Crude Survival Rate Research Articles

Survival by Dialysis Modality in Critically Ill Patients with Acute Kidney Injury

Among critically ill patients, acute kidney injury (AKI) requiring dialysis is associated with mortality rates generally in excess of 50%. Continuous renal replacement therapies (CRRT) often are recommended and widely used, although data to support its superiority over intermittent hemodialysis (IHD) are lacking. Data from the Program to Improve Care in Acute Renal Disease (PICARD), a multicenter observational study of AKI, were analyzed. Among 398 patients who required dialysis, the risk for death within 60 d was examined by assigned initial dialysis modality (CRRT [n = 206] versus IHD [n = 192]) using standard Kaplan-Meier product limit estimates, proportional hazards ("Cox") regression methods, and a propensity score approach to account for selection effects. Crude survival rates were lower for patients who were treated with CRRT than IHD (survival at 30 d 45 versus 58%; P = 0.006). Adjusted for age, hepatic failure, sepsis, thrombocytopenia, blood urea nitrogen, and serum creatinine and stratified by site, the relative risk for death associated with CRRT was 1.82 (95% confidence interval 1.26 to 2.62). Further adjustment for the propensity score did not materially alter the association (relative risk 1.92; 95% confidence interval 1.28 to 2.89). Among critically ill patients with AKI, CRRT was associated with increased mortality. Although the results could reflect residual confounding by severity of illness, these data provide no evidence for a survival benefit afforded by CRRT. Larger, prospective, randomized clinical trials to compare CRRT and IHD in severe AKI are needed.

Survival Analysis of 81 Children with Primary Spinal Gliomas: A Population-Based Study

Primary spinal gliomas are rare. Most clinical studies are based on single centers with small numbers of patients and limited length of follow-up. Because data from the Cancer Registry cover larger numbers of patients and longer durations of follow-up, our objective was to define prognostic factors that might predict the survival at a national population level. From 1971 to 1995, data of 81 children (age <15 years) with primary spinal gliomas from the Cancer Registry of England and Wales were analyzed. Median survival and crude survival rates in respect of 7 variables (age, sex, morphology, WHO grade, socioeconomic status, geographical region, and period of diagnosis) were calculated using the Kaplan-Meier method. The Cox regression was performed for estimating hazard ratios (HR) for death. Results showed that the 1-, 5-, and 10-year crude survival rates for this population were 72.84, 60.49, and 58.0%, respectively. Both univariate and multivariate analyses revealed that only morphology (HR 2.79 for nonependymoma, p = 0.05) and WHO grade (HR 6.74 for high grade, p = 0.01) were significant prognostic factors. Results from this population-based study are very helpful for comparison with other population-based studies and for public health purposes.

Comparison of effects of socioeconomic and geographic variations on survival for adults and children with glioma

The authors analyzed the effects of socioeconomic status (SES) and geographic variations on survival rates for adults and children with glioma, studying the data of 30,489 adults and 2940 children from the Cancer Registry in England and Wales. The median survival time and crude survival rates for eight variables (age, sex, morphology, World Health Organization grade, tumor site, SES, geographic region, and period of diagnosis) were calculated using the Kaplan-Meier method. Distributions among different variables were compared using the chi-square test. Cox regressions were performed to estimate the hazard ratios (HR) to death. The median survival time and 1-, 5-, and 10-year crude survival rates for adults were 0.42 years and 29.1, 12, and 7.7%, respectively; the values for children were 9.33 years and 72.69, 54.32, and 49.5%, respectively. Similar gradients in SES from the south to the north exist in both populations (p < 0.001, chi-square test). Multivariate analyses revealed that all eight variables influenced survival in adults, including independent effects of sex (HR 0.94 for female, p < 0.001), SES (HR 1.03/quintile of deprivation, p < 0.001), and geographic region (HR 1.10 for outside southern England, p < 0.001). In children, only five of the eight variables affected survival; sex, SES, and geographic variation did not have an effect. Although age and tumor characteristics are well-known prognostic factors for both adults and children with glioma, SES and geographic variation also play significant roles in the survival of adults. The effects of SES and geographic variation may be directly related to the National Health Service in the United Kingdom.

