Deficiencies in the Diagnosis and Treatment of Pulmonary Metastatic Osteosarcoma: A Chinese Multidisciplinary Survey

Background and objective Osteosarcoma is the most frequent primary cancer of bone. The incidence is higher in adolescents. Large improvement, though, has been made in the treatment of osteosarcoma under the framework of multidisciplinary team, an important prognostic factor for osteosarcoma is pulmonary metastasis. Surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. Undoubtedly, surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. However, since current conceptions within the surgical approach to lung metastasectomy involve multidisciplinary collaboration, which are highly variable,there is not neither consensus nor standardized practice patterns. We conduct a survey aiming to reveal areas of consistency in current clinical practice on lung metastasectomy among Chinese osteosarcoma high volume centers. Methods A questionnaire survey specific to the nationwide high volume centers of osteosarcoma was conducted from September 2015 to November 2015. Analyses were stratified by hospital, working duration, case volume and medical discipline. Results Of 150 invited physicians, 105 participated, resulting in an overall response rate of 70%. Forty-one percent of the responded physicians agreed with the statement that orthopedic oncology should play a predominant role in the multidisciplinary team. More than 64% of respondents chose metastasectomy as the preferred local control approach, and up to 78.1% of respondents recommended pulmonary metastasectomy for patients. Compared with orthopedic surgeons, other physicians were significantly more likely to report not advocating pulmonary metastasectomy in their practice (ORothers=0.02; 95%CI: 0.00-0.22; P=0.001), and thoracic surgeons were more likely to decide metastasectomy according to indications rather than the number limit of metastases (ORthoracic surgeons=20.93; 95%CI: 2.05-213.64; P=0.001). For the most preferred radiographic evaluation option, approximately 83% of respondents reported diagnostic use of computed tomography (CT). More than 70% of respondents reported that chest CT follow-up should be 3 months after the primary site resection; approximately 68% deemed the diagnostic accuracy of CT about 90%; most respondents (92%) recommended the extrapulmonary imaging evaluation simultaneously. Around 46% of respondents reported that survival duration longer than 6 months after pulmonary metastasectomy is beneficial. Conclusion This study offers new information about the variability in the reported management of pulmonary metastatic osteosarcoma in China, reflecting the deficiencies in unified practice patterns. The results of this survey also provide baseline data for future research and for the development of international guidelines

Maritime Security on the Asia-Pacific: A Navigational Map for the New U.S. Administration

Created as part of the 2017 Jackson School for International Studies SIS 495: Task Force.Maritime security in the Asia-Pacific entails “traditional” security concerns such as naval power, and “non-traditional” security issues such as piracy, climate change and fisheries depletion. This task force evaluates policy options for a comprehensive maritime strategy for U.S. leadership

Yellowfin Tuna (Thunnusalbacares) Fishing Ground Forecasting Model Based On Bayes Classifier In The South China Sea

Using the yellowfin tuna (Thunnusalbacares,YFT)longline fishing catch data in the open South China Sea (SCS) provided by WCPFC, the optimum interpolation sea surface temperature (OISST) from CPC/NOAA and multi-satellites altimetric monthly averaged product sea surface height (SSH) released by CNES, eight alternative options based on Bayes classifier were made in this paper according to different strategies on the choice of environment factors and the levels of fishing zones to classify the YFT fishing ground in the open SCS. The classification results were compared with the actual ones for validation and analyzed to know how different plans impact on classification results and precision. The results of validation showed that the precision of the eight options were 71.4%, 75%, 70.8%, 74.4%, 66.7%, 68.5%, 57.7% and 63.7% in sequence, the first to sixth among them above 65% would meet the practical application needs basically. The alternatives which use SST and SSH simultaneously as the environmental factors have higher precision than which only use single SST environmental factor, and the consideration of adding SSH can improve the model precision to a certain extent. The options which use CPUE’s mean ± standard deviation as threshold have higher precision than which use CPUE’s 33.3%-quantile and 66.7%-quantile as the threshol

Additional file 2 of Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study

Additional file 2: Table S1.Baseline characteristics by participant site. Table S2.Multivariate analyses of recurrence-free survival in total population (Cox model). Table S3.Multivariate analyses of overall survival in total population (Cox model). Table S4.Interaction between preoperative CEA and CA19-9 with risk of outcomes. Table S5.Multivariate analyses of recurrence-free survival in colorectal cancer subgroup with CEA < 5 ng/ml (Cox model). Table S6.Multivariate analyses of recurrence-free survival in colorectal cancer subgroup with CEA ≥ 5 ng/ml (Cox model). Table S7. Multivariate analyses of overall survival in colorectal cancer subgroup with CEA < 5 ng/ml (Cox model). Table S8.Multivariate analyses of overall survival in colorectal cancer subgroup with CEA ≥ 5 ng/ml (Cox model). Table S9.A frailty model analysis of preoperative CA19-9 (cutoff: 37 U/ml) on colorectal cancer outcomes in total population. TableS10.Cox proportional hazard regression analysis of preoperative CA19-9 (cutoff:74 U/ml) on colorectal cancer outcomes in total population. Table S11.Relationship between preoperative CA19-9 and benefit from adjuvant chemotherapyin patients with stage II colorectal cancer

Additional file 1 of Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study

Additional file 1: FigureS1. Association between preoperative CA19-9 status and overall survival. (a) overall population. (b) patients with normal preoperative CEA. (c) patientswith elevated preoperative CEA. Solid yellow lines are unadjustedhazard ratios, with dashed yellow lines showing 95% confidence intervalsderived from restricted cubic spline regressions. Reference lines for noassociation are indicated by the solid bold lines at a hazard ratio (HR) of 1.0. Dashed blue curves show the fraction of the population with different levels of preoperative CA19-9. Arrows indicate the concentration of preoperative CA19-9 with HR of 1.0. CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; E, number of events; HR, hazard ratio; N, number of patients. FigureS2. Kaplan‐Meier curves for overall survival according to the preoperative CA19-9 group. (a) overall population. (b) patients with normal preoperative CEA. (c) patientswith elevated preoperative CEA. CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen. FigureS3. Kaplan‐Meier curves according to the joint group of preoperative CEA and CA19-9 in colorectal cancer patients. (a) recurrence-free survival. (b) overall survival. CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; OS, overall survival; RFS, recurrence-free survival. FigureS4. Forest plot for recurrence-free survival of preoperative CA 19-9 groups stratified by clinicopathological features based on the Cox models. P values for interaction were calculated using Cox regression model. HR and 95%CIs were given and visually represented by the squares and error bars. CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidence interval; HR, hazard ratio. FigureS5. Forest plot for performance overallsurvival of preoperative CA19-9 groups stratified by clinicopathological features based on the Cox models. P values for interaction were calculated using Cox regression model. HR and 95%CIs were given and visually represented by the squares and error bars. CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CI, confidenceinterval; HR, hazard ratio. FigureS6. Kaplan‐Meier curves according to the joint group of preoperative CEA and CA19-9 in patients with stage II colorectal cancer. (a) recurrence-free survival.(b) overall survival. CA 19-9, carbohydrate antigen 19-9;CEA, carcinoembryonic antigen; OS, overall survival; RFS, recurrence-freesurvival