Difference In Length Of Survival Research Articles

Predicting access to postoperative treatment after glioblastoma resection: an analysis of neighborhood-level disadvantage using the Area Deprivation Index (ADI).

Social determinants of health (SDoH)-socioeconomic and environmental factors-impact outcomes. The Area Deprivation Index (ADI), a composite of seventeen SDoH factors, has been correlated with poorer outcomes. We aimed to compare outcomes and treatment access for glioblastoma, a universally fatal malignant brain tumor, in patients more (ADI 34-100%) versus less disadvantaged (ADI 0-33%). A 5-year retrospective study of Rhode Island Hospital and Mayo Clinic databases was conducted from 2012 to 2017 for patients ≥ 18years with glioblastoma. Patient addresses were matched to ADI percentiles and grouped into more (top 66% ADI) and less disadvantaged. Adjusted multivariable regressions were used to compare outcomes between groups. A total of 434 patients met inclusion; 92.9% were insured, 56.2% were more disadvantaged (n = 244), and the more disadvantaged cohort was younger on average (62years). After adjustment, the more disadvantaged group had decreased odds of receiving gross total resection (adjusted odds ratio (aOR) 0.43, 95% CI [0.27-0.68]; p < 0.001). This cohort also had decreased odds of undergoing chemotherapy (aOR 0.51[0.26-0.98]), radiation (aOR 0.39[0.20-0.77]), chemoradiation (aOR 0.42[0.23-0.77]), tumor-treating fields (aOR 0.39[0.16-0.93]), and clinical trial participation (aOR 0.47[0.25-0.91]). No differences in length of survival or postoperative Karnofsky Performance Status Scale were observed. More disadvantaged glioblastoma patients had decreased odds of receiving gross total resection. They also exhibited decreased odds of receiving standard of care like chemoradiation as well as participating in a clinical trial, compared to the less disadvantaged group. More research is needed to identify modifiable SDoH barriers to post-operative treatment in disadvantaged patients with glioblastoma.

Treatment Outcomes in Spinal Metastatic Disease With Indeterminate Stability.

Study Design:Retrospective cohort study.Objective:The purpose of this study was to compare outcomes between different treatment modalities for metastatic disease with indeterminate instability (Spinal Instability Neoplastic Score [SINS] 7-12).Methods:We retrospectively reviewed neurologically intact patients treated for spinal metastatic disease with a SINS of 7 to 12. The cohort was stratified by treatment approach: external beam radiation therapy alone (EBRT), surgery + EBRT (S+E), and cement augmentation + EBRT (K+E). Kaplan-Meier analysis was used to assess differences in length of survival (LOS) and ability to ambulate at time of death. Multivariate analysis was performed to assess adjusted LOS and ability to ambulate at time of death.Results:The cohort included 211 patients, S+E (n = 57), EBRT (n = 128), and K+E (n = 27). In the S+E group, the median LOS was 430 days, which was statistically longer than the median LOS for the EBRT group (121 days) and the K+E group (169 days). In the S+E group, 52 patients (91.2%) and in the K+E group 24 patients (92.3%) retained the ability to ambulate at their time of death compared to 99 patients (77.3%) of the EBRT patients (P = .01). The overall rate of revision treatment at the spinal level initially treated was 17.5%, S+E (15.8%), EBRT (20.3%), and K+E (7.7%).Conclusions:The length of survival, ability to maintain ambulatory ability, and revision treatment rates were all improved following surgical management and radiation therapy compared to radiation therapy alone. The authors’ conclusion from these results are that patients with indeterminate spinal instability should be discussed in a multidisciplinary setting for the need of spinal stabilization in addition to radiation therapy.

Contribution of Lynch syndrome to early onset malignancy in Ireland.

