All-cause Survival Research Articles

Effect of sidedness on survival among patients with early-stage colon cancer: a SEER-based propensity score matching analysis

BackgroundMost previous studies compared survival between left-sided and right-sided colon cancer without adjustment for clinicopathological parameters. We investigated the effect of sidedness on survival among patients with early-stage colon cancer, using a propensity score matching method.MethodsThe 18 registry custom data within the SEER database were used to identify patients who were diagnosed with colon cancer between 2010 and 2014. A propensity score matching analysis was performed using the nearest neighbor method. Survival was estimated using the Kaplan–Meier method. A Cox proportional hazards model was applied to determine the prognostic factors.ResultsIn the unmatched cohort, 25,094 (35.72%) patients were diagnosed with left-sided colon cancer and 45,156 (64.28%) with right-sided colon cancer. After propensity score matching, each cohort included 5118 patients, and the clinicopathological characteristics were well balanced. In the unmatched cohort, left-sided colon cancer had superior all-cause (χ2=315, P<0.01) and cancer-specific (χ2=43, P<0.01) survival than right-sided tumors. However, in the matched cohort, no difference was observed for all-cause (χ2=0.7, P=0.4) and cancer-specific (χ2=0, P=0.96) survival between left and right colon cancer. The Cox model did not indicate sidedness as a prognostic factor. In the subgroup analysis, stage II right-sided colon cancer had a better survival outcome, while stage III left-sided tumors had a better survival outcome.ConclusionsAfter adjusting for clinicopathological characteristics in this study, sidedness showed no impact on survival in early-stage colon cancer. However, sidedness was associated with prognostic differences in stages II and III early-stage colon cancer.

P74 Long-term Survival After Minimally Invasive Resection versus Open Pancreaticoduodenectomy for Pancreatic Cancers: A Systematic Review and Meta-analysis

IntroductionIt remains unclear whether minimally invasive pancreaticoduodenectomy (MIPD) and open pancreaticoduodenectomy (OPD) influences long-term survival in periampullary cancers. This review aims evaluate long-term survival between MIPD and OPD for periampullary cancers.MethodsA systematic review was performed to identify studies comparing long-term survival after MIPD and OPD. The I2 test was used to test for statistical heterogeneity and publication bias using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year survival, and disease-specific 5-year and 3-year survival. Meta-regression was performed for the 5- year and 3-year survival outcomes with adjustment for study (region, design, case matching), hospital (centre volume), patient (ASA grade, gender, age), and tumor (stage, neoadjuvant therapy, subtype (i.e. ampullary, distal bile duct, duodenal, pancreatic)). Sensitivity analyses performed on studies including pancreatic ductal adenocarcinoma (PDAC) only.ResultsThe review identified 31 relevant studies. Among all 58,622 patients, 8716 (14.9%) underwent MIPD and 49,875 (85.1%) underwent OPD. Pooled analysis revealed similar 5-year overall survival after MIPD compared with OPD (HR: 0.78, 95% CI 0.50–1.22, p = 0.2). Meta-regression indicated case matching, and ASA Grade II and III as confounding covariates. The statistical heterogeneity was limited (I2 = 12, c2 = 0.26) and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Sensitivity subset analyses for PDAC demonstrated similar 5-year overall survival after MIPD compared with OPD (HR 0.69, 95% CI: 0.32–1.50, p = 0.3).ConclusionLong-term survival after MIPD is similar to OPD. Thus, MIPD can be recommended as a standard surgical approach for periampullary cancers.

Cancer Stage, Treatment, and Survival Among Transgender Patients in the United States.

