Cumulative Nonrecurrence Rate Research Articles

Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis.

To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow-up ranged from 18 to 66 months. Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow-up period. Systemic-pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non-recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self-limiting. BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic-pulmonary shunts and clinical failure are the risk factors for recurrence.

Effect of Prolonged Use of Dronedarone on Recurrence in Patients with Non-Paroxysmal Atrial Fibrillation After Radiofrequency Ablation (DORIS): Rationale and Design of a Randomized Multicenter, Double-Blinded Placebo-Controlled Trial.

Prolonged use of anti-arrhythmic drugs (AAD) beyond the post-ablation blanking period to maintain sinus rhythm has been adopted in clinical practice but without sufficient evidence. Dronedarone is an AAD valid for maintaining sinus rhythm with fewer side effects than other AAD for long-term use. We sought to investigate the effect of prolonged use of dronedarone on the recurrence of non-paroxysmal AF patients beyond 3 months within the first year after ablation. Non-paroxysmal AF patients will receive dronedarone for 3 months after radiofrequency ablation. Patients without drug side effects and atrial tachyarrhythmia (AT) recurrence will then be randomly divided into dronedarone and placebo groups and followed up until 1 year after ablation. The primary endpoint is the cumulative nonrecurrence rate post 3 months to 1 year after ablation. Patients will receive 7-day Holter monitoring (ECG patch) at 6, 9, and 12 months after ablation to evaluate AT recurrence. Secondary endpoints include dronedarone withdrawal due to side effects or intolerance of AT recurrence, time to the first recurrence, repeat ablation, electrical cardioversion, unscheduled emergency room visit, or re-hospitalization. This trial will evaluate whether prolonged use of dronedarone effectively reduces the recurrence rate after ablation in non-paroxysmal AF patients. The result of this trial will provide evidence for optimizing post-ablation anti-arrhythmic therapy. ClinicalTrials.gov ; NCT05655468, 19-December-2022.

Tumor Differentiation and EGFR Mutation Associated with Disease-Free Survival in Stage IA Lung Adenocarcinoma Patients with Curative Surgery.

BackgroundNearly 30% of stage IA non-small-cell lung cancer patients eventually die of recurrence or metastasis. This study aimed to predict stage IA lung adenocarcinoma (LADC) patients who underwent radical resection with a high risk of recurrence or metastasis.MethodsInformation on clinicopathological, genetic and therapeutic features and recurrence status was collected in this retrospective and two-center study. A nomogram based on multivariate analysis was established to predict disease-free survival. Further stratification was performed to identify populations with a high risk of relapse.ResultsA total of 1584 patients with pathological stage IA LADC who underwent radical surgery between 2011 and 2015 were enrolled from two medical institutions in this study. The nomogram including tumor differentiation and EGFR mutation had a higher C-index of 0.880 (95% CI 0.833–0.926) compared to 0.598 (95% CI 0.486–0.711) for the AJCC 8th TNM staging system. Furthermore, the C-index for the validation cohort was 0.798 (95% CI 0.738–0.857). In addition, the 3-year cumulative nonrecurrence rate in the high-risk group stratified by this model was 21.8% compared to 98.1% in the low-risk group.ConclusionThis study proposed a new nomogram including tumor differentiation and EGFR mutation to predict recurrence or metastatic probability in stage IA LADC patients who underwent radical surgery. This nomogram could identify patients in the high-risk group and help guide adjuvant treatment in the future.

Comparison of hyperdry amniotic membrane transplantation and conjunctival autografting for primary pterygium