Timing of Initiation of Dialysis in Critically Ill Patients with Acute Kidney Injury

Among critically ill patients, acute kidney injury (AKI) is a relatively common complication that is associated with an increased risk for death and other complications. To date, no treatment has been developed to prevent or attenuate established AKI. Dialysis often is required, but the optimal timing of initiation of dialysis is unknown. Data from the Program to Improve Care in Acute Renal Disease (PICARD), a multicenter observational study of AKI, were analyzed. Among 243 patients who did not have chronic kidney disease and who required dialysis for severe AKI, we examined the risk for death within 60 d from the diagnosis of AKI by the blood urea nitrogen (BUN) concentration at the start of dialysis (BUN < or = 76 mg/dl in the low degree of azotemia group [n = 122] versus BUN > 76 mg/dl in the high degree of azotemia group [n = 121]). Standard Kaplan-Meier product limit estimates, proportional hazards (Cox) regression methods, and a propensity score approach were used to account for selection effects. Crude survival rates were slightly lower for patients who started dialysis at higher BUN concentrations, despite a lesser burden of organ system failure. Adjusted for age, hepatic failure, sepsis, thrombocytopenia, and serum creatinine and stratified by site and initial dialysis modality, the relative risk for death that was associated with initiation of dialysis at a higher BUN was 1.85 (95% confidence interval 1.16 to 2.96). Further adjustment for the propensity score did not materially alter the association (relative risk 1.97; 95% confidence interval 1.21 to 3.20). Among critically ill patients with AKI, initiation of dialysis at higher BUN concentrations was associated with an increased risk for death. Although the results could reflect residual confounding by severity of illness, they provide a rationale for prospective testing of alternative dialysis initiation strategies in critically ill patients with severe AKI.

Survival Analysis of Children with Primary Malignant Brain Tumors in England and Wales: A Population-Based Study

Primary malignant brain tumor is the second most common cancer in children. To investigate factors affecting children’s survival at a population level, data of 3,169 patients (age <15 years) from the Cancer Registry in England and Wales were used. They were diagnosed during 1971–1990 and followed up until 1995. Variables including age, gender, morphology, WHO grade, tumor site, socioeconomic status, geographical region, and period of diagnosis were available for analysis using the Kaplan-Meier method and the Cox hazards ratio (HR) regression. Results showed that the median survival and the 1-, 5-, and 10-year crude survival rate for this population were 8.7 years, 72.4, 54.0, and 49.2% respectively. Survival was influenced by age (HR 0.88/5 years), morphology (ependymoma HR 2.43), WHO grades (HR 1.42/grade), tumor sites (brain stem HR 2.11), and periods of diagnosis (HR 0.88/5 years). Gender, socioeconomic status, and geographical region did not affect their survival. Results from this population-based data are very helpful for comparison with other hospital-based studies and for public health purposes.

Total pelvic exenteration: a justified procedure.

Twenty patients with advanced primary or locally recurrent pelvic tumours treated by total pelvic exenteration are described. There wer no operative or postoperative deaths. The most frequent postoperative complications appeared to be related to previous irradiation. Four patients developed non-fatal intestinal complications within 30 days of operation that required further surgery. After a mean follow-up of 19 months the crude 2-year survival rate was 40 per cent. This procedure is judged to be useful in a selected group of patients.

Endoscopic transanal resection of rectal tumours - a preliminary report of its use

Endoscopic transanal resection (ETAR) of rectal tumours is a simple and inexpensive procedure, well tolerated in elderly patients or those undergoing palliation. We have performed 137 ETARs in 81 patients with a 30-day mortality rate of 11.1 per cent and a postoperative complication rate of 15.3 per cent. Thirty-one patients (38 per cent) had ETAR for palliation: in this group rectal bleeding was abolished or improved in 66 per cent of patients, altered bowel habit (diarrhoea) corrected in 77 per cent of patients, faecal incontinence improved in 50 per cent of patients and rectal pain (including tenesmus) improved in 50 per cent of patients. Twenty-three patients (28 per cent) were treated for large benign rectal polyps: in this group symptoms were universally abolished. The technique is particularly suited to the management of these patients. Twenty-seven elderly patients with theoretically 'curable' rectal cancer underwent ETAR with a 78 per cent crude survival rate at 1 year. While long-term results remain to be assessed, ETAR appears a useful technique for treating selected patients with rectal tumours.