BackgroundTransgender persons face many barriers to health care that may delay cancer diagnosis and treatment, possibly resulting in decreased survival. Yet, data on cancer in this population are limited. We examined cancer stage at diagnosis, treatment, and survival among transgender patients compared with cisgender patients in the National Cancer Database (NCDB).MethodsGender (male, female, or transgender) was extracted from medical records from patients diagnosed with cancer between 2003 and 2016. Logistic regression estimated odds ratios (ORs) for the associations between gender and stage at diagnosis and treatment receipt. Cox proportional hazards regression estimated hazard ratios (HRs) for associations between gender and all-cause survival.ResultsAmong 11 776 699 persons with cancer in NCDB, 589 were transgender. Compared with cisgender patients, transgender patients may be more likely to be diagnosed with advanced stage lung cancer (OR = 1.76, 95% confidence interval [CI] = 0.95 to 3.28); be less likely to receive treatment for kidney (OR = 0.19, 95% CI = 0.08 to 0.47) and pancreas (OR = 0.33, 95% CI = 0.11 to 0.95) cancers; and have poorer survival after diagnosis with non-Hodgkin lymphoma (HR = 2.34, 95% CI = 1.51 to 3.63), prostate (HR = 1.91, 95% CI = 1.06 to 3.45), and bladder cancers (HR = 2.86, 95% CI = 1.36 to 6.00). Similar associations were found for other cancer sites, although not statistically significant.ConclusionTransgender patients may be diagnosed at later stages, be less likely to receive treatment, and have worse survival for many cancer types. Small sample size hampered our ability to detect statistically significant differences for some cancer sites. There is a need for transgender-focused cancer research as the population ages and grows.

Risk factors and prognostic impact of post-discharge bleeding after endovascular therapy for peripheral artery disease.

This study evaluated the incidence, predictors, and impact of bleeding requiring hospitalization following successful endovascular therapy (EVT) for peripheral artery disease. Platelet inhibition after EVT reduces the risk of major adverse limb events but increases the risk of bleeding. The incidence of post-discharge bleeding after EVT, its independent predictors, and its prognostic importance in clinical practice have not been fully addressed. We evaluated 779 consecutive patients who underwent EVT. We found that 77 patients (9.9%) were hospitalized for major bleeding during follow-up after EVT (median 39 months, range 22-66 months), with almost half (48.1%) of the bleeding categorized as gastrointestinal bleeding. Significant predictors of post-discharge bleeding were hemodialysis (hazard ratio (HR), 3.12; 95% CI: 1.93 to 5.05; p < 0.001) and dual antiplatelet therapy (DAPT) use (HR, 1.87; 95% CI: 1.03 to 3.41; p = 0.041). During follow-up, the all-cause mortality-free survival rate was significantly worse in patients who had experienced major bleeding than in those who had not (log-rank test χ2 = 54.6; p < 0.001). Cox proportional hazards analysis showed that major bleeding (HR, 2.78; 95% CI: 1.90 to 4.06; p < 0.001) was an independent predictor of all-cause death after EVT. Hospitalization for post-discharge bleeding after EVT is associated with a substantially increased risk of death, even after successful EVT. We concluded that patients' predicted bleeding risk should be considered when selecting patients likely to benefit from EVT, and that the risk should be considered especially thoroughly in hemodialysis patients.

Preoperative coronary artery calcifications in veterans predict higher all-cause mortality in early-stage lung cancer: a cohort study.

BackgroundLung cancer patients often have comorbidities that may impact survival. This observational cohort study examines whether coronary artery calcifications (CAC) impact all-cause mortality in patients with resected stage I non-small cell lung cancer (NSCLC).MethodsVeterans with stage I NSCLC who underwent resection at a single institution between 2005 and 2018 were selected from a prospectively collected database. Radiologists blinded to patient outcomes graded CAC severity (mild, moderate, or severe) in preoperative CT scans using a visual estimation scoring system. Inter-rater reliability was calculated using the kappa statistic. All-cause mortality was the primary outcome. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to compare time-to-death by varying CAC.ResultsThe Veteran patients (n=195) were predominantly older (median age of 67) male (98%) smokers (96%). The majority (68%) were pathologic stage IA. Overall, 12% of patients had no CAC, 27% mild, 26% moderate, and 36% severe CAC. Median unadjusted survival was 8.8 years for patients with absent or mild CAC versus 6.3 years for moderate and 5.9 years for severe CAC (P=0.01). The adjusted hazard ratio for moderate CAC was 1.44 (95% CI, 0.85–2.46) and for severe CAC was 1.73 (95% CI, 1.03–2.88; P for trend <0.05).ConclusionsThe presence of severe CAC on preoperative imaging significantly impacted the all-cause survival of patients undergoing resection for stage I NSCLC. This impact on mortality should be taken into consideration by multidisciplinary teams when making treatment plans for patients with early-stage disease.

