Survival Duration Of Patients Research Articles

Clinical analysis and literature review of 7 cases of plasmacytoma first diagnosed with head and neck symptoms

Objective:In order to better understand the condition and provide the groundwork for early detection and treatment of plasmacytomas, it is important to examine the clinical characteristics, therapeutic options, and effectiveness of plasmacytomas that are initially identified with head and neck symptoms. Methods:Retrospective analysis, evaluation, and discussion of the clinical data of 7 patients with plasmacytoma initially diagnosed with head and neck symptoms and admitted to the Affiliated Hospital of Qingdao University during the period of June 2013 to November 2022 was done in combination with pertinent literature. Results:All seven patients were diagnosed with plasmacytoma by histopathology, with lesions located in the nasopharyngeal oropharynx in 4 cases, nasal sinuses in 2 cases, and ventricular zone in 1 case. Clinical manifestations and imaging were atypical, with localized manifestations, of which 2 cases were accompanied by multiple skeletal lesions throughout the body, and 4 cases had lymph node metastasis. Surgery was preferred for all patients, and individualized treatment was recommended after surgery. Of the 7 patients, 3 patients underwent surgery and chemotherapy, 2 patients underwent surgery and radiotherapy and chemotherapy, 1 patient underwent surgery and radiotherapy, and 1 case was treated with surgery only. The follow-up period was 3-60 months, with a 100% follow-up rate. 5 cases were alive and 2 cases died of multiple myeloma after 4-5 years Conclusion:Plasmacytomas first diagnosed with head and neck symptoms are rare, and extramedullary plasmacytomas have a better prognosis, while more advanced multiple myeloma has a poorer prognosis; Therefore, enhancing the quality of survival as well as the duration of survival for patients with plasmacytomas requires early diagnosis and individualized treatment.

Untapping the Prognostic Value of Patient-Generated Health Data in Locally Advanced Non-small Cell Lung Cancer

BackgroundPatient-generated health data (PGHD), which includes patient-reported outcomes (PROs) and wearable device data, may have prognostic value for cancer patients. We tested that hypothesis using data from several prospective trials where patients with locally advanced non-small cell lung cancer (LA-NSCLC) were treated with definitive chemoradiotherapy. MethodsCox proportional hazards models were utilized to identify the baseline patient-reported symptom that best predicted progression-free survival (PFS) duration in a trial that involved PRO-CTCAE collection (Cohort 1). Using data from trials that included EORTC QLQ-C30 questionnaires and wearable devices (Cohort 2), the same symptom was tested as a predictor of PFS. Baseline physical inactivity was also tested as a predictor of PFS. A simple risk stratification tool utilizing PROs and physical activity was proposed. ResultsIn Cohort 1 (n = 50), anorexia was the only pretreatment PRO that was significantly associated with PFS after Bonferroni correction (HR = 3.94, P = .002). In Cohort 2 (n = 58), baseline anorexia was also significantly associated with PFS (HR = 2.48, P = .018), as was physical inactivity (HR = 3.11, P < .001). Median PFS duration for patients in Cohort 2 with anorexia or physical inactivity was 6 months, compared to 18 months for other patients (HR = 3.08, P < .001). Median overall survival duration for patients with anorexia or physical inactivity was 19 months, compared to 65 months for other patients (HR = 2.44, P = .021). ConclusionPGHD, including PROs and wearable device data, can provide valuable prognostic information for LA-NSCLC patients treated with definitive chemoradiotherapy. These findings should be validated using larger datasets.