BackgroundThe purpose of this study was to evaluate the safety and effectiveness of the hyperdry amniotic membrane transplantation compared with conjunctival autografting for the treatment of primary pterygium.MethodsOne hundred and forty-one eyes from 130 patients with primary pterygium were treated with excision followed by hyperdry amniotic membrane or conjunctival autografting after random selection. Seventy-nine eyes from 71 patients received hyperdry amniotic membrane transplantation (HD-AM group), and 62 eyes from 59 patients received conjunctival autografting (CG group). Patients were followed up at one week and one, three, six, and 12 months post-surgery. Recurrence rate, postoperative complications, and final follow-up patient visits were prospectively evaluated.ResultsThe mean follow-up duration was 12.56 ± 4.35 months in the HD-AM group and 12.85 ± 3.90 months in the CG group. Recurrences were detected in four eyes (5.06%) in the HD-AM group and 13 eyes (20.97%) in the CG group. A statistically significant difference in frequency of recurrence between the two groups (P = 0.003) was observed. The cumulative non-recurrence rates at six and 12 months in all patients stratified by age and sex were not significantly different (P = 0.642 and P = 0.451, respectively, by log-rank test). Graft retraction and necrosis were not detected in the two groups during the follow-up period.ConclusionHyperdry amniotic membrane transplantation was effective in preventing pterygium recurrence when compared with conjunctival autografting and can be considered a preferable and safe grafting procedure for primary pterygium.Trial registrationCurrent Controlled Trials ISRCTN16900270, Retrospectively registered (Date of registration: 3 May 2018).

Bronchial artery embolisation for the management of haemoptysis in patients with pulmonary tuberculosis

To evaluate immediate and long-term outcomes of bronchial artery embolisation (BAE) for the treatment of haemoptysis in patients with pulmonary tuberculosis (TB), and to clarify factors that influence recurrence. Of 398 patients with haemoptysis who underwent BAE between January 2004 and June 2009, 169 were retrospectively reviewed. All of the patients had either a history of pulmonary TB or a current diagnosis of TB. Follow-up ranged from 1 day to 66 months. Haemoptysis was stopped or markedly decreased, with subsequent clinical improvement, in 163 patients (96.4%); in 50 patients symptoms recurred during the follow-up period. Disease activity, aortography and mycetoma showed a statistically significant correlation with recurrence rate. Cumulative non-recurrence rates were 76.1% for 12 months and 51.4% for 40 months. The median non-recurrence time was 41.2 months. Disease activity and mycetoma showed a statistically significant correlation with early recurrence. Only one major complication was observed. BAE is a safe and effective treatment option for the control of haemoptysis in TB patients. Disease activity and mycetoma both correlate with higher recurrence rate and early time of recurrence.

Bronchial and Nonbronchial Systemic Artery Embolization in Patients With Major Hemoptysis: Safety and Efficacy of N-Butyl Cyanoacrylate

The purpose of this study was to evaluate the safety and efficacy of N-butyl cyanoacrylate for bronchial and nonbronchial systemic artery embolization in the management of major hemoptysis. From March 2004 through March 2006, 108 patients with major hemoptysis underwent embolization with N-butyl cyanoacrylate. The common conditions causing hemoptysis were bronchiectasis (n = 34), sequelae of tuberculosis (n = 31), active tuberculosis (n = 18), lung cancer (n = 8), and aspergilloma (n = 6). A retrospective analysis of postprocedure outcomes, including immediate success, recurrence of hemoptysis, cause of recurrence, and complications, was performed. Immediate success was achieved in 105 patients (97.2%). During the follow-up period (range, 5 days-63 months; median, 28.5 months), recurrent hemoptysis was found in 21 of the 105 patients (20%). Repeat angiograms (n = 14) revealed incomplete embolization during the initial procedure in seven patients with early recurrence (< 3 months) and revascularization of nonbronchial systemic collateral arteries in seven patients with late recurrence (> 3 months). No recanalization of embolized arteries was found on repeat angiograms or at follow-up CT. The cumulative nonrecurrence rates were 91.4% 1 month, 83.4% 1 year, 76.7% 3 years, and 56.8% 5 years after the initial procedure. The procedure-related complications included transient chest pain (n = 21) and denudation of the bronchial mucosa (n = 3), which was clinically silent but found at bronchoscopy. N-butyl cyanoacrylate is a safe and effective agent for embolization in patients with major hemoptysis.