Evaluation of hypophysectomy for treatment of hypersomatotropism in 25 cats.

BackgroundSuccessful treatment of cats with hypersomatotropism by transsphenoidal hypophysectomy is described in small numbers of cats.ObjectivesTo describe the endocrine profile, survival, and remission rates of hypersomatotropism and diabetes mellitus in a cohort of cats with hypersomatotropism that underwent hypophysectomy between 2008 and 2020.AnimalsTwenty‐five client‐owned cats with spontaneous hypersomatotropism.MethodsRetrospective study. Diagnosis of hypersomatotropism was based on clinical signs, plasma insulin‐like growth factor‐1 (IGF‐1) concentration, and imaging of the pituitary gland. Growth hormone (GH) and IGF‐1 concentrations were measured repeatedly after surgery. Survival times were calculated based on follow‐up information from owners and referring veterinarians.ResultsMedian postoperative hospital stay was 7 days (range, 3‐18 days). One cat died within 4 weeks of surgery. Median plasma GH concentration decreased significantly from 51.0 ng/mL (range, 5.0‐101.0 ng/mL) before surgery to 3.8 ng/mL (range, 0.6‐13.0 ng/mL) at 5 hours after surgery. Remission of hypersomatotropism, defined as normalization of plasma IGF‐1 concentration, occurred in 23/24 cats (median, 34 ng/mL; range, 14‐240 ng/mL) and 22/24 cats entered diabetic remission. Median survival time was 1347 days (95% confidence interval, 900‐1794 days; range, 11‐3180 days) and the overall 1‐, 2‐, and 3‐year all‐cause survival rates were 76%, 76%, and 52%, respectively.Conclusions and Clinical ImportanceThis study shows the beneficial outcome of hypophysectomy in cats with hypersomatotropism, marked by low death rate and a high percentage of diabetic remission and definitive cure.

Surgeon Volume And Established Hospital Peri-operative Mortality Rate Together Predict Superior Outcomes After Open AAA Repair

ABSTRACT BACKGROUND In 2018, the SVS published hospital volume guidelines for elective open abdominal aortic aneurysm (AAA) repair, recommending elective open surgical repair for AAA be performed at centers with an annual volume of at least 10 open aortic operations of any type and a documented perioperative mortality of 5% or less. Recent work suggests a yearly surgeon volume of ≥7 open aortic cases for improved outcomes. The objective of this study is to assess the importance of hospital volume and surgeon volume at these cut points in predicting 1-year mortality after OSR for AAA. METHODS We evaluated patients undergoing elective open AAA repair using The New York Statewide Planning and Research Cooperative System database from 2003 to 2014. The effect of the SVS guidelines on postoperative mortality and complications was evaluated. Confounding between hospital and surgeon volume was identified using mixed-effects multivariate cox proportional hazards analysis. The effect of interactions between hospital volume, established hospital perioperative survival, and surgeon volume on post-operative outcomes was investigated. RESULTS The cohort consisted of 7,594 elective open AAA repairs performed by 542 surgeons in 137 hospitals over the 12 years. Analysis of the 2018 guidelines using the SPARCS database resulted in 1-year and 30-day mortality rates of 9.2% (8.3–10.1) and 3.5% (2.9-4.1) for centers that were within the guidelines and 13.6% (12.5–14.7) and 6.9% (6.1-7.8) for those that were outside the guidelines, respectively (both p CONCLUSIONS These data demonstrate centers that meet the SVS AAA volume guidelines are associated with improved 1-year and 30-day all-cause survival; however, are confounded by surgeon volume. Surgeon open aortic volume ≥7 and established hospital perioperative mortality of ≤5% each independently predict 1-year survival after open AAA repair, while hospital volume is less important. Surgeons with an annual volume of at least 7 open aortic operations of any type should perform elective open AAA repair at centers with a documented perioperative mortality of 5% or less.

A comparison of the Breslow depth and all-cause survival of male and female genital melanomas

To the Editor: Genital melanomas account for 0.52% of primary melanomas.1 Genital melanomas are more common in women, and vaginal tumors have worse survival than vulvar tumors.1,2 However, differences in Breslow depth among genital tumors has not been fully explored. This study explored differences in Breslow depth and all-cause survival between vulvar, vaginal, penile, and scrotal melanoma.

Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients.

Background: Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). Methods: data of 184 of the 466 patients followed in the Independent study (NCT00710788) were post hoc examined to assess the association three concurrent measures of vascular calcification and all-cause survival. Specifically, coronary artery calcification (CAC) was determined by the Agatston and the volume score while abdominal aorta calcification was determined by plain X-ray of the lumbar spine (Kauppila score (KS)). Survival and regression models as well as metrics of risk recalculation were used to test the association of VC and outcome beyond the Framingham risk score. Results: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting HD were analyzed. Over 36 (median 36; interquartile range: 8–36) months of follow-up 69 patients expired. Each measure of VC (CAC or KS) predicted all-cause mortality independently factors commonly associated with all-cause survival (p < 0.001). Far more importantly, each measurement of VC significantly improved risk prediction and patient reclassification (p < 0.001) beyond traditional cardiovascular risk factors. Conclusions: Overall, presence and extension of VC, irrespective of the arterial site, predict risk of all-cause of death in patients starting hemodialysis. Of note, both CAC and KS increase risk stratification beyond traditional CV risk factors. However, future efforts are needed to assess whether a risk-based approach encompassing VC screening to guide HD patient management improves survival.

Soluble urokinase-type plasminogen activator receptor predicts peripheral artery disease severity and outcomes.

Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with chronic kidney disease (CKD) severity and peripheral artery disease (PAD). We hypothesize an association of PAD severity and suPAR in patients without advanced CKD and further risk stratification according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. For study purposes, suPAR was measured in 334 PAD patients (34% women, age 69 (62–78) years, eGFR 68 ± 20 mL/min/1.72 m2) by commercial ELISA. Patients were followed for 10 years to assess long-term all-cause survival by Cox regression. Higher suPAR levels were associated with lower ankle–brachial index (R = −0.215, p = 0.001) in patients with PAD without media-sclerosis (n = 236). suPAR levels inversely correlated with decreased glomerular filtration rate (R = −0.476, p < 0.001) and directly correlated with urinary albumin-to-creatinine ratio (R = 0.207, p < 0.001). Furthermore, higher suPAR levels associated with a higher KDIGO risk score (p < 0.001). Baseline suPAR was significantly associated with all-cause mortality (HR 1.40 (95% CI 1.16–1.68), p < 0.001) over 10 years. suPAR remained associated with mortality (HR 1.29 (1.03–1.61), p = 0.026) after multivariable adjustment for age, sex, cardiovascular risk factors, and eGFR. Future research may define a standard role for suPAR assessment in PAD’s work-up and treatment, especially in patients with CKD.

Mortality Rates in Alzheimer's Disease and Non-Alzheimer's Dementias: A Systematic Review and Meta-Analysis

Background: People with dementia die prematurely. Identifying differences in mortality rates between different types of dementia may aid in the development of preventive interventions for these most vulnerable populations. Methods: A systematic search of the MEDLINE, PubMed, EMBASE, and Cochrane Library from inception to May 31, 2020 was conducted for case-control or cohort studies providing mortality and survival-related outcomes among people with different types of dementia. The primary outcomes were the all-cause mortality rate and survival time from dementia diagnosis between the general population, people with Alzheimer’s disease (AD), and those with non-AD dementias. The secondary outcomes were age at death and survival time from disease onset. Random-effects meta-analyses were conducted. Effect sizes included hazard ratios (HRs) and mean differences (MDs) with 95% confidence intervals (CIs). Potential moderators were identified through meta-regression and subgroup analyses. The Newcastle Ottawa Scale was used to measure the methodological quality of eligible studies. Heterogeneity was assessed with the I2 statistic and sensitivity analyses were undertaken. Findings: Data were extracted from 78 eligible studies encompassing 152,353 controls and 63,125 cases of dementia. All-cause mortality occurred in 20,927 of 152,174 controls and in 2,684 of 8,102 cases of dementia during a median 5-year follow-up. After diagnosis, the median survival time for people with AD was 4·4 (range, 1·3, 10) years. Compared to controls, the HR of all-cause mortality was highest for Lewy body dementia (17·88; 95% CI, 5·87, 54·46). Compared to AD, a diagnosis of any non-AD dementia was associated with a higher risk of all-cause mortality (HR, 1·33; 95% CI, 1·21, 1·46), a shorter survival time from diagnosis (MD, -1·12; 95% CI, -1·52, -0·72), and a younger age at death (MD, -1·76; 95% CI, -2·67, -0·85). However, group differences between distinct subtypes of non-AD dementia were not significant. Interpretation: AD is the most common type of dementia and the leading cause of mortality world-wide, but non-AD dementias have a worse prognosis in terms of mortality and survival. Funding: None to declare. Declaration of Interest: None to declare