Identification and model construction of survival-associated proteins for pancreatic cancer based on deep learning

Pancreatic cancer (PC) is a malignancy typified by its insidious onset, rapid progression, limited resectability, poor treatment response, and exceedingly dismal prognosis. The transition from precursor lesions to infiltrating malignant tumors in pancreatic cancer is concomitant with the accrual of genetic mutations. The elucidation of proteins linked to the prognosis of pancreatic cancer holds paramount importance in the realm of pancreatic cancer management. Herein, we introduce DeepPCSA, a model tailored for the screening of target proteins and the prediction of survival time, employing both conventional methodologies and deep learning techniques for patient survival analysis. This framework leverages the LASSOCOX regression approach on differentially expressed genes (DEGs) to discern pivotal genes, succeeded by the development of a prognostic model employing convolutional and fully connected layers to prognosticate patient survival duration. Furthermore, we account for covariates such as age, gender, and other pertinent factors for independent prognostic scrutiny, affirming the autonomy of our model as a prognostic determinant. Employing unsupervised clustering methodologies, we delineated two molecular subtypes delineated by disparate biological processes. Ultimately, via drug sensitivity analysis, we delineated the interrelation between survival duration and pharmaceuticals, substantiating the necessity for tailored drug interventions catering to patients of varying risk strata.

Effect of glucose lymphocyte ratio on prognosis in patients operated with the diagnosis of pancreatic adenocarcinoma

Aims: Pancreatic adenocarcinoma is one of the most aggressive cancers, and predicting prognosis and survival clinically is challenging. Prognostic markers, easily accessible and routinely evaluated in diagnostic tests, are frequently seen in the literature for survival prediction. So far, the glucose lymphocyte ratio (GLR) has emerged as an indicator that can assess both metabolic dysregulation and immune response. In this study, the aim was to assess the impact of GLR on prognosis and survival by following patients diagnosed with pancreatic adenocarcinoma who underwent surgery. Methods: Between January 1, 2016, and April 31, 2021, a totalof 58 patients who underwent Whipple procedure due to pancreatic adenocarcinoma at the Department of General Surgery, Hitit University, were included in the study. Demographic characteristics, tumor features, laboratory results, and survival durations of the patients were collected. GLR was determined as a mortality predictor, and estimated survival times associated with GLR were determined using Kaplan-Meier Survival analysis. The optimal GLR value was determined through ROC analysis. Results: During the postoperative period, the average follow-up time for patients was 11.39 months, with the longest follow-up time being 48 months. During this period, 43 patients (74.14%) were deceased, while 15 patients (25.86%) survived. The mean age and ASA scores of deceased patients were significantly higher compared to survivors (p&lt;0.001 and p&lt;0.001, respectively). Glucose levels were significantly higher in the mortality group compared to the survival group (p=0.008). GLR was notably higher in the mortality group (p=0.170; p=0.703; p=0.429; and p=0.031). The GLR value that best distinguished the two groups was found to be 94.6387 with 93.3% specificity and 95.8% positive predictive value. Crossing this threshold increased the mortality risk approximately 4.27 times within one year and increased the overall mortality risk by approximately 15 times (p=0.014 and p=0.002). The estimated life expectancy for patients below the threshold value was calculated to be an average of 20.996 months, whereas for patients above the threshold value, this expectation was calculated to be an average of 4.427 months (p&lt;0.001). Conclusion: We believe that GLR may be helpful in predicting one-year survival and determining overall survival duration in patients undergoing surgery for pancreatic adenocarcinoma.

Wavelet scattering transform and entropy features in fluorescence spectral signal analysis for cervical cancer diagnosis

Cervical cancer is a prevalent malignant tumor within the female reproductive system and is regarded as a prominent cause of female mortality on a global scale. Timely and precise detection of various phases of cervical cancer holds the potential to substantially enhance both the rate of successful treatment and the duration of patient survival. Fluorescence spectroscopy is a highly sensitive method for detecting the biochemical changes that arise during cancer progression. In our study, fluorescence spectral data is collected from a diverse group of 110 subjects. The potential of the scattering transform technique for the purpose of cancer detection is explored. The processed signal undergoes an initial decomposition into scattering coefficients using the wavelet scattering transform (WST). Subsequently, the scattering coefficients are subjected to computation for fuzzy entropy, dispersion entropy, phase entropy, and spectral entropy, for effectively characterizing the fluorescence spectral signals. These combined features generated through the proposed approach are then fed to 1D convolutional neural network (CNN) classifier to classify them into normal, pre-cancerous, and cancerous categories, thereby evaluating the effectiveness of the proposed methodology. We obtained mean classification accuracy of 97% using 5-fold cross-validation. This demonstrates the potential of combining WST and entropic features for analyzing fluorescence spectroscopy signals using 1D CNN classifier that enables early cancer detection in contrast to prevailing diagnostic methods.