The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft

A randomized, prospective study was performed to determine the efficacy and safety of amniotic membrane transplantation (AMT) vs conjunctival autograft (CAG) as adjunctive therapy after surgical excision of primary pterygium. Eighty-six eyes of 78 patients with pterygium that were either advancing more than 3 mm onto the cornea or causing extreme irritation were included in the study, randomized to either AMT (44 eyes of 39 patients) or CAG (42 eyes of 41 patients) as adjunctive therapy, and operated on by a single surgeon. The mean follow-up was 14.40 ± 5.4 months in the AMT group and 12.35 ± 3.13 months in the CAG group. There were 18 recurrences (40.9%) in the AMT group and 2 (4.8%) in the CAG group (P < .007). The cumulative proportion that were recurrence-free at 12 months was 0.6 ± 0.15 for the AMT group and 0.95 ± 0.07 for the CAG group (P = .0003, Log-rank test). The cumulative nonrecurrence rate at 6 and 12 months in all patients stratified by age and gender was not significantly different. No major complications were observed in either group. The authors conclude that amniotic membrane transplantation has an unacceptably high recurrence rate compared to conjunctival autograft transplantation as adjunctive therapy following excision of pterygium.—Michael D. Wagoner A randomized, prospective study was performed to determine the efficacy and safety of amniotic membrane transplantation (AMT) vs conjunctival autograft (CAG) as adjunctive therapy after surgical excision of primary pterygium. Eighty-six eyes of 78 patients with pterygium that were either advancing more than 3 mm onto the cornea or causing extreme irritation were included in the study, randomized to either AMT (44 eyes of 39 patients) or CAG (42 eyes of 41 patients) as adjunctive therapy, and operated on by a single surgeon. The mean follow-up was 14.40 ± 5.4 months in the AMT group and 12.35 ± 3.13 months in the CAG group. There were 18 recurrences (40.9%) in the AMT group and 2 (4.8%) in the CAG group (P < .007). The cumulative proportion that were recurrence-free at 12 months was 0.6 ± 0.15 for the AMT group and 0.95 ± 0.07 for the CAG group (P = .0003, Log-rank test). The cumulative nonrecurrence rate at 6 and 12 months in all patients stratified by age and gender was not significantly different. No major complications were observed in either group. The authors conclude that amniotic membrane transplantation has an unacceptably high recurrence rate compared to conjunctival autograft transplantation as adjunctive therapy following excision of pterygium.—Michael D. Wagoner

Serum alanine aminotransferase levels and survival after hepatectomy in patients with hepatocellular carcinoma and hepatitis C virus‐associated liver cirrhosis

We examined whether sustained alleviation of inflammation as monitored by serum alanine aminotransferase (ALT) levels was associated with longer survival in hepatectomized hepatocellular carcinoma (HCC) patients with hepatitis C virus-associated liver cirrhosis (HCV-LC). Thirty-four hepatectomized patients with HCV-LC and HCC as a single nodule, and for whom more than 5 years had elapsed after the hepatectomy, were studied. They had no histologic evidence of portal or hepatic vein invasion. They were subdivided into two groups according to their serum ALT levels in the 2 years after hepatectomy: the low ALT group comprised 13 patients whose serum ALT levels showed a sustained low level below 80 IU, and the high ALT group comprised 21 patients whose serum ALT levels showed several peaks or plateaus above 80 IU. The patients had been followed-up prospectively with frequent ultrasonography and magnetic resonance imaging or computed tomography for recurrence for > 5 years. The survival period, non-recurrence interval and number of recurrences were observed. Recurrences were treated with transcatheter chemoembolization in all cases. The cumulative survival rate in the low ALT group was significantly better than that in the high ALT group (P < 0.05). The 5-year survival in the low ALT group was as high as 92.3% (12 of 13) compared with 33.3% (7 of 21) in the high ALT group (P < 0.05). The cumulative non-recurrence rate in the low ALT group was also significantly better than that in the high ALT group (P < 0.01). The survival period correlated well with the interval until the first recurrence (r = 0.545, P = 0.006). There was a tendency for the number of recurrences in the low ALT group (1.5 +/- 0.4, mean +/- SE) to be fewer than that in the high ALT group (2.2 +/- 0.4), although this was not significant. Sustained alleviation of inflammation, as indicated by low ALT levels, provides a survival advantage mainly due to the longer non-recurrence interval, and possibly because of fewer recurrences, in hepatectomized HCC patients with HCV-LC.

