Factor For Good Outcome Research Articles

Green Coexistence for 5G Waveform Candidates: A Review

There is a growing demand for 5G applications in all fields of knowledge. Current applications, such as the Internet of Things, smart homes, and clean energy, require sophisticated forms of 5G waveforms. Researchers and developers are investigating the requirements of 5G networks for better waveform types, which will result in high spectrum efficiency and lower latency with less complexity in systems. This paper proposes an assessment of various 5G waveform candidates [filtered orthogonal frequency-division multiplexing (OFDM), universal filtered multicarrier (UFMC), filter bank multicarrier (FBMC), and generalized frequency-division multiplexing] under the key performance indicators (KPIs). This paper assesses the main KPI factors (computational complexity, peak-to-average-power ratio, spectral efficiency, filter length, and latency). Moreover, this paper compares and evaluates all KPI factors in various 5G waveforms. Finally, this paper highlights the strengths and weaknesses of each waveform candidate based on the KPI factors for better outcomes in the industry. In conclusion, the current review suggests the use of optimized waveforms (FBMC and UFMC) for better flexibility to overcome the drawbacks encountered by previous works. Regarding coexistence, FBMC and UFMC showed better coexistence with CP-OFDM in 4G networks with a new radio spectrum. The rapprochement between the above-mentioned waveforms has been called green coexistence and is due to the mix between one waveform in 4G networks and two waveforms in 5G networks based on the subcarrier and subband shaping (FBMC and UFMC).

Mitofusin-2 acts as biomarker for predicting poor prognosis in hepatitis B virus related hepatocellular carcinoma

ObjectiveTo investigate the expression of Mitofusin-2 (MFN2) in HCC tissues and its role in the development of HCC.MethodsA total of 107 HCC specimens were collected for tissue microarray analysis and immunohistochemistry (IHC) analysis. The relationship between MFN2 expression and clinical features of patients with HCC was analyzed.ResultsExpression level of MFN2 in HCC tissues was 0.92 ± 0.78, significantly lower than that of matched paracancerous liver tissues (1.25 ± 0.75). Patients with low expression of MFN2 had significantly higher rates of cirrhosis than those with high expression of MFN2 (P = 0.049). Kaplan-Meier survival analysis showed that HCC patients with low expression of MFN2 had a worse prognosis in overall survival than HCC patients with high expression of MFN2 (P = 0.027). Patients with high expression of MFN2 had a better prognosis in disease-free survival compared with HCC patients with low expression of MFN2 (P = 0.047). Vascular invasion and MFN2 expression were shown to be prognostic variables for overall survival in patients with HCC. Multivariate analysis showed that vascular invasion (P < 0.001) and MFN2 expression (P = 0.045) were independent prognostic factors for overall survival. Vascular invasion (P < 0.001) and MFN2 expression (P = 0.042) were independent risk factors associated with disease-free survival.ConclusionOur data revealed that MFN2 expression was decreased in HCC samples. High MFN2 expression was correlated with longer survival times in patients with HCC and served as an independent factor for better outcomes. Our study therefore provides a promising biomarker for the prognostic prediction of HCC and a potential therapeutic target for the disease.

Decreased expression of peroxisome proliferator-activated receptor alpha indicates unfavorable outcomes in hepatocellular carcinoma.