Deterioration of Performance Status during Palliative Radiotherapy Suggests a Significant Short Survival Duration: Indicating the Necessities for Considering Radiotherapy Discontinuation.

Discontinuation of palliative radiotherapy due to a patient's declining general condition poses a clinical dilemma for palliative care physicians. This study aimed to investigate the survival duration of patients whose performance status (PS) deteriorated during palliative radiotherapy and inform decisions regarding early treatment discontinuation. We retrospectively analyzed data from patients referred from our institute's palliative care department who underwent ≥10 fractions of palliative radiotherapy between March 2017 and December 2021. PS was assessed using the Eastern Cooperative Oncology Group (ECOG) scale. Survival duration was calculated from the final day of palliative radiotherapy to death using the Kaplan-Meier method. A total of 35 patients underwent palliative radiotherapy. Seven (20%) experienced deterioration in ECOG PS during treatment. Their median survival duration was significantly shorter at 22 days (95% confidence interval: 1-94 days) compared to 125 days (95% confidence interval: 82-150 days) for the 28 patients whose PS remained stable (p = 0.0007). Deterioration in ECOG PS during palliative radiotherapy signifies a markedly shorter survival duration. Careful assessment of a patient's condition throughout treatment is crucial, and early discontinuation should be considered if their general health worsens rather than strictly adhering to the initial schedule.

Epidemiology and Survival of the Patients with Tuberculosis Covered by the Zabol Tuberculosis Center from 2006 to 2014

Background: Tuberculosis (TB) primarily targets the lungs and stands as the leading cause of death globally among diseases caused by a single agent. It is estimated that one-third of the world›s population is infected with TB. This study was undertaken due to the significant presence and incidence of TB in Zabol, an endemic city in Iran. Methods: We examined patient records (n=4092) spanning from 2006 to 2014, analyzing the data using SPSS. The Kaplan-Meier model was employed to assess patient survival rates, the Cox regression model helped identify factors affecting survival and mortality, and the classic Mantel-Haenszel method was utilized to calculate the mortality rate. Results: The patients’ mean age was 53.97 years, with a standard deviation of 20.55. Females comprised 59.78% of the study population, and 84.93% of the TB cases were pulmonary. Furthermore, 89.85% of the patients underwent successful treatment. Throughout the study period, there were 240 recorded deaths among TB patients. The average survival duration for patients was 2638 days, with a five-year survival rate of 75%. An increase in age every 10 years significantly raised the risk of death among TB patients (P&lt;0.05). However, no significant impact on patient survival was observed in relation to other variables, such as gender, history of recurrence, treatment delay, place of conflict, residency, and nationality. Conclusion: The findings of this study can provide useful information so that planners and health officials can take effective measures with appropriate interventions in order to diagnose the disease faster and follow up with appropriate treatment.

Identification of predictors for short-term recurrence: comprehensive analysis of 296 retroperitoneal liposarcoma cases

