Benefit In Terms Of Survival Research Articles

Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study

Objective To evaluate the association of volume limited and pressure limited (lung protective) mechanical ventilation with two year survival in patients with acute lung injury.Design Prospective cohort study.Setting 13 intensive...

1107 DOES PARTIAL NEPHRECTOMY RESULT IN A DURABLE OVERALL SURVIVAL BENEFIT IN THE ELDERLY?

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121107 DOES PARTIAL NEPHRECTOMY RESULT IN A DURABLE OVERALL SURVIVAL BENEFIT IN THE ELDERLY? Marc Smaldone, Brian Egleston, Anthony Corcoran, Serge Ginzberg, Rosalia Viterbo, David Chen, Richard Greenberg, Robert Uzzo, and Alexander Kutikov Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Brian EglestonBrian Egleston Philadelphia, PA More articles by this author , Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Serge GinzbergSerge Ginzberg Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author , and Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1215AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent evidence from the EORTC suggests that nephron sparing surgery may not afford an overall survival benefit in all-comers with small localized renal tumors and a normal contralateral kidney. Our objective was to assess if the impact of partial nephrectomy (PN) and radical nephrectomy (RN) on overall mortality differed by patient age in a Medicare population undergoing surgery for T1a Renal Cell Carcinoma (RCC). METHODS Using linked Surveillance, Epidemiology and End Results (SEER)-Medicare data, we identified patients >66 years of age who underwent PN or RN for T1a (≤4cm) RCC from 1995-2007. Linked Medicare data were available through 2009. The effects of procedure type on overall mortality by age were assessed using time dependent Cox proportional hazards models adjusted by propensity score based weighting. RESULTS 6,331 patients (mean age 74.2±5.5 years, 56.4% male) who underwent PN (n=1,862; 29.4%) or RN (n=4,469; 70.6%) for ≤4cm RCC (mean tumor size 2.8±0.8cm) were identified. Stratified by procedure type, significant differences were observed in tumor size (p<0.001), gender (p<0.001), marriage status (p=0.01), and area of residence (p=0.003), while Charlson Comorbidity Index (CCI), race, and tumor grade were similar between groups. Adjusting for clinical and demographic characteristics, in patients ≤84 years of age at diagnosis a statistically significant survival benefit for PN compared to RN was observed at one (age 66: HR 2.1 CI 1.2-3.7; age 75: HR 1.4 CI 1.1-1.8) and three (age 66: HR 1.8, CI 1.1-3.0; age 75: HR 1.3 CI 1.1-1.6) years following diagnosis while these trends become insignificant in patients >84 years of age. However, this benefit diminished over time, and little significant survival benefit with PN was observed at 5 and 10 years following surgery regardless of age (>66 years). CONCLUSIONS These data demonstrate that PN is associated with an initial overall survival advantage in Medicare patients with T1a RCC. Nonetheless, the effect diminishes over time and is not generally evident in patients alive at 5 and 10 years following surgery. Lacking strong evidence regarding a long term survival benefit, the decision to perform PN in elderly patients should be individualized and placed in the context of baseline renal function, expected surgical morbidity, and competing risks to survival. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e449 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc Smaldone Philadelphia, PA More articles by this author Brian Egleston Philadelphia, PA More articles by this author Anthony Corcoran Philadelphia, PA More articles by this author Serge Ginzberg Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The survival impact of systematic lymphadenectomy in endometrial cancer with the use of propensity score matching analysis

We sought to evaluate whether patients with endometrial cancer in the Surveillance, Epidemiology, and End Results database who underwent lymphadenectomy demonstrate improved survival. The study population comprised 50,969 patients. The 3-year cause-specific survival was tested by using propensity score matching (PSM) analysis. The PSM analysis generated a balanced, matched cohort in which baseline characteristics were not significantly different. The benefit of systematic lymphadenectomy appears to be significant for presumed stage I International Federation of Gynecology and Obstetrics grade 3 cancers and presumed stages II-III cancer. The omission of lymphadenectomy in stage I did not appear to show a deleterious survival consequence if the differentiation grade was moderate (grade 2) or well (grade 1). Using PSM analysis, our results show no evidence of benefit in terms of survival for systematic lymphadenectomy in women with stage I endometrial cancer, except for grade 3 cancers.