586 Background: Lynch syndrome (LS) is an autosomal dominant hereditary cancer syndrome responsible for 2 -6% of hereditary colorectal cancers. LS is caused by germ-line mutations in mismatch repair genes (MMR): MLH1, MSH2, MSH6, PMS2 or EPCAM. This results in microsatellite instability, a phenotypic hallmark of LS-associated colorectal cancer. The aim of this study was to construct and analyse a database of Irish MMR mutation carriers. Methods: Records were from two of the three existing cancer genetics clinics in Ireland. Clinicopathological data of all probands (n=57) including names, dates of birth and death, carrier status and phenotype were recorded. Death certificates were used to confirm information regarding deceased mutation carriers. An ANOVA test was used to establish statistical significance of variations in age by gene. Length of survival based on stage was assessed using Kaplain Meier curves. Results: 345 affected individuals were identified. The most common cancers recorded were colorectal (53%), breast (12%) and endometrial (10%). 138 confirmed carriers were identified: 65 MLH1 (47%), 43 MSH2 (31%), 11 MSH6 (8%), 17 PMS2 (12%), and 2 EPCAM (1%). 22 patients have died since confirmation of Lynch Syndrome, 50% of whom died within 2.5 years of first diagnosis. All deceased carriers had at least one cancer diagnosis and 50% had developed multiple cancers. 59% of deaths were directly related to cancer. 7 of these patients had Stage 4 cancer at diagnosis. There was a significant difference in length of survival based on stage. (p=.048) Phenotype frequencies varied significantly by gene. (see table 1) Median age of first diagnosis of any cancer was 44.5 years (range 23-81). There was no difference in age at presentation by gene mutated. Conclusions: Under-diagnosis of LS misses a powerful preventive and therapeutic opportunity. LS causes early onset cancer diagnosis with substantial societal impact. A significant number of Lynch Syndrome cases have poor clinical outcomes. Genotype/Phenotype frequencies. [Table: see text]

Survival and Habitat of Pen-Raised Northern Bobwhites at Camp Robinson Wildlife Demonstration Area, Arkansas (Poster Abstract)

Post-release survival of pen-reared northern bobwhite (Colinus virginianus) is often extremely low. Although predation is usually assumed to cause low survival rates, very little detailed research has been conducted into cause-specific mortality of pen-reared bobwhites in natural settings. Further, little is known about habitat selection by pen-reared bobwhites, and the relationship between habitat and survival. We report results based on 110 radiomarked bobwhites out of 2500 banded and released at Camp Robinson Wildlife Demonstration Area in Arkansas. Birds were released at 125 sites in coveys of 20 birds per site. Release sites were ranked based on habitat quality. In addition, habitat analyses were conducted over each individual’s area of activity. In March 2001, when monitoring of birds ended, 6 birds remained alive. Mortality agents included avian predators (51%, n = 49), mammalian predators (36%, n = 35) and unknown predators (13%, n = 12). Other causes of mortality included radio collars (5%, n = 5) and apparent heat stress (3%, n = 3). Most mortality occurred within 1 month of release (66%, n = 73). Overall mean survival was 36.4 +- 4.3 days. We found no significant difference in length of survival among birds released at good, medium, or poor sites (P = 0.97). Regardless of release site, birds were located most often in shrub cover (50%, n = 388 locations) while the second most common habitat used was herbaceous cover (29%, n = 230 locations). During callback trapping in May 2001, we recaptured 14 bobwhites that were banded and released in August of 2000, and 6 wild birds, suggesting that pen-reared birds actually outnumbered wild birds.

Causes of Death in Patients with Aortic Aneurysmal Disease (1987-2014)

