The effectiveness of 100mg aspirin in preventing superimposed preeclampsia in women with chronic hypertension: a real-world study.

To investigate gestational multiple metabolic abnormalities aggregation and diagnostic criteria for gestational metabolic syndrome (GMS), and to analyze the risk factors of GMS. A cohort study recruiting 309 pregnant women with preeclampsia, 627 pregnant women with gestational diabetes mellitus (GDM) and 1245 normal pregnant women was performed from January 2008 to December 2011 in Guangdong Women and Children's Hospital. Information regarding age, gestational weeks, basic blood pressure, admission blood pressure, height and body mass index(BMI)before pregnancy was recorded. Biochemical indicators including fasting plasma glucose (FPG), fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), free fatty acids (FFA) were tested. GMS was diagnosed with three or all of the following conditions: (1) overweight and/or obesity before pregnancy (BMI ≥ 25 kg/m(2)); (2) hypertension with blood pressure ≥ 140/90 mm Hg (1 mm Hg = 0.133 kPa); (3) hyperglycemia:diagnosed as GDM; (4) dyslipidemia with TG ≥ 3.23 mmol/L. The incidence of GMS of the three groups were calculated and the risk factors were analyzed. (1) The age, gestational weeks, basic blood pressure, admission blood pressure, BMI before pregnancy of women with preeclampsia and women with GDM were significantly different compared to normal women, respectively (P < 0.01). (2) Biochemical indicators of women with preeclampsia were as following: FPG (4.6 ± 1.0) mmol/L, FINS (10.1 ± 5.6) mU/L, TC (6.3 ± 1.6) mmol/L, TG (3.9 ± 1.8) mmol/L, HDL-C (1.4 ± 0.4) mmol/L, LDL-C (3.0 ± 1.0) mmol/L, FFA (0.8 ± 0.4) mmol/L. And those in women with GDM were: FPG (4.7 ± 0.9) mmol/L, FINS (10.2 ± 5.8) mU/L, TC (5.7 ± 1.3) mmol/L, TG (3.2 ± 1.1) mmol/L, HDL-C (1.4 ± 0.4) mmol/L, LDL-C (2.7 ± 0.9) mmol/L, FFA (0.6 ± 0.3) mmol/L. In normal pregnant women they were: FPG (4.3 ± 0.5) mmol/L, FINS (9.0 ± 4.4) mU/L, TC (5.7 ± 1.1) mmol/L, TG (2.8 ± 1.1) mmol/L, HDL-C (1.5 ± 0.4) mmol/L, LDL-C (2.9 ± 0.8) mmol/L, FFA (0.6 ± 0.2) mmol/L. Statistic differences were found in preeclampsia and GDM women compared to normal women respectively (P < 0.01). (3) The prevalence of GMS in preeclampsia group and in GDM group was 26.2% (81/309) and 13.6% (85/627), statistically different from that of the control group (0)(P < 0.01). (4) Compared to normal women, women with preeclampsia had higher risk of developing GMS (OR = 1.62, 95%CI 1.31 - 2.00, P < 0.01). The risk factors were BMI (OR = 1.29, 95%CI 1.13 - 1.47) and TG (OR = 2.49, 95%CI 1.87 - 3.31). Also, women with GDM had higher risk of developing GMS than normal women (OR = 1.27, 95%CI 1.09 - 1.49, P < 0.01), and the risk factors were BMI (OR = 1.13, 95%CI 1.04 - 1.23) and TG (OR = 1.16, 95%CI 1.02 - 1.33). TG was the independent risk factor in both preeclampsia women and GDM women (P < 0.01, P < 0.05). HDL-C seemed to have less importance in identifying GMS (P > 0.05). According to the GMS diagnostic criteria used in this study, some preeclampsia patients and some GDM women had aggregation of multiple metabolic abnormalities including pre-pregnancy overweight/obesity, hyperglycemia, high blood pressure and dyslipidemia. TG was the independent risk factor for GMS. HDL-C seemed to have less importance in identifying GMS.