Exercise and amyotrophic lateral sclerosis

Amyotrophic Lateral Sclerosis (ALS) is a progressive and fatal neurodegenerative disease in which much burden is geared towards end-of-life care. Particularly in the earlier stages of ALS, many people have found both physiological and psychological boosts from various types of physical exercise for disused muscles. Proper exercise is important for preventing atrophy of muscles from disuse-a key for remaining mobile for as long as possible-and as long as it is possible to exercise comfortably and safely, for preserving cardiovascular fitness. However, the typical neuromuscular patient features a great physical inactivity and disuse weakness, and for that reason many controversial authors have contested exercise in these patients during years, especially in ALS which is rapidly progressive. There is an urgent need for dissecting in detail the real risks or benefits of exercise in controlled clinical trials to demystify this ancient paradigm. Yet, recent research studies document significant benefits in terms of survival and quality of life in ALS, poor cooperation, small sample size, uncontrolled and short-duration trials, remain the main handicaps. Sedentary barriers such as early fatigue and inherent muscle misuse should be overcome, for instance with body-weight supporting systems or non-invasive ventilation, and exercise should be faced as a potential non-monotonous way for contributing to better health-related quality of life.

A meta-analysis to determine the effect on survival of platelet transfusions in patients with either spontaneous or traumatic antiplatelet medication-associated intracranial haemorrhage

ObjectivesThe aim of this study was to evaluate by meta-analysis the current level of evidence in order to establish the impact of a platelet transfusion on survival in patients on...

Should Endovascular Intervention be the First Choice to Treat Central Vein Stenosis in Hemodialysis Population?

Purpose: To evaluate the clinical features and the survival benefits of Chinese hemodialysis (HD) patients with central vein stenosis (CVS) undergoing different treatments. Methods: From January 1, 2011 to Dec 31, 2012, 116 HD patients at high risk of CVS at our hospital had their bilateral central veins assessed by vascular ultrasound and conventional venography. We compared the clinical outcome of 24 non-treated asymptomatic, 17 non-treated symptomatic CVS and 6 treated symptomatic CVS. Treatment costs of CVS were recorded and patients’ survival rates were estimated by Kaplan-Meier analysis. Results: Among 116 patients, 47 were diagnosed with CVS. The timespan between symptomatic presentation and the diagnosis of CVS was more than 10 months averagely. Compared with non-CVS patients, the duration of HD in CVS patients was longer (33.8 ± 14.5 vs 1.1 ± 0.7 months) and the rate of central venous catheter (CVC) insertion was higher (87.2% vs 14.5%). Only 6 patients tried to maintain vascular access by endovascular intervention, the cost for which was $5210 per person, much higher than other treatment options. While 30 patients refused endovascular intervention for fear of re-stenosis risk and high treatment costs, among whom 28 lost their initial vascular access. The 12-month survival rates were 87.8%, 60% and 80.3%, respectively. The 24-month survival rates were 48.8%, 60% and 42.8%, respectively. No significant difference was found among the three groups. Conclusions: Endovascular intervention may not be the first choice for HD patients with CVS, considering long term survival benefit and high treatment cost.

32 Does complete revascularisation confers a long term survival benefit in patients with chronically occluded coronary vessels?

IntroductionChronic total occlusion (CTO) of coronary vessels is a relatively common finding on diagnostic angiography. There has been increasing interest in this clinically important area with development of technologies resulting...

Surgical resection of liver metastasis of breast cancer: A multidisciplinary approach—Study case-control.

e11086 Background: In patients with metastatic breast cancer, only the appearance of metastases in the liver occurs in 10% of cases. Unlike colorectal cancer, liver resection is rarely given and its place remains to be defined. The aim of this retrospective study was to compare the survival of two populations with resectable liver metastases (LM) treated for one only medically and for the other surgically preceded by a medical treatment. Methods: From 1988 to 2007, among 100 patients operated of liver metastases of breast cancer at the Curie Institute, 51 were included in this case-control study. Only a positive bone scan was authorized as other metastatic localization. Operated patients received chemotherapy and/or hormonal therapy before surgery and had to be either stabilized or in response. These patients were matched to 51 patients treated only medically. All patients had to have a performance status of 0-1 and the LM should be R0 resected (no residual microscopically desease) with less than 4 metastases. The matching criteria were: patient age, year of diagnosis of breast cancer, time to onset between breast cancer and metastasis, histological type, stage, and status of hormone receptors of breast cancer. The pairing was done 1/1/. Results: In univariate analysis, survival was better in the 2 populations if patients were N -, had no bone metastases or were operated. In multivariate analysis only the liver resection was prognostic. In a Cox model adjusted for paired data yields a RR. = 3.18 (p <0.0001) in favor of surgical treatment. Conclusions: In a selected population, hepatic resection of metastases of breast cancer is a real benefit in terms of survival.

