PURPOSE: Glioblastoma (GBM) carries a high propensity for in-field failure despite trimodality management. Past studies have failed to show outcome improvements with dose-escalation. Herein, we examined trends and outcomes associated with dose-escalation for GBM. MATERIALS AND METHODS: The National Cancer Database was queried for GBM patients who underwent surgical resection and external-beam radiation with chemotherapy. Patients were excluded if doses were less than 59.4 Gy; dose-escalation referred to doses ≥66 Gy. Odds ratios identified predictors of dose-escalation. Univariable and multivariable Cox regressions determined potential predictors of overall survival (OS). Propensity-adjusted multivariable analysis better accounted for indication biases. RESULTS: Of 33,991 patients, 1,223 patients received dose-escalation. Median dose in the escalation group was 70 Gy (range, 66 to 89.4 Gy). The use of dose-escalation decreased from 8% in 2004 to 2% in 2014. Predictors of escalated dose were African American race, lower comorbidity score, treatment at community centers, decreased income, and more remote treatment year. Median OS was 16.2 months and 15.8 months for the standard and dose-escalated cohorts, respectively (p = 0.35). On multivariable analysis, age >60 years, higher comorbidity score, treatment at community centers, decreased education, lower income, government insurance, Caucasian race, male gender, and more remote year of treatment predicted for worse OS. On propensity-adjusted multivariable analysis, age >60 years, distance from center >12 miles, decreased education, government insurance, and male gender predicted for worse outcome. CONCLUSION: Dose-escalated radiotherapy for GBM has decreased over time across the United States, in concordance with guidelines and the available evidence. Similarly, this large study did not discern survival improvements with dose-escalation.
Bias (Epidemiology) ; Cohort Studies ; Comorbidity ; Continental Population Groups ; Drug Therapy ; Education ; European Continental Ancestry Group ; Glioblastoma ; Humans ; Insurance ; Male ; Odds Ratio ; Radiotherapy ; United States

Objective: The Prostate Cancer Prevention Trial risk calculator (PCPT-RC) is an online tool for assessing the risk of prostate cancer (PCa) based on age, race, serum PSA, biopsy history, family history, and other factors. This study aimed to investigate the value, sensitivity and specificity of the PCPT-RC 2.0 in assessing the risk of PCa in the Chinese high-risk population. METHODS: This study included 622 patients with the high risk of PCa characterized by high serum PSA (PSA >3 μg/L) or abnormality in digital rectal examination or imaging of the prostate. According to the results of prostate biopsy, we divided the patients into a PCa and a non-PCa group and used the PCPT-RC 2.0 for evaluation of all the cases followed by statistical analysis. RESULTS: PCa was detected in 264 (42.4%) of the 622 patients, including 126 cases of high-grade malignancy. Compared with the non-PCa group, the PCa patients showed a significantly older age (［68.40 ± 7.30］ vs ［72.80 ± 7.20］ yr, P <0.001), higher serum PSA level (［11.20 ± 7.76］ vs ［15.06 ± 10.65］, P <0.001), and higher PCPT risk score (［37.0 ± 10.8］% vs ［44.4 ± 12.6］%, P <0.001). The PCPT risk score exhibited a greater area under the ROC curve than the level of serum PSA in evaluating the risk of PCa (0.67 vs 0.61, P <0.05), but no statistically significant difference between the two in predicting the risk of high-grade malignancy (0.67 vs 0.66, P >0.05). CONCLUSIONS The PCPT risk score is valuable in predicting the risk of PCa in China, which may play a better role than the serum PSA level in screening PCa and avoid unnecessary prostate biopsy, though its advantage is not so obvious in identifying high-grade malignancy. A prediction tool needs to be established for evaluating the risk of PCa in the Chinese population.
Age Factors ; Aged ; Asian Continental Ancestry Group ; Biopsy ; China ; Continental Population Groups ; Digital Rectal Examination ; Humans ; Male ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; pathology ; prevention & control ; ROC Curve ; Risk Assessment ; methods ; Risk Factors