Although smoking during pregnancy may lead to many adverse effects, such as fetal growth restriction, placental abruption, stillbirth, and preterm labor, smoking is the only environmental exposure known to consistently reduce the risk of preeclampsia and gestational hypertension.1 The article by Wikstrom et al2 is a major step forward in understanding this protective effect. Using data from the Swedish Medical Birth Register in a large epidemiological study of >600 000 Nordic women, the authors conclude that use of Swedish snuff, a smokeless tobacco, did not reduce the risk of preeclampsia and gestational hypertension but that tobacco, when smoked, did. They infer that combustion products of tobacco, such as carbon monoxide (CO), protect against preeclampsia but that constituents of tobacco, such as nicotine, do not. The data strengthen and extend results of a previous smaller study using the Swedish Medical Birth Register, which had reported a similar association.3 Although snuff use did not reduce the risk of mild or severe preeclampsia, preeclampsia that began before or after 37 weeks of gestation, or preeclampsia with or without delivery of a small for gestational age (SGA) infant or stillbirth, smoking reduced the risk of all categories of preeclampsia except for preeclampsia with an SGA infant or stillbirth. Of considerable interest, using data from women who changed their tobacco habits at gestational weeks 30 to 32 from those reported at the first antenatal visit (usually before 15 weeks of gestation), Wikstrom et al2 found that women who had reported smoking at the first antenatal visit but no use of tobacco at 30 to …

A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China

Circulating levels of the antiangiogenic marker sFLT-1 are increased in first versus second pregnancies

Preeclampsia is a heterogeneous disorder prevalent in 3-10% of pregnant women globally. The etiology is multifactorial. There is a initial stage of endothelial dysfunction and placental ischemia (Stage 1); this leads to maternal syndrome of hypertension, edema, and proteinuria (Stage 2). Drugs acting on immunomodulatory, anti-inflammatory, antioxidant and proresolving pathways can minimize the complications of preeclampsia. The therapeutic effect of aspirin is based on acetyl group and salicylate group. Both components have independent therapeutic effects on anti-inflammatory pathway and proresolving pathway. This study was designed to assess the effectiveness and safety of aspirin in prevention and treatment of symptoms and complications of preeclampsia in women at high risk of preeclampsia. This is a prospective experimental study to evaluate the effectiveness of aspirin versus placebo in the prevention of maternal syndrome of preeclampsia in women with high risk of preeclampsia (G1=97, G2=92). Patients with age≥34, chronic hypertension, multiple pregnancies, gestational diabetes, and high pulsatility index of uterine artery were enrolled between 12 and 20weeks of gestation and prescribed 75mg aspirin daily till 34weeks of gestation. Control group was not prescribed aspirin. There was a reduction in relative risk of preeclampsia in aspirin group as compared with control group. There was no significant increase in the number of cases of abruption placenta, preterm delivery, neonatal intraventricular hemorrhage, patent ductus arteriosus, and postpartum hemorrhage following aspirin therapy. In patients with high mean pulsatility index of uterine arteries, low dose aspirin can be a useful intervention. Uterine artery Doppler is a simple and noninvasive test which can be used safely for the prediction of preeclampsia. Aspirin is safe, economical, and easily available commercially.