Shining D' light on chronic kidney disease: Mechanisms that may underpin the cardiovascular benefit of vitamin D

Hypovitaminosis D is a significant health-care burden worldwide, particularly in susceptible populations such as those with chronic kidney disease (CKD). Recent epidemiological studies have identified that both higher serum vitamin D concentrations and use of vitamin D supplements may confer a survival benefit both in terms of all-cause and cardiovascular mortality. There is potential to investigate this inexpensive therapy for the CKD population, which suffers excessive cardiovascular events, although the mechanisms explaining this link have yet to be fully elucidated. This review discusses potential mechanisms identified in the basic science literature that may provide important insights into how vitamin D may orchestrate a change in cardiovascular risk profile through such diverse mechanisms as inflammation, atherogenesis, glucose homeostasis, vascular calcification, renin-angiotensin regulation and alterations in cardiac physiology. Where available, the clinical translation of these concepts to intervention trials in the CKD population will be reviewed.

Abstract 1004: Hedgehog signaling promotes tumor vascularization, growth and metastasis of breast cancer via upregulation of CYR61

Abstract Several clinical trials have used chemotherapeutic drugs that specifically target vascular endothelial cell growth factor (VEGF). Although these trials have demonstrated significant improvements in response rates, findings to date have not indicated substantial benefits in terms of survival. This is likely to be due to the ability of tumor cells to utilize several alternative pathways to establish vasculature. Hence, there is an urgent need to define and target other active pathways that contribute to angiogenesis, such that the vascularity of the tumor can be effectively reduced. Hedgehog (Hh) signaling, which promotes cell growth and vascularization during fetal development, is activated in several cancers and has been implicated to play a role in promoting cancer progression. We have investigated the role of Hh signaling in impacting tumor malignancy by promoting tumor vascularity. We engineered sonic hedgehog (SHH)-deficient, tumorigenic breast cancer lines, MDA-MB-231 and MCF10AT, to ectopically express the Hh activating ligand, SHH such that the pathway is constitutively activated. Upregulation of SHH-mediated signaling results in the acquisition of enhanced malignant behavior in vitro (increased growth, invasion, migration, and anchorage independent growth) and in vivo (increased tumor take rate and rapidly growing tumors). Furthermore, the SHH expressing cells are able to enhance migration, invasion and network formation of endothelial cells in vitro and elicit increased vasculature in tumor xenografts, in vivo. Using mass spectrometry-mediated analysis of the secretome of the breast cancer cells with constitutive Hh signaling, we identified CYR61 (cysteine-rich angiogenic inducer 61) as a potential mediator of the angiogenic effects of breast cancer cells. Further, our studies show that CYR61 plays a critical role in mediating the vasculature-enhancing effects of breast cancer cells. Taken together, our lab has identified a robust contributor of tumor vascularization which may be an effective VEGF-independent anti-vascularization therapeutic target. We acknowledge grant support from the Department of Defense-Breast Cancer Research Program (07-1-0400). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1004. doi:10.1158/1538-7445.AM2011-1004

Non-invasive ventilation: established and expanding roles

Non-invasive ventilation (NIV) has become the standard of care for most patients with ventilatory failure due to an acute exacerbation of chronic obstructive pulmonary disease (COPD). In all but a small minority, even of the very sickest, there is little to be lost by at least a short trial of NIV. In patients with acute cardiogenic pulmonary oedema, NIV results in a more rapid physiological improvement and resolution of dyspnoea, but the benefits in terms of survival have been called into question by two recent randomised controlled trials. There are no randomised controlled trials of NIV in patients with acute ventilatory failure due to obesity but the outcome from invasive ventilation is poor and the results of NIV encouraging. Finally, NIV may have a role during the transition from active care, aimed to extend life, to palliative care.

Extrapleural pneumonectomy or supportive care: treatment of malignant pleural mesothelioma?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether extrapleural pneumonectomy (EPP) is superior to supportive care in the treatment of patients with malignant pleural mesothelioma (MPM). Overall, 110 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that EPP confers no advantage to chemotherapy and palliative treatment in terms of survival and symptom improvement. Ten studies evaluated the role of EPP in the management of MPM. The median survival was 13 months and perioperative and 30-day mortality rates were 5.7% and 9.1%, respectively. There was a high morbidity rate of 37% including atrial fibrillation, empyema and supraventricular arrhythmias. Disease recurred in 73% of patients at a median time of 10 months. Median hospital stay was 13 days and intensive care unit stay was 1.5 days. At three months postsurgery, improvement in symptoms was achieved in 68% of patients. Significant advantages were observed in patients with epithelial MPM (19 vs. 8 months, P<0.01) compared to non-epithelial MPM and with N2 disease (19 vs. 10 months) compared to N1 or N0 disease, respectively. Two studies reported outcomes after chemotherapy in patients with MPM. The median survival was 13 months and symptoms improved in 50% of patients. Response rate of 21% was achieved and the median time to disease progression was 7.2 months. Postoperative haematological toxicity was common and included neutropenia (25%), anaemia (5%) and thrombocytopenia (7.4%). Two studies analysed palliative treatment in mesothelioma and reported a median survival of seven months and improvement in symptoms in 25% of patients at one-year post-treatment. The 30-day mortality rate was 7.8% and complications included prolonged air leak (9.8%) and empyema (4%). Median hospital stay was seven days. Overall, EPP shows no benefit in terms of survival or symptom improvement which is compounded by its high operative mortality and recurrence rate.