OBJECTIVE: To study the genetic polymorphisms of 7 Y chromosome single nucleotide polymorphisms (Y-SNPs) among unrelated Mongolian males from Inner Mongolia Region. METHODS: Seven Y-SNPs with expected allelic frequencies close to 0.50:0.50 in Mongolian population were selected from databases including HapMap and relevant literature. The Y-SNPs were then analyzed among 95 unrelated male Mongolian DNA samples with ligase detection reaction (LDR) technique. Statistical analysis was carried out with Arlequin 3.5. RESULTS: All of the 7 Y-SNPs had 2 alleles. Seven haplotypes were identified among the 95 samples, with the haplotype diversity (HD) being 0.7990. Except for rs17316007, whose allelic frequencies was 0.832:0.168, each of the remaining Y-SNPs had a allelic frequency close to 0.50:0.50. The gene diversity (GD) for rs17316007 was 0.2825, while those of the remaining Y-SNPs were all greater than 0.4375. CONCLUSION Except for rs17316007, the other 6 Y-SNPs showed good diversity and genetic polymorphism, and may be used for individual identification and paternity testing for the Inner Mongolia region.
Asian Continental Ancestry Group ; China ; Chromosomes, Human, Y ; genetics ; Gene Frequency ; Genetics, Population ; Haplotypes ; Humans ; Male ; Polymorphism, Single Nucleotide

PURPOSE: The use of prostate-specific antigen as a biomarker for prostate cancer (PC) has been controversial and is, therefore, not used by many countries in their national health screening programs. The biological characteristics of PC in East Asians including Koreans and Japanese are different from those in the Western populations. Potential lifestyle risk factors for PC were evaluated with the aim of developing a risk prediction model. MATERIALS AND METHODS: A total of 1,179,172 Korean men who were cancer free from 1996 to 1997, had taken a physical examination, and completed a lifestyle questionnaire, were enrolled in our study to predict their risk for PC for the next eight years, using the Cox proportional hazards model. The model’s performance was evaluated using the C-statistic and Hosmer–Lemeshow type chi-square statistics. RESULTS: The risk prediction model studied age, height, body mass index, glucose levels, family history of cancer, the frequency of meat consumption, alcohol consumption, smoking status, and physical activity, which were all significant risk factors in a univariate analysis. The model performed very well (C statistic, 0.887; 95% confidence interval, 0.879 to 0.895) and estimated an elevated PC risk in patients who did not consume alcohol or smoke, compared to heavy alcohol consumers (hazard ratio [HR], 0.78) and current smokers (HR, 0.73) (p < 0.001). CONCLUSION: This model can be used for identifying Korean and other East Asian men who are at a high risk for developing PC, as well as for cancer screening and developing preventive health strategies.
Alcohol Drinking ; Asian Continental Ancestry Group ; Body Height ; Decision Support Techniques ; Early Detection of Cancer ; Forecasting ; Glucose ; Humans ; Life Style* ; Male ; Mass Screening ; Meat ; Motor Activity ; Physical Examination ; Population Characteristics ; Proportional Hazards Models ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Risk Factors ; Smoke ; Smoking

OBJECTIVETo examine the association between habitual sleep duration and obesity among Chinese adults.

METHODSThe association of sleep duration and obesity was investigated among 7,094 community-dwelling Chinese adults. Sleep duration was self-reported. In this study, obesity was defined as follows: body mass index (BMI) ⋝ 28 kg/m2, waist circumference (WC) ⋝ 85 cm in men and ⋝ 80 cm in women, and percent body fat (%BF) ⋝ 25 in men and ⋝ 35 in women. Logistic and quantile regressions were employed to examine relationships of interest.

RESULTSOverall, 6.42% of the participants reported short sleep durations (< 6 h/d) while 14.71% reported long (⋝ 9 h/d) sleep durations. Long sleepers (⋝ 9 h/d) represented a greater frequency of women with obesity [odds ratio (OR): 1.30; 95% confidence interval (CI), 1.02-1.67] and high body fat (1.43, 1.04-1.96) than those who slept 7-8 h/d. An association between long sleep times and higher BMI estimations was found across the 10th-75th percentile of the BMI distribution. Among men, long sleepers (⋝ 9 h/d) presented lower risks of developing abdominal obesity compared with individuals who slept 7-8 h/d (OR = 0.79, 95% CI: 0.44-0.99).

CONCLUSIONOur study suggests that long sleep durations are associated with general obesity in Chinese women but reduced waist circumferences in men. Confirmatory studies are needed to determine the heterogeneous association of sleep time and obesity by gender.

Adipose Tissue ; physiology ; Adult ; Asian Continental Ancestry Group ; Body Mass Index ; China ; Female ; Humans ; Male ; Middle Aged ; Rural Population ; Sleep ; physiology ; Surveys and Questionnaires ; Urban Population ; Waist Circumference

OBJECTIVETo develop a risk model for predicting later development of diabetic nephropathy (DN) in Chinese people with type 2 diabetes mellitus (T2DM) and evaluate its performance with independent validation.