Objective To investigate the clinical characteristics and the optimal time of delivery in pregnant women with severe preeclampsia complicated with ascites. Methods A retrospective study was conducted on 179 severe preeclampsia mothers and their 195 neonates, presented in the First Affiliated Hospital of Wenzhou Medical College from Jan. 2003 to Dec. 2005, who were divided into two groups： 32 complicated with ascites （aseites group） and 147 without （non-ascites group）. The general conditions, mode of delivery and complications including eclampsia, hemolysis, elevated serum level of liver enzymes, and low platelets （HELLP syndrome）, liver failure, renal failure, heart failure, hypoproteinemia, placental abruption, postpartum hemorrhage and puerperal infection, were also analyzed. Clinical data of all infants （38 from aseites group and 157 from non-aseites group） were analyzed. The incidence and mortality rate of small for gestational age （SGA） in both group within the same gestational age group and those between different gestational age groups in the ascites group were compared. Results （1） The average gestations at admission and delivery in the ascites group were earlier than the other [admission： （32.5±2.1）weeks vs （36.1±3.5）weeks; delivery： （34.1±2.3） weeks vs （37.2±1.5）weeks, P〈0.05]. The rate of systemic antenatal care in the ascites group was lower than that of the non-ascites group （25.0% vs 53.7%, P〈0. 05）. More complications were found in the ascites group than in the non-ascites group （hypoproteinemia： 100.0%vs 47.0% ;liver and renal failure： 31.2% vs 8.2%; HELLP syndrome： 9.4% vs 2.0%; postpartum hemorrhage： 18.8% vs 2.0% ; all P〈0.05）. （2） The incidence of SGA in the ascites group was all higher than that in the non-ascites group, however, significant differences was only found between the two groups at 〉36 weeks （7/9 vs 30.2%, P〈0.05）. The perinatal mortality rates of SGA in the ascites group at 〈32 weeks and 32-34 weeks were significantly higher than that in the non-ascites group respectively （〈32 weeks： 69.2% vs 19.2%, P〈0.05; 32-34 weeks： 2/7 vs 0, P〈0.05）. （3） The highest perinatal mortality rate and the highest incidence of SGA in the ascites group were found in the groups of 〈32 weeks and 〉36 weeks, respectively. Conclusions The early onset of ascites and higher rate of complications in severe preeclamptic women implies the adverse maternal and fetal outcomes. Ascites in severe preeclampsia cases should alert the clinicians. The optimal time for delivery might be at 32-36 weeks of gestations. Key words: Pre-eclampsia; Ascites; Retrospective studies

BackgroundAdverse pregnancy outcomes, such as preterm birth, preeclampsia (PE), small for gestational age (SGA), pose significant risks to maternal and neonatal health and contribute to healthcare burdens. Placental Growth Factor (PIGF), a key pro-angiogenic biomarker involved in placental development, has been implicated in the pathophysiology of these complications. This study aimed to investigate the association between maternal serum PIGF levels and adverse pregnancy outcomes in a prospective cohort.MethodsWe conducted a cohort study involving 5,870 women with singleton pregnancies enrolled at Nanjing Drum Tower Hospital from January 2017 to September 2020. Participants were followed from early pregnancy (≤14 gestational weeks) through delivery. Logistic regression models were used to evaluate the associations between serum PIGF levels (measured at 11–14 gestational weeks) and adverse pregnancy outcomes, reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Dose–response relationships were assessed using restricted cubic spline analysis.ResultsSerum PIGF concentrations in early pregnancy were inversely associated with PE (OR = 0.97, 95% CI:0.96 – 0.98), preterm PE (OR = 0.96, 0.94 – 0.98), SGA <10th percentile (OR = 0.99, 0.98 – 0.99) and SGA <3rd percentile (OR = 0.98, 0.97 – 0.99). Expressed as multiples of the median (MoM), PIGF showed stronger associations with these outcomes, including PE (OR = 0.32, 0.21 – 0.48), preterm PE (OR = 0.23, 0.09 – 0.56), SGA <10th percentile (OR = 0.67, 0.54 – 0.83) and SGA <3rd percentile (OR = 0.43, 0.29 – 0.64), compared with its absolute concentrations. Notably, PIGF demonstrated a consistent inverse association with PE across different modes of conception, including spontaneous pregnancies (OR = 0.97, 0.96 – 0.98) and those conceived via ovulation induction or in vitro fertilization (OR = 0.95, 0.92 – 0.97). The highest predictive performance for PE was observed between 28–34 gestational weeks, with an area under the curve (AUC) of 0.79 (95% CI: 0.77 – 0.81). Additionally, dose–response analysis revealed nonlinear associations between PIGF levels and risks of SGA <10th and SGA <3rd.ConclusionThis cohort study reinforces the inverse association between maternal PIGF levels and the risks of PE and SGA. The findings highlight the potential clinical utility of PIGF as a gestational age–specific biomarker in prenatal risk stratification.