IntroductionHepatocellular carcinoma (HCC) has a close relationship with lipid metabolism. Peroxisome proliferator-activated receptor α (PPARα) plays a crucial role in the regulation of fatty acid oxidation in the liver. However, the role of PPARα in HCC remains unclear.MethodsA total of 804 HCC specimens were collected to construct a tissue microarray and for immunohistochemical analysis. The relationship between PPARα expression and clinical features of HCC patients was analyzed. Kaplan–Meier analysis was conducted to assess the prognostic value of PPARα expression levels.ResultsThe expression of PPARα in HCC was noticeably decreased in HCC tissues. HCC patients with high levels of PPARα expression in cytoplasm had smaller tumors (P=0.027), less vascular invasion (P=0.049), and a higher proportion of complete involucrum (P=0.038). Kaplan–Meier analysis showed that HCC patients with low PPARα expression in the cytoplasm had significantly worse outcomes in terms of overall survival (P<0.001), disease-free survival (P=0.024), and the probability of recurrence (P=0.037). Similarly, overall survival was significantly shorter in HCC patients with negative PPARα expression in the nucleus (P=0.034). Multivariate Cox analyses indicated that tumor size (P=0.001), TNM stage (P<0.001), vascular invasion (P<0.001), and PPARα expression in the cytoplasm (P<0.001) were found to be independent prognostic variables for overall survival.ConclusionOur data revealed that PPARα expression was decreased in HCC samples. High PPARα expression was correlated with longer survival times in HCC patients, and served as an independent factor for better outcomes. Our study therefore provides a promising biomarker for prognostic prediction and a potential therapeutic target for HCC.

Does recipient work status pre-transplant affect post–heart transplant survival? A United Network for Organ Sharing database review

Recipient-related factors, such as education level and type of health insurance, are known to affect heart transplantation outcomes. Pre-operative employment status has shown an association with survival in abdominal organ transplant patients. We sought to evaluate the effect of work status of heart transplant (HTx) recipients at the time of listing and at the time of transplantation on short- and long-term survival. We evaluated the United Network for Organ Sharing (UNOS) registry for all adult HTx recipients from 2001 to 2014. Recipients were grouped based on their work status at listing and at heart transplantation. Kaplan-Meier estimates illustrated 30-day, 1-year, 5-year, and 10-year survival comparing working with non-working groups. The Cox proportional hazards regression model was applied to adjust for covariates that could potentially confound the post-transplantation survival analysis. Working at listing for HTx was not significantly associated with 30-day and 1-year survival. However, 5- and 10-year mortality were 14.5% working vs 19.8% not working (p < 0.0001) and 16% working vs 26% not working (p < 0.0001), respectively. Working at HTx appeared to be associated with a survival benefit at every time interval, with a trend toward improved survival at 30 days and 1 year and a significant association at 5 and 10 years. Kaplan-Meier analysis demonstrated a 5% and 10% decrease in 5- and 10-year mortality, respectively, for the working group compared with the group not working at transplantation. The Cox proportional hazards regression model showed that working at listing and working at transplantation were each associated with decreased mortality (hazard ratio [HR] = 0.8, 95% confidence interval [CI] 0.71 to 0.91; and HR = 0.76, 95% CI 0.65 to 0.89, respectively). This study is the first analysis of UNOS STAR data on recipient work status pre-HTx demonstrating: (1) an improvement in post-transplant survival for working HTx candidates; and (2) an association between working pre-HTx and longer post-HTx survival. Given that work status before HTx may be a modifiable risk factor for better outcomes after HTx, we strongly recommend that UNOS consider these important findings for moving forward this patient-centered research on work status. Working at listing and working at HTx are associated with long-term survival benefits. The association may be reciprocal, where working identifies less ill patients and also improves well-being. Consideration should be given to giving additional weight to work status during organ allocation. Work status may also be a modifiable factor associated with better post-HTx outcomes.

Abstract TP366: Last Known Well To Acute Stroke Treatment Time Is the Key Factor For A Good Outcome As Measured by Modified Rankin Score at 1-Year post Discharge Follow-Up