Multidimensional Evaluation of All-Cause Mortality Risk and Survival Analysis for Hospitalized Patients with COVID-19.

Background: Coronavirus disease 2019 (COVID-19) has caused over 3.8 million deaths globally. Up to date, the number of death in 2021 is more than that in 2020 globally. Here, we aimed to compare clinical characteristics of deceased patients and recovered patients, and analyze the risk factors of death to help reduce mortality of COVID-19.Methods: In this retrospective study, a total of 2719 COVID-19 patients were enrolled, including 109 deceased patients and 2610 recovered patients. Medical records of all patients were collected between February 4, 2020, and April 7, 2020. Clinical characteristics, laboratory indices, treatments, and deep-learning system- assessed lung lesion volumes were analyzed. The effect of different medications on survival time of fatal cases was also investigated.Results: The deceased patients were older (73 years versus 60 years) and had a male predominance. Nausea (10.1% versus 4.1%) and dyspnea (54.1% versus 39.2%) were more common in deceased patients. The proportion of patients with comorbidities in deceased patients was significantly higher than those in recovered patients. The median times from hospital admission to outcome in deceased patients and recovered patients were 9 days and 13 days, respectively. Patients with severe or critical COVID-19 were more frequent in deceased group. Leukocytosis (11.35×109/L versus 5.60×109/L) and lymphocytopenia (0.52×109/L versus 1.58×109/L) were shown in patients who died. The level of prothrombin time, activated partial prothrombin time, D-dimer, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, creatine kinase, glucose, brain natriuretic peptide, and inflammatory indicators were significantly higher in deceased patients than in recovered patients. The volumes of ground-glass, consolidation, total lesions and total lung in all patients were quantified. Complications were more common in deceased patients than in recovered patients; respiratory failure (57.8%), septic shock (36.7%), and acute respiratory distress syndrome (26.6%) were the most common complications in patients who died. Many treatments were more frequent in deceased patients, such as antibiotic therapy (88.1% versus 53.7%), glucocorticoid treatment (70.6% versus 11.0%), intravenous immunoglobin treatment (36.6% versus 4.9%), invasive mechanical ventilation (62.3% versus 3.8%). Antivirals, antibiotics, traditional Chinese medicines and glucocorticoid treatment may significantly increase the survival time of fatal cases. Quantitative computed tomography imaging results were correlated with biochemical markers.Conclusions: Most patients with fatal outcomes were more likely to have common comorbidities. The leading causes of death were respiratory failure and multiple organ dysfunction syndrome. Acute respiratory distress syndrome, respiratory failure and septic shock were the most common serious complications. Antivirals, antibiotics, traditional Chinese medicines, and glucocorticoid treatment may prolong the survival time of deceased patients with COVID-19.

Other and All-Cause Mortality among Men Diagnosed with Prostate Cancer in the PLCO Trial

