Factor For Good Outcome Research Articles

The impact of cancer patient pathway on timing of radiotherapy and survival: a cohort study in glioblastoma patients.

Glioblastoma (GBM) is an aggressive brain tumor in which primary therapy is standardized and consists of surgery, radiotherapy (RT), and chemotherapy. However, the optimal time from surgery to start of RT is unknown. A high-grade glioma cancer patient pathway (CPP) was implemented in Norway in 2015 to avoid non-medical delays and regional disparity, and to optimize information flow to patients. This study investigated how CPP affected time to RT after surgery and overall survival. This study included consecutive GBM patients diagnosed in South-Eastern Norway Regional Health Authority from 2006 to 2019 and treated with RT. The pre CPP implementation group constituted patients diagnosed 2006-2014, and the post CPP implementation group constituted patients diagnosed 2016-2019. We evaluated timing of RT and survival in relation to CPP implementation. A total of 1212 patients with GBM were included. CPP implementation was associated with significantly better outcomes (p < 0.001). Median overall survival was 12.9 months. The odds of receiving RT within four weeks after surgery were significantly higher post CPP implementation (p < 0.001). We found no difference in survival dependent on timing of RT below 4, 4-6 or more than 6 weeks (p = 0.349). Prognostic factors for better outcomes in adjusted analyses were female sex (p = 0.005), younger age (p < 0.001), solitary tumors (p = 0.008), gross total resection (p < 0.001), and higher RT dose (p < 0.001). CPP implementation significantly reduced time to start of postoperative RT. Survival was significantly longer in the period after the CPP implementation, however, timing of postoperative RT relative to time of surgery did not impact survival.

Identification of predictive factors for better outcomes in LINAC-based radiation treatment for cerebral cavernous malformation

The effectiveness of radiation therapy in the treatment of cerebral cavernous malformations (CCM) remains debatable. However, numerous studies have shown a reduction in hemorrhage risk following radiotherapy for CCM. Therefore, herein, we share our experiences utilizing linear accelerator (LINAC)-based radiation for treating CCMs, with the aim of identifying the key factors influencing the therapeutic outcomes. We conducted a retrospective review of all patients with non-brainstem CCMs who underwent radiation treatment, as recorded in the NOVALIS registry at our institution. T2-weighted MR images were used for volumetric assessments using the iPlan radiotherapy planning software. To determine the independent predictors of nidus volume reduction and perilesional brain edema (PBE), we performed multivariate Cox regression analysis to calculate hazard ratios. Twenty patients with 31 non-brainstem CCMs were enrolled in this study. Analysis revealed age as an independent predictive factor for both nidus volume reduction and PBE after radiation treatment for CCM. Furthermore, a single fraction dose of 17 Gy or more was identified as an independent predictor of nidus volume decrease, while a single fraction dose of 18 Gy or more was found to be an independent risk factor for PBE in patients with CCM following LINAC-based radiation therapy. LINAC-based radiation therapy for non-brainstem CCMs with a single fraction radiation dose between 16.5 and 17.5 Gy, or a biologically equivalent dose of approximately 120 Gy, may be the most effective at reducing nidus volume and limiting side effects, particularly in patients under the age of 55 years. We further observed that the risk of PBE increased as the maximum radiation dose delivered to a 1 cc volume of the surrounding normal brain exceeded approximately 17.3 Gy. Therefore, we believe that calculating the D1cc of the normal brain may help to predict the occurrence of PBE when radiotherapy is administered to non-brainstem CCMs.

Body composition in elderly with myocardial infarction

Abstract Background Body mass index may differ significantly from true fatness and cannot distinguish between excess body fat (BF) and an increase in fat-free mass (FFM) (a surrogate for skeletal muscle mass). Both FFM and BF have been shown to influence prognosis. Greater skeletal muscle strength enables better mobility and cardiorespiratory fitness, both of which are known prognostic factors for better outcome. There are no data on a possible association between body composition and prognosis in the elderly with myocardial infarction. Purpose We aimed to evaluate the effects of FFM and BF on 30-day and one-year all-cause mortality in patients ≥ 65 years of age with MI who underwent PCI. Methods This retrospective study was conducted at a tertiary referral hospital with a 24/7 PCI service. We screened 8348 MI patients, of whom 3946 were ≥ 65 years old. We formed four groups of patients with different body composition: HighFFM-LowBF (22 patients), HighFFM-HighBF (2165 patients), LowFFM-LowBF (1165 patients), and LowFFM-HighBF (594 patients). These groups were compared. Data were analyzed using descriptive statistics. Results The lowest mortality was observed in the HighFFM-LowBF group (4.5%), followed by the HighFFM-HighBF group (9.3%), LowFFM-LowBF and LowFFM-HighBF (13.0% and 13.1%, respectively; p=0.002 (Figure 1). After one year, mortality was 18.2% in the HighFFM-LowBF group, 16.1% in the HighFFM-HighBF group, 22.6% in the LowFFM-LowBF group, and 26.4% in the LowFFM-HighBF group; p&amp;lt; 0.0001. (Figure 2). After adjustment for confounders, body composition groups were not associated with 30-day mortality (p=0.14), but were independently associated with one-year mortality risk (p=0.012). Conclusion Our result suggests that body composition is important in elderly patients with MI. We found that elderly patients with greater FFM (≈ muscle mass) survived better. The highest mortality was observed in sarcopenic obese elderly (low muscle mass and high body fat percentage).All-cause mortality in 30 daysOne-year all-cause mortality

