Anniversaries and Special Events ; Genomics ; Humans ; Internationality ; Mammography ; utilization ; Neoplasms ; diagnosis ; drug therapy ; genetics ; prevention & control

Bezoars ; complications ; Fruit ; adverse effects ; Gallstones ; diagnosis ; pathology ; Humans ; Ileus ; diagnosis ; etiology ; Male ; Middle Aged ; Seeds ; adverse effects ; Tomography, X-Ray Computed

Humans ; Neoplasms ; therapy ; Practice Guidelines as Topic ; Singapore

[Objective]To evaluate the terminal hair growth of different body positions among in pregnant women ,analyze the contribution of each area to the diagnosis to hirsutism ,to improve the mFG scoring system.[Method]Pregnant women aged 20~41 years,with normal range of total testosterone levels and non-hirsute were recruited at their prenatal care in Sun Yat-sen Memorial Hospital,Sun Yat-sen University. They were followed up before pregnancy,at the 5th and the 9th week,the 10th and the 14th week, the 15th and the 20th week,the 21th and the 24th week of gestation. Then 72 more cases of pregnant women were recruited and followed up at 15~24th week. At each time of followed up,their total testosterone(TT)levels was examined by liquid chromatography tandem mass spectrometry(LC/MS-MS)and terminal hair growth were assessed by mFG score. Significant difference procedure least(LSD) analysis of variance was used to compare the levels of testosterone and mFG score in different gestational weeks. Receiver operating characteristics(ROC)analysis and logistics analysis were conducted to evaluate the contributory strength of hair growth in each body position for the diagnosis of hirsutism. The scores in the body area which made a significant contribution to the total were summed up and termed the simplified mFG score(sFG score). Following,the sFG scores were subjected to ROC analysis to determine the thresh-old that would maximize both the sensitivity and specificity of the measure to accurately distinguish hirsute from non-hirsute patients.[Results]Among the forty three pregnant women who were followed-up from before pregnancy to 24th week,the mean±SD for TT was (1.09 ± 0.59)nmol/L before pregnancy,and(1.13 ± 0.40),(1.28 ± 0.38),(1.83 ± 0.63),(1.82 ± 0.52)nmol/L for 5~ 9th,10~14th,15~20th week,and the mFG score was 1.65 ± 0.60,2.30 ± 0.45,3.60 ± 0.68,4.20 ± 0.41 and 4.40 ± 0.77,respectively. The order of the facial and body sites presented with new terminal hair growth was upper abdomen,lower abdomen,lower back,up-per lip,thighs,upper back,chest,upper arm,and chin,in sequence. After analyzing 115 cases(including the 72 cases recruited later),ROC analysis showed that the diagnostic value of different sites for hirsutism(mFG≥5):upper lip>lower back>thighs>lower abdomen>upper arm>upper back>chest/upper abdomen. Four sites among them ,namely upper lip ,lower back ,thighs and lower abdomen had the best diagnostic value,and the AUC for ROC were 0.779,0.728,0.675,and 0.626,respectively. Both ROC and logistic analysis indicated that he most significant body areas in defining hirsutism(defined as an mFG score≥5)were the upper lip, lower back,thighs,and lower abdomen. Using a cut-off value of 3,the combination of the four areas has the best sensitivity and specificity in distinguishing hirsute from non-hirsute women. [Conclusion]The study suggested that the mFG score increased as pregnancy progressed before the 24 weeks of gestation. The subset of upper lip,lower back,thighs and lower abdomen may be a reli-able simplification of mFG system for the evaluation of excess hair growth. The cut-off value was of≥3.

Anniversaries and Special Events ; Global Health ; Humans ; Mortality, Premature ; Neoplasms ; prevention & control

Adult ; Carcinoma, Renal Cell ; complications ; pathology ; Castleman Disease ; complications ; pathology ; Humans ; Kidney Neoplasms ; complications ; pathology ; Male ; Sentinel Lymph Node Biopsy

Androgen Antagonists ; therapeutic use ; Anilides ; therapeutic use ; Antineoplastic Agents, Hormonal ; therapeutic use ; Bone Neoplasms ; complications ; secondary ; Goserelin ; therapeutic use ; Humans ; Male ; Middle Aged ; Nitriles ; therapeutic use ; Prostatic Neoplasms ; complications ; drug therapy ; Purpura, Thrombotic Thrombocytopenic ; drug therapy ; etiology ; Tosyl Compounds ; therapeutic use

INTRODUCTIONMost international clinical practice guidelines for prostate cancer (PCa) are driven by data derived in a Western setting. However, tumour biology and clinical disease progression are likely to differ in the Asian population. We compare the performance of the revised American Joint Committee on Cancer (AJCC) prognostic groups with the commonly used D'Amico Risk Classification and conventional predictors for PCa, in a large cohort of Asian patients.