BackgroundThe short-term (≤ 1 year) recurrence (STR) is the primary determinant impacting both the life quality and survival duration in patients who have undergone surgical resection for retroperitoneal liposarcoma (RPLS), a condition with intricate and ambiguous pathogenesis. The purpose of this study was to analyze the risk factors associated with STR in cases of RPLS and primary retroperitoneal liposarcoma (PRPLS).MethodsFor this retrospective observational study, a total of 296 RPLS cases were selected as research subjects, who experienced tumor recurrence during the follow-up period. The Local recurrence-free survival (LRFS) rates were estimated using the Kaplan–Meier method and subsequently compared between groups utilizing the log-rank test. The subsequent analyses involved univariate and multivariate logistic regression to identify predictors of STR in RPLS cases. Additionally, a logistic regression model was constructed for PRPLS.ResultsThe 1-, 3-, and 5-year LRFS rates of the 296 RPLS cases were 51.7%, 16.9%, and 7.1%, respectively. In the univariate analysis, several factors were found to be associated with STR, including preoperative neutrophil/lymphocyte ratio (NLR), smoking history, surgical frequency, combined organ excision, operative time, intraoperative bleeding, transfer to the intensive care unit (ICU), multiple primary tumors, tumor shape and capsule characteristics, histological subtype, and presence of tumor necrosis. The elevated preoperative NLR, surgical frequency of ≥ 3 times, transfer to the ICU, presence of multiple primary tumors, and tumor necrosis were identified as independent risk factors for STR in surgically resected RPLS. Conversely, diabetes, intact tumor capsule, and well-differentiated histological subtype appeared to be independent protective factors. Analysis for PRPLS revealed that tumor capsule and tumor necrosis were independent predictors of STR.ConclusionsThe elevated preoperative NLR, surgical frequency of ≥ 3 times, transfer to the ICU, presence of multiple primary tumors, tumor necrosis, and tumor capsule were expected to serve as predictive factors of STR for surgical resected RPLS and PRPLS.

UK Stakeholder Perspectives on Surrogate Endpoints in Cancer, and the Potential for UK Real-World Datasets to Validate Their Use in Decision-Making.

Duration of overall survival in patients with cancer has lengthened due to earlier detection and improved treatments. However, these improvements have created challenges in assessing the impact of newer treatments, particularly those used early in the treatment pathway. As overall survival remains most decision-makers' preferred primary endpoint, therapeutic innovations may take a long time to be introduced into clinical practice. Moreover, it is difficult to extrapolate findings to heterogeneous populations and address the concerns of patients wishing to evaluate everyday quality and extension of life. There is growing interest in the use of surrogate or interim endpoints to demonstrate robust treatment effects sooner than is possible with measurement of overall survival. It is hoped that they could speed up patients' access to new drugs, combinations, and sequences, and inform treatment decision-making. However, while surrogate endpoints have been used by regulators for drug approvals, this has occurred on a case-by-case basis. Evidence standards are yet to be clearly defined for acceptability in health technology appraisals or to shape clinical practice. This article considers the relevance of the use of surrogate endpoints in cancer in the UK context, and explores whether collection and analysis of real-world UK data and evidence might contribute to validation.

Association between anaemia and long-term prognosis in patients with non-ST segment elevation myocardial infarction

Background The majority of existing studies examining the association between anaemia and the prognosis of patients with acute coronary syndrome (ACS) have focused on all patients with ACS without further categorisation. As a result, there is a dearth of research specifically exploring the relationship between anaemia and the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). To address this gap, this study aimed to investigate the correlation between anaemia and the long-term prognosis of NSTEMI patients. Methods This study included 482 NSTEMI patients who underwent percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Chongqing Medical University from September 1, 2016 to May 31, 2022, and the patients were classified into the major adverse cardiovascular events (MACE) group and non-MACEs group according to whether or not they had developed MACE as of February 28, 2023 at follow-up.COX regression analysis was used to assess whether anaemia was an independent factor influencing MACE occurrence in patients with NSTEMI. Receiver operating characteristic (ROC) curve analysis was conducted to determine if haemoglobin levels could enhance the predictive capacity of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis of NSTEMI patients. Haemoglobin levels were categorised into two groups based on the optimal cut-off value and transformed into binary data. The log-rank test was performed to compare the two groups, and a risk function was plotted. Results During a median follow-up period of 31 months, 124 (25.7%) MACE were identified. Univariate and multivariate COX regression analyses revealed that sex, age, smoking history, diabetes, creatinine, erythrocyte count, and haemoglobin level were independent risk factors that significantly influenced survival time. Subsequently, ROC curve analysis was performed to evaluate the predictive accuracy of specific variables. When the cut-off value for the decline ratio of haemoglobin was set at 128.50, the area under the curve (AUC) was determined to be 0.604, with a sensitivity of 0.403 and a specificity of 0.771. Similarly, setting the cut-off value for the reduction ratio of the GRACE score at 141.5 yielded an AUC of 0.700, with a sensitivity of 0.645 and a specificity of 0.709. Furthermore, when the cut-off value for the predicted probability of haemoglobin combined with the GRACE score was 0.270, the AUC was calculated as 0.702, with a sensitivity of 0.677 and a specificity of 0.696. Conclusion Haemoglobin levels were identified as an independent factor influencing the survival duration of patients with NSTEMI.