Outcomes of care at higher-level trauma centers in octogenarians with a history of anticoagulant use who fall from ground level

BackgroundThe appropriate care of octogenarian trauma patients after a fall from ground level (FFGL) is a key factor for better outcomes. The purpose of this study is to use data from a national database to evaluate the outcomes of patients who are 80–89 years old with a history of anticoagulant use, sustained a FFGL, and were treated at a higher-level care institution. MethodsThe Trauma Quality Improvement Program (TQIP) database of the calendar year 2017–2018 was accessed for the study. All hospitalized trauma patients between the ages of 80–89 years old with a history of anticoagulant use and sustaining an injury after FFGL were included in the study. Other variables included in the study are sex [male], race [white], initial systolic blood pressure (SBP mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hypotension with an SBP<110 mmHg and other comorbidities. The outcomes of the patients were compared with the care at higher-level trauma centers (Level I & Level II) and lower-level trauma centers (Level III) using propensity matched analysis. ResultsAfter propensity matching, 2348 patients were identified in each group. There was no clinically significant difference between the patients’ characteristics who were treated at higher-level and lower-level care centers. A paired matched analysis showed greater mortality in patients who were treated at higher-level care centers compared to lower-level care centers (3.7% vs 2.6%, P = 0.03). The absolute difference in mortality was 1.1%[95% CI: 0.001, 0.022] which may not have any clinical relevance. A greater number of patients were discharged to home and a lesser number of patients were discharged to a skilled nursing facility (SNF) when they were treated at higher-level trauma centers. Conclusion & relevanceThe care at higher-level trauma centers did not show any benefit in-hospital mortality in the short term. A higher number of patients was discharged to home without assistance.

Effectiveness of Postoperative Physiotherapy Compared to Postoperative Instructions by Treating Specialist Only in Patients With an Ankle Fracture: A Systematic Review.

In current literature, the benefit of postoperative physiotherapy versus postoperative instructions by treating specialist only remains unclear. The aim of this review is to systematically assess existing literature regarding the functional outcome of postoperative physiotherapy compared to postoperative instructions by treating specialist only in the rehabilitation of patients with an ankle fracture. The secondary aim is to determine if there is a difference in ankle range of motion, strength, pain, complications, quality of life, and patient's satisfaction between these 2 rehabilitation methods. For this review, the PubMed/MEDLINE, PEDro, Embase, Cochrane, and CINAHL databases were searched for studies that compared postoperative rehabilitation groups. The electronic data search detected 20 579 articles. After exclusion, 5 studies with a total of 552 patients were included. Overall, no significant benefit in functional outcome of postoperative physiotherapy was seen compared to the instructions-only group. One study even found a significant benefit in favor of the instructions-only group. An exemption for beneficial effect of the use of physiotherapy could be made for younger patients, as 2 studies described younger age as a factor for better outcomes (functional outcome and ankle range of motion) in the postoperative physiotherapy group. Patients' satisfaction, described by one study, was found to be significantly higher in the physiotherapy group (P = .047). All other secondary aims showed no significant difference. Because of the limited number of studies and the heterogeneity among studies, a valid conclusion about the general effect of physiotherapy cannot be formed. However, we identified limited evidence suggesting a possible benefit of physiotherapy in younger patients with an ankle fracture in functional outcome and ankle range of motion.

