Background: Web-based applications are available for prognostication of individual patients. These prognostic models were developed for groups of patients. No one is the average patient, and using these calculators to inform individual patients could provide misleading results.
Objective: This article gives an example of paradoxical results that may emerge when indices used for prognosis of the average person are used for care of an individual patient.
Methods: We calculated the expected mortality risks of stomach cancer and its associated comorbidities. Mortality risks were calculated using data from 140,699 Veterans Administration nursing home residents.
Results: On average, a patient with hypertension has a higher risk of mortality than one without hypertension. Surprisingly, among patients with lung cancer, hypertension is protective and reduces risk of mortality. This paradoxical result is explained by how group-level, average prognosis could mislead individual patients. In particular, average prognosis of lung cancer patients reflects the impact of various comorbidities that co-occur in lung cancer patients. The presence of hypertension, a relatively mild comorbidity of lung cancer, indicates that more serious comorbidities have not occurred. It is not that hypertension is protective; it is the absence of more serious comorbidities that is protective. The article shows how the presence of these anomalies can be checked through the mathematical concept of preferential risk independence.
Conclusion: Instead of reporting average risk scores, web-based calculators may improve accuracy of predictions by reporting the unconfounded risks.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1089/jpm.2016.0126 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Census Tract Rurality, Predominant Race and Ethnicity, and Distance to Lung Cancer Screening Facilities : An Ecological Study.
Ann Intern Med
January 2025
Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington (C.L.W., A.C.W., J.A.G.).
Background: The U.S. Preventive Services Task Force recommends annual lung cancer screening (LCS) for adults who meet specific age and smoking history criteria.
View Article and Find Full Text PDFObjective: To investigate the effect of Brucea javanica Oil combined with chemotherapy on serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), immune mechanism, and prognosis in patients with lung cancer and provide a reference for its clinical diagnosis and treatment.
Methods: This study involved 112 lung cancer patients from June 2019 to January 2022 at Shanghai Guanghua Hospital. They were randomly divided into two groups: control (chemotherapy only) and observation (chemotherapy + Brucea javanica oil emulsion).
Brain metastasis (BM) is a poor prognostic factor in cancer patients. Despite showing efficacy in many extracranial tumors, immunotherapy with anti-PD-1 monoclonal antibody (mAb) or anti-CTLA-4 mAb appears to be less effective against intracranial tumors. Promisingly, recent clinical studies have reported that combination therapy with anti-PD-1 and anti-CTLA-4 mAbs has a potent antitumor effect on BM, highlighting the need to elucidate the detailed mechanisms controlling the intracranial tumor microenvironment (TME) to develop effective immunotherapeutic strategies.
View Article and Find Full Text PDFCryoshocked Adipocytes Mediated Dual-Modal Strategy Combining Photodynamic Therapy and Triptolide Palmitate for Pulmonary Metastatic Melanoma Treatment.
Adv Sci (Weinh)
January 2025
Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Pulmonary metastasis represents one of the most prevalent forms of metastasis in advanced melanoma, with mortality rates reaching 70%. Current treatments including chemotherapy, targeted therapy, and immunotherapy frequently exhibit limited efficacy or present high costs. To address these clinical needs, this study presents a biomimetic drug delivery system (Ce6-pTP-CsA) utilizing cryoshocked adipocytes (CsA) encapsulating the prodrug triptolide palmitate (pTP) and the photosensitizer Ce6, exploiting the characteristic of tumor cells to recruit and lipolyze adipocytes for energy.
View Article and Find Full Text PDFImpact of sex hormones on pheochromocytomas, paragangliomas, and gastroenteropancreatic neuroendocrine tumors.
Eur J Endocrinol
January 2025
Department of Internal Medicine IV, LMU University Hospital, LMU Munich, 80336 Munich, Germany.
Objective: The effects of sex hormones remain largely unexplored in pheochromocytomas and paragangliomas (PPGLs) and gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Methods: We evaluated the effects of estradiol, progesterone, Dehydroepiandrosterone sulfate (DHEAS), and testosterone on human patient-derived PPGL/GEP-NET primary culture cell viability (n = 38/n = 12), performed next-generation sequencing and immunohistochemical hormone receptor analysis in patient-derived PPGL tumor tissues (n = 36).
Results: In PPGLs, estradiol and progesterone (1 µm) demonstrated overall significant antitumor effects with the strongest efficacy in PPGLs with NF1 (cluster 2) pathogenic variants.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!