甲状腺乳頭癌Ｎ０症例の予防的頚部郭清

Objective: To ascertain whether prophylactic neck dissection offers an advantage for patients with papillary thyroid carcinoma (PTC) in the absence of clinically metastatic lymphadenopathy.Design: A retrospective study of 108 PTC patients without clinically metastatic lymphadenopathy who were treated at Tenri Hospital between 1977 and 1987. We compared the cumulative non-recurrence rate of cervical metastasis between 68 patients who underwent lymphnode operation (OP group) and 40 patients without any lymphnode operation (non-OP group). There were no significant differences in age and the stages of primary tumors between the two groups. Furthermore, we compared the cumulative non-recurrence rate of cervical metastasis among 40 patients with D0, 26 with D1, 27 with D2 and 2 with D3 dissection and found no significant differences in age and the stages of primary tumors. The mean follow-up period was 16.1±3.0 (MEAN±SD) years.Results: The rate of occult lymphnode metastasis was 79.4% in the OP group. The 20-year non-recurrence rates were 92.6% in the OP group and 87.5% in the non-OP group and generalized Wilcoxon test showed no significant difference between the two groups. The 20-year non-recurrence rates were 87.5% in D0, 92.3% in D1 and 100% in the D2 and D3 dissection group. Generalized Wilcoxon and Logrank tests showed, that there were also no significant differences among them. No patients died of PTC.Conclusion: Although patients with PTC in the absence of clinically metastatic lymphadenopathy had many occult metastases, the frequency of recurrences of cervical metastasis was low. Furthermore, non-recurrence rate in patients without any prophylactic operation was not significantly different compared to patients who underwent some prophylactic dissection. Thus, prophylactic neck dissection does not seem to offer any advantage for patients with PTC in the absence of clinically metastatic lymphadenopathy.

Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results.

To clarify the immediate effect and long-term results of bronchial artery embolization (BAE) for hemoptysis due to benign diseases and the factors influencing the outcomes. One hundred and one patients (aged 34-89 years) received bronchial artery embolization with polyvinyl alcohol particles and gelatin sponge for massive or continuing moderate hemoptysis caused by benign pulmonary diseases and resistant to medical treatment. After BAE, bleeding stopped in 94 patients (94%). The immediate effect was unfavorable in cases where feeder vessels were overlooked or the embolization of the intercostal arteries was insufficient. Long-term cumulative hemoptysis nonrecurrence rates after the initial embolization were 77.7% for 1 year and 62.5% for 5 years. In bronchitis (n = 9) and active tuberculosis (n = 4) groups, an excellent (100%) 5-year cumulative nonrecurrence rate was obtained. The rate was lower in groups with pneumonia/abscess/pyothorax (n = 8) or with pulmonary aspergillosis (n = 9) (53.3%, 1-year cumulative nonrecurrence). There were higher incidences of early recurrence among patients with massive hemorrhage or more marked vascularity and systemic artery-pulmonary artery shunt in angiography: however, these trends were not statistically significant BAE can yield long-term benefit in patients with hemoptysis due to benign diseases. Technical problems in the procedure had an impact on the short-term effect. The degree of hemorrhage or the severity of angiographical findings were not significant factors affecting the outcome. The most significant factor affecting long-term results was whether the inflammation caused by the underlying disease was medically well controlled.

Close Association between High Serum ALT and More Rapid Recurrence of Hepatocellular Carcinoma in Hepatectomized Patients with HCV-Associated Liver Cirrhosis and Hepatocellular Carcinoma