MATERIALS AND METHODSWe retrospectively reviewed data for 404 consecutive Singaporean patients receiving definitive radiotherapy at our centre between December 1996 and October 2006. The primary outcome was biochemical relapse-free survival (BRFS), defined using the Phoenix definition. The secondary outcome was overall survival (OS). Prognostic risk groups were defined using AJCC 7th edition (AJCC7) and 6th edition (AJCC6). Univariate analysis (UVA) and multivariate analysis (MVA) were performed for the following putative risk factors: age, Gleason score, prognostic grouping, tumour classification, radiation delivery technique, radiotherapy dose, hormonal therapy and initial PSA value.

RESULTSFor the cohort, median age was 69 years. Median follow-up was 66.3 months. Five-year BRFS rate was 84.3% with 71 biochemical relapses and 5-year OS rate was 89.1% with 54 deaths. The concordance-indices for BRFS prediction were 0.588, 0.550 and 0.567 for AJCC7, AJCC6 and D'Amico respectively. Initial PSA, T-stage and AJCC7 were prognostic for BRFS on UVA. Comparison of AJCC7 vs. D'Amico showed no statistical additional value of either classification system although D'Amico was superior when compared to AJCC6 in predicting BRFS. T-stage ≥3 and D'Amico were significant prognostic factors for BRFS on MVA.

CONCLUSIONIn our local, predominantly Chinese population, neither AJCC6 nor AJCC7 demonstrated a high predictive accuracy for BRFS although AJCC7 has a slightly better predictive ability than AJCC6.

Aged ; Aged, 80 and over ; Asia ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Practice Guidelines as Topic ; Prognosis ; Prostatic Neoplasms ; pathology ; radiotherapy ; Radiotherapy ; methods ; Retrospective Studies ; United States

Unusual sites of metastases are recognized in patients with renal cell carcinoma (RCC). However, the prognostic implications of these sites are not well understood. We used the Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification for metastatic RCC to evaluate 912 consecutive patients with RCC managed at the Singapore General Hospital between 1990 and 2009. Among these patients, 301 had metastases either at diagnosis or during the course of illness. Nasal metastases, all arising from clear cell RCC, were identified histologically in 4 patients (1.3% of those with metastasis). All 4 patients were classified as MSKCC poor prognosis by current risk criteria. Nasal metastases were significantly associated with lung and bone metastases. The frequency of nasal metastases in patients with metastatic RCC is about 1%, occurring predominantly in patients with clear cell RCC. Nasal metastases are associated with poor prognosis as estimated by the MSKCC risk classification, with attendant implications for selection of targeted therapy, and are usually associated with multi-organ dissemination, including concurrent lung and bone involvement.
Antineoplastic Agents ; therapeutic use ; Bone Neoplasms ; secondary ; Carcinoma, Renal Cell ; diagnostic imaging ; secondary ; therapy ; Female ; Humans ; Indoles ; therapeutic use ; Kidney Neoplasms ; diagnostic imaging ; pathology ; therapy ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Nephrectomy ; Nose Neoplasms ; pathology ; secondary ; therapy ; Pyrroles ; therapeutic use ; Skull Neoplasms ; diagnostic imaging ; secondary ; Tomography, X-Ray Computed

INTRODUCTIONHigh levels of toxicities have been observed when docetaxel is administered at the standard dose of 75 mg/mevery 3 weeks (Q3W) in the real-world treatment of Asian patients with metastatic castrate-resistant prostate cancer (CRPC). This study aimed to evaluate the efficacy and tolerability of 2 attenuated regimens more widely used in an Asian setting to minimise toxicity - 60 mg/mQ3W and weekly docetaxel (20 mg/mto 35 mg/m).

MATERIALS AND METHODSMedical records of 89 CRPC patients between December 2003 and April 2013 were reviewed. Pairwise statistical analysis was performed, comparing efficacy and safety outcomes of 75 mg/mQ3W and weekly docetaxel with 60 mg/mQ3W. Treatment endpoints used were prostate-specific antigen (PSA) response (decrease of ≥50% from baseline), pain improvement after cycle 2, overall survival, time to disease progression and radiological response.

RESULTSPatients who received docetaxel at 75 mg/mQ3W were younger than those who received 60 mg/mQ3W (62 years and 66 years, respectively;= 0.0489). Both groups had similar response rates. Compared with patients on 60 mg/mQ3W, more patients on weekly regimens were symptomatic at baseline (63.2% and 87.5%, respectively;= 0.0173). Longer overall survival was observed in the 60 mg/mQ3W arm than the weekly docetaxel arm (16.9 months and 10.6 months, respectively;= 0.0131), though other measures of response did not differ significantly.

CONCLUSIONOur data supports the use of 60 mg/mQ3W docetaxel which has similar efficacy and an acceptable toxicity profile compared to the standard 75 mg/mQ3W regimen. Weekly docetaxel has significant palliative benefits among symptomatic patients despite lower overall survival.