Introduction: This study examined the cause of death of patients with aortic aneurysms treated for this disease between 1987 and 2014 to understand the current natural history of this condition. Methods: This study results from analysis of a prospectively maintained data base of patients treated by the author. Data points were obtained from practice records and supplemented by data made available through CHeRL (Centre for electronic Health Record Linkage). Six hundred and twenty two patients were treated consecutively between 1987 and 2014. At closure of the study in 2014, 402 patients had died and date of death was available. Cause of death was available by ICD (International Classification of Diseases) 9 or 10 in 89% of patients. Method of treatment of aneurysmal disease was available in all patients. Ethics approval for this study was obtained from the Centre for Health Research, Cancer Institute, New South Wales Department of Health. Statistical analysis was conducted by comparison of mean ±95% conference interval. Where appropriate contingency table analysis was constructed. Statistical significance was accepted at P < 0.05. Results: Mean age at presentation was 75.6 years (95%C.I. 74.8 - 76.3). Mean age at death was 81 years (95%C.I. 80.2 - 81.7). Predicted age at death based on Australian Bureau of Statistics life tables was 86.25 years (95%C.I. 85.8 - 86.8). Between 1987 and 1999, mean age at presentation was 74.5 years (95%C.I. 73.3 - 75, n = 304, Females = 78). Between 2000 and 2014, mean age at presentation was 75.3 years (95%C.I. 74.1 - 75, n = 318, females = 54). The difference for females presenting 1987 to 1999 compared 2000 to 2014 was significant, p < 0.01. Death was due to the following causes unknown 11%, cardiovascular disease 27.7%, pulmonary related disease 9.7% and aortic related disease 20.6%. Patients died of aortic related causes significantly earlier (within 2 years) compared to patients with other causes of death (5 to 8 years) due to presentation with ruptured aortic aneurysm. Cardiovascular related causes of death, malignancy and pulmonary related causes of death accounted for the majority of deaths post-treatment. There was no significant difference in length of survival among patients dying from these causes. Conclusion: Patients with successfully treated aneurysmal disease can expect to survive 5 - 8 years post-treatment. Presentation with aortic aneurysm rupture results in significantly shortened life expectancy. Patients presenting in the ninth decade of life and with less than 5 years life expectancy may not benefit from elective repair of aortic aneurysm.

Original Research: Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands: Preliminary Results

Paper is omnipresent on hospital units, but few studies have examined the possible role of paper in the spread of nosocomial pathogens. To determine by laboratory investigation how long bacterial pathogens can survive on office paper and whether bacteria can be transferred from hands to paper and back to hands in a "worst-case scenario." Samples of four bacterial pathogens (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus hirae) were prepared according to standard laboratory procedures. Sterile swatches of office paper were inoculated with the pathogens and bacterial survival was tested over seven days. To test the transmission of bacteria from one person's hands to paper and back to another person's hands, the fingertips of volunteers were inoculated with a nonpathogenic strain of E. coli; these volunteers then pressed the inoculum onto sterile paper swatches. Another group of volunteers whose hands had been moistened pressed their fingertips onto the contaminated paper swatches. Bacteria transferred to the moistened fingertips were cultivated according to standard laboratory procedures. The four tested organisms showed differences in length of survival depending on environmental room conditions, but were stable on paper for up to 72 hours and still cultivable after seven days. Test organisms were transferred to paper, survived on it, and were retransferred back to hands. Paper can serve as a vehicle for cross-contamination of bacterial pathogens in medical settings if current recommendations on hand hygiene aren't meticulously followed.

Outcome of AIDS-associated cryptococcal meningitis initially treated with 200 mg/day or 400 mg/day of fluconazole

BackgroundAIDS-associated cryptococcal meningitis has a high mortality. Fluconazole was the only systemic antifungal therapy available in our centre. From 1999–2001 we used low-dose fluconazole (200 mg daily initially), and did not offer therapy to patients perceived to have poor prognoses. In 2001 donated fluconazole became available, allowing us to use standard doses (400 mg daily initially). Antiretroviral therapy was not available during the study period.MethodsRetrospective chart review of adult patients before and after the fluconazole donation.Results205 patients fulfilled the inclusion criteria, 77 before and 128 after the donation. Following the donation fewer patients received no antifungal treatment (5% vs 19%, p = 0.002), and more patients received standard-dose fluconazole (90% vs 6%, p < 0.001). In-hospital mortality was 25%. Impaired consciousness, no antifungal treatment received and cerebrospinal fluid antigen titre > 1,000 were independent predictors of in-hospital mortality. Concomitant rifampicin did not affect in-hospital survival. Thirteen patients were referred to the tertiary referral hospital and received initial treatment with amphotericin B for a mean of 6 days – their in-hospital survival was not different from patients who received only fluconazole (p = 0.9). Kaplan-Meier analysis showed no differences in length of survival by initial treatment with standard or low doses of fluconazole (p = 0.27 log rank test); median survival was 76 and 82 days respectively.ConclusionOutcome of AIDS-associated cryptococcal meningitis is similar with low or standard doses of fluconazole. The early mortality is high. Initial therapy with amphotericin B and other measures may be needed to improve outcome.