Men with prostate cancer have high cause-specific survival, and most deaths are from other causes. This study aimed to investigate other and all-cause mortality in a large cancer screening cohort. From the PLCO (Prostate, Lung, Colorectal and Ovarian) Cancer Screening Trial cohort, we selected men diagnosed with prostate cancer from 1994-2014. We examined other and all-cause survival by prostate cancer risk level, defined as the D'Amico categories for localized disease (low, intermediate and high risk) plus nonlocalized disease. We developed 3 Cox proportional hazards models to assess the relationship between risk level and survival. Model I controlled for age, race, study arm and diagnosis year. Model II additionally controlled for other demographic and medical history factors. Model III additionally controlled for initial treatment. Of 76,672 men in PLCO and 10,859 prostate cancer cases, 9,248 (85.2%) had known prostate cancer risk level (mean±SD age 70.4±6.2 years). Median followup time from diagnosis was 10.8 years (IQR 6.8-15.0). Of 3,318 deaths 81% were from other causes. Compared to the low risk group, other-cause mortality HRs were 1.13 (95% CI 1.04-1.23), 1.35 (95% CI 1.21-1.50) and 1.63 (95% CI 1.35-1.97) for intermediate risk, high risk and advanced disease, respectively, in model II. Model III HRs were similar to model II except for advanced disease, where the HR decreased to 1.35. Other-cause survival was greater in lower vs higher risk disease, even after controlling for lifestyle characteristics and comorbidities. Further research is needed to identify factors contributing to this higher other-cause mortality to help mitigate the risk.

Ten-Year Relative Survival From the Diagnosis of Parkinson's Disease: A Nationwide Database Study

ObjectivesVarying early survival rates have been reported across studies on patients with Parkinson's disease (PD). In this study, we reported the 10-year relative survival rate of patients with PD using a nationwide database. DesignThis was a population-based cohort study. Setting and ParticipantsWe identified incident PD cases from 2004 to 2006 using the PD registration codes from the National Health Insurance Service database covering the entire South Korean population. MethodsRelative survival up to 10 years was evaluated by adjusting all-cause survival for expected survival, estimated from population life tables and matched by sex, age, and year of diagnosis. ResultsOf the 10,159 patients with PD, 4675 (46.0%) patients survived 10 years after diagnosis. Relative survival rates decreased with time after diagnosis (0.972 after 1 year, 0.772 after 5 years, and 0.588 after 10 years). Ten-year relative survival gradually decreased with age at diagnosis. Men had a lower relative survival rate than women 2 years post diagnosis, and if they were older than 60 years. Conclusions and ImplicationsPatients diagnosed with PD are expected to have a lower 10-year relative survival. In the real world, patients with PD might have lower survival than the general population even in the early disease stage. Our results suggest further efforts to prevent premature mortality among patients with PD.

Understanding disparities in cancer prognosis: An extension of mediation analysis to the relative survival framework.

Mediation analysis can be applied to investigate the effect of a third variable on the pathway between an exposure and the outcome. Such applications include investigating the determinants that drive differences in cancer survival across subgroups. However, cancer disparities may be the result of complex mechanisms that involve both cancer‐related and other‐cause mortality differences making it difficult to identify the causing factors. Relative survival, a commonly used measure in cancer epidemiology, can be used to focus on cancer‐related differences. We extended mediation analysis to the relative survival framework for exploring cancer inequalities. The marginal effects were obtained using regression standardization, after fitting a relative survival model. Contrasts of interests included both marginal relative survival and marginal all‐cause survival differences between exposure groups. Such contrasts include the indirect effect due to a mediator that is identifiable under certain assumptions. A separate model was fitted for the mediator and uncertainty was estimated using parametric bootstrapping. The avoidable deaths under interventions can also be estimated to quantify the impact of eliminating differences. The methods are illustrated using data for individuals diagnosed with colon cancer. Mediation analysis within relative survival allows focus on factors that account for cancer‐related differences instead of all‐cause differences and helps improve our understanding on cancer inequalities.

Penile cancer and the HPV attributable fraction in Scotland; A retrospective cohort study.

Penile cancer (PeC) is a highly morbid disease which is rising in certain settings including Scotland. A component of PeC is associated with Human Papillomavirus (HPV) although its influence on clinical outcomes is debatable as is whether the fraction attributable to HPV is increasing. A total of 122 archived tissue samples derived from patients diagnosed with PeC between 2006-2015 were collated and tested for HPV DNA using molecular PCR. HPV positivity was determined for the overall population and by calendar year of diagnosis to determine any temporal trends. The influence of age, deprivation, smoking, tumour stage and tumour grade on likelihood of HPV positivity was determined by logistic regression. In addition, the influence of HPV status and the other clinical and demographics variables on all-cause death and death from PeC was assessed. HPV was detected in 43 % (95 % CI: 34-52) of penile cancers and the majority of infections were HPV 16. The HPV component of PeC did not increase over the time period (p for linear trend - 0.226). No demographic or clinical variables were associated with HPV positivity neither was HPV status associated with improved all-cause or cancer-specific survival during the follow up period. The rise in PeC in Scotland may not be attributable to a rise in HPV-associated cancer; this is consistent with oropharyngeal cancer (OPC) in the UK where there is an increase in both HPV positive and negative cancer. This work calls for a larger multi centre study to enable further detailed investigation into the implications of HPV infection in PeC.