Emotional climate in residential care scale for youth: Psychometric properties and measurement invariance

Research has shown that social and contextual factors, such as climate in Residential Youth Care (RYC), are key protective factors for better outcomes in youth who experienced maltreatment. Even if increasing attention has been given to residential climate as a therapeutic tool, available measures are still scarce and revealed some limitations. This study aims to adapt and validate a brief self-report measure to assess the emotional climate of residential care homes as perceived by youth who live there: the Emotional Climate in Residential Care Scale for youth (ECRC-Y). Participants were 372 youth (61.8% girls), aged between 12 and 24 years old, living in 33 Portuguese residential care facilities. The ECRC-Y was adapted from the Emotional Climate in the Classroom Scale, which is a 15-item measure based on an evolutionary approach, assessing the emotional climate according to three affect regulation systems: threat, drive, and soothing systems. A confirmatory factor analysis (CFA) was performed, and measurement invariance was tested for sex. The CFA indicated a trifactorial measurement model, in agreement with the theoretically proposed model. The ECRC-Y showed adequate internal consistency and construct validity in relation to external variables. Measurement invariance was supported for the ECRC-Y. Girls presented higher levels of threat related emotions, when compared with boys. Overall, the ECRC-Y is an appropriate self-report measure that may be useful for research and practice purposes within RYC settings, giving information about the emotional climate of residential care homes as perceived by youth in care.

Donor Selection Considering Donor Age in Hematopoietic Cell Transplant Recipients 50-75 Years of Age

Background: The number of hematopoietic cell transplantation (HCT) in older patients has been increasing. Although donor selection is a key factor for better outcomes, older patients frequently lack HLA-matched sibling donors (MSD) due to their comorbidities. Previous studies have shown that increased donor age is associated with a high mortality. In this study, we sought to identify the best donors for older patients and evaluated appropriate alternatives for MSD. Patients and methods: For this retrospective cohort study, clinical data of donors and recipients were obtained from the registry data of the Japanese Society for Transplantation and Cellular Therapy (JSTCT). This study included 9,687 patients between the ages of 50-75 with acute leukemia or myelodysplastic syndrome who received the first HCT between 2011 and 2020 from MSD (N=1,317), 8/8 HLA-matched (HLA-A, -B, -C, and -DRB1 allele-level) unrelated donors (8/8 MUD) (N=2,341), 7/8 HLA-matched unrelated donors (7/8 MUD) (N=1,371), haploidentical related donors (HRD) (N=721), or single-unit cord blood (CB) (N=3,937). Only donors over 40 years of age were chosen to become MSD. For HRD, at least two-antigen (HLA-A, -B, -DR antigen-level) mismatched donors were included, and for CB donors, a maximum of two-antigen mismatched donors were included. Risk factors for overall mortality and other endpoints were analyzed using Cox proportional hazards models and Fine and Gray's proportional hazards models, respectively. Results: The median donor age excluding CB was 42 years (range, 13-73). The unadjusted probability of overall survival (OS) at five years post-transplantation was highest in HCT from younger (<40 years) 8/8 MUD (48% [95% CI, 44.7%-51.2%)] followed by those from older 8/8 MUD (46% [95% CI, 42.7%-49.6%)]. The probability of OS in HCT from MSD was 43% (95% CI, 39.9%-46.0%). After adjusting for other significant factors in multivariable analysis, younger 8/8 MUD were significantly associated with a higher rate of survival (adjusted hazard ratio [aHR], 0.86; 95% CI, 0.77-0.97, P=0.012), compared to MSD (Figure), especially in patients with high-risk disease (aHR, 0.83; 95% CI, 0.71-0.97, P=0.018). On categorization of recipient age by 5 years, survival in younger 8/8 MUD was higher than that in MSD, and that trend became more apparent as recipient age increased (P for trend=0.002). On the other hand, survival in MSD was comparable to that in older 8/8 MUD, younger 7/8 MUD, and CB. Relapse rate in MSD was significantly higher than those in other donors except for HRD, while non-relapse mortality (NRM) in MSD was significantly lower except younger 8/8 or 7/8 MUD (Figure). Incidence of grades III-IV acute graft-versus-host disease (aGVHD) was significantly lower in younger 8/8 (aHR, 0.66; 95% CI, 0.50-0.86, P=0.002) or 7/8 MUD (aHR, 0.72; 95% CI, 0.52-0.98, P=0.039) than MSD. As for a graft source, no significant difference between bone marrow and peripheral blood stem cells was observed in survival. Conclusions: Younger 8/8 MUD is the first choice as a donor source in older patients due to both low rates of relapse and NRM. The second choice is MSD, older 8/8 MUD, younger 7/8 MUD, and CB. This study will provide older patients with more opportunities to find appropriate donors in suitable timing. Reducing NRM may be a key for HLA-mismatched donors to be an alternative donor option. Figure: Forest plots of donor groups for overall survival, relapse, and non-relapse mortality (NRM). MSD, HLA-matched sibling donors; MUD, HLA-matched unrelated donors; HRD, haploidentical related donors; CB, cord blood Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Microbiome and Colorectal Cancer Management.