Non-Mixture Cure Model Estimation in Bladder Cancer Patients: A Novel Approach with Exponentiated Weibull Exponential Distribution.

Cure models are frequently used in survival analysis to account for a cured fraction in the data. When there is a cure rate present, researchers often prefer cure models over parametric models to analyse the survival data. These models enable the ability to define the probability distribution of survival durations for patients who are at risk. Various distributions can be considered for the survival times, such as Exponentiated Weibull Exponential (EWE), Exponential Exponential (EE), Weibull and lognormal distribution. The objective of this research is to choose the most appropriate distribution that accurately represents the survival times of patients who have not been cured. This will be accomplished by comparing various non-mixture cure models that are based on the EWE distribution with its sub-distributions, and distributions distinct from those belonging to the EWE distribution family. A sample of 85 patients diagnosed with superficial bladder tumours was selected to be used in fitting the non-mixture cure model. In order to estimate the parameters of the suggested model, which takes into account the presence of a cure rate, censored data, and covariates, we utilized the maximum likelihood estimation technique using R software version 3.5.7. Upon conducting a comparison of various parametric models fitted to the data, both with and without considering the cure fraction and without incorporating any predictors, the EE distribution yields the lowest AIC, BIC, and HQIC values among all the distributions considered in this study, (1191.921/1198.502, 1201.692/1203.387, 1195.851/1200.467). Furthermore, when considering a non-mixture cure model utilizing the EE distribution along with covariates, an estimated ratio was obtained between the probabilities of being cured for placebo and thiotepa groups (and its 95% confidence intervals) were 0.76130 (0.13914, 6.81863). The findings of this study indicate that EE distribution is the optimal selection for determining the duration of survival in individuals diagnosed with bladder cancer.

A new model to estimate duration of survival in patients with hepatocellular carcinoma with BCLC intermediate stage

It is difficult to determine whether an individual therapy contributes to the elongation of survival because of the difficulty of organizing clinical research in patients who receive multiple treatments in HCC. We aimed to establish a new model of survival prediction in patients with intermediate stage HCC to establish standards in the recent and coming multi-MTA era. This analysis was prepared using a data set of 753 patients diagnosed HCC prior to 2017. Multiple regression analysis showed age, naïve or recurrence, the size of the largest tumor nodule, the number of nodules, total bilirubin, albumin and α-fetoprotein as independent predictors of survival. A Weibull model had the best fit and, based on these predictors, we established a new predicted survival model. The survival duration can be predicted the proposed model; EXP (4.02580 + (− 0.0086253) × age + (− 0.34667) × (naïve/recurrence) + (− 0.034962) × (number of nodules) + (− 0.079447) × (the size of the largest nodule) + (− 0.21696) × (total bilirubin) + 0.27912 × (albumin) + (− 0.00014741) × (α-fetoprotein)) × (− natural logarithm(0.5))^0.67250. This model is useful for the planning and evaluating the efficacy of recent sequential therapies in multi-MTA era.

Low Serum Creatinine as Well as High Serum Creatinine Is Associated with Prognosis of Patients with Cancer in End-of-Life.