Abstract PO-177: Cancer burden and survival among transgender patients in the United States

Abstract Background: Cancer burden among transgender patients is currently unknown due to a paucity of available data. Transgender patients face many barriers to healthcare, including discrimination, stigma, and lack of health insurance. Consequently, there may be delays in cancer diagnoses and treatment, resulting in increased cancer mortality among transgender individuals compared to cisgender persons. We sought to examine cancer stage at diagnosis, cancer treatment, and survival among transgender patients compared to cisgender patients in a large national cancer database. Methods: Data from the National Cancer Database (NCDB) included patients diagnosed with cancer between 2003 – 2016. Gender was recorded by physicians in the medical record and we included individuals categorized as “Male”, “Female”, or “Transsexual” (transgender). We examined primary cancers with ≥10 cases occurring in transgender adults aged ≥18 years. Multivariable logistic regression was used to estimate odds ratios (ORs) for advanced stage at diagnosis (stages III and IV versus stages 0, I, and II) and receipt of cancer treatment (e.g. surgery, chemotherapy, radiotherapy, or a combination) comparing transgender and cisgender patients for each cancer site. Hazard ratios (HRs) were estimated with Cox proportional hazards regression to estimate the associations between physician- recorded gender and all-cause survival for each cancer site. Models were adjusted for age at diagnosis, race/ethnicity, insurance status, year of diagnosis, stage at diagnosis, and treatment receipt as applicable. Results: There were 589 transgender cancer patients among the ≥11 million patients in NCDB. Differences in stage at diagnosis, treatment, and survival between transgender and cisgender cancer patients were not broadly observed across cancer sites. However, transgender patients with lung and bronchus cancer may be more likely to be diagnosed at later stages (OR: 1.76, 95% CI: 0.95, 3.28) than cisgender patients. In addition, compared to cisgender patients, transgender patients were less likely to receive treatment for kidney cancer (OR: 0.22, 95% CI: 0.09, 0.55). Finally, survival was worse in transgender patients compared to cisgender patients with non-Hodgkin lymphoma (HR: 2.36; 95% CI: 1.51, 3.70) and urinary bladder cancer (HR: 2.03, 95% CI: 1.31, 3.14). Conclusion: For specific cancers types, transgender patients may be diagnosed at a later stage, be less likely to receive treatment, and have worse survival. However, this study was hampered by the small number of transgender patients and the lack of self-reported gender identity separate from natal sex. Routine collection of gender identity in cancer registries and patient records will allow for improved estimates of cancer incidence, risk, and more meaningful comparisons between transgender and cisgender cancer patients. There is an urgent need to expand our knowledge of cancer burden among transgender individuals as this population grows and ages. Citation Format: Sarah S. Jackson, Xuesong Han, Ziling Mao, Leticia Nogueria, Gita Suneja, Ahmedin Jemal, Meredith S. Shiels. Cancer burden and survival among transgender patients in the United States [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-177.

Effects of etomidate use in ICU patients on ventilator therapy: a study of 12,526 patients in an open database from a single center.

BackgroundThere is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients.MethodsThis retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose–mortality relationship of etomidate.ResultsAll-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR: 1.84, 98.75% CI: 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]).ConclusionsEtomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.

