Suchergebnisse

AbstractAttempts at measuring decentralisation are still in an underdeveloped stage. The reason for this lies in the failure to devise common standards against which measurement is possible and the lack of consensus about the very meaning of decentralisation. An attempt to measure decentralisation was made by Vengroff and Ben Salem in the context of Tunisia nearly a decade ago. An expanded and adapted version of this model is used to measure decentralisation in Kerala using the same judgmental criteria that they used after involving a panel of nine experts. These experts had a fairly good understanding of the practice of decentralisation to score on the basis of the adapted criteria. An ideal form of decentralisation envisaged in this measurement exercise is devolution. It has been found that on a scale ranging between 0 and 5, the state of Kerala obtained a score of 2.00 in spite of the fact that the investment that the state had made in decentralisation has no parallels anywhere in the developing countries. Such a low score, despite the much publicised campaign for decentralisation, was due to the focus on planning rather than on decentralisation issues. Attempts to measure decentralisation will not only enable us to develop more contextually valid measures of decentralisation, but also contribute to the clarification of the concept of decentralisation, particularly by identifying aspects neglected hitherto. Copyright © 2003 John Wiley & Sons, Ltd.

PurposePhosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutations are frequently observed in primary breast cancer. We evaluated their prognostic relevance by performing a pooled analysis of individual patient data.Patients and MethodsAssociations between PIK3CA status and clinicopathologic characteristics were tested by applying Cox regression models adjusted for age, tumor size, nodes, grade, estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, treatment, and study. Invasive disease-free survival (IDFS) was the primary end point; distant disease-free survival (DDFS) and overall survival (OS) were also assessed, overall and by breast cancer subtypes.ResultsData from 10,319 patients from 19 studies were included (median OS follow-up, 6.9 years); 1,787 patients (17%) received chemotherapy, 4,036 (39%) received endocrine monotherapy, 3,583 (35%) received both, and 913 (9%) received none or their treatment was unknown. PIK3CA mutations occurred in 32% of patients, with significant associations with ER positivity, increasing age, lower grade, and smaller size (all P amp;lt; .001). Prevalence of PIK3CA mutations was 18%, 22%, and 37% in the ER-negative/HER2-negative, HER2-positive, and ER-positive/HER2-negative subtypes, respectively. In univariable analysis, PIK3CA mutations were associated with better IDFS (HR, 0.77; 95% CI, 0.71 to 0.84; P amp;lt; .001), with evidence for a stronger effect in the first years of follow-up (0 to 5 years: HR, 0.73; 95% CI, 0.66 to 0.81; P amp;lt; .001; 5 to 10 years: HR, 0.82; 95% CI, 0.68 to 0.99; P = .037); amp;gt; 10 years: (HR, 1.15; 95% CI, 0.84 to 1.58; P = .38; P heterogeneity = .02). In multivariable analysis, PIK3CA genotype remained significant for improved IDFS (P = .043), but not for the DDFS and OS end points.ConclusionIn this large pooled analysis, PIK3CA mutations were significantly associated with a better IDFS, DDFS, and OS, but had a lesser prognostic effect after adjustment for other prognostic factors. (C) 2018 by American Society of Clinical Oncology ; Funding Agencies|Cancer Council Victoria; National Health and Medical Research Council of Australia; National Breast Cancer Foundation, Australia; Breast Cancer Research Foundation, New York; Fonds de la Recherche Scientifique; Ontario Institute for Cancer Research; Government of Ontario; Trentino Biomolecular Oncologic Network (Trebionet) project; Swedish Research Council; Swedish Cancer Society