We investigated whether or not a high serum alanine aminotransferase (ALT) level is associated with a more rapid recurrence of hepatocellular carcinoma (HCC) in hepatectomized patients with hepatitis C virus (HCV)-associated liver cirrhosis (LC) (HCV-LC) and HCC. Thirty-three hepatectomized patients with HCV-LC and HCC of a single nodule who had no histologic evidence of portal or hepatic vein invasion and who had been followed up for more than 3 years were included in the study. They were subdivided into two groups according to their serum ALT levels, ALT being a well-known marker of inflammatory necrosis in the liver. Seventeen patients whose serum ALT levels showed several peaks or plateaus above 80 international units (IU) were designated as the high ALT group, and 16 patients whose serum ALT levels showed a sustained low level below 80 IU until the first recurrence were designated as the low ALT group, and the interval between hepatectomy and the first recurrence was observed. In the high ALT group, HCC recurred within 3 years in 70.6% of the patients. In contrast, it recurred in only 18.8% of the low ALT group within the same period (p < 0.05). There was a significant difference (p = 0.0201) between the two groups in the cumulative nonrecurrence rate. The mean interval in recurrent patients between hepatectomy and the first recurrence in the high ALT group (23.6 ± 2.8 months; mean ± SE) was significantly (p < 0.02) shorter than that in the low ALT group (49.3 ± 9.7 months). The expected interval between hepatectomy and recurrence was as short as 2.8 ± 0.5 years (mean ± SE) in the high ALT group, compared with 5.8 ± 0.7 years in the low ALT group (p < 0.05). These results showed that the recurrence of HCC was accelerated in the high ALT group, suggesting that suppression of the rise in ALT level after hepatectomy by treatment with anti-inflammatory drugs may prolong the interval until recurrence by about 2 years in hepatectomized patients with HCC and HCV-LC.

The effects of intravesical chemoimmunotherapy with epirubicin and bacillus Calmette-Gu�rin for prophylaxis of recurrence of superficial bladder cancer: a preliminary report

The effects of intravesical chemoimmunotherapy with epirubicin and bacillus Calmette-Guérin (BCG) for prophylaxis of recurrence of superficial bladder cancer (pTa, pT1) were investigated in 29 patients aged a median of 70 years between January of 1991 and May of 1993. The patients received intravesical instillation of 40 mg epirubicin immediately after transurethral resection (TUR) of the bladder cancer. At 1 week after TUR, 80 mg Tokyo-strain BCG was instilled into the bladder once a week for 6 weeks. Thereafter, the patients were followed by cystoscopy and urinary cytology at 3-month intervals until recurrence was detected. Of the 29 patients, 28 had no evidence of disease over a mean follow-up period of 20 months. The 1 case of recurrence occurred at 3 months after TUR and that patient died of cancer progression. The simple recurrence rate was 3.5% after therapy. According to the person-years method, the number of recurrent tumors per 100 patient-months was 0.17. The cumulative nonrecurrence rate determined for all cases was 96.5% at 30 months. Adverse reactions, including urinary frequency, urgency, and miction pain, among others, were observed in 27 patients (93%). Only 1 patient was withdrawn from the treatment because of severe bladder-irritation symptoms due to the BCG instillation. The intravesical chemoimmunotherapy with epirubicin and BCG seemed to be effective for prophylaxis of recurrence of superficial bladder cancer.

Treatment of 255 patients with bladder tumors

During about 10 years from November, 1977 to March, 1987, two hundreds and fifty-five patients with bladder tumors were treated at the Department of Urology, Hamamatsu University School of Medicine and the affiliated hospitals. There were 198 males and 57 females with the highest age incidence in the seventies. Histologically, 242, 11 and 2 tumors were of transitional cell, squamous cell and adenocarcinoma, respectively. Of the 242 transitional cell carcinomas, 7 were Tis; 43 Ta, 111 T1, 33 T2, 19 T3, 5 T4, 14 M+ (with metastatic lesion), and 10 TX. As to grading, 6 was G0; 66 G1, 100 G2, 64 G3, and 6 GX. Staging was correlated with grading. The 5-year survival rates (Kaplan-Meier's method) were 64% in patients with transitional cell carcinoma; 58% in those with squamous cell carcinoma. In patients with transitional cell carcinoma, the 5-year survival rates were 100% for G0, 73% for G1, 73% for G2 and 40% for G3. As to staging, the 5-year survival rates were 67%, 81%, 81%, 35%, 41%, 40% and 12% in patients with stage of Tis, Ta, T1, T2, T3, T4 and M+, respectively. As to the initial treatment, the 5-year survival rates after TUR (137 cases), partial cystectomy (4 cases) and total cystectomy (56 cases) were 81%, 36% and 61%, respectively. The rate of intravesical recurrence after TUR was evaluated with the cumulative non-recurrence rate calculated by Kaplan-Meier's method.(ABSTRACT TRUNCATED AT 250 WORDS)