The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for pre-eclampsia. There was no statistically significant difference in postpartum hemorrhage (PPH) incidence between the aspirin and control groups. This study aimed to evaluate the potential bleeding risk of 100 mg aspirin in high-risk pregnant women and the difference in the incidence of PPH according to maternal characteristics. This is a secondary data analysis of the APPEC study. Platelet counts and coagulation test results were collected at five follow-up visits. Subgroups defined by maternal age (<35 years and ≥35 years), pre-pregnancy body mass index (pre-BMI, <28 kg/m 2 and ≥28 kg/m 2 ), parity, gestational age at enrollment, and medical history, including pre-eclampsia, chronic hypertension, and diabetes mellitus, were analyzed. Logistic regression analysis was used to determine the statistical significance of the difference in the incidence of PPH after aspirin administration in pregnant women in each subgroup. Adjustment using multiple logistic regression models followed these analyses. Binary logistic regression was used to determine the relationship between pre-BMI and PPH. There was no significant difference between the aspirin and control groups in bleeding risk (3.4% [16/464] vs. 3.0% [13/434], T = 0.147, P = 0.701). No significant difference was found in the incidence of PPH in total (relative risk = 1.220, 95% confidence interval [CI] = 0.720-2.067, P = 0.459; aspirin group vs. control group, 6.5% [30/464] vs. 5.3% [23/434], P = 0.459) or in subgroup analysis. A significant correlation between pre-BMI and PPH was found in the aspirin group, while in the control group there was no significant correlation (aspirin group, odds ratio [OR] = 1.086, 95% CI = 1.004-1.175, P = 0.040; control group, OR = 1.060, 95% CI = 0.968-1.161, P = 0.209). A dosage of 100 mg of aspirin per day, initiated from 12 to 20 gestational weeks until 34 weeks of gestation, did not increase the risk of potential bleeding and PPH regardless of the maternal characteristic. In the aspirin group, the positive correlation between BMI and PPH was significant. ClinicalTrials.gov, NCT01979627.

To examine the effect of chronic hypertension (CH), with and without superimposed pre-eclampsia (PE), on the incidence of a small-for-gestational-age (SGA) neonate and to explore the possible mechanism for such association. Data for this study were derived from prospective screening for adverse pregnancy outcomes in women with singleton pregnancy attending their first routine hospital visit at 11-13 weeks' gestation, which included recording of maternal characteristics and medical history and measurement of mean arterial pressure (MAP). Birth-weight Z-score, adjusted for gestational age and maternal and pregnancy characteristics, and incidence of SGA were compared between those with and those without CH in the total population and in the subgroups of pregnancies with and without PE. Regression analysis was used to examine the relationship between MAP and birth-weight Z-score and incidence of SGA and PE in those with and those without CH. The study population constituted 74 226 pregnancies, including 1052 (1.4%) with CH and 73 174 without CH. PE developed in 233 (22.1%) cases of the group with CH and in 1662 (2.3%) of those without CH. In the group that developed PE, there was no significant difference for either median birth-weight Z-score or incidence of SGA between those with CH and those without CH. In the group without PE, the incidence of SGA was twice as high in those with CH than in those without. There was a significant association between log10 MAP multiples of the median and incidence of SGA and PE, which was more marked in those with CH than in those without. CH is associated with an increased risk of SGA and PE and this is related to MAP at 11-13 weeks' gestation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

