Purpose: Age at diagnosis has been identified as a major determinant of thyroid cancer-specific survival. But the cut-off value for age was controversial. The interaction among gender, age and histologic subtypes needed to be answered.Methods: We identified 59,892 thyroid cancer (TC) patients from the Surveillance, Epidemiology, and End Results (SEER) database. We divided the patients into the following three groups according to age: 20-44 years (young), 45-64 years (middle-aged), and ≥ 65 years (elderly). Logistic regression model was used to identify factors relating to prognosis in elderly patients. Multivariable Cox regression model identified potential prognostic factors. All statistical tests were two-sided.Results: Elderly patients had significantly worse prognosis than the other two groups, P=0.001. Elderly patients had higher proportion of male gender, advanced tumor grade, follicular subtype and advanced tumor stage. There was no survival difference for elderly patients to receive lobectomy and total thyroidectomy, P=0.852. Cox proportional hazards regression model showed that gender, marital status, histology, tumor grade, tumor size, TNM stage, surgery and radiotherapy were all independent prognostic factors in the multivariable analysis. Male patients with TC had worse prognosis than their female counterparts in differentiated tumor but not in undifferentiated tumor. There were more patients of larger tumor, advanced TNM stage and histologic subtypes in male patients.Conclusions: In conclusion, there were a series of factors contributing to the poor prognosis in elderly patients including clinic-pathologic factors and therapy selection. There was no survival difference for elderly patients to receive lobectomy and total thyroidectomy.
Sarcopenia is an independent predictor of IAI. Our nomogram was a simple and practical instrument to quantify the individual risk of IAI and could be used to identify patients at a high risk.
Introduction
Diabetes mellitus (DM), a common tuberculosis (TB) comorbidity, is associated with delayed bacillary clearance during anti-TB treatment and unfavorable outcomes. Bedaquiline (BDQ), when used as part of multidrug regimen for multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB), has been shown to be effective and safe although treatment outcome and risks for patients with MDR/XDR-TB and DM are unknown. A multicenter retrospective study was conducted to compared the safety and effectiveness of 24-week BDQ-containing anti-TB treatment for patients with MDR/XDR-TB with and without DM.
Methods
The study of patients with MDR/XDR-TB with or without DM (enrolled February 2018–September 2019, 21 Chinese hospitals) was supervised by the New Drug Introduction and Protection Program (NDIP). Of 640 patients with MDR/XDR-TB receiving BDQ-containing anti-TB treatments, two propensity score-matched groups (107 DM/107 non-DM) were compared for cumulative culture conversion rate, time to culture conversion, adverse events, and corrected QT interval.
Results
Body mass index was higher in patients with DM than patients without DM (23.29 ± 3.9 vs. 20.5 ± 3.6,
P
< 0.001); lung cavity prevalence (86.9% vs. 72.9%,
P
= 0.037) was also higher in patients with DM; the non-DM group had higher hepatitis prevalence (29.0% vs. 15.9%,
P
= 0.022). No significant intergroup differences were found for sputum culture conversion rate at week 8 (80.0% vs. 81.4%,
P
= 0.884), at week 24 (95.6% vs. 98.2%,
P
= 0.629), or for median time to sputum culture conversion [56 days (IQR 28–63) vs. 56 days (IQR 28–84) (
P
= 0.687)]. Favorable post-24-week treatment outcomes were presented by 90.7% and 93.5% in the DM group and non-DM group, respectively, without significant intergroup differences (
P
= 0.448). The DM adverse event rate exceeded non-DM rate (77.6% vs. 64.5%,
P
= 0.035).
Conclusion
Despite some differences in baseline characteristics, Chinese patients with MDR/XDR-TB with or without DM had similar sputum culture conversion rates and favorable treatment outcomes post-24-week BDQ-containing anti-TB treatment. Low BMI but not DM is risk factor associated with unfavorable outcome of patients with MDR/XDR-TB.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40121-021-00396-9.
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