang Xiaonan Zheng Tianhai Lin Hang Xu Ping Tan Qiang Wei Department of Urology Institute of UrologyWest China HospitalSichuan UniversityChengduSichuan 610041China West China Medical School Sichuan UniversityChengduSichuan 610041China Institutes for Systems Genetics Frontiers Science Center for Disease-Related Molecular NetworkWest China HospitalSichuan UniversityChengduSichuan 610041China

Background:Studies have classified muscle-invasive bladder cancer(MIBC)into primary(initially muscle-invasive,PMIBC)and secondary subtypes(initially non-muscle-invasive but progresses,SMIBC),for which controversial survival outcomes were demonstrated.This study aimed to compare the survival outcomes between PMIBC and SMIBC patients in China.Methods:Patients diagnosed with PMIBC or SMIBC at West China Hospital from January 2009 to June 2019 were retrospectively included.Kruskal-Wallis and Fisher tests were employed to compare clinicopathological characteristics.Kaplan-Meier curves and Cox competing proportional risk model were used to compare survival outcomes.propensity score matching(PSM)was employed to reduce the bias and subgroup analysis was used to confirm the outcomes.Results:A total of 405 MIBC patients were enrolled,including 286 PMIBC and 119 SMIBC,with a mean follow-up of 27.54 and 53.30 months,respectively.The SMIBC group had a higher proportion of older patients(17.65%[21/119]vs.9.09%[26/286]),chronic disease(32.77%[39/119]vs.22.38%[64/286]),and neoadjuvant chemotherapy(19.33%[23/119]vs.8.04%[23/286]).Before matching,SMIBC had a lower risk of overall mortality(OM)(hazard ratios[HR]0.60,95%confidence interval[CI]0.41-0.85,P=0.005)and cancer-specific mortality(CSM)(HR 0.64,95%CI 0.44-0.94,P=0.022)after the initial diagnosis.However,higher risks of OM(HR 1.47,95%CI 1.02-2.10,P=0.038)and CSM(HR 1.58,95%CI 1.09-2.29,P=0.016)were observed for SMIBC once it became muscle-invasive.After PSM,the baseline characteristics of 146 patients(73 for each group)were well matched,and SMIBC was confirmed to have an increased CSM risk(HR 1.83,95%CI 1.09-3.06,P=0.021)than PMIBC after muscle invasion.Conclusions:Compared with PMIBC,SMIBC had worse survival outcomes once it became muscle-invasive.Specific attention should be paid to non-muscle-invasive bladder cancer with a high progression risk.

关键词： Mortality Muscle-invasive bladder cancer propensity score Survival

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Estimating Survival Treatment Effects with Covariate Adjustment Using propensity score

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Acta Mathematica Sinica,English Series 2022年第11期38卷 2057-2068页

作者： Yong Xiu CAO Xin Cheng ZHANG Ji Chang YU School of Statistics and Mathematics Zhongnan University of Economics and LawWuhan 430073P.R.China

propensity score is widely used to estimate treatment effects in observational studies.The covariate adjustment using propensity score is the most straightforward method in the literature of causal inference.In this article,we estimate the survival treatment effect with covariate adjustment using propensity score in the semiparametric accelerated failure time model.We establish the asymptotic properties of the proposed estimator by simultaneous estimating equations.We conduct simulation studies to evaluate the finite sample performance of the proposed method.A real data set from the German Breast Cancer Study Group is analyzed to illustrate the proposed method.

关键词： Accelerated failure time model covariate adjustment observational study propensity score simultaneous estimating equations

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Transjugular intrahepatic portosystemic shunt vs conservative treatment for recurrent ascites:A propensity score matched comparison

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World Journal of Gastroenterology 2022年第41期28卷 5944-5956页

作者： Martin Philipp Theresia Blattmann Jörn Bienert Kristian Fischer Luisa Hausberg Jens-Christian Kröger Thomas Heller Marc-AndréWeber Georg Lamprecht Department of Medicine Division of Gastroenterology and EndocrinologyRostock University Medical CenterRostock 18057Germany Institute of Diagnostic and Interventional Radiology Pediatric Radiology and NeuroradiologyRostock University Medical CentreRostock 18057Germany