BackgroundAlthough lymph node dissection (LND) has been commonly used for patients with bronchopulmonary carcinoids (PCs), the prognostic values of the positive lymph node ratio (PLNR) and the number of removed nodes (NRN) remain unclear.MethodsPatients with resected PCs were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015). The optimal cut-off values of the PLNR and NRN were determined by X-tile. The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare the overall survival (OS) and cancer-specific survival (CSS) of patients in different PLNR and NRN groups.ResultsThe study included 1622 patients. The optimal cut-off values of the PLNR and NRN for survival were 13% and 13, respectively. In both Kaplan-Meier analysis and univariable Cox proportional hazards regression analysis before IPTW, a PLNR ≥13% was significantly associated with worse OS (HR = 3.364, P<0.001) and worse CSS (HR = 7.874, P<0.001). These findings were corroborated by the IPTW-adjusted Cox analysis OS (HR = 2.358, P = 0.0275) and CSS (HR = 8.190, P<0.001) results. An NRN ≥13 was not significantly associated with worse OS in either the Kaplan-Meier or Cox analysis before or after IPTW adjustment. In the Cox proportional hazards analysis before and after IPTW adjustment, an NRN ≥13 was significantly associated with worse CSS (non-IPTW: HR = 2.216, P=0.013; IPTW-adjusted: HR = 2.162, P=0.024).ConclusionA PLNR ≥13% could predict worse OS and CSS in patients with PCs and might be an important complement to the present PC staging system. Extensive LND with an NRN ≥13 might have no therapeutic value for OS and may even have an adverse influence on CSS. Its application should be considered on an individual basis.

Preeclampsia and associated hypertensive disorders of pregnancy represent a leading cause of global maternal and neonatal morbidity and mortality. Identification of women at high risk for developing preterm-preeclampsia and prophylaxis with low-dose aspirin has the potential to significantly reduce the rate of preterm-preeclampsia. In addition, risk assessment and monitoring of women in the second and third trimester of pregnancy, to aid in early detection of evolving disease, timely referral to specialist care, and active monitoring of women with confirmed or suspected preeclampsia is essential for improving maternal and neonatal outcomes. The angiogenesis-related biomarkers sFlt-1 and PlGF have been shown to have clinical value to aid in the prediction, diagnosis, and risk stratification of preeclampsia when used either alone or in combination with other risk factors. However, currently there is no consensus on the optimum strategy to link first trimester screening for preterm-preeclampsia with appropriate second and third trimester risk assessment strategies. This opinion paper will outline the current evidence for first trimester preeclampsia screening and prevention, as well as the evidence for various risk stratification approaches for detection of evolving preeclampsia through the second and third trimesters of pregnancy, and proposes a potential model integrating these tools. This article is protected by copyright. All rights reserved.