Evaluation of sCD163 and sTWEAK in patients with stable peripheral arterial disease and association with disease severity as well as long-term mortality

Background and aimsThe TNF-superfamily member sTWEAK and its scavenger receptor sCD163 are potentially involved in pathophysiological processes of atherosclerosis. In patients with peripheral arterial disease, previous research has shown that sTWEAK and the sCD163/sTWEAK ratio were independently associated with long term all-cause and cardiovascular survival. Since previous investigations emphasized on symptomatic peripheral arterial disease including critical limb ischemia, this study evaluates sTWEAK and sCD163 in a cohort of stable peripheral arterial disease including asymptomatic (Fontaine stage I) and intermittent claudication (Fontaine stage II) patients. MethodssTWEAK concentrations of 354 patients were measured using a commercially available ELISA kit. sCD163 was quantified using a multiplex bead assay. Cox proportional hazards regression was used to assess outcome after a seven-year follow-up. Hazard ratios are given as interquartile range. ResultsPatients with intermittent claudication exhibited increased sCD163 levels in comparison to asymptomatic patients (p = 0.002). However, sTWEAK was not related to peripheral arterial disease severity (p = 0.740). A multivariable Cox-proportional hazard models including sTWEAK and cardiovascular risk factors (age, HbA1c, CRP, LDL-C, BMI, eGFR) revealed an inverse association with all-cause mortality (HR 0.775 (95% CI 0.623–0.965) and cardiovascular mortality (HR 0.710 (95% CI 0.534–0.944)). Further multivariable models including sCD163 or the sCD163/sTWEAK ratio and cardiovascular risk factors showed no association with mortality. ConclusionsThis study highlights the use of sCD163 as a novel biomarker for PAD severity and supports sTWEAK as an independent predictor of all-cause and cardiovascular mortality even in stable peripheral arterial disease.

Reproductive Outcomes After Breast Cancer in Women With vs Without Fertility Preservation

The practice of fertility preservation (FP) in women with breast cancer (BC) is spreading, but long-term reproductive outcomes after FP are largely unknown. To investigate the long-term reproductive outcomes in women who did or did not undergo FP at the time of BC diagnosis. A Swedish nationwide cohort study was conducted to investigate the long-term reproductive outcomes of women with BC receiving FP at 1 of the regional FP programs from 1994 to 2017 (n = 425). Population comparators with BC but without history of FP (n = 850) were sampled from regional BC registers, matched on age, calendar period of diagnosis, and county. Data on live births, assisted reproductive technology (ART) use, and mortality were retrieved from population-based registers. Data analysis was performed from January to September 2020. History of having received FP compared with no history of FP (unexposed). The primary outcome was hazard ratios (HRs) of live births and ART treatments following BC in women with vs without FP and the cumulative incidence of these events in the presence of the competing risk of death. Women who had undergone FP (n = 425) had lower parity (302 [71.1%] were nulliparous compared with 171 [20.1%] in the unexposed group), were younger (mean [SD] age, 32.1 [4.0] vs 33.3 [3.6] years), more often had estrogen receptor-positive tumors (289 [68.0%] vs 515 [60.6%]), and were more often scheduled for chemotherapy (399 [93.9%] vs 745 [87.7%]). Of 425 women exposed to FP, 97 (22.8%) had at least 1 post-BC live birth (mean follow-up, 4.6 years), compared with 74 of 850 women (8.7%) unexposed to FP (mean follow-up, 4.8 years). Overall, live birth rates after BC were significantly higher among women with FP (adjusted hazard ratio [aHR], 2.3; 95% CI, 1.6-3.3). The 5-year and 10-year cumulative incidence of post-BC live births was 19.4% and 40.7% among FP-exposed women vs 8.6% and 15.8% among comparators, respectively. Rates of ART use were also higher in the FP group (aHR, 4.8; 95% CI, 2.2-10.7). The all-cause mortality rate was lower in women exposed to FP (aHR, 0.4; 95% CI, 0.3-0.7), with 5-year cumulative incidence of death of 5.3% (95% CI, 3.1%-9.0%) vs 11.1% (95% CI, 8.7%-14.1%) for women with vs without FP. In this cohort study of Swedish women after a BC diagnosis, successful pregnancy after BC was possible both in women with and without FP at the time of diagnosis, but a significantly higher likelihood of post-BC live births and ART treatments was observed in women who underwent FP, without any negative association with all-cause survival. This information is valuable for health care clinicians responsible for oncologic treatment and reproductive counseling of women diagnosed with breast cancer at reproductive age.