The clinicopathological features and prognosis of signet ring cell carcinoma of the esophagus: A 10-year retrospective study in China.

The aim of this study was to analyze the clinicopathological features and prognosis of esophageal signet ring cell (SRC) carcinoma in China.Patients with poorly differentiated adenocarcinoma were identified in two hospitals from January 2006 to June 2016. The patients were divided into three groups according to component of SRCs: SRC≥50% group, SRC < 50% group and non-SRC poorly differentiated adenocarcinoma group.Fifty-seven patients had carcinoma (SRC≥50%), and 79 patients had tumors containing <50% SRCs, and 535 patients was in non-SRC poorly differentiated adenocarcinoma group. There were no significant differences among the three groups in clinicopathological characteristics. Patients in SRC≥50% group had a lower overall survival rate (at 3-year 37.6%versus71.1%; at 5-year 0% versus 43.3%; p<0.001) compared with the control group. Even survival outcome of patients in SRC < 50%was inferior to that of in control group (at 3-year 53.0%versus71.1%; at 5-year 25.9% versus 43.3%; p<0.001). Female sex, large tumor size and increasing TNM stage were independent prognostic factors for SRC ≥50% esophageal carcinoma patients.The incidence of esophageal SRC carcinoma is relatively rare and the worst outcome is observed in the SRC≥ 50% group. It is necessary to explore new therapeutic modalities to achieve further improvements in the clinical outcome of these patients

Incidence and Effects of Polypharmacy on Clinical Outcome among Patients Aged 80+: A Five-Year Follow-Up Study.

Polypharmacy is a problem of growing interest in geriatrics with the increase in drug consumption in recent years, is defined according to the WHO criteria as the, ''concurrent use of five or more different prescription medication". We investigated the clinical characteristics of polypharmacy and identified the effects of polypharmacy on clinical outcome among patients aged 80+ admitted to Chinese PLA general hospital.Older men aged ≥80 years (n = 1562) were included in this study. The included participants attended a structured clinical examination and an interview carried out by a geriatrician and trained nurses. A follow-up survey in 2014 was carried out on survivors in the same way as in 2009. The clinical outcome measured were adverse drug reactions, falls, frailty, disability, cognitive impairment, mortality. The association between polypharmacy and clinical outcome was assessed by logistic regression.The mean (range) age of the included participants was 85.2 (80-104) years. Medication exposure was reported by 100% of the population. Mean number of medications reported in this population was 9.56±5.68. The prevalence of polypharmacy (≥6 medications) in the present study was 70%. At the time of the follow-up survey, an increase in the number of taken medicines had occurred among half of the survivors. The risk of different outcomes in relation to number of medications rises significantly, the odds ratios were 1.21 (95% confidence interval [CI]1.17-1.28) for adverse drug reactions, 1.18 (95% CI 1.10-1.26) for falls, 1.16 (95% CI 1.09-1.24) for disability, and 1.19 (95% CI 1.12-1.23) for mortality. There was no association between increasing number of medications and cognitive impairment.Our study demonstrates that polypharmacy is very common in the very old patients, and observed that number of medications was a factor associated with difference clinical outcome independently of the age, type of medications prescribed and accompanied comorbidities

Kaplan-Meier survival curves by the presence of SRCs.

<p>Kaplan-Meier survival curves by the presence of SRCs.</p

Characteristics of the patients according to the therapy group.

<p>Characteristics of the patients according to the therapy group.</p

Perioperative and histopathological variables of the resected specimen.

<p>Perioperative and histopathological variables of the resected specimen.</p

Consort diagram.

<p>Consort diagram.</p

Hematoxylin and eosin—Stained section (200 magnification) of a biopsy specimen showing (A) SRC≥50% and (B) SRC<50%, and (C) poorly differentiated adenocarcinoma (reference group).

<p>Hematoxylin and eosin—Stained section (200 magnification) of a biopsy specimen showing (A) SRC≥50% and (B) SRC<50%, and (C) poorly differentiated adenocarcinoma (reference group).</p

Univariate analysis of the 57 patients with primary esophageal carcinoma containing ≥50%SRCs.

<p>Univariate analysis of the 57 patients with primary esophageal carcinoma containing ≥50%SRCs.</p

ORs of different outcomes in relation to number of medications.

<p>ADR, Adverse Drug Reactions; CI,Confidence interval; OR, odds ratio. ORs are for risk with increasing of medications by one.</p><p>*Adjusted for age, type of medications and comorbidities.</p><p>ORs of different outcomes in relation to number of medications.</p

Changes (%) in functional ability (IADL test) and cognitive capacity (MMSE test) among survivors from 2009 to 2014.

<p>NP, Non-polypharmacy; P, Polypharmacy; EP, Excessive Polypharmacy; ADR, Adverse Drug Reactions. p-Values for categorical variables were measured with a chi-square (x²) test and for continuous variables with ANOVA.</p><p>Changes (%) in functional ability (IADL test) and cognitive capacity (MMSE test) among survivors from 2009 to 2014.</p