The prognosis of end-of-life patients is challenging, and clinicians have attempted to predict survival more accurately. High serum creatinine (sCr) levels are associated with lower survival rates in patients with various cancers; however, low sCr levels are commonly expected in patients with terminal cancer because of muscle wasting and malnutrition. Therefore, we investigated the prevalence of low and high sCr levels and their association with survival duration in patients with terminal cancer in a palliative care unit. We analyzed the medical records of 280 patients admitted to a palliative care unit. Patients were divided into low (<0.5 mg/dL), normal (0.5-1.2 mg/dL), and high (>1.2 mg/dL) sCr groups. Kaplan-Meier survival curves using sCr levels were plotted and compared using the log-rank test. Using stepwise selection, a multivariable Cox proportional hazards model was used to identify the significant prognostic factors. The median survival durations in the high-, low-, and normal-sCr groups were 9.57 days, 22.26 days, and 27.51 days, respectively. Multivariable Cox proportional hazard model identified that males (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.16-2.85), poor performance status (HR, 3.43; 95% CI, 1.12-10.54), total parenteral nutrition use (HR, 1.84; 95% CI, 1.09-3.1), high sCr (HR, 2.74; 95% CI, 1.52-4.94), and low sCr (HR, 1.22; 95% CI, 1.07-1.43) were significantly associated with a shorter survival time. Low and high serum creatinine levels were significantly associated with poor survival in patients with cancer at the end-of-life stage. Therefore, readily available and simple biomarkers may help plan advanced care in palliative care settings.

Preconditioning of the motor network with repetitive navigated transcranial magnetic stimulation (rnTMS) to improve oncological and functional outcome in brain tumor surgery: a study protocol for a randomized, sham-controlled, triple-blind clinical trial

BackgroundThe extent of resection of glioma is one of the most important predictors of the survival duration of patients after surgery. The presence of eloquent areas within or near a tumor often limits resection, as resection of these areas would result in functional loss and reduced quality of life. The aim of this randomized, triple-blind, sham-controlled study is to investigate the capability of repetitive navigated transcranial magnetic stimulation (rnTMS) over the primary motor cortex to facilitate the functional reorganization of the motor network.MethodsOne hundred forty-eight patients with tumors in movement-relevant areas will be included in this randomized, sham-controlled, bicentric, triple-blind clinical trial. Patients considered at high risk for postoperative motor deficits according to an initial nTMS assessment will receive inhibitory rnTMS at 1 Hz for 30 min followed by a short motor training of 10 min. Stimulation will be applied to the fiber endings of the corticospinal tract closest to the tumor based on individualized tractography. Stimulation will be performed twice daily for each 30 min for 5–28 days depending on the individually available time between study inclusion and surgery. The intervention is controlled by a sham stimulation group (1:1 randomization), where a plastic adapter will be placed on the coil. We expect a comparable or better motor status 3 months postoperatively as measured by the British Medical Research Council (BMRC) score for the affected upper extremity (non-inferiority) and a higher rate of gross total resections (superiority) in the rnTMS compared to the sham group.DiscussionThe generated reorganization of the brain’s areas for motor function should allow a more extensive and safer removal of the tumor while preserving neurological and motor function. This would improve both survival and quality of life of our patients.Trial registrationDRKS.de DRKS00017232. Registered on 28 January 2020.

Survival analysis of recurrent breast cancer patients using mix Bayesian network

IntroductionBreast cancer (BC) is the most common cancer among women. Iranians have an 11% BC recurrence rate, which lowers their survival rates. Few studies have investigated cancer recurrence survival rates. This study's major purpose is to use a mixed Bayesian network (BN) to analyze recurrent patients' survival. Material and methodsThis study aimed to evaluate the pathobiological features, age, gender, final status, and survival time of the patients. Bayesian imputation was used for missing data. The performance of BN was optimized through the utilization of a blacklist and prior probability. After structural and parametric learning, posterior conditional probabilities and mean survival periods for the node arcs were predicted. The hold-out technique based on the posterior classification error was used to investigate the model's validation. ResultsThe study included 220 cancer recurrence patients. These patients averaged 47 years old. The BN with a blacklist and prior probability has a higher network score than other networks. The hold-out technique verified structural learning. The Directed Acyclic Graph showed a statistically significant relationship between cancer biomarkers (ER, PR, and HER2 receptors), cancer stage, and tumor grade and patient survival duration. Patient death was also significantly associated with education, ER, PR, HER2, and tumor grade. The BN reports that HER2 negative, ER positive, and PR positive patients had a higher survival rate. ConclusionSurvival and death of relapsed patients depend on biomarkers. Based on the findings, patient survival can be predicted with their features.