Last Known Well To Acute Stroke Treatment Time Is the Key Factor For A Good Outcome As Measured by Modified Rankin Score at 1-Year post Discharge Follow-Up Background/Purpose: The modified Rankin Scale (mRS) is a scale for measuring the degree of disability or dependence in the daily activities of patients. It is also used as a clinical outcome measure for stroke, with 0-2 equals good outcome and 3-5 equals poor outcome. In 2015, our stroke program set out to measure the long term clinical outcome of our stroke patients who have received intravenous (IV) and/or mechanical thrombolysis, by following these patients for 1 year via telephone interview. By the end of 2016, our data shows that 75% of these patients have a mRS of 0-2 at 1-year follow up. While our data reflects the effectiveness of our stroke program, we also analyzed the data to investigate the commonality in the care of patients who have a good outcome versus poor outcome long term. Methods: mRS is collected at discharge, 30-day, 90-day, 6-month, and 1-year by telephone interview by stroke program coordinator, on patients who received IV and/or mechanical thrombolysis in 2015. After 1 year, patients with mRS 3-5 at discharge are divided into two groups. Group 1 have patients with mRS 0-2 at 1 -year, and Group 2 made up of patients with mRS 3-5 at 1-year. We then compared factors that could have contributed to the clinical outcome - Age, Door-to-tissue plasminogen activator (tPA) time, Last Known Well (LKW) to tPA time, LKW to Angio Suite, stroke severity, and discharge disposition. Results: 72 patients were reviewed. 44 patients retained at 1 year follow up. 18 patients in Group 1 and 6 patients in Group 2. The most significant factor for a good outcome is the LKW to treatment time. Group 1 has a median LKW to tPA time of 108 minutes and LKW to Angio time of 138 minutes; while Group 2 has 208 minutes and 238 minutes, respectively. Looking at LKW to tPA between Group 1 and Group 2 - the t-value is -3.40249. The p-value is 0.001494. The result is significant at p&lt;0.05. For the same 2 groups looking at LKW to Angio time, the t-value is -3.55212. The p-value is 0.002268. The result is significant at p&lt;0.05. Conclusion: Last Known Well to acute stroke treatment time is the key factor for good stroke clinical outcome.

Short-Term Postoperative Outcome of Laparoscopic Total Mesorectal Excision in Rectal Carcinoma

Despite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. Aim of this study is to determine the feasibility and morbidity after laparoscopic Total Mesorectal Excision(TME), implementing a standardized operative technique and recovery protocol. The first 30 patients treated laparoscopically were included. Standardized oncological clearance ensured by early central vascular ligation, medial to lateral approach, and complete mesorectalexcision. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed.Total number of patient was 30. In 26 patients anterior resection was done, in 4 patients Abdominoperineal resection was done.Overall mean operating time was 224( 242-137) minutes. In anterior resection Mean operating time was 187( 236-137) minutes, whereas in lap APR operating time was 210(242-178) minutes. In total 4 patients(13%) were converted to open procedure. Average bleeding in anterior resection group was 120 ml( 50-200ml), in Lap APR 210 ml(115-350ml). Mean number of lymphnodes removed in AR 16. In APR1, Mean time to flatus was 1.5 days. Mean time to stool 4.2 days, mean length of hospital stay in AR 8.6 days, in APR 11.5 days. Overall morbidity 23%(7), major morbidity 10%(3). There is no mortality, no anastomotic leak, and no 30 days readmission.laparoscopic Total Mesorectal Excision is safe and leads to excellent results in terms of recovery and short term outcomes. Key factors for better outcomes is adoption of a standardized technique and training model.Medicine Today 2016 Vol.28(2): 75-78

Clinical and genetic analysis of recurrent adult-type granulosa cell tumor of the ovary: Persistent preservation of heterozygous c.402C>G FOXL2 mutation.

BackgroundAdult-type granulosa cell tumors of the ovary (aGCTs) are rare tumors that represent 2–5% of ovarian malignancies. The prognosis of this tumor is favorable, and it is characterized by slow progression. 10–30% of these tumors recur after 4–7 years of the primary surgery and the 5-year survival rate from the first recurrence is 55%, for the incompletely resected patients. At this time, complete resection is the only prognostic factor for better outcome, and establishing a novel strategy for identification and/or treatment of recurrent tumors is crucial. After the discovery of heterozygous c.402C>G FOXL2 mutations in 97% of cases of aGCT, much effort has been made to find the role of the mutation on the pathogenesis of aGCT, however, little is known about the role of the mutation in disease progression.MethodsWe analyzed the clinical data of 56 aGCT patients to find a marker of recurrence. In particular, we compared the FOXL2 status in 5 matched primary and recurrent samples by immunohistochemistry, and TaqMan allelic discrimination assay to address the role of FOXL2 in potential mechanisms of recurrence.ResultsThe clinical data analysis was consistent with complete resection as an indicator of disease eradication, though the sample size was limited. The genetic analysis showed all the samples, including recurrent tumor samples up to 14 years after the primary surgery, expressed heterozygous c.402C>G FOXL2 mutation and the FOXL2 protein expression.ConclusionThis report describes the preservation of heterozygous c.402C>G FOXL2 mutation in recurrent aGCTs. This finding adds further credence to the concept that the c.402C>G FOXL2 mutation is oncogenic and integral to this disease.