Globally, colorectal cancer (CRC) is one of the most typical lethal cancers. One of the main factors for better outcomes in CRC management is the early detection of the disease. As an integral component of human metabolism and homeostasis, gut microbiome has recently been a subject of extensive research for its role in the pathogenesis, diagnosis, and treatment of CRC. Microbial dysbiosis (the decrease in beneficial gut flora and the increase of detrimental populations) leads to chronic inflammation and genetic alteration in the host cells, triggering and promoting CRC carcinogenesis. Identifying these microbial changes in depth would potentially isolate the pathogenic microbiota species and establish biomarker models for early detection of CRC. On the other hand, modifying these microbial changes would help formulate preventative and therapeutic strategies for CRC, developing a more precise CRC management plan according to each patient's microbial print. This essay explains gut microbiome composition, microbial changes (dysbiosis) in CRC carcinogenesis, the probability of creating microbiome-based CRC biomarkers, and potential microbiome-targeted treatment options.

Predicting factors for better outcomes of stable supination external rotation type 2 ankle fractures

PurposeStable Weber B ankle fractures are treated by a walking boot for 6 weeks and bearing full weight through the boot as tolerated. The aim of the present study was to assess the outcome parameters of this treatment protocol, evaluate the efficacy of using the walking boot, and investigate any possible predicting factors that could affect the outcomes. MethodsAll the patients with stable Weber B ankle fractures, treated in our hospital between January 2018 and December 2018, were prospectively included to the study. The patients were evaluated clinically, and the patient-reported outcome measures data were collected at the 2 and 6 weeks post-injury. Chi square, Spearman's rho test, independent samples and paired sample t-tests were used for the monovariant analysis. ResultsA total of 128 consecutive patients (aged 52.2 ± 19.1 years) with supination external rotation type 2 fracture were finally included to the study. At the 2 weeks follow-up, the reported outcome measures scores were in moderate levels, but improved significantly at the 6 weeks follow-up (p < 0.0001). Multivariant analysis revealed that the ability to bear full weight without the boot at the 2 weeks after diagnosis was the only variable, which made statistically unique contribution to the foot and ankle disability index score at the 6 weeks (p = 0.005). ConclusionConservative treatment using a walking boot with advice to bear full weight of stable ankle Weber B fractures can bring to good functional outcomes. The ability to bear full weight without the aid of the walking boot at 2 weeks after diagnosis was the only significant predicting factor for better outcomes at 6 weeks after diagnosis.

P42.03 Predictive Factors of Response to PD-(L)1 Inhibitors in Patients With Advanced Non-Small Cell Lung and High PD-L1 Expression

Tumor PD-L1 expression is the only validated predictive biomarker in advanced NSCLC patients (pts) treated with PD-(L)1 inhibitors. Analysis of PD-L1 expression by immunohistochemistry has been validated in histological samples. Smoking and overweight have been described as predictive factors of better outcome, whereas bone metastases, antibiotics, corticosteroids and proton pump inhibitors as possible negative predictive factors. The aim of our study was to analyze different potential predictive factors to PD-(L)1 inhibitors in pts with advanced NSCLC and high PD-L1 expression. This retrospective study was carried out in pts with advanced NSCLC and high PD-L1 expression treated with PD-(L)1 inhibitors with median follow-up of 12.8 months [3.6-73.9]. Clinical and histological variables of interest were registered. Kaplan-Meier estimations were used to calculate survival, while the log-rank test was implemented to make comparisons. The impact of variables on survival was assessed through univariate and bivariate analysis. We included 86 pts, the mean age was 66 y [36-84], 24.4% were females, 73.3% were former smokers and 22.1% current smokers, 38,4% presented normal Body Mass Index, 79% pts had non-squamous NSCLC, and 12% pts had cytological sample for PD-L1 determination. 72 (83.7%) pts received monotherapy with PD-(L)1 inhibitor, 4 (4.7%) pts chemotherapy plus PD-(L)1 inhibitor and 10 (11.6%) pts received PD-(L)1 inhibitors with other immunotherapy drug. The median OS and PFS were 23.0 months (95% CI, 13.7 to 32.4) and 9.5 months (95% CI, 2.3 to 16.7), respectively. ORR and DCR in overall patients were 55.6% and 71.5%, respectively. The median OS in complete/partial response vs. stable disease vs. progression disease was not reached vs. 14.0 months (95% CI, 8.1 to 19.8) vs. 4.2 months (95% CI, 2.6 to 8.0), respectively (P<0,001). The median OS in patients receiving treatment beyond progression was not reached vs. 10.4 months (95% CI, 8.2 to 12.6) in patients that stopped treatment (P<0,001). A trend to better results were observed in patients with overweight or smokers, and a trend to worse OS was observed in pts with bone metastasis. No differences in OS were observed according to the tumor sample (cytological vs histological samples). Response to immunotherapy and treatment beyond progression were predictive of better outcome in pts with advanced NSCLC and high PD-L1 expression. No significant differences in survival were observed according to the type of tumor sample or clinical characteristics.