Paget's disease of the anal margin.

A follow-up study of 22 patients with Paget's disease of the anal margin was conducted to determine the prevalence of invasive disease and coexisting visceral carcinomas, cure and survival rates. Seventy-three per cent of the patients suffered from persistent pruritus ani. Seven (32 per cent) patients had malignancy (invasive Paget's disease (n = 5) and coexisting visceral carcinoma (n = 2] and six (27 per cent) developed malignancy (invasive Paget's disease (n = 4) and coexisting visceral carcinoma (n = 2] during follow-up, giving an overall occurrence of malignancies of 59 per cent (95 per cent confidence limits: 36-79). The median follow-up period was 9 (range 0.5-25) years. No difference in length of history could be found between patients with or without malignancy. The estimated cure rate by actuarial analysis among radically treated patients was 64 per cent (95 per cent confidence limits: 43-91) at 1 year and 45 per cent (95 per cent confidence limits: 18-72) at 8 years after primary treatment. The 5- and 10-year crude survival rates of 54 per cent and 45 per cent, respectively, were significantly lower than the corresponding values of 84 per cent and 60 per cent for the normal population (P less than 0.01). Patients with persistent pruritus ani and a perianal skin lesion should be biopsied frequently. If Paget's disease is diagnosed, physical examination of the patient and anorectal region must be done carefully and repeatedly.

Cancer of the large bowel in a defined population: Canterbury, New Zealand, 1970–4

A total of 1024 new cases of cancer of the large bowel occurred in Canterbury, New Zealand (population 400,796), in the 5 years 1970--4. Of these, 992 were diagnosed before death and are reviewed in this paper. The high incidence of this disease in New Zealanders of European origin is illustrated. A significant difference in site distribution of primary tumours between the sexes was found, with a female preponderance of cancer of the proximal colon gradually changing to a male preponderance of cancer of the rectum. In all, 61.5 per cent of the patients had lymph node metastases or advanced disease at the time of diagnosis or treatment. Largely as a consequence of this, only 65 per cent were able to have potentially curative treatment. The estimated crude 5-year survival rate of the whole group was 32.7 per cent (relative rate 42.8 per cent) and the crude 5-year survival rate after potentially curative surgery was 48.4 per cent (relative rate 62.4 per cent). The results are compared with those of other authors. They emphasize the generally unsatisfactory outcome of treatment.

Radical mastectomy in the treatment of breast cancer. A follow-up study over ten and fifteen years.

Abstract Four hundred and two radical mastectomies have been followed up over a minimum period of 10 years. Postoperative radiotherapy was used only in cases with histologically proved glandular metastasis. The operation mortality was 1.5 per cent; crude survival rate, 44.8 per cent; deaths from other causes, 8.5 per cent; and cancer recurrence rate, 45 per cent. A 15-year follow-up of patients treated before 1955 has shown a further 5.6 per cent of late recurrences. Local recurrence, apart from generalized metastasis, has proved extremely rare in this series.

Pathology and prognosis of carcinoma of the stomach.