PurposeOctogenarians constitute a growing number of diagnoses for colorectal cancer. However, the optimal treatment for these increasingly vulnerable octogenarians with colorectal cancer remains a challenging issue. The aim of this study was to evaluate the oncologic outcomes of colorectal cancer, comparing octogenarians (> 80 years) and younger age (60–79 years).MethodsA total of 657 patients underwent surgery for colorectal cancer between January 2015 and December 2019 at Gangneung asan hospital. Among them, 444 patients over the age of 60 were enrolled. The exclusion criteria were as follows: only local resection, R1 and R2 resection, Stage IV, absence of data in follow-up, concurrent inflammatory bowel disease, concurrent malignancy, and prior history of malignancy. The patients were divided into two groups according to their age: Octogenarian group (OG, aged > 80 years, n = 83), and younger group (YG, aged 60 to 79 years, n = 361). Inverse probability of treatment weight (IPTW) was used to control for confounding factors.ResultsWe used Inverse Probability of Treatment Weighting (IPTW) to control confounding factors and ensure a balanced comparison between octogenarians (OG) and younger patients (YG). Before IPTW adjustment, the OG had significantly worse 3-year overall survival (90.0% vs. 78.6%, p = 0.045), while 3-year disease-free survival (DFS) was similar between YG and OG (87.8% vs. 83.6%, p = 0.349). Additionally, the OG had a higher rate of emergency surgery (21.7% vs. 11.4%, p = 0.020), higher ASA classification (≥ III in 66.3% vs. 48.8%, p = 0.006), higher overall mortality (43.4% vs. 21.9%, p < 0.001), and less frequent use of adjuvant chemotherapy (17.2% vs. 57.6%, p < 0.001). Multivariate analysis showed that older age (hazard ratio [HR] = 2.177, 95% confidence interval [CI]: 1.452–3.264, p < 0.001), emergency surgery (HR = 1.831, 95% CI: 1.157–2.897, p = 0.010), severe postoperative complications (Clavien-Dindo III-V. HR = 1.357, 95% CI: 1.035–1.779, p = 0.027), higher TNM stage (stage III, HR = 5.143, 95% CI: 2.009–13.167, p < 0.001), and presence of perineural invasion (HR = 1.588, 95% CI: 1.058–2.385, p = 0.026) were significant predictors of worse survival. Similarly, independent factors associated with recurrence included emergency surgery (HR = 2.653, 95% CI: 1.550–4.542, p < 0.001), poor tumor differentiation (HR = 2.842, 95% CI: 1.198–6.743, p = 0.018), higher TNM stage (stage III, HR = 7.826, 95% CI: 2.355–26.016, p < 0.001), and presence of perineural invasion (HR = 1.876, 95% CI: 1.152–3.055, p = 0.011). However, age was not an independent factor associated with recurrence. In the subgroup analysis, the OG group with no or mild complications (Clavien-Dindo classification I-II) had a significantly better 3-year OS compared to those with severe complications (87.7% vs. 37.5%, p = 0.002). After IPTW adjustment, there were no significant differences in OS (73.2% vs. 77.5%, p = 0.120) or DFS (87.2% vs. 87.5%, p = 0.863) between the two groups. These findings suggest that age alone is not a critical determinant of oncologic outcomes once confounding variables are controlled.ConclusionAfter IPTW adjustment, age was not an independent factor affecting oncologic outcomes. Instead, emergency surgery, severe complications, advanced stage, tumor differentiation, and perineural invasion were significant predictors of survival and recurrence. In the subgroup analysis, octogenarians with no or mild complications had significantly better 3-year OS than those with severe complications. These findings suggest that perioperative management and disease severity, rather than age alone, should guide treatment decisions.