P-103 CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF HEPATOCELLULAR CARCINOMA ANALYSIS OF A TERTIARY REFERRAL CENTER IN BRAZIL

In Brazil, hepatocellular carcinoma (HCC) is the sixth leading cause of cancer-related deaths and the incidence is increasing worldwide. Several modifiable and non-modifiable HCC risk factors have been described. However, clinical and epidemiological aspects of HCC are still underreported in Brazil. To investigate the main characteristics of patients with HCC at one Brazilian tertiary care center. Retrospective analysis of patients diagnosed with HCC in the last 3 years. Epidemiological, clinical, tumor characteristics, staging and type of treatment were reviewed. 70 patients were included. There was a predominance in males (78%) and mean age was 65,6 (± 12,2) years. 60 (90%) patients were cirrhotic. Etiologies of liver cirrhosis were: alcohol abuse (31%), hepatitis C infection (22%), followed by cryptogenic (17%), nonalcoholic fatty liver disease (14%) and hepatitis B infection (11%). 38 (54%) cirrhotic patients were Child-Pugh A, 42 (60%) harbored a single tumor at diagnosis and 37 (52%) had normal alpha-fetoprotein. 38 (51%) were classified as Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, 12 BCLC B (17%) and 22 BCLC C or D (31%). 34 (48%) patients were diagnosed at a non-curative stage. Chemoembolization and radiofrequency ablation were the main procedures performed in 20 (28%) and 15 (21%), respectively. 10 (14%) were transplanted. The mortality during the period analyzed was 27%. Alcohol abuse and hepatitis C infection were the leading causes of chronic liver disease associated with HCC. Approximately 50% of patients were classified as very early or early stage, which are potentially curable. These results highlight the need to increase early diagnosis and policies focused on changing risk factors for better outcomes.

Publication Rate of Abstracts Presented at AAPOS Annual Meetings: From Conference Abstract to Full-Text Article.

To review and analyze abstracts presented at American Association for Pediatric Ophthalmology and Strabismus (AAPOS) annual meetings, and to identify publication rates and potential predictive factors for better outcomes. All abstracts accepted for presentation at AAPOS annual meetings from 2013 to 2017 were examined. A comprehensive literature search via PubMed and Scopus was conducted to identify whether the abstracts had been published as full text. A multivariate analysis was achieved to assess the factors related to successful publication, and a Kaplan-Meier analysis was performed to evaluate the publication time course of abstracts. Of 819 analyzed abstracts, 437 (53%) were published in peer-reviewed journals with a median impact factor of 2.7. The overall mean time to publication was 3 ± 2.2 years. The multivariate analysis revealed that abstracts were more likely to be published if they were accepted at an AAPOS annual meeting as an oral paper (P < .001), if they were prospective (P > .001) and multicenter (P = .013) studies, and if they had strabismus, retina, and vitreous disorders and diagnosis as main topics (P = .022). The Kaplan-Meier analyses revealed significant differences in the publication time distribution for multicenter versus single-center abstracts and paper versus poster and e-poster (P < .05). More than half of the abstracts accepted for presentation at the AAPOS annual meetings were published in peer-reviewed journals within 3 years from submission to the meeting. The factors associated with a higher publication rate were the prospective study design, multicentricity, and presentation at the meeting as an oral paper. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XX-XX.].

End-to-side neurorrhaphy in peripheral nerves: Does it work?

Acute peripheral nerve injuries are common and can cause physical disabilities with sensory and functional sequelae; they therefore require surgery. The aim of this study was to conduct a systematic review to assess the clinical applicability of end-to-side neurorrhaphy in peripheral nerve reconstruction, based on available evidence. We carried out a systematic review of the literature using MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scielo and Scopus through March 16, 2021. Most of the selected studies were qualitative and employed nonrandomized groups of patients, without standardized scales for assessing outcomes, which made statistical analysis difficult. Efficacy varied from 24% to 81%. Factors for better outcome included the type of injury, type of injured nerve (sensory, motor or mixed), presence of an epineural window, topography, injury extension <1.3 cm, and intervention within 2 weeks of injury. Clinical studies so far lack scientific evidence on end-to-side neurorrhaphy in peripheral nerve lesions.

Feasibility and Outcomes of a Third Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Few therapeutic options are available for patients with acute myeloid or lymphoblastic leukemia (AML/ALL) relapsing after a second allogeneic stem cell transplantation (alloSCT2). In selected patients a third allogeneic stem cell transplantation (alloSCT3) has been used, but no detailed analysis is available so far. The European Society for Blood and Marrow Transplantation (EBMT) registry was screened for patients with acute leukemia (AL) receiving alloSCT3 from an identical or alternative donor to treat AL in either haematological relapse or disease persistence after alloSCT2 between 2001 and 2018. Feasibility, efficacy, outcome, and risk factors of this approach were analyzed retrospectively. Forty-five patients (median age, 37 years, range 12-71) with AML (n=34) or ALL (n=11) were identified. Eleven patients received alloSCT3 in complete remission (CR), 34 had active disease. Fifteen patients were transplanted from the same donor at all three transplants, 30 patients had at least 2 different donors. Between alloSCT2 and alloSCT3, the donor was changed in 25 patients. After alloSCT3, 38 patients engrafted, and 26 achieved CR or CR with incomplete hematological reconstitution (CRi). Acute graft-versus-host disease (GvHD) grade II-IV was observed in 19%, chronic GvHD occurred in 13%. After 1-year, cumulative incidences of leukemia relapse and non-relapse mortality were 47% and 42%, respectively. Median progression free and overall survival (PFS/OS) from alloSCT3 were 2.5 and 4 months, respectively, 1-year PFS and OS were 11% and 20%,. Outcome was improved in patients with at least one donor change (1-year PFS/OS: 17%/30%), further factors for better outcome included an unrelated donor for alloSCT3, Karnofsky performance score >80, and more recent year of alloSCT3. Only patients with AML achieved >1 year OS. In conclusion, results after a third alloSCT are poor, limiting this procedure to few, highly selected patients. Recurrent relapses of acute leukemia after alloSCT remain an unmet therapeutic need.

Crossing the Death Valley of publication process in cornea and ocular surface diseases: from abstracts presented at the Association for Research in Vision and Ophthalmology annual meeting to full-text manuscripts.

This study was conducted to analyze the profile and publication rate of abstracts in indexed journals presented in the cornea section at the Association for Research in Vision and Ophthalmology Annual Meeting and to further identify potential predictive factors for better outcomes. Abstracts accepted for presentation at the 2013 Association for Research in Vision and Ophthalmology Annual Meeting in the cornea section were sought via PubMed and Scopus to identify whether they had been published as full-text manuscripts. First author's name, time of publication, journal's name, and impact factor were recorded. A multivariate regression was performed to explore the association between variables and both the likelihood of publication and the journal's impact factor. A Kaplan-Meier analysis was performed to evaluate the time course of publication of abstracts. Of the 939 analyzed abstracts, 360 (38.3%) were published in journals with a median impact factor of 3.4. The median time interval between abstract submission and article publication was 22 months. The multivariate analysis revealed that abstracts were more likely to be published if they were funded (OR=1.482, p=0.005), had a control group (OR=1.511, p=0.016), and had a basic science research scope (OR=1.388, p=0.020). The journal's impact factor was higher in funded studies (β=0.163, p=0.002) but lower in multicenter studies (β=-0.170, p=0.001). The Kaplan-Meier analyses revealed significant differences in the publication time distribution for basic science vs clinical abstracts (χ2=7.636), controlled vs uncontrolled studies (χ2=6.921), and funded vs unfunded research (χ2=13.892) (p<0.05). Almost 40% of Association for Research in Vision and Ophthalmology abstracts were published within 5 years from submission. Funding support, basic research scope, and controlled design were the determinants of better outcomes of publication.

CML-319: Impact of Insurance Differences in Outcomes in Colombian Patients with Chronic Myeloid Leukemia (CML)

Context Adherence is a key factor for good outcomes in CML. There are two types of insurance in Colombia: Contributory (CS) and Subsidized Systems (SS), which provide highly unequal access to Tyrosine Kinase Inhibitors (TKI) for CML. Objective The aim of this report is to compare outcomes in patients with different access to TKI and analyze other factors that affect progression-free survival (PFS). Design The Colombian Association of Hematology and Oncology (ACHO)'s hematological disease registry (RENEHOC) is a multicenter study; it has collected information on CML patients since 2019, in 14 centers with institutional Ethics Committee approval. Setting RENEHOC is a real-world registry and captures information from academic and general community centers. Patients or other participants 357 CML adult patients treated in the last 20 years. Interventions Treatment was according to investigators' preferences. Imatinib was first-line treatment for 223 patients (62.4%), dasatinib for 69 (19.4%) and nilotinib 53 (14.8%); 47.9% required a second line of treatment. Main outcome measures Primary end points were Optimal Response (OR) according to LeukemiaNet 2020 definition and progression-free survival (PFS) rates. The Kaplan-Meier method was used to assess PFS, and hazard ratios (HR) using Cox proportional regression modeling were estimated. Results Mean age was 54 years (19–92), 60.1% were males, most patient were diagnosed in chronic phase (92%) and 36% were high Sokal. At a median follow for the entire cohort of 69 months (1–228), 60% of patients were in OR, including 11 patients in treatment-free remission (TFR). There were no significant differences between contributory and subsidized cohorts in terms of patient or disease characteristics. 76% of patients were in OP at the last visit in the CS in comparison to 48% for the SS cohort. Ten patients died, all CML-related. The only significant prognosis factors associated with PFS were Sokal score (mean PFS: 57 months low/int vs 39 high; p=0.012) and type of insurance (mean PFS 70 months for CS vs 57.7 for SS; p=0003). Conclusions This report suggests that differences in access to TKI in CML according to insurance regimes results in significantly different PFS. This is the first time in the country that the impact of these attention inequalities in CML patient care have been demonstrated. Funding ACHO has received grants for RENEHOC project from Takeda, Abbvie, Amgen, Dr. Reddy's.

196P Menopausal symptoms in premenopausal patients with luminal early breast cancer developing chemotherapy-induced amenorrhea

Chemotherapy-induced amenorrhea (CIA) has been identified as a prognostic factor for better outcome in luminal breast cancer (BC) patients. Though, it may be associated to menopausal symptoms affecting patients’ quality of life. The aim of this study was to assess patients’ complaints related to CIA.

Interferon β-1a subcutaneously 3 times/week clinical outcome in relapsing multiple sclerosis in Finland.

Prognostic factors and long-term treatment response of interferon β-1a s.c tiw has not been studied in a real-life clinical cohort in Finland. The aim of the paper was to evaluate long-term treatment response, prognostic clinical factors and adherence among interferon β-1a s.c tiw treated patients in Finland. A retrospective review of medical records was performed. Confirmed relapsing multiple sclerosis patients treated with interferon β-1a s.c tiw 22μg or 44μg as their first treatment, from 1996 to 2010 in Western Finland, were included. Longitudinal generalized linear regression models were applied to assess risk of disability progression, using Expanded Disability Status Scale (EDSS), during the treatment period. Odd’s ratios with 95% confidence intervals (95% CI) were calculated for risk factors: gender, age at diagnosis, treatment delay, dose, baseline EDSS and EDSS change in one year. Kaplan-Meier was applied to study median time to discontinuation. Mean duration of treatment in 293 cases was 2.9 years (min 0.04, max 13.5). EDSS increase vs. no increase in one-year carried a significant risk for long-term disability progression (1.20, 1.08-1.33). Older age, defined by a 10-year increase in age at diagnosis (1.43, 1.07-1.91) and one-year delay to treatment start showed an increased risk for disability progression (1.05, 0.99-1.11), but gender (0.66, 0.38-1.15) or initial dose (1.00, 0.45-2.25) showed no risk. Treatment was stopped in 37% due to disease activation at median of 1.7 years, and in 25% due to side effects at 9.3 months. Our results show that young age, a short delay to treatment start and slower disability progression were identified as factors for better outcome among cases with interferon β-1a s.c tiw as their first disease modifying treatment.

Evolving Selection of Unrelated Donor for Hematopoietic Stem Cell Transplantation for Patients with β Thalassemia