Abstract The pathology and prognosis of 205 patients treated by total or partial gastrectomy for carcinoma of the stomach during the years 1951-5 have been evaluated. One hundred and sixteen patients (61 per cent) had a partial gastrectomy and 74 (39 per cent) had a total gastrectomy. The overall postoperative mortality was 25 per cent and this was greater for total than for partial gastrectomy. The crude survival rate was 19.4 per cent at 5 years and 11.4 per cent at 10 years. Carcinoma of the cardia had a worse prognosis than tumours at other sites. There were no 5-year survivors among patients with the linitis plastica type of carcinoma of the stomach. Tumours classified as poorly differentiated or anaplastic carcinoma had a poorer prognosis than well-differentiated adenocarcinomas. The amount of lymphocytic and plasma-cell infiltration of the tumour has a very significant effect on prognosis. Five out of the 7 patients with a heavy infiltrate of such cells survived over 5 years. Lymph-node involvement is the feature having the greatest influence on prognosis. There was a 40 per cent 5-year survival rate in the absence of node involvement and an 11 per cent 5-year survival rate with involved nodes. Patients with involved nodes surviving over 5 years had, on the average, fewer positive glands than those with involved nodes who survived for less than 5 years. No benefit follows from total rather than partial gastrectomy provided the cancer and regional lymph-nodes can be removed with the simpler procedure. Four case reports are presented to illustrate the difficulties in assessing the prognosis of gastric cancer.

The survival of patients with colorectal cancer treated in a regional hospital.

Abstract The survival rate for 301 patients who had a resection for colorectal cancer in Oxford over a 6-year period between 1966 and 1971 has been reviewed. The crude and age-adjusted 5-year survival rates for those who had a resection for cure were 37·3 per cent and 53·8 per cent respectively. The corresponding survival rates for all patients after resection were 25·8 and 37·2 respectively. The most important determinant of survival was the pathological stage of the primary tumour, the agecorrected 5-year survival being 100 per cent for stage A lesions, 58 per cent for stage B, 27·1 for stage C and 5·5 per cent for stage D. Patients who presented with either intestinal obstruction or perforation of their carcinoma had a significantly worse prognosis than those who did not. Patients under 35 years of age did not survive as long as older patients. Those patients who had an anterior resection survived longer than those who underwent colectomy or abdominoperineal resection, probably due to the selection of pathologically favourable cases in the former group. The occurrence of infection in the postoperative period did not influence survival. Thus, in general, patients with colorectal cancer have a poor 5-year survival (with the exception of stage A lesions), and this indicates the need for development of effective adjuvant therapy after surgery for this disease.

Basal cell carcinoma of the anus-a clinical study of 34 cases.

Thirty-four patients with basal cell carcinoma of the anus were treated in Denmark between 1943 and 1974. The tumours were usually between 1 and 2 cm in diameter and localized to the anal margins. Three tumours had a diameter of 10 cm and extended into the anal canal. In one case the tumour had spread to the regional lymph nodes. Modes of treatment were wide local excision (27 patients), abdominoperineal excision of the rectum (4 patients), colostomy combined with radiotherapy (1 patient) and radiotherapy alone (2 patients). Local recurrence was observed in 8 cases. After retreatment (re-excision: 5 patients), excision of the rectum (1 patient) and radiotherapy (2 patients), no recurrences were observed in the follow-up period ( greater than 5 years). The crude 5-year survival rate was 72.6 per cent. The death rate was not higher than in the normal population of the same age and sex and no death was due to the basal cell carcinoma.

Recurrent head and neck cancer: the results of treatment.

Abstract A study of 144 patients with cancer of the head and neck showed that 67 (46 per cent) developed recurrent cancer. Radical second treatment, almost exclusively by surgery, secured an 11 out of 67 or 16 per cent crude 5-year survival rate for recurrent head and neck cancer. Further analysis showed that the prospects of successful second treatment were negligible or nil with certain identifiable tumours or tumour sites. When these identifiable cases are excluded the survival rate for head and neck cancer became 11 out of 45 or 24 per cent. Age and general condition rendered some patients unfit for radical surgery. In this series 30 patients were treated by radical surgery with a patients cured: patients surgically treated ratio of 11 out of 30 or 36 per cent.

Squamous cell carcinoma of the anus at one hospital from 1948 to 1984.