METHODSWe used data collected from the project 'Comprehensive Research on the Prevention and Control of Diabetes', which was a community-based study conducted by the Jiangsu Center for Disease Control and Prevention in 2013. A total of 11,771 eligible participants were included in our study. The endpoint was a clear diagnosis of DN. Data was divided into two components: a training set for model development and a test set for validation. The Cox proportional hazard regression was used for survival analysis in men and women. The model's performance was evaluated by discrimination and calibration.

RESULTSThe incidence (cases per 10,000 person-years) of DN was 9.95 (95% CI; 8.66-11.43) in women and 11.28 (95% CI; 9.77-13.03) in men. Factors including diagnosis age, location, body mass index, high-density-lipoprotein cholesterol, creatinine, hypertension, dyslipidemia, retinopathy, diet control, and physical activity were significant in the final model. The model showed high discrimination and good calibration.

CONCLUSIONThe risk model for predicting DN in people with T2DM can be used in clinical practice for improving the quality of risk management and intervention.

Aged ; Asian Continental Ancestry Group ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; pathology ; Female ; Humans ; Male ; Middle Aged ; Models, Biological ; Reproducibility of Results ; Risk Factors ; Urban Population

BACKGROUND: Worldwide, approximately 2% of new cancers are of the brain. Five-year survival rates among brain cancer patients have been reported as a little over a third. Differences in clinical outcomes between brain tumor patients of different races remain poorly understood. METHODS: A retrospective chart review was performed on brain tumor resection patients≥18 years old. Demographics, treatment variables, and survival outcomes were collected. Primary outcomes were length of stay, recurrence rate, progression-free survival (PFS), and overall survival (OS). RESULTS: A total of 452 patients were included in analysis. Females and males had nearly a 1:1 ratio (n=242 and n=220, respectively). Mean age was 54.8 years (SD: 14.5 range: 18–90). Females composed 69% (n=48) of Asian patients; males constituted 31% (n=22). Mean age of the Asian patients was 55.9 years (SD: 14.6 range: 26–89). Asian-only cohort tumor pathologies included glioblastoma (GBM) (n=14), high-grade glioma (n=7), low-grade glioma (n=4), meningioma (n=38), and metastases (n=7). Of the 185 meningioma patients, non-Asian patients comprised 79% of the group (n=146). Of the 65 GBM patients in total, non-Asian patients made up 89% of the GBM cohort (n=58). There were no statistically significant differences between these groups of both cohorts in recurrence (p=0.1580 and p=0.6294, respectively), PFS (p=0.9662 and p=0.4048, respectively), or OS (p=0.3711 and p=0.8183, respectively). CONCLUSION: Studies evaluating the survival between patients of different racial backgrounds against several tumor varieties are rare. Patients of certain racial backgrounds may need additional consideration when being attended to despite the same mutational composition as their counterparts. Repeated studies using national databases may yield more conclusive results.
Asian Continental Ancestry Group* ; Biomarkers ; Brain Neoplasms* ; Brain* ; Cohort Studies ; Continental Population Groups ; Demography ; Disease-Free Survival ; Female ; Glioblastoma ; Glioma ; Humans ; Length of Stay ; Male ; Meningioma ; Neoplasm Metastasis ; Pathology ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVETo study the polymorphisms of human platelet antigen (HPA) 1-16 and human leukocyte antigen (HLA)-A and -B loci among ethnic Han population from Shandong.

METHODSA total of 588 samples from platelet donors were genotyped for the above loci with sequence-specific primer PCR and sequence-specific oligonucleotide probe PCR.

RESULTSThe frequencies of HPA-la, -1b, HPA-2a, -2b, HPA-3a, -3b, HPA-4a, -4b, HPA-5a, -5b, HPA-6a, -6b, HPA-15a, -15b were 0.9974, 0.0026, 0.9456, 0.0544, 0.5417, 0.4583, 0.9983, 0.0017, 0.9889, 0.0111, 0.9903, 0.0097, 0.5434 and 0.4583, respectively. The HPA-7-14 and HPA-16 showed no heterozygosity as the b allele was not detected in such loci. The most common genotypic combination for HPA was HPA-(1,4,7-14,16,17) aa-2aa-3ab-5aa -6aa-15ab (0.1820). HLA-A2 (0.3070) and HLA-B13 (0.1361) demonstrated the highest frequencies at their respective loci.