Background: Many Chinese patients with hematologic disease, who need allogeneic hematopoietic stem cell transplantation(HSCT) commonly lack an HLA matched sibling since a Chinese family often has a single child due to Chinese one-child policy in the past 10years. As an alternative option, unrelated HSCT is the feasible option for the patients without matched related donors (MRD). Many study have found that thalassemia-free survival (TFS) was approximately 90% in unrelated donor HSCT (UDT) for TM patients. Donor selection is one of key factors for better outcomes after hematopoietic stem cell transplantation (HSCT). Choosing the most suitable donors for TM patients can be challenging to physicians and search coordinators. It is shown that increased donor age is associated with high mortality. However, outcomes of donor factors such as age, sex, CMV status, ABO type, matching of HLA loci and female donor pregnancy history for TM patients have rare been taken into account and evaluated. Aims: The aim of this study was to develop and validate the principal of donor selection and to evaluate the impact of donor characteristics on survival outcomes especially in case of mismatch unrelated donor. Patients and Methods: Between December 2008 to December 2018,274 TM patients with a median age of 6 years (2-23) had no suitable matched related donor performed an unrelated HSCT. 189 patients have been typed by high resolution (HR) HLA typing for HLA-A/B/C/DRB1 loci, at the start of the donor's search process and 85 typed by high resolution (HR) HLA typing for HLA-A/B/C/DRB1/DQB1 loci. Patients, donors and transplant characteristics are summarized in Table 1 Result: 217 (79.2%) recipient were HLA full matched (FM) with donors, 51 (18.6%) of recipient-donor pairs were HLA one locus mismatched (mm) and 6 (2.2%) two loci mm . Statistically significant differences were observed in overall survival (OS) and thalassemia-free survival (TFS) among full matched group, one loci mm matched group and two loci mm group, the corresponding OS, TFS were 95.4%,88.2%,66.7% (P=0.010,shown in Figure one) and 93%,88%,66.7% (P=0.089) respectively. Risks for cGVHD were higher in recipient-donor HLA-mm transplantation, particularly significant in two loci mm transplant,P=0.000(Figure2). ABO compatibility did not affect OS and TFS (94.8 vs. 93%,P=0.572 and 94.8% vs. 90.2, P=0.190 respectively in ABO matched group and ABO mismatched group), whereas ABO mismatched was associated with higher rate of graft rejection (GR) although not statistically significant ( 0% vs. 4.3%, P=0.069). Notably, donor age was significantly associated with worse survival. Both OS and TFS for donor older than 40 years old was significantly worse than those &lt;40 years old(94.6%vs.85% P=0,051)and (93% vs.82%, P=0.042) respectively( Figue3). Interestingly, previous pregnancy of female donors prior to donation had an impact on acute GVHD, parous female donors resulted in a significantly increased risk of aGVHD (31.8 vs. 13.1%,P=0.024) . However, donor other characteristics such as sex, parity, and cytomegalovirus serostatus were not associated with survival . For CMV- recipients, a CMV+ donor was not significantly associated with an increase in OS or TFS (92.7 vs. 93.3%, P=0.998, P=0.998 and 90.5% vs. 93.3%;P=0.601 respectively). Conclusion:Donor age and donor-recipient HLA match are important when selecting unrelated donors. Transplants from donors older than 40 years old should probably be avoided. Younger donors associates with better overall survival and lower rates of acute and cGVHD. When selecting unrelated donors, avoidance of parous female donors if possible as to avoid high incidence of aGVHD. Other donor characteristics such as sex, parity, and cytomegalovirus serostatus were not associated with survival. ABO mismatching (any type: major, minor or bidirectional) was not associated with OS, TFS or GVHD but related to graft rejection. In the future we will observe ABO mismatch among donors and recipients on engraftment time. Disclosures No relevant conflicts of interest to declare.

Clinical outcome of stereotactic body radiotherapy for lung-only oligometastatic head and neck squamous cell carcinoma: Is the deferral of systemic therapy a potential goal?

ObjectivesOligometastatic head and neck squamous cell carcinoma (HNSCC) is a rare entity with no evidence-based treatment recommendations available to support the use of local ablative therapies. The aim of our study was to report on the clinical benefit of stereotactic body radiotherapy (SBRT) for patients with lung-only oligometastases, defined by the presence of 1 to 5 pulmonary lesions. Material and MethodsSBRT was applied in case of single lesions deemed amenable to local treatment only (“de novo” pattern) or after first line chemotherapy at time of disease oligoprogression (“induced” pattern). To assess the potential deferral of systemic therapy in both time points, we analyzed time to progression (TTP) defined as the time from the last day of SBRT to disease progression or death from any cause. Cox regression analysis was performed to identify predictive factors of better outcome. ResultsTwenty-seven patients were retrospectively evaluated. The majority (81.5%) had HPV negative disease and a “de novo” oligometastatic pattern (78.6%). The median maximum lesion diameter and target size were 1.5 cm and 22.7 cc, respectively. At a median follow-up of 22 months (range 6–73), the median TTP was 10 months (95% CI: 9.5–21.1), with 1- and 2-year rates of 56.2% and 35%, respectively. The objective response rate at 3 months after SBRT was 75%. At multivariate analysis baseline T3/T4 stage had a HR for worse outcome of 5.38 (p = 0.033). Acute toxicity was minimal (G1/G2 of 14.8%). ConclusionIn properly selected oligometastatic patients, SBRT has potential for sustained deferral of systemic treatment.