Purpose Octogenarians constitute a growing number of diagnoses for colorectal cancer. However, the optimal treatment for these increasingly vulnerable octogenarians with colorectal cancer remains a challenging issue. The aim of this study was to evaluate the oncologic outcomes of colorectal cancer, comparing octogenarians (&gt;80 years) and younger age (60-79 years). Methods A total of 657 patients underwent surgery for colorectal cancer between January 2015 and December 2019 at Gangneung asan hospital. Among them, 444 patients over the age of 60 were enrolled. The exclusion criteria were as follows: only local resection, R1 and R2 resection, Stage IV, absence of data in follow-up, concurrent inflammatory bowel disease, concurrent malignancy, and prior history of malignancy. The patients were divided into two groups according to their age: Octogenarian group (OG, aged &gt; 80 years, n=83), and younger group (YG, aged 60 to 79 years, n=361). Inverse probability of treatment weight (IPTW) was used to control for confounding factors. Results We used Inverse Probability of Treatment Weighting (IPTW) to control confounding factors and ensure a balanced comparison between octogenarians (OG) and younger patients (YG). Before IPTW adjustment, the OG had significantly worse 3-year overall survival (90.0% vs. 78.6%, p=0.045), while 3-year disease-free survival (DFS) was similar between YG and OG (87.8% vs. 83.6%, p=0.349). Additionally, the OG had a higher rate of emergency surgery (21.7% vs. 11.4%, p=0.020), higher ASA classification (≥ III in 66.3% vs. 48.8%, p=0.006), higher overall mortality (43.4% vs. 21.9%, p&lt;0.001), and less frequent use of adjuvant chemotherapy (17.2% vs. 57.6%, p&lt;0.001). Multivariate analysis showed that older age (hazard ratio [HR] = 2.177, 95% confidence interval [CI]: 1.452-3.264, p&lt;0.001), emergency surgery (HR = 1.831, 95% CI: 1.157-2.897, p=0.010), severe postoperative complications (Clavien-Dindo III-V. HR = 1.357, 95% CI: 1.035-1.779, p=0.027), higher TNM stage (stage III, HR = 5.143, 95% CI: 2.009-13.167, p&lt;0.001), and presence of perineural invasion (HR = 1.588, 95% CI: 1.058-2.385, p=0.026) were significant predictors of worse survival. Similarly, independent factors associated with recurrence included emergency surgery (HR = 2.653, 95% CI: 1.550 -4.542, p&lt;0.001), poor tumor differentiation (HR = 2.842, 95% CI: 1.198-6.743, p=0.018), higher TNM stage (stage III, HR = 7.826, 95% CI: 2.355-26.016, p&lt;0.001), and presence of perineural invasion (HR = 1.876, 95% CI: 1.152-3.055, p=0.011). However, age was not an independent factor associated with recurrence. In the subgroup analysis, the OG group with no or mild complications (Clavien-Dindo classification I-II) had a significantly better 3-year OS compared to those with severe complications (87.7% vs. 37.5%, p=0.002). After IPTW adjustment, there were no significant differences in OS (73.2% vs. 77.5%, p=0.120) or DFS (87.2% vs. 87.5%, p=0.863) between the two groups. These findings suggest that age alone is not a critical determinant of oncologic outcomes once confounding variables are controlled. Conclusion After IPTW adjustment, age was not an independent factor affecting oncologic outcomes. Instead, emergency surgery, severe complications, advanced stage, tumor differentiation, and perineural invasion were significant predictors of survival and recurrence. In the subgroup analysis, octogenarians with no or mild complications had significantly better 3-year OS than those with severe complications. These findings suggest that perioperative management and disease severity, rather than age alone, should guide treatment decisions.

To examine the effect of first-trimester screening for pre-eclampsia (PE) on the prediction of delivering a small-for-gestational-age (SGA) neonate and the effect of prophylactic use of aspirin on the prevention of SGA. The data for this study were derived from two multicenter studies. In SPREE, we investigated the performance of screening for PE by a combination of maternal characteristics and biomarkers at 11-13 weeks' gestation. In ASPRE, women with a singleton pregnancy identified by combined screening as being at high risk for preterm PE (> 1 in 100) participated in a trial of aspirin (150 mg/day from 11-14 until 36 weeks' gestation) compared to placebo. In this study, we used the data from the ASPRE trial to estimate the effect of aspirin on the incidence of SGA with birth weight < 10th , < 5th and < 3rd percentile for gestational age. We also used the data from SPREE to estimate the proportion of SGA in the pregnancies with a risk for preterm PE of > 1 in 100. In SPREE, screening for preterm PE by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor identified a high-risk group that contained about 46% of SGA neonates < 10th percentile born at < 37 weeks' gestation (preterm) and 56% of those born at < 32 weeks (early); the overall screen-positive rate was 12.2% (2014 of 16 451 pregnancies). In the ASPRE trial, use of aspirin reduced the overall incidence of SGA < 10th percentile by about 40% in babies born at < 37 weeks' gestation and by about 70% in babies born at < 32 weeks; in babies born at ≥ 37 weeks, aspirin did not have a significant effect on incidence of SGA. The aspirin-related decrease in incidence of SGA was mainly due to its incidence decreasing in pregnancies with PE, for which the decrease was about 70% in babies born at < 37 weeks' gestation and about 90% in babies born at < 32 weeks. On the basis of these results, it was estimated that first-trimester screening for preterm PE and use of aspirin in the high-risk group would potentially reduce the incidence of preterm and early SGA by about 20% and 40%, respectively. First-trimester screening for PE by the combined test identifies a high proportion of cases of preterm SGA that can be prevented by the prophylactic use of aspirin. © 2018 Crown copyright. Ultrasound in Obstetrics & Gynecology © 2018 ISUOG.

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention.