Predictors of all-cause early mortality and cancer-specific early mortality in patients with nasopharyngeal squamous cell carcinomas.

Characteristics and Predictors of Early Deaths in Newly Diagnosed Classical Hodgkin Lymphoma

Patients with esophageal cancer liver metastasis face a high risk of early mortality, making accurate prediction crucial for guiding clinical decisions. However, effective predictive tools are currently limited. In this study, we used clinicopathological data from 1897 patients diagnosed with esophageal cancer liver metastasis between 2010 and 2020, which were sourced from the SEER database. Prognostic factors were identified using univariate and multivariate logistic regression, and seven machine learning models, including extreme gradient boosting (XGBoost) and support vector machine (SVM), were developed to predict early mortality. The models were evaluated using Receiver Operating Characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and F1 scores. Results showed that 40% of patients experienced all-cause early mortality and 38% had cancer-specific early mortality. Key predictors of early mortality included age, location, chemotherapy, and lung metastasis. Among the models, XGBoost performed best in predicting all-cause early mortality, while SVM excelled in predicting cancer-specific early mortality. These findings demonstrate that machine learning models, particularly XGBoost and SVM, can serve as valuable tools for predicting early mortality in patients with esophageal cancer liver metastasis, aiding clinical decision making.

Patients with lung cancer are known to be at increased risk for venous thromboembolism (VTE). Venous thromboembolism is associated with increased risk for early mortality. However, there have been no studies performing a comprehensive assessment of risk factors for VTE or early mortality in lung cancer patients undergoing systemic chemotherapy in a global real-world setting. CANTARISK is a prospective, global, noninterventional cohort study including patients with lung cancer initiating a new cancer therapy. Clinical data were collected until 6-month follow-up. The impact of patient-, disease-, and treatment-related factors on the occurrence of VTE and early mortality was evaluated in univariable and multivariable Cox regression analyses. A previously validated VTE risk score (VTE-RS) was also calculated (also known as Khorana score). Of 1,980 patients with lung cancer who were enrolled from 2011 to 2012, 84% had non-small cell lung cancer. During the first 6 months, 121 patients developed a VTE (6.1%), of which 47% had pulmonary embolism, 46% deep vein thrombosis, 3% catheter-associated thrombosis, and 4% visceral thrombosis. Independent predictors for VTE included female sex, North America location, leg immobilization, and presence of a central venous catheter. The VTE-RS was not significantly associated with VTE in either univariable or multivariable analysis in this population. During the study period, 472 patients died, representing 20%, 24%, 36%, and 25% with VTE-RS 1, 2, ≥3, or unknown, respectively (p < .0001). Significant independent predictors of early mortality include older age, current/former smoking, chronic obstructive pulmonary disease, Eastern Cooperative Oncology Group performance status ≥2, no prior surgery, and metastatic disease, as well as the VTE-RS. In this global, prospective, real-world analysis, several demographic, geographic, and clinical factors are independent risk factors for VTE and early mortality in patients with lung cancer. The VTE-RS represents a significant independent predictor of early mortality but not for VTE in lung cancer in the era of targeted therapy. Multiple risk factors for both venous thromboembolism (VTE) and early mortality in patients with lung cancer receiving systemic chemotherapy should guide best practice by better informing clinical evaluation and treatment decision-making. The Khorana risk score is of value in assessing the risk of early all-cause mortality along with other clinical parameters in patients with lung cancer receiving systemic therapy. Further study is needed to fully evaluate the validity of the risk score in predicting the risk of VTE in the modern era of lung cancer therapy.

PurposeTo explore the relationship between venous thromboembolism (VTE) and early mortality (within six months) in Chinese patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) after entering the era of precision treatment.MethodsA cohort of 706 consecutive subjects with newly diagnosed metastatic NSCLC were prospectively observed. Clinical and survival data were recorded over a six-month follow-up period. The predictive factors for the occurrence of VTE and the relationship with early mortality were evaluated through univariate and multivariate analyses.ResultsDuring the six-month follow-up period, VTE events occurred in 12.2% (86/706) of the enrolled patients. In the multivariate analyses for VTE, an age older than 70 years (vs < 70: sub-distribution hazard radio [SHR], 1.678; 95% confidence interval (CI), 1.073–2.600; P=0.022), an Eastern Cooperative Oncology Group performance status ≥2 (vs 0/1: SHR, 1.946; 95% CI, 1.277–2.970; P=0.002), and having an ALK rearrangement (vs non-rearrangement: SHR, 2.377; 95% CI, 1.186–4.760; P=0.015) were significantly associated with the occurrence of VTE. Within six months, 116 subjects (16.4%) died, and the occurrence of VTE (vs no VTE: adjusted HR: 1.863; 95% CI: 1.178–2.947, P=0.008) was remarkably associated with early mortality. Further analysis showed 98 patients (13.9%) with early mortality had EGFR/ALK wild-type genes, with a risk of early mortality 5.935-fold higher than that of patients with an EGFR mutation/ALK rearrangement. Finally, subgroup analyses showed that VTE occurrence was a significant factor for predicting early mortality in patients with EGFR/ALK wild-type genes (adjusted HR: 1.682; 95% CI: 1.023–2.768, P=0.041).ConclusionPatients with an EGFR mutation/ALK rearrangement had a significantly decreased risk of early mortality in the era of targeted therapy; however, VTE occurrence remained an important predictor for early mortality in metastatic NSCLC patients, especially in patients with EGFR/ALK wild-type genes.

Patients with hepatitis C virus (HCV) undergoing primary elective total joint arthroplasty (TJA) are at increased risk of postoperative complications. Patients with chronic liver disease and cirrhosis, specifically Child-Pugh Class B and C, who are undergoing general surgery have high 2-year mortality risks, approaching 60% to 80%. However, the role of Child-Pugh and Model for End-Stage Liver Disease classifications of liver status in predicting survivorship among patients with HCV undergoing elective arthroplasty has not been elucidated. What factors are independently associated with early mortality (< 2 years) in patients with HCV undergoing arthroplasty? We performed a retrospective study at three tertiary academic medical centers and identified patients with HCV undergoing primary elective TJA between January 2005 and December 2019. Patients who underwent revision TJA and simultaneous primary TJA were excluded. A total of 226 patients were eligible for inclusion in the study. A further 25% (57) were excluded because they were lost to follow-up before the minimum study requirement of 2 years of follow-up or had incomplete datasets. After the inclusion and exclusion criteria were applied, the final cohort consisted of 75% (169 of 226) of the initial patient population eligible for analysis. The mean follow-up duration was 53 ± 29 months. We compared confounding variables for mortality between patients with early mortality (16 patients) and surviving patients (153 patients), including comorbidities, HCV and liver characteristics, HCV treatment, and postoperative medical and surgical complications. Patients with early postoperative mortality were more likely to have an associated advanced Child-Pugh classification and comorbidities including peripheral vascular disease, end-stage renal disease, heart failure, and chronic obstructive pulmonary disease. However, both groups had similar 90-day and 1-year medical complication risks including myocardial infarction, stroke, pulmonary embolism, and reoperations for periprosthetic joint infection and mechanical failure. A multivariable regression analysis was performed to identify independent factors associated with early mortality, incorporating all significant variables with p < 0.05 present in the univariate analysis. After accounting for significant variables in the univariate analysis such as peripheral vascular disease, end-stage renal disease, heart failure, chronic obstructive pulmonary disease, and liver fibrosis staging, Child-Pugh Class B or C classification was found to be the sole factor independently associated with increased odds of early (within 2 years) mortality in patients with HCV undergoing elective TJA (adjusted odds ratio 29 [95% confidence interval 5 to 174]; p < 0.001). The risk of early mortality in patients with Child-Pugh Class B or C was 64% (seven of 11) compared with 6% (nine of 158) in patients with Child-Pugh Class A (p < 0.001). Patients with HCV and a Child-Pugh Class B or C at the time of elective TJA had substantially increased odds of death, regardless of liver function, cirrhosis, age, Model for End-Stage Liver Disease level, HCV treatment, and viral load status. This is similar to the risk of early mortality observed in patients with chronic liver disease undergoing abdominal and cardiac surgery. Surgeons should avoid these major elective procedures in patients with Child-Pugh Class B or C whenever possible. For patients who feel their arthritic symptoms and pain are unbearable, surgeons need to be clear that the risk of death is considerably elevated. Level III, therapeutic study.

BackgroundMetastatic rectal cancer is an incurable malignancy, which is prone to early mortality. We aimed to establish nomograms for predicting the risk of early mortality in patients with metastatic rectal cancer.MethodsIn this study, clinical data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database.We utilized X-tile software to determine the optimal cut-off points of age and tumor size in diagnosis. Significant independent risk factors for all-cause and cancer-specific early mortality were determined by the univariate and multivariate logistic regression analyses, then we construct two practical nomograms. In order to assess the predictive performance of nomograms, we performed calibration plots, time-dependent receiver-operating characteristic curve (ROC), decision curve analysis (DCA) and clinical impact curve (CIC).ResultsA total of 2570 metastatic rectal cancer patients were included in the study. Multivariate logistic regression analyses revealed that age at diagnosis, CEA level, tumor size, surgical intervention, chemotherapy, radiotherapy, and metastases to bone, brain, liver, and lung were independently associated with early mortality of metastatic rectal cancer patients in the training cohort. The area under the curve (AUC) values of nomograms for all-cause and cancer-specific early mortality were all higher than 0.700. Calibration curves indicated that the nomograms accurately predicted early mortality and exhibited excellent discrimination. DCA and CIC showed moderately positive net benefits.ConclusionsThis study successfully generated applicable nomograms that predicted the high-risk early mortality of metastatic rectal cancer patients, which can assist clinicians in tailoring more effective treatment regimens.

Background: Gastric varices (GV) bleed less frequently than esophageal varices however, gastric variceal bleeding is more severe with higher mortality and rebleeding rates. Treatment of Gastric variceal bleeding (GVB) by tissue adhesive mainly cyanoacrylate glues has been used for Gastric variceal obturation. We aimed to determine predictors of early rebleeding and mortality in patients with the first attack of GVB. Materials and methods: The study included 120 patients with a first attack of GVB.The patients subjected to thorough history, full examination, laboratory, and radiological investigations. Child Turcott Pugh score (CTP), and model of end stage liver disease (MELD) score were calculated. Upper gastrointestinal (GI) endoscopy with gastric variceal obturation (GVO) by cyanoacrylate glues were done for all included patients. Follow up during hospitalization and 6 weeks after discharge to determine early rebleeding (within 14 days) and early mortality (within 6 weeks). Results: Among 120 included patients in the study, 24 patients (20%) were presented with early rebleeding and 19 patients (15.83%) were presented with early mortality. Multi-variable logestic regression analysis showed that, Child Pugh Score was an independent prognostic factor associated with early rebleeding and early mortality. It was found that, current smoking, increased bilirubin, INR, creatinine, decreased albumin, presence of ascites, higher CTP and MELD scores are significantly more in early rebleeding and early mortality groups, while lower platelet count in early rebleeding only. Moreover, hepatic encephalopathy, and higher transaminases are more in early mortality group. There was no significant difference in gastric variceal signs between the study groups except that increase mortality in patients with more than one varix. Conclusion: Child Turcott Pugh score was an independent prognostic factor associated with early rebleeding and early mortality in patients with GVB.