Radical Resection Improves Survival for Patients with pT2 Gallbladder Carcinoma

Radical resection (wedge resection of the gallbladder bed and dissection of the hepatoduodenal ligament, portal, and celiac lymph nodes) has been reported to improve survival from pathologic T2 gallbladder carcinoma (pT2 GBCa; invasion through the muscularis without perforation of the serosa). We report our experience and the outcome of patients with pT2 GBCa. Between 1989 and 2000 at Vanderbilt University Medical Center ten patients were found to have pT2 disease after cholecystectomy. The patients had an average age of 64 ± 13 years and underwent either radical resection (n = 5) or no further surgical therapy (n = 5). Of the patients who underwent cholecystectomy only, one (20%) is still alive at 27 months and four (80%) died of recurrent GBCa between 6.5 and 21 months. For the patients who underwent radical resection all five are alive at 15 to 83 months with no recurrence. The proportion of patients surviving pT2 GBCa after radical resection was significantly greater than with cholecystectomy alone ( P &lt; 0.05). The difference in length of survival between the two groups was also significant ( P &lt; 0.05). Morbidity after radical resection was low (pancreatic leak in one patient), and there were no operative mortalities. Radical resection significantly improved survival over cholecystectomy alone for patients with pT2 GBCa. The procedure has low morbidity and mortality rates. Therefore a radical resection operation is indicated for patients with pT2 GBCa.

Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients.

Reports on the surgical treatment of brain metastases from melanoma in a large group of patients are sparse. The goal of this paper is to review the surgical experience in a series of 91 patients with brain metastases from primary melanoma treated at a single institution. Seven hundred eighty patients underwent resection of brain metastases at Memorial Sloan-Kettering Cancer Center between 1974 and 1994. The records of 91 (11.7%) of these patients who had melanoma were retrospectively reviewed. The median time from diagnosis of the primary melanoma to diagnosis of the brain lesion was 14.1 months. The overall median length of survival following craniotomy was 6.7 months. Fifteen patients with resected multiple metastases had shorter median survival times than 76 patients with a single lesion (5.4 months compared with 7.8 months, p = 0.12). In eight patients with cerebellar metastases the median length of survival was significantly shorter than that found in patients with supratentorial lesions (2 compared with 7 months, p = 0.03). There was no difference in length of survival between 49 patients who underwent postoperative whole-brain radiation therapy (WBRT) and 29 patients who did not (9.5 compared with 8.3 months, p = 0.67). The incidence of brain metastasis recurrences in WBRT-treated and untreated patients was similar (56% and 45.7%, respectively). Only the presence of infratentorial metastases (p = 0.0013) and unresected recurrence of brain metastases (p = 0.0003) had an impact on outcome according to a Cox regression analysis. Five patients (5.5%) died within 31 days of surgery. Overall survival rates at 1, 2, 3, and 5 years were 36.3, 18.7, 13.2, and 6.6%, respectively. Although melanoma metastatic to the brain carries a foreboding prognosis, patients who do not display preoperative neurological deficits, harbor a single lesion situated supratentorially, and have no lung or visceral metastases may derive significant palliative benefit from surgical resection of brain metastases.

Do Calcium Channel Blockers Adversely Affect Hormonal Treatment of Prostate Cancer Through an Inhibition of Apoptosis?

Background: Hormonal therapy of prostate cancer is mediated, in part, through apoptosis. This process is dependent on intracellular calcium influx. This study investigates whether the use of calcium channel blockers inhibits this process and thereby negatively impacts hormonal therapy. Methods: Records from patients dying from metastatic prostate cancer in three medical centers were reviewed. The date of diagnosis, date of metastatic disease, date of death, Gleason sum, type of hormone therapy, and calcium channel blocker used were recorded. Results: Of the 180 patients, 26 were on a calcium channel blocker at the time of their hormonal therapy. The length of survival from the time of hormone therapy to death in these patients did not differ from the 154 patients not on a calcium channel blocker (respective median survival time of 819 days versus 730 days, p = 0.913—log rank test of the survival curves). Similarly, there were no differences in length of survival from the date of diagnosis between the two groups. Other analyzed factors (type of hormone therapy, Gleason score, and interval between diagnosis and metastatic disease) also did not affect length of survival from the time of hormonal treatment or time of diagnosis. Conclusion: We found no evidence that calcium channel blockers inhibit the therapeutic efficacy of hormonal treatment for metastatic prostate cancer.