Sa1720 Predictive Factors for Better Outcomes in Colonoscopy-Associated Perforation

Sa1720 Predictive Factors for Better Outcomes in Colonoscopy-Associated Perforation

Pure endoscopic management of epileptogenic hypothalamic hamartomas.

Hypothalamic hamartomas (HH) are rare congenital malformations located in the region of the tuber cinereum and third ventricle. Their usual clinical presentation is characterized by gelastic/dacrystic seizures which often become pharmaco-resistant and progress to secondary focal/generalized intractable epilepsy causing mostly in children cognitive and behavioral problems (particularly in cases of progressive epileptic encephalopathy) and precocious puberty. Whereas gelastic seizures can be surgically controlled either by resection of the lesion or disconnection (tissue-destructive) procedures, aimed at functionally prevent the spreading of the epileptic burst; generalized seizures tend to respond better to HH excision rather than isolated neocortical resections, which generally fail to control them. Prospective analysis of 14 consecutive patients harboring HH treated in an 8-year period; 12 patients had unilateral and two bilateral HH. All patients were managed by pure endoscopic excision of the HH. The mean operative time was 48min and mean hospital stay was 2days; perioperative blood loss was negligible in all cases. Two patients showed a transient diabetes insipidus (DI); no transient or permanent postoperative neurological deficit or memory impairment was recorded. Complete HH excision was achieved in 10/14 patients. At a mean follow-up of 48months, no wound infection, meningitis, postoperative hydrocephalus, and/or mortality were recorded in this series of patients. Eight patients became seizure free (Engel class I), 2 other experienced worthwhile improvement of disabling seizures (Engel class II); 2 patients were cured from gelastic attacks while still experiencing focal dyscognitive seizures; and 2, having bilateral HH (both undergoing unilateral HH excision), did not experience significant improvement and required later on a temporal lobectomy coupled to amygdalohyppocampectomy. Overall, the followings resulted to be predictive factors for better outcomes in terms of seizure control: (1) cases of unilateral, Delalande class B, HH, (2) shorter history of epilepsy. Endoscopic resection of HH proved, in our series, to be effective in achieving complete control or in reducing the frequency of seizures. Furthermore, this approach has confirmed its minimally invasive nature with a very low morbidity rate: of note, it allowed to better preserve short-term memory and hypothalamic function.

Analysis of predictive factors of ramucirumab plus paclitaxel for advanced gastric cancer.

185 Background: Ramucirumab (RAM) is a novel anti-VEGF antibody approved in 2015 in Japan. Predictive factors for RAM in combination with paclitaxel (PTX) remain largely unknown. Methods: We reviewed 77 consecutive advanced gastric cancer patients who were treated with RAM plus PTX between June 2015 and June 2016 in our institution. We evaluated treatment outcome and analyzed potential predictive factors by univariate and multivariate analyses. Results: Median age was 67 years (range 35-83) and 51 % of the patients were male. The ECOG performance status (PS) was ≥ 2 in 8 patients. 89% (69/77) patients were treated as second line chemotherapy. Objective response rate (ORR) in patients who have measurable disease was 52 % (17/33). Median progression free survival (PFS) and overall survival (OS) and was 6.0 months (95% confidence interval [CI] = 4.3-7.1) and 10.4 months (95% CI 6.8-13.6), respectively. The most frequent adverse events were peripheral neuropathy (44%), G3 ≥ neutropenia (34%), hypertension (32%) and bleeding (27%). At multivariate analysis, hypertension was independent factor for OS (Hazard ratio [HR] = 0.35, 95% CI = 0.14-0.90, P = 0.03). Also, bleeding (HR = 0.23, 95% CI = 0.09-0.55, P = 0.001) was independent factor for PFS and hypertension (HR = 0.47, 95% CI = 0.22-1.02, P = 0.06) had trend toward to show better PFS. Conclusions: RAM plus PTX showed promising efficacy for advanced gastric cancer. RAM related toxicities such as hypertension and bleeding/hemorrhage were independent factors for better outcome. Further investigation is warranted to verify our analysis.