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) placement is an effective intervention for recurrent tense ascites. Some studies show an increased risk of acute on chronic liver failure(ACLF) associated with TIPS placement. It is not clear whether ACLF in this context is a consequence of TIPS or of the pre-existing liver disease.AIM To better understand the risks of TIPS in this challenging setting and to compare them with those of conservative therapy.METHODS Two hundred and fourteen patients undergoing their first TIPS placement for recurrent tense ascites at our tertiary-care center between 2007 and 2017 were identified(TIPS group). Three hundred and ninety-eight patients of the same time interval with liver cirrhosis and recurrent tense ascites not undergoing TIPS placement(No TIPS group) were analyzed as a control group. TIPS indication,diagnosis of recurrent ascites, further diagnoses and clinical findings were obtained from a database search and patient records. The in-hospital mortality and ACLF incidence of both groups were compared using 1:1 propensity score matching and multivariate logistic regressions.RESULTS After propensity score matching, the TIPS and No TIPS groups were comparable in terms of laboratory values and ACLF incidence at hospital admission. There was no detectable difference in mortality(TIPS: 11/214, No TIPS 13/214). During the hospital stay, ACLF occurred more frequently in the TIPS group than in the No TIPS group(TIPS: 70/214, No TIPS: 57/214, P = 0.04). This effect was confined to patients with severely impaired liver function at hospital admission as indicated by a significant interaction term of Child score and TIPS placement in multivariate logistic regression. The TIPS group had a lower ACLF incidence at Child scores scores of 8 to 10 points.CONCLUSION TIPS placement for recurrent tense ascites is associated with an increased rate of AC

关键词： Liver cirrhosis Ascites Transjugular intrahepatic portosystemic shunt Acute on chronic liver failure Mortality propensity score

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Positive sputum culture of Candida spp.as a risk factor for 30-day mortality in patients with hospital-acquired pneumonia:A propensity-score matched retrospective clinical study

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Chinese Medical Journal Pulmonary and Critical Care Medicine 2023年第2期1卷 113-118页

作者： Yaopin Han Yihui Zuo Zhe Luo Minjie Ju Jianlan Hua Binfeng He Yixing Wu Jing Zhang Department of Pulmonary and Critical Care Medicine Zhongshan HospitalFudan UniversityShanghai 200032China Department of Clinical Medicine Shanghai Medical CollegeFudan UniversityShanghai 200032China Department of Critical Care Medicine Zhongshan HospitalFudan UniversityShanghai 200032China

Background:Candida species(Candida spp.)are commonly isolated microorganisms from lower respiratory tract(LRT)specimens of patients with hospital-acquired pneumonia(HAP);however,the clinical significance remains controversial.This study aimed to investigate the correlation between Candida spp.in the LRT and the clinical features and prognosis of HAP.Methods:This retrospective analysis included eligible patients with HAP from the database of a prospective study carried out between 2018 and 2019 in nine Chinese hospitals.Data on demographics,clinical characteristics,and prognosis were collected and analyzed.propensity score matching(PSM)was used to balance the baseline characteristics.Results:A total of 187 HAP patients were enrolled.After PSM of severity score,27 cases with positive sputum culture of Candida spp.were compared with the control group at a ratio of 1:1.The Candida-positive group had more bacterial isolates in blood culture than the Candida-negative group(39.1%[9/23]vs.7.7%[2/26],χ^(2)=6.928,effect size[ES]=0.38,95%CI:0.12-0.61,P=0.008).The proportion of patients with chronic lung diseases was significantly higher in the Candida-positive group(55.6%[15/27]vs.22.2%[6/27],χ^(2)=6.312,ES=0.34,95%CI:0.07-0.59,P=0.012).The 30-day prognosis of HAP was significantly different between the two groups(80.8%[21/26]vs.38.5%[10/26],χ^(2)=9.665,ES=0.43,95%CI:0.19-0.66,P=0.002).Univariable logistic regression analysis showed that LRT Candida spp.colonization was a risk factor for 30-day mortality of HAP(OR=6.720,95%CI:1.915-23.577,P=0.003).Conclusions:Candida spp.in the LRT was associated with 30-day mortality of HAP.Patients with chronic under-lying lung diseases tend to have Candida spp.colonization.

关键词： Hospital-acquired pneumonia Candida species Prognosis Mortality propensity score

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Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

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World Journal of Clinical Cases 2024年第12期12卷 2040-2049页

作者： Mei-Hua Sun Liu-Sheng Wu Ying-Yang Qiu Jun Yan Xiao-Qiang Li Department of Thoracic Surgery Peking University Shenzhen HospitalShenzhen 518036Guangdong ProvinceChina School of Medicine Tsinghua UniversityBeijing 100084China Yong Loo Lin School of Medicine National University of SingaporeSingapore 119077Singapore

BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

关键词： Enhanced recovery after surgery Non-small cell lung cancer Perioperative care propensity score Video-assisted thoracic surgery

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What Can Comparative Effectiveness Research,propensity score and Registry Study Bring to Chinese Medicine?