Ovarian involvement by serous surface papillary carcinoma.

Serous surface papillary carcinoma (SSPC) is a multicentric peritoneal tumor that can spare or minimally involve the ovaries and has been reported to be more aggressive than the usual form of serous carcinoma of the ovary (SCO). From 360 serious ovarian carcinomas, we selected 87 cases with high histological grade, clinical stage III, residual disease after the first operation, similar chemotherapeutic regimens, and at least a 4-year follow-up period. Of these, 33 patients had SSPC in which the tumors were smaller than 10 mm (ovaries not enlarged), and 54 had SCO in which the tumors were larger than 5.0 cm. The 33 cases with SSPC were then subdivided according to tumor size: (a) 17 patients had SSPC characterized by tumors that were smaller than 5.0 mm in largest dimension and that involved only the ovarian surface or showed minimal superficial invasion of the ovarian cortex (maximum depth, 3 mm); (b) 16 patients had SSPC characterized by tumors that measured 5.1 to 10 mm and involved the ovarian surface, cortex, and/or medulla. The subdivision of the SSPC into small and large types was found to be of no clinical statistical significance; thus, the two groups were recombined as a single group. The difference in length of survival between SSPC and SCO at 24 months (39% versus 32%, respectively) and the median survival times (SSPC = 17 months and SCO = 18 months) were not statistically significant. However, the 48-month survival rate (SSPC = 28% and SCO = 9%), was statistically significant (p = 0.027).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of Psychosocial Support on Patients with Metastatic Breast Cancer

This article reviews evidence that psychosocial support may influence the progression of cancer, as indicated by differences in length of survival. Psychotherapeutic methods that have proved to be effective involve direct confrontation of fears; expression of affect, including aegative feelings; provision of social support; and training in self-hypnosis for analgesia. Possible mechanisms for this psychosocial effect on progression of disease include changes in diet and exercise, better use and provision of health care, and positive effects on the sensitivity of the endocrine and immune systems to stress. The author reviews the limitations of these theories and offers suggestions for future research.

Regional differences in breast cancer survival are correlated with differences in differentiation and rate of proliferation

Patients with invasive ductal breast cancer and with 5 to 12 years of follow-up, identified from two pathology laboratories serving hospitals in two distinct but fairly close regions, were studied for differences in length of survival. In the years when the cases were diagnosed, population screening was not performed, adjuvant systemic therapy was not administered, and surgical treatment and irradiation protocols were similar in the hospitals served by the two laboratories. There was a significant difference in length of survival between the two regional groups (N1 = 160, N2 = 111; P = .006). Survival rate at 10 years in the two regions was 48% and 69%. Distribution of age, tumor size, and lymph node status (as negative or positive as well as number of positive nodes) were similar, but quantitative and qualitative microscopic features differed. Patients from the region in which the prognosis was less favorable had the higher median values for the mitotic activity index (14 v 4; P < .0001) and for nuclear area (59.2 v 38.2; P < .0001). Nuclear and histologic grade distributions were also different between the regions. Logistic regression analysis confirmed that the regional survival differences are correlated with the microscopic features, even after adjustment for age, tumor size, and lymph node status. Comparison of breast cancers from the periods 1970 to 1974 and 1988 to 1989 in one of the two regions revealed that the clinical and microscopic proliferation features were similar over time. These results, apart from indicating regional variation in breast cancer survival rate correlated to differences in the microscopic characteristics of the disease between regions, provide additional support to previous reports that qualitative and, especially, quantitative microscopic differentiation and proliferation features have significant bearing on the prognosis of breast cancer patients.