Abstract TP237: In Hyperacute Recanalization Therapy, Early Hospital Arrival Should Improve Outcome in Patients With Large Artery Occlusion but Not Without It

Introduction: Early hospital arrival form symptom onset has been related to the good outcome. However, it has been unknown whether in hyperacute recanalization therapy, early hospital arrival improves outcome in patients with and without large artery occlusion (LAO). We evaluated the association of onset-to-door (OTD) time with clinical outcome after hyperacute recanalization therapy in patients with and without LAO. Methods: Consecutive stroke patients treated using hyperacute recanalization therapy including intravenous thrombolysis using tissue-plasminogen activator (tPA) and endovascular therapy (EVT) were studied. Good outcome was defined as mRS ≤2 at hospital discharge. All patients were divided into patient with and without LAO. Results: From 2014 September to 2016 July, 129 (median age, 73 [64-82] years; 86 [67%] males) patients were analyzed. tPA alone was administered in 65 (50%) patients, EVT alone in 33 (26%), and tPA and EVT in 31 (24%). At discharge, 67 (52%) patients achieved the good outcome. Ninety-one patients (71%) were classified into the LAO group and 38 (29%) were into the non-LAO group. The OTD was similar between the LAO and the non-LAO groups (1.57 [0.87-3.42] h vs. 1.38 [0.76-2.68], p=0.420). Forty-six (51%) patients in the LAO and 21 (55%) patients in the non-LAO groups had good outcome (p=0.701). Regarding patients with LAO, age, OTD, and NIHSS score were significantly associated with good outcome (p=0.021, 0.014, and 0.001). Multivariate regression analysis also showed the OTD was the independent negative factor for good outcome (OR 0.77, 95%CI: 0.65-0.91, p=0.003). On the other hand, when we analyzed patients without LAO, OTD and NIHSS score were also significantly associated with good outcome (p=0.009, and 0.004). However, multivariate regression analysis did not show the OTD was the independent factor for good outcome (OR 0.83, 95%CI: 0.58-1.18, p=0.299). Only NIHSS score was independently related to it (OR 0.80, 95%CI: 0.67-0.96, p=0.018). Conclusion: Impact of early hospital arrival on clinical outcome after hyperacute recanalization therapy differed between patients with and without LAO. In hyperacute recanalization therapy, early hospital arrival should improve outcome in patients with LAO but not without it.

Abstract TP14: Predictors of Good Outcome after Endovascular Therapy for Acute Posterior Circulation Stroke

Background and Purpose: Endovascular therapy (ET) is increasingly utilized in acute ischemic stroke treatment and is now considered the gold standard approach for select patient populations. Prior studies have demonstrated that eventual patient outcome depend on both patient specific factors as well as procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome after ET for acute posterior circulation stroke Methods: We reviewed our prospectively collected endovascular databases at two tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015. Baseline characteristics, procedural data and outcomes were evaluated. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 214 qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score (NIHSS), anesthesia modality (conscious sedation vs general anesthesia), procedural length and reperfusion status were significantly associated with outcomes in the univariate analysis Multivariate logistic regression indicated that only smoking (odds ratio, 2.49; 95% confidence interval 1.16-5.36; P=0.019), low NIHSS (odds ratio, 0.92; 95% confidence interval 0.88-0.96; P&lt;0.001), and successful reperfusion (mTICI 2b-3) (odds ratio, 13.65; 95% confidence interval 1.71-108.76; P=0.014), were independent predictors of good outcomes. Conclusion: Our study suggests that baseline NIHSS, smoking and reperfusion status are independent predictors of good outcomes after ET for acute posterior circulation stroke.