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Chinese Journal of Integrative Medicine 2014年第10期20卷 792-795页

作者：廖星谢雁鸣 Institute of Basic Research in Clinical Medicine China Academy of Chinese Medical Sciences

The impact of evidence-based medicine and clinical epidemiology on clinical research has contributed to the development of Chinese medicine in modem times over the past two decades.Many concepts and methods of modem science and technology are emerging in Chinese medicine research,resulting in constant progress.Systematic reviews,randomized controlled trials and other advanced mathematic approaches and statistical analysis methods have brought reform to Chinese medicine.In this new era,Chinese medicine researchers have many opportunities and challenges.On the one hand,Chinese medicine researchers need to dedicate themselves to providing enough evidence to the world through rigorous studies,whilst on the other hand,they also need to keep up with the speed of modem medicine research.For example,recently,real world study,comparative effectiveness research,propensity score techniques and registry study have emerged.This article aims to inspire Chinese medicine researchers to explore new areas by introducing these new ideas and new techniques.

关键词： comparative effectiveness research propensity score registry study Chinese medicine

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Bone metastasis is a late-onset and unfavorable event in survivors of gastric cancer after radical gastrectomy:Results from a clinical observational cohort

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Cancer Pathogenesis and Therapy 2024年第1期2卷 50-57页

作者： Cheng Zhang Xiaopeng Zhang Chong Feng Yahui Yang Minmin Xie Ying Feng Zhijun Wu Hui Xu Changhao Wu Tai Ma Department of Oncology The First Affiliated Hospital of Anhui Medical UniversityHefeiAnhui 230022China Anhui Provincial Cancer Institute/Anhui Provincial Office for Cancer Prevention and Control HefeiAnhui 230022China Department of Noncommunicable Diseases and Health Education Hefei Center for Disease Control and PreventionHefeiAnhui 230091China Department of Oncology The Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsu 221006China Department of Oncology Ma’anshan Municipal People’s HospitalMa’anshanAnhui 243099China Department of Biochemistry and Physiology Faculty of Health and Medical SciencesUniversity of SurreyGuildford GU27HXUnited Kingdom

Background The timing and incidence of recurrent bone metastasis(BM)after radical gastrectomy in patients with gastric cancer(GC)as well as the survival of these patients were not fully understood.The aim of this study was to analyze the data of an observational GC cohort and identify patients who underwent curative gastrectomy and had recurrent BM to describe and clarify the pattern and profile of BM evolution after surgery.Methods Data were retrieved from a hospital-based GC cohort,and patients who underwent upfront radical gastrectomy were selected.The time points of specific organ metastatic events were recorded,and the person-year incidence rate of metastatic events was calculated.The latency period of BM events after gastrectomy was measured and compared with that of the other two most common metastatic events,liver metastasis(LM)and distant lymph node metastasis(LNM),using analysis of variance.propensity score matching and subgroup analysis were used for sensitivity analysis.Results A total of 1324 GC cases underwent radical gastrectomy between January 2011 and December 2021.Of these,67 BM,218 LM,and 248 LNM occurred before the last follow-up.The incidence of BM events was 1.7/100 person-years,which was approximately 3-fold lower than that of LM and distant LNM events(5.5 and 6.3 per 100 person-years,respectively).BM events had a significantly longer latency(median time,16.5 months)than LM and LNM events(11.1 and 12.0 months,respectively).Recurrent BM led to a worse prognosis(median survival,4.5 months)than those of LM and LNM events(median survival,7.7 and 7.1 months,respectively).However,no difference in overall survival after gastrectomy was observed among the groups.Conclusions Compared with other common metastatic events,BM in GC after gastrectomy is a late-onset event indicating poor survival.

关键词： Stomach neoplasms Neoplasm metastasis Incidence Survival analysis propensity score

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Performance of Bayesian propensity score Adjustment for Estimating Causal Effects in Small Clinical Trials

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Open Journal of Statistics 2023年第1期13卷 1-15页

作者： Airi Takagi Takuhiro Yamaguchi Clinical Research Data Center Tohoku University Hospital Sendai Japan Department of Biostatistics Tohoku University Graduate School of Medicine Sendai Japan

propensity score (PS) adjustment can control confounding effects and reduce bias when estimating treatment effects in non-randomized trials or observational studies. PS methods are becoming increasingly used to estimate causal effects, including when the sample size is small compared to the number of confounders. With numerous confounders, quasi-complete separation can easily occur in logistic regression used for estimating the PS, but this has not been addressed. We focused on a Bayesian PS method to address the limitations of quasi-complete separation faced by small trials. Bayesian methods are useful because they estimate the PS and causal effects simultaneously while considering the uncertainty of the PS by modelling it as a latent variable. In this study, we conducted simulations to evaluate the performance of Bayesian simultaneous PS estimation by considering the specification of prior distributions for model comparison. We propose a method to improve predictive performance with discrete outcomes in small trials. We found that the specification of prior distributions assigned to logistic regression coefficients was more important in the second step than in the first step, even when there was a quasi-complete separation in the first step. Assigning Cauchy (0, 2.5) to coefficients improved the predictive performance for estimating causal effects and improving the balancing properties of the confounder.

关键词： Bayesian Estimation Causal Inference propensity score Quasi-Complete Separation Prior Distribution

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