Two hundred and twenty-eight patients with anal carcinoma treated between 1948 and 1984 were reviewed. Of 145 with anal canal carcinoma, 118 were treated by total anorectal excision, nine by local excision and 13 by radiotherapy. Fifteen patients were inoperable. There were five postoperative deaths. Crude and cancer-specific survival rates of 123 patients treated 5 or more years previously were 58 and 64 per cent. These rates for patients undergoing total anorectal excision were 62 and 65 per cent, and local excision 87 and 100 per cent. Eighty-three patients had carcinoma of the anal margin. Of these, 55 were treated by local excision, 18 by total anorectal excision and 20 by radiotherapy. Eight patients were inoperable. Crude and cancer-specific survival rates for 72 patients followed for 5 years were 55 and 57 per cent with respective rates of 65 and 69 per cent after local excision and 36 and 40 per cent after total anorectal excision. The 5-year survival rate of 27 patients with TNM N1 stage was 48 per cent. Histological confirmation was obtained in only nine of these patients, however, but five (55 per cent) survived 5 years after block dissection or radiotherapy. Metachronous lymphadenopathy occurred in 25 patients. The 5-year survival rate in the 23 cases that were histologically confirmed was 35 per cent after block dissection (17 cases) and radiotherapy (four cases). Using a modification of Papillon's T classification for anal canal carcinoma, stage correlated with survival after combining T1 with T2 tumours and T2 with T3 tumours. Five-year survival rates in these groups were 60 and 54 per cent respectively. The TN M-UICC classification for anal margin carcinoma correlated with survival in a similar manner. The 5-year survival rate was 65 per cent for patients with T1 and T2 tumours and 33 per cent for those with T3 and T4 tumours.

Survival following microscopically confirmed radical resection of N0 gastric cancer.

In a series of 128 patients operated on for gastric cancer, 27 satisfied microscopic criteria for radical resection. The median age of these patients was 72.3 (range 36-84) years at operation; the median hospital stay after surgery was 12.9 days. The median observation time was 3.8 years and the crude 5-year survival rate 48 per cent. Older patients did remarkably well. No significant difference was found in the number of survivors, survival-observation time or hospital stay in the age groups 55-64, 65-74 or 75-84 years. Thus, age alone should not be considered a barrier to curative surgical treatment. When the study was ended, 12 of the 27 patients who underwent microscopically confirmed radical resection were still alive; six had died from recurrent gastric cancer and nine from other causes. At 5 years after microscopically confirmed radical resection for gastric carcinoma, the gastric cancer-specific mortality rate was 23 per cent.

Factors contributing to the racial differences in prostate cancer mortality

To analyse, in a retrospective cohort study, differences in rates of surgical treatment for prostate cancer between African-Americans and White Americans, and to evaluate the extent to which these differences are associated with disparities in survival rates between these groups. Clinical, pathological, and demographic data from 4279 men diagnosed with clinically localized prostate cancer between 1980 and 1997 were used. The variables assessed included age, disease stage, tumour grade, comorbidities, treatment method, and socio-economic status (SES). Kaplan-Meier survival curves were generated and compared using log-rank tests. The Cox proportional hazards method was used for analyses involving adjustments for potential confounding factors. The surgical treatment rate was 17% for African-American and 28% for White patients (P < 0.001). In those patients treated conservatively or by radiation therapy, both crude and cancer-specific survival rates were lower for African-Americans than for Whites (P < 0.001). However, for patients undergoing surgery, differences in survival between African-Americans and Whites were not statistically significant. According to our models, SES explained 50% and surgical treatment rates approximately 34% of the differences in survival between African-Americans and Whites. This analysis suggests that the lower prostate cancer survival rates for the African-Americans in the present population can be largely explained by differences in SES and lower surgical treatment rates. Efforts to increase awareness of treatment options among African-American patients may be a way of improving survival in this group.