A retrospective outcome analysis of 42 patients undergoing pulmonary metastasectomy after the resection of a primary colorectal cancer with metachronous liver metastases

Introduction: Resection of pulmonary metastases in patients with treated colorectal cancer is believed to provide a long term survival benefits. There is however little current evidence to support that the subgroup of patients who undergo hepatic resection of metachronous liver metastases prior to pulmonary metastatectomy also derive a survival benefit from surgery. We investigated our patients in order to assess long term survival and to identify possible factors influencing their prognosis.

Use of Autopulse™ automated band chest compression device in out-of-hospital cardiac arrest resuscitation: effect on hemodynamics

ObjectivesThe objective of the study was to assess the effects of an automated external cardiac massage device (ECM), Autopulse™ band chest compression, on arterial blood pressure (BP) during resuscitation by specialist personnel in out-of-hospital cardiac arrest and, in particular, on the diastolic BP, which determines coronary perfusion.Patients and methodsThis was a prospective two-centre study comprising adults with prolonged cardiac arrest. Systolic, diastolic and mean blood pressures (SBP, DBP and MBP) measured via an arterial catheter (invasive method) during manual ECM were compared to those recorded during automated ECM. The principal end-point was the difference in DBP between values measured during manual ECM and during thoracic band ECM.ResultsData on 29 patients were analysed. The median DBP increased once the AutopulseTM activity was initiated, from 17 mmHg [11–25] to 23 mmHg [18–28] (P < 0.001).The SBP rose from 72 mmHg [55–105] to 106 mmHg [78–135] (P = 0.02). The MBP went from 29 mmHg [25–38] to 36 mmHg [30–45] (P = 0.002). However, no increase was seen in ETCO2 (end-tidal carbon dioxide) with Autopulse™ (21 mmHg [13–36] vs 22 mmHg [12–35],P = 0.80).ConclusionThese results show that thoracic band cardiac compression significantly improves the BP during cardiac resuscitation, particularly the DBP, which controls coronary perfusion. While we do not yet have evidence for a possible benefit in terms of survival, this increase in DBP and MBP is promising.

Investigation of the change in myocardial blood flow by perfusion CMR after revascularisation of chronically occluded coronary arteries

The perceived clinical benefits of undertaking revascularisation to coronary artery chronic total occlusions (CTO) relate to improvements in angina symptoms and prognosis1,2. Long term survival benefits from CTO revascularisation has been suggested in several large observational studies despite a significant failure rate1,3. Data about the physiological consequences of successful opening of a CTO are limited and heterogeneous4. CMR imaging can provide quantitative information on MBF (myocardial blood flow) in this context.

Esophageal Cancer Surgery in Patients Older than 75: Long Term Results

Purpose : The purpose of this study was to evaluate short and long term results after esophageal cancer resection in patients older than 75.Methods : We retrospectively analyzed the database of esophageal cancer surgically treated in our department between January 2003 and December 2009 to identify patients older than 75. The preoperative, operative, postoperative and long term characteristics were analyzed.Results : Among 137 patient, 23 were older than 75. The histological subtype was adenocarcinoma in 100%. The surgical techniques were a “Lewis-Santy” procedure in 43%, a trans-hiatal resection in 22%, a “Sweet” procedure in 13%, a stripping in 13% and a McKeown procedure in 9%. The in-hospital postoperative mortality was 13%. The in-hospital postoperative morbidity (Dindo-Clavien Grade > 2, deceased patients included) was 26%. In univariate analysis, no statistically significant risk factor of morbidity was found. A Charlson Comorbidity Index > 2 was, in univariate analysis, the sole risk factor of postoperative mortality (p = 0.0362). The mean hospital stay was 22 ± 12 days. The median survival was 24.2 months. The 5-year overall survival was 39% and the 5-year disease free survival was 26%. 57% of long-term deaths were not cancer related.Conclusion : Esophageal surgery performed in selected patients older than 75 has an acceptable morbidity and mortality but when a severe complication occurs, it leads to death in half of the cases. Surgery enables a long term survival benefit. This study confirmed our attitude of not considering age as a contra-indication for esophageal surgery but rather considering general status, self-reliance and associated comorbidities for patients’ selection.