CONCLUSIONThe HPA and HLA loci are highly polymorphic among ethnic Hans from Shandong. The distribution of HPA polymorphisms also shows a great ethnic and territorial difference. It is important to construct regional database for the genotypes of HPA and HLA loci for platelet donors.

Alleles ; Antigens, Human Platelet ; genetics ; Asian Continental Ancestry Group ; genetics ; statistics & numerical data ; Blood Donors ; China ; Female ; Gene Frequency ; Genetics, Population ; Genotype ; HLA-A Antigens ; genetics ; HLA-B Antigens ; genetics ; Humans ; Linkage Disequilibrium ; Male ; Polymorphism, Genetic

OBJECTIVETo understand the epidemiological characteristics of head injuries in children.

METHODSData was derived from the Chinese National Injury Surveillance System (NISS) in 2014. Method on descriptive analysis was applied to depict general information, injuries events and clinical characteristics of head injuries among children under 18 years of age.

RESULTSA total number of 47 690 cases with child head injuries in 2014 were collected, including 32 542 males and 15 148 females. 43.47% of them were under 1-4 years of age. In October, 06:00 PM appeared the peak time for the injuries to happen. The three leading causes responsible for child head injuries were falls (69.57%), hit by blunt force (14.23%) or road traffic (11.01%). Main locations responsible for the head injuries to happen were:at home (44.98%), at public places (19.65%) or on roads/streets (15.81%). Recreation activates (77.88%), driving (7.32%), sports (5.72%) were the three major activities causing the injuries to take place. Majority of the cases happened unintentionally (95.35%), with bruise (71.69%) or mild injuries (85.27%) and went back home after treatment (90.25%).

CONCLUSIONSIn 2014, child head injuries were seen more in males than in females and mostly occured at home. The leading causes for head injuries would include falls, hit by blunt stuff or road traffic .

Accidental Falls ; statistics & numerical data ; Accidents, Traffic ; statistics & numerical data ; Asian Continental Ancestry Group ; statistics & numerical data ; Automobile Driving ; Child ; China ; epidemiology ; Craniocerebral Trauma ; epidemiology ; Environment ; Female ; Humans ; Male ; Population Surveillance ; Recreation ; Sports ; Transportation ; Wounds and Injuries ; epidemiology

OBJECTIVETo investigate the cumulative effect regarding the family history of cardiovascular disease and smoking on ischemic stroke events in population with Mongolian ethnicity.

METHODSBased on data gathered from the baseline investigation, a 10-year prospective cohort follow-up project was conducted among 2 589 participants with Mongolian ethnicity. Ischemic stroke events were defined as the outcomes of the study. All the 2 589 participants were categorized into four subgroups: without family history of cardiovascular disease/nonsmokers, without family history of cardiovascular disease/smokers, with family history of cardiovascular disease/nonsmokers and with family history of cardiovascular disease/smokers, according to family history of cardiovascular disease and smoking status. Cumlative incidence rates of events among the four subgroups was described with Kaplan-Meier curves. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (95%CI) of ischemic stroke events among the four subgroups.

RESULTSData from the Kaplan-Meier curves showed that the cumulative incidence rates of ischemic stroke were 1.17% (15/1 278), 3.83% (37/967), 5.70% (9/158) and 8.33% (15/180) for the groups of no family history of cardiovascular disease/nonsmokers, no family history of cardiovascular disease/smokers, with family history of cardiovascular disease/nonsmokers and with family history of cardiovascular disease/smokers, respectively. By cox proportional hazards model, after adjusting for age, male, drinking status, systolic and diastolic blood pressure, body mass index, fasting glucose, total cholesterol, triglycerides, LDL cholesterol factors, the HRs (95% CI) of ischemic stroke were 2.26 (1.19-4.28) and 2.45 (1.13-5.33) in the no family history of cardiovascular disease/smokers group, with family history of cardiovascular disease/smokers group when compared to the no family history of cardiovascular disease/nonsmokers group, respectively. The risk of ischemic stroke appeared the highest in the group with family history of cardiovascular disease/smokers (all P<0.05).

CONCLUSIONSmoking may increase the risk of ischemic stroke events among the population with family history of cardiovascular disease.

Alcohol Drinking ; Asian Continental Ancestry Group ; ethnology ; genetics ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; ethnology ; genetics ; Cholesterol ; Cholesterol, LDL ; Genetic Predisposition to Disease ; Humans ; Incidence ; Male ; Mongolia ; epidemiology ; Population Surveillance ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Smoking ; adverse effects ; epidemiology ; Stroke ; epidemiology ; genetics