Low free T3 levels are related to early mortality in patients with decompensated cirrhosis and acute-on chronic liver failure

BackgroundThe lung is the most vulnerable site for distant thyroid cancer (TC) metastasis, and individuals who have TC lung metastases (TCLMs) succumb to the illness shortly after diagnosis. This study aims to identify the risk factors of early mortality in TCLM patients and develop a reliable and accurate prediction model. An accurate nomogram for predicting early mortality (survival time ≤3 months) in TCLM patients is necessary.MethodsBetween 2010 and 2015, information gathered from TCLM patients in the Surveillance, Epidemiology, and End Results (SEER) database was used to develop and internally evaluate a prediction model. External validation was performed using data acquired from a Chinese population. All-cause early death (ACED) encompassed mortality from any cause within this period, whereas cancer-specific early death (CSED) specifically referred to deaths explicitly attributed to TC or its complications on the death certificate. The risk factors for CSED and ACED were identified independently using univariate and multivariable logistic regressions. The nomogram’s accuracy was confirmed via receiver operating characteristic (ROC) curve analysis, and calibration curves were used to evaluate the consistency between the model predictions and the actual outcomes. Decision curve analysis (DCA) was performed to assess the model's clinical applicability.ResultsThis study included 945 patients, 636 (67.3%) of whom died shortly after diagnosis and 335 (35.4%) of whom died from TCLM-related complications. Multivariable logistic regression analyses independently identified six predictors for ACED and seven predictors for CSED. The areas under the curve (AUCs) of the nomogram for predicting ACED and CSED were 0.912 [95% confidence interval (CI): 0.889–0.931] and 0.732 (95% CI: 0.691–0.776), respectively. Combined with the results of the calibration curve analysis, these findings demonstrated that the nomograms effectively predicted the risk of early death in both the internal and external sets. DCA revealed that the nomograms provide considerable clinical advantages.ConclusionsIn the present study, nomograms were developed to reliably predict the risk of early mortality in individuals with TCLM. These tools can assist physicians in identifying high-risk patients and implementing tailored treatment plans as soon as possible.

Ferritin in decompensated cirrhosis: Iron or inflammation?

Risk of Early Mortality in Patients with Newly Diagnosed Multiple Myeloma

Causes and Predictors of Early Mortality in HIV-Positive and HIV-Negative Patients with Diffuse Large B-Cell Lymphoma

Literature Review

The overall survival of patients with multiple myeloma (MM) has been improved greatly over the last 2 decades with the broader use of novel drugs and autologous tandem transplantation. However, more than one tenth of myeloma patients still die shortly after diagnosis. We therefore aim to investigate the risk factors of early mortality (death within 60 days after diagnosis) in patients with MM. We included in this study 451 consecutive patients with MM, newly diagnosed at an Asian tertiary medical center between January 1, 2002 and April 30, 2015. A total of 57 subjects who experienced early mortality were identified. Risk factors for early mortality in myeloma patients were collected and analyzed. Early mortality occurred in 57 (12.6%) of the myeloma patients. In the multivariate analysis, being male (adjusted OR 2.93, 95% CI 1.17-7.31), serum albumin < 3.5 g/dL (adjusted OR 2.71, 95% CI 1.09-6.74), primary plasma cell leukemia (adjusted OR 17.61, 95% CI 1.01-306.05), serum albumin (adjusted OR 2.70, 95% CI 1.15-6.38), corrected serum calcium ≥ 12 mg/dL (adjusted OR 2.94, 95% CI 1.21-7.14), and LDH ≥ 250 U/L (adjusted OR 3.07, 95% CI 1.50-6.27) were identified as independent risk factors of early mortality. Pneumonia with other infections contributed most to early mortality (n = 36, 65%), followed by renal failure and cardiac failure. The early mortality rate is high (12.6%) in patients with MM. Patients who are male and those with primary plasma cell leukemia, low serum albumin, high-corrected serum calcium, or LDH are at risk of early mortality. Nearly two thirds of the myeloma patients who experienced early mortality in our study (37 of 57, 65%) died of infection. Once a high-risk group is identified, much effort is required to target new approaches for prevention, early detection, and treatment of infections.

Presence of Comorbidities Do Not Predict Early Mortality or Survival in Older Patients (≥60 Years) with Acute Myeloid Leukemia (AML) Undergoing Intensive Induction Therapy.