Review of Tolvaptan in the Treatment of Hyponatremia

Hyponatremia is a very common electrolyte disorder and is a significant independent predictor of medical prognosis and costs. Tolvaptan is a vasopressin receptor antagonist developed for the treatment of hyponatremia. It has its principal application in the treatment of euvolemic and hypervolemic hyponatremia. Its major role is in the treatment of heart failure (HF), cirrhosis and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). While at present tolvaptan has not demonstrated long term survival benefit with its use, it clearly has proven short term efficacy in the management of hyponatremia by demonstrating improvement in serum sodium levels at an acceptable rate without evidence of over-correction.

Guidelines for the management of castrate-resistant prostate cancer.

Secondary hormonal manipulations In patients who develop CRPC and who are relatively asymptomatic, secondary hormonal treatments may be attempted. Level 2 Evidence, Grade C recommendation To date, no study of secondary hormone treatment has demonstrated benefits in terms of survival, but most trials have been smaller and heavily confounded by the future treatments used. In patients treated with luteinizing-hormonereleasing hormone agonist monotherapy or who have had an orchidectomy, total androgen blockade (TAB) with testosterone antagonists, such as bicalutamide, can offer PSA responses in 30% to 35% of patients. For patients who progress on ADT without evidence of distant metastases, it is suggested to screen them for bone metastases and to monitor them for visceral metastases/progression with abdomen and chest imaging. Exact timing of imaging may be modulated using PSA doubling time. Imaging techniques most commonly used include nuclear bone scans and abdominal computed tomography and chest X-ray. The role of magnetic resonance imaging and positron emission tomography is still unclear. For patients who have undergone TAB, the antiandrogen could be discontinued to exclude an antiandrogen withdrawal response (AAWD). The introduction or changes of an AA or the use of ketoconazole has been reported to have transient PSA reductions in about 30% of patients. 3 Level

Strategies to Prevent Cellular Rejection in Pediatric Heart Transplant Recipients

Despite more than 40 years' experience in pediatric heart transplantation, cellular rejection remains a significant cause of morbidity and mortality. In this review, strategies and agents to prevent acute cellular rejection are discussed. Strategies to prevent rejection are divided into two phases - induction and maintenance therapies. Currently, the most commonly used induction agents are polyclonal antibodies (rabbit or equine antithymocyte globulin) and interleukin-2 receptor antibodies (daclizumab or basiliximab). Induction therapies have reduced early rejection, are renal sparing, and can reduce corticosteroid exposure, but have not yet been shown to have a longer term survival benefit. Multiple maintenance immunosuppressants are available. Nearly all regimens include a calcineurin inhibitor (either ciclosporin [cyclosporine] or tacrolimus). Most combinations in pediatric heart transplantation include an antiproliferative agent (azathioprine, mycophenolate mofetil or, less commonly, sirolimus). Everolimus has seen increasing use in adult heart transplant patients in Europe but, to date, its use is rare in pediatric heart transplantation. The use of corticosteroids as a third agent is still common, but strategies to avoid or minimize their use are increasing. The 'best' combination of therapies varies between studies. By gaining a better understanding of individuals' genetic and environmental risk factors, we may in the future be able to better predict the course of cardiac allografts and enhance our ability to tailor immunosuppression to individual patient variables with the ultimate goal of inducing a state of immune tolerance.

Implications of head and neck cancer treatment failure in the neck

Objective Study the survival of patients with cervical lymphatic squamous cell carcinoma recurrence. Study Design Review of tumor registry database. Setting Academic health science center. Subjects and Methods Forty-seven isolated neck recurrence patients identified from 224 recurrences from a total of 1291 patients treated between 1998 and 2007. The main outcome measurements were neck lymph nodal recurrence, treatment-specific survival, and overall survival. Results A total of 47 patients had neck recurrence; 10 of the neck recurrence patients (21.3%) had regional disease (N+) at initial presentation. Median survival for patients with neck recurrence was 14.7 months (95% confidence interval [CI] 8.6-18.1 mo), and five-year survival for this group was five percent (95% CI 0%-30%). Neck dissection salvage therapy for neck recurrence resulted in the best survival. Conclusion Neck dissection as a salvage therapy for neck recurrence resulted in the best survival, and there was no survival benefit in terms of whether a patient had a neck dissection or not as his or her initial therapy.