Clinicopathological Study of High-dose Fractionated Radiation Therapy in the Treatment of Glioblastoma

Twenty-six adults with glioblastoma multiforme (grade 4 astrocytoma) were postoperatively given high-dose fractionated radiation therapy (5 Gy twice weekly) with Linac X-rays. The results were compared with those in 26 patients treated by conventional fractionated radiation therapy (2 Gy 5 times weekly). The survival rates following treatment with high-dose fractionated radiation therapy and conventional fractionated radiation therapy were 65% vs. 65% at 1 year, 31% vs. 8% at 2 years, 14% vs. 4% at 3 years, and 4% vs. 0% at 5 years. The difference in length of survival between the two treatment groups was not statistically significant (p = 0.423). Autopsies were performed on 11 patients given high-dose radiation therapy and 13 who received conventional irradiation. In the high-dose group one patient had no residual tumor (vs. none in the conventional group) ; four had small residual tumors (vs. three) ; one had extensive coagulative necrosis of the tumor and surrounding brain tissue (vs. four) ; four had proliferative tumor growth (vs. four) ; and one had mixed glioblastoma and fibrosarcoma (vs. two). Complete cure may be possible in some cases, if extensive tumor removal is feasible and is followed by high-dose fractionated radiation therapy. The biological effect appears to be much greater with high-dose than with conventional fractionated radiation therapy. Therefore, in cases of tumor recurrence, a second course of radiation therapy must be undertaken cautiously.

Causes of Variations in Effectiveness of Bracon cephi (Gahan) (Hymenoptera: Braconidae) as a Parasite of the Wheat Stem Sawfly

AbstractAdults of B. cephi emerged at the same time as the adults of their host, the wheat stem sawfly, and started to oviposit about mid-July. The second generation started to emerge between August 5 and 15. This generation, which was complete in some years, was apparently only partial in years in which adults of the first generation continued to oviposit late in the season. In most cases the larvae of Bracon that were present at harvest time were from eggs laid after August 1.Most of the overwintering B. cephi were located in the lower internodes of the sawfly-infested wheat stems. Although B. cephi attacked some sawfly larvae in their stubs most sawflies escaped parasitism once they had cut their host stems.High host densities per stem in hollow-stemmed wheats were detrimental to Bracon during the early part of the season as the unparasitized sawfly larvae in stems containing B. cephi destroyed the parasite larvae.The sawfly-susceptible wheats were more suitable than the resistant for parasitism. Generally, differences in parasitism between wheats and between barleys were caused by differences in length of survival of the sawfly larvae in the different host plants; longer survival led to higher parasitism.The fluctuations in amounts of parasitism mainly depended on the synchronization of development between B. cephi and the sawfly. Parasitism increased when the sawfly larvae cut their host stems sufficiently late to allow establishment by the second generation of B. cephi and decreased when the sawfly cut too early for parasitism by the second generation. The date of ripening of the host plant governs the date of cutting by the sawfly; hence, the amount of parasitism is influenced by the levels of soil moisture and temperature during the growing season, by differences in rate of development of various plant hosts, and by the date of seeding. Low levels of parasitism resulted from early ripening of the sawfly host plants in two consecutive years, whereas a moderately high level occurred even though the weather of the current year was conducive to early ripening, provided that the wheat in the preceding year had ripened late. It appears that moderate to high levels of parasitism required that the crop ripen late in at least one year out of two.

Mortality of Adult and Young Mallards

A RECENT examination by E. O. Höhn of the recovery dat of mallards (Anas p. platyrhynca) ringed under the British Birds marking scheme shows an intresting difference in length of survival of birds siged as adults as compared with those ringed as young (British Birds, 41, No. 8 ; August 1948). Ringing recoveries of 305 adult mallards showed that 65·3 per cent died during the first year after ringing, 23·9 per centr during the second year, 6·6 per cent during the third year and 4·2 per cent during subsequent years. The average length of further survival from the date of ringing was one year and two months. Of 828 mallards ringed as young, 89 per cent died during the first year after ringing, 9·6 per cent during the second year, 0·6 per cent during the third year and 0·8 per cent during succeeding years. The average period of survival was 4·5 months after ringing. The mortality recorded by Höhn is almost entirely due to shooting.