A Comparison of the duration of knee survival in patients with primary knee osteoarthritis who have treated viscosupplementation or arthroscopic debridement.

Giriş: Eklem içi viskosuplementasyon ve artroskopik debridmanın diz artroplastisi uygulamasının zamanlamasını geciktirip geciktirmeyeceğini belirlemek.&#x0D; Gereç ve Yöntem: Kliniğimize dizde ağrı ve hareket kısıtlılığı ile başvuran, Kellgren – Lawrence sınıflamasına göre grade 2-3 primer osteoartrit tanısına sahip hastalardan , ilk ve rutin kontrol muayenelerinde VAS ve OX-12 kayıtları olup, en az 5 yıl (6,7 ±1,4 yıl) takip edilen 142 hasta çalışmaya dahil edildi.&#x0D; 142 hastanın 87'si (%61,3) kadın, 55'i (%38,3) erkekti. Hastaların yaş ortalaması 53,2 ± 14,3 idi. Gruplar, ortalama ilk başvuru sırasındaki yaşı, cinsiyet, morbid obezite ve diyabet varlığı, ortalama Visual Pain Score (VPS), Oxford-12 Questionary (OX-12) skorları ve sigara kullanımı açısından karşılaştırıldı. İlk başvuru tarihi ile artroplasti uygulanma tarihi arasında geçen süre de gruplar arasında karşılaştırıldı.&#x0D; Bulgular ve tartışma: 142 hastanın 87'sine (%61,3) 6,7±1,4 artroplasti uygulandı. Sadece NSAİİ alan hastalardan oluşan kontrol grubu, viskosuplementasyon uygulanan hastalar ve artroskopik debridman yapılan hastalarda, total diz artroplastisi oranı sırasıyla %61,5, %60,4 ve %61,9 idi.&#x0D; Sonuç: Altıncı ay ile ikinci yıl arasında ağrı gibi klinik semptomlarda düzelme olmasına rağmen, viskosuplementasyon ve artroskopik debridmanın dejeneratif süreci ve radyolojik kötüleşmeyi düzeltmediğini ve total diz artroplastisine kadar geçen süreyi etkilemediğini belirledik.

Establishment of a novel survival assessment and prediction model for advanced gastric cancer patients receiving immunotherapy.

Currently, there are only a few risk assessment tools that provide predictions of survival duration for patients with gastric cancer (GC) receiving immunotherapy. The purpose of the present study was to develop and validate a nomogram that uses statistical data to predict survival and make risk assessments for patients with advanced staged GC. A total of 1,013 patients consisting of a development cohort (n=501) and validation cohort (n=512) collected during the time interval between January 2018 and June 2022 were included in the present study. The analysis consisted of the discrimination index, calibration plots and decision curve of the nomogram model. A total of 167 (33.33%) patients from the development cohort, and 158 (30.85%) from the validation cohort died during the observation period. The median overall survival (OS) of female patients was higher at 980 days (95% CI, 613-NA) compared with that of male patients, which was 748 days (95% CI, 597-NA; P=0.24). The median survival of patients with domestic immunotherapy was 789 (95% CI, 597-NA) days, which was lower compared with the imported immunotherapy group who had a median OS of 980 days (95% CI, 582-NA; P=0.22). A total of four independent predictors, age (HR=1.012; P=0.0245), histological grade (HR=1.395; P=0.016), immunotherapy cycles (HR=0.932; P=0.028) and line of first immunotherapy (HR=1.693; P=0.0003), were identified. The C-index was 0.64 and 0.67 for the development and validation cohorts, respectively. Patients who received more cycles of immunotherapy as the first-line treatment with highly differentiated tumor led to increase in the survival time of the patients. Thus, this nomogram could be used to determine the benefit of immunotherapies on patients at various stages of treatment of GC.