Factores pronósticos en neoplasias malignas primarias de glándulas salivares: Estudio retrospectivo de 20 años

Abstract: Objective. To analyze the possible prognostic factors for survival and disease-free survival in a group of patients with primary malignant salivary gland tumors. Design. Seventy-five patients with salivary gland carcinomas were studied retrospectively from 1980 to 2003. All cases were initially treated with surgery. Postoperative radiotherapy was applied in 52% of the patients. Survival and disease-free survival were analyzed with the Kaplan-Meier method. The association between the different prognostic factors and survival was studied with the Log Rank test for univariate analysis and the Cox proportional model for multivariate analysis. Results. The 5-year and 10-year crude survival rates were 74.9% and 63% and cause-specific survival rates were 77.7% and 65.3% respectively. The 5-year and 10-year disease-free survival rates were 51.8% and 43.2%. Tumor location, sex, pathologic stage, tumor size, facial palsy, perineural spread and vascular spread showed statistical significance in survival and recurrence (p<0.05). Facial palsy and vascular spread were prognostic factors in the multivariate analysis. Conclusion. In our group of patients, facial palsy and vascular spread are the most important factors for survival and recurrence. Postoperative radiotherapy does not appear to improve the prognosis of our patients.

Gastric Carcinoids

To analyze tumor biology and the outcome of differentiated treatment in relation to tumor subtype in patients with gastric carcinoid. Gastric carcinoids may be subdivided into ECL cell carcinoids (type 1 associated with atrophic gastritis, type 2 associated with gastrinoma, type 3 without predisposing conditions) and miscellaneous types (type 4). The biologic behavior and prognosis vary considerably in relation to type. A total of 65 patients from 24 hospitals (51 type 1, 1 type 2, 4 type 3, and 9 type 4) were included. Management recommendations were issued for newly diagnosed cases, that is, endoscopic or surgical treatment of type 1 and 2 carcinoids (including antrectomy to abolish hypergastrinemia) and radical resection for type 3 and 4 carcinoids. Infiltration beyond the submucosa occurred in 9 of 51 type 1, 4 of 4 type 3, and 7 of 9 type 4 carcinoids. Metastases occurred in 4 of 51 type 1 (3 regional lymph nodes, 1 liver), the single type 2 (regional lymph nodes), 3 of 4 type 3 (all liver), and 7 of 9 type 4 carcinoids (all liver). Of the patients with type 1 carcinoid, 3 had no specific treatment, 40 were treated with endoscopic or surgical excision (in 10 cases combined with antrectomy), 7 underwent total gastrectomy, and 1 underwent proximal gastric resection. Radical tumor removal was not possible in 2 of 4 patients with type 3 and 7 of 9 patients with type 4 carcinoid. Five- and 10-year crude survival rates were 96.1% and 73.9% for type 1 (not different from the general population), but only 33.3% and 22.2% for type 4 carcinoids. Subtyping of gastric carcinoids is helpful in the prediction of malignant potential and long-term survival and is a guide to management. Long-term survival did not differ from that of the general population regarding type 1 carcinoids but was poor regarding type 4 carcinoids.

Immediate Functional Loading of Edentulous Maxilla: A 5‐Year Retrospective Study of 388 Titanium Implants

Immediate functional loading is a new surgical-prosthetic technique that can be used extensively in implant placement. Because of a lack of experimental reports regarding edentulous maxilla, we decided to evaluate the survival rate of immediately loaded dental implants in this area. Forty-three patients (44.4% male) with a median age of 55 years receiving 388 implants (mean 9.0 per case) were enrolled in this study. Cross-arch acrylic provisional restorations were performed in the same stage. Data were analyzed by Kaplan-Meier product limit estimation. Stratification of implants survival was performed for the available variables of interest, and comparisons were analyzed by a log rank test. Cox algorithm was used for multivariable analysis. At 5-year follow-up, the crude survival rate (overall survival not stratified according to any available variable) was 98%. All failures occurred within 6 months from loading. We found differences in survival relating to: 1) implant diameter (99.37% for diameter < or =5.25 mm and 93.75% for diameter >5.25 mm); 2) number of implants (99.29% for < or =10 implants and 96.30% for >10); and 3) gender (97.08% and 99.54% for males and females, respectively). Cox regression analysis showed that diameter of implants adjusted for patient age and gender was associated to an average risk of failure (hazard rate) of 3.13 (P value = 0.042, 95% confidence interval 1.04 to 9.43) per mm (from 3 to 6.5). Immediate functional loading is a reliable surgical-prosthetic procedure in edentulous maxillae. Implants with wider diameter are associated with a higher risk of failure.