Survival Outcomes in Palliative Sedation Based on Referring Versus On-Call Physician Prescription.

This study sought to determine the survival duration of patients who underwent palliative sedation, comparing those who received prescriptions from referring physicians versus on-call physicians. It included all patients over 18 years old who died in the Palliative Care, Internal Medicine, and Oncology units at the Hospital Universitario of Jerez de la Frontera between 1 January 2019, and 31 December 2019. Various factors were analyzed, including age, gender, oncological or non-oncological disease, type of primary tumor and refractory symptoms. Statistical analysis was employed to compare survival times between patients who received palliative sedation from referring physicians and those prescribed by on-call physicians, while accounting for other potential confounding variables. This study revealed that the median survival time after the initiation of palliative sedation was 25 h, with an interquartile range of 8 to 48 h. Notably, if the sedation was prescribed by referring physicians, the median survival time was 30 h, while it decreased to 17 h when prescribed by on-call physicians (RR 0.357; 95% CI 0.146-0.873; p = 0.024). Furthermore, dyspnea as a refractory symptom was associated with a shorter survival time (RR 0.307; 95% CI 0.095-0.985; p = 0.047). The findings suggest that the on-call physician often administered palliative sedation to rapidly deteriorating patients, particularly those experiencing dyspnea, which likely contributed to the shorter survival time following sedation initiation. This study underscores the importance of careful patient selection and prompt initiation of palliative sedation to alleviate suffering.

P103: Impella 5.5: An Alternative Therapy for Complex Patients with WHO Class II Pulmonary Hypertension

Background: Pulmonary hypertension (PH) is associated with advanced heart failure, which results in a worse prognosis, limits candidacy for heart transplant (HTx), and increases complications after HTx. Heart/lung transplant may overcome the complications of PH. However, the survival duration of patients after dual organ transplant is significantly shorter than HTx alone. We present a case of cardiogenic shock and severe PH in which we used temporary mechanical circulatory support with an Impella 5.5 to optimize PH successfully. Case: A 54-year-old female blood group O after workup and review by our selection committee was listed as status 6 for HTx due to non-ischemic cardiomyopathy. Right heart catheterization showed an RA of 15 mmHg, PA 75/37 (50), and PCWP 32. The Fick cardiac index was 1.2L/min/m2 with a PA saturation of 52% and PVR of 5.2 WU. On 3mcg/kg/min of Nipride, mPA was 38, and PCWP of 26. Concern for progression to fixed PH despite milrinone led our team to proceed with Impella 5.5 placement. Her PH improved after Impella to PA 51/15 (27) and PCWP of 15 with a PVR of 2.7 WU. She underwent a successful HTx and remains alive at 2 years without recurrent pulmonary hypertension. Decision-making: In a complex patient with WHO class II PH (unrelated to mitral valve disease), therefore not a candidate for therapies such as MitraClip, LV unloading is known to optimize multi-organ function and reduce PH. Traditionally the inability of sustained reversal of PH (mPA <40, PVR <3.5wu) with medical management is a contraindication for HTx. Given our patient’s choice to decline LVAD placement, our heart team felt it prudent to use the Impella 5.5 in an attempt to unload the LV fully. Conclusion: Our case shows the potential impact the Impella 5.5 device can have on patients with severe pulmonary hypertension. The implication of this therapy in avoiding heart/lung transplant, and potentially improving survival, should be explored.

Intratumoral PPT1-positive macrophages determine immunosuppressive contexture and immunotherapy response in hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is a malignancy with limited treatment options and poor prognosis. Macrophages are enriched in the HCC microenvironment and have a significant impact on disease progression and therapy...