Clinical outcome and prognostic factors of revision arthroscopic rotator cuff tear repair.

The aim of this study was to evaluate the clinical outcome of arthroscopic rotator cuff revision surgery in a cohort of patients and to identify prognostic factors for this procedure. Fifty-one consecutive patients undergoing revision arthroscopic rotator cuff repair were prospectively followed over a minimum period of one year. Radiologic findings and clinical data regarding primary and revision surgery were collected. Clinical evaluation was performed pre- and post-operatively by means of Constant Score and Simple Shoulder Test. Median age at the time of revision surgery was 60years (range 36-77years). Median follow-up was 25months (range 12-58months). There were 17 men (33.3%) and 34 women (66.7%). The majority of the tears affected the supraspinatus tendon alone (51%) or both the supra- and infraspinatus tendons (35.3%). Significant improvements were seen in terms of active forward elevation, active external rotation, pain, Simple Shoulder Test score, Constant Score, and post-operative satisfaction-age, gender, and time to revision surgery did not show significant predictive value. A smaller tear size and pre-operative elevation greater than 90° were demonstrated to be independent prognostic factors for better outcome. However, the mean increase in Constant Score was not related to the size of the tear, range of motion, or age. The results of this study indicate that arthroscopic revision rotator cuff repair results in reliable improvement in shoulder function, pain, and satisfaction. Pre-operative active range of motion and tear size seem to determine final outcome. A similar increase in mean Constant Score can be achieved even in large tears in patients aged over 65years. IV.

Prediction of biological behavior and prognosis of colorectal cancer patients by tumor MSI/MMR in the Chinese population.

Colorectal cancers (CRCs) exhibiting microsatellite instability (MSI) have special biological behavior. The clinical predictors for MSI and its survival relevance for the Chinese population were still unclear. Seven hundred ninety-five CRC patients were retrospectively assessed. Mismatch repair (MMR) proteins (MSH2, MSH6, PMS1, and MLH1) expression was detected by immunohistochemistry using tumor tissues of all patients. DNA MSI status was analyzed by polymerase chain reaction in 182 samples randomly selected from the 795 cases. Among all CRC tumor tissues, 97 cases (12.2%) were with an MMR protein-deficient (MMR-D) phenotype, whereas 698 cases (87.8%) were with an MMR proteins intact (MMR-I) phenotype. A total of 21 (11.5%) CRCs were identified as having high microsatellite instability, 156 (85.7%) tumors were having microsatellite stability (MSS), and five (2.7%) were having low microsatellite instability. Importantly, MMR status was demonstrated to be moderately consistent with MSI status (κ=0.845, 95% confidence interval [CI] 0.721, 0.969). Unconditional logistic regression analysis revealed age, number of lymph node, tumor diameter, and tumor site as predictors for MSI with a substantial ability to discriminate different MSI status by area under curve of 80.62% using receiver operation curve. Compared with MMR-I, MMR-D was an independent prognostic factor for longer overall survival (hazard ratio =0.340, 95% CI 0.126, 0.919; P=0.034). MMR-D is an independent prognostic factor for better outcome. Our results may provide evidence for individualized diagnosis and treatment of CRC, but this will require further validation in larger sample studies.

Prognostic and predictive aspects of the tumor immune microenvironment and immune checkpoints in malignant pleural mesothelioma

ABSTRACTMalignant pleural mesothelioma (MPM) is an aggressive cancer with a poor prognosis and an increasing incidence, for which novel therapeutic strategies are urgently required. Since the immune system has been described to play a presumed role in the protection against MPM, characterization of its tumor immune microenvironment (TME) and immune checkpoints can identify new immunotherapeutic targets and their predictive and/or prognostic value.To characterize the TME and the immune checkpoint expression profile, we performed immunohistochemistry (IHC) on formalin-fixed paraffin embedded (FFPE) tissue sections from 54 MPM patients (40 at time of diagnosis; 14 treated with chemotherapy). We stained for PD-1, PD-L1, TIM-3, LAG-3, CD4, CD8, CD45RO, granzyme B, FoxP3 and CD68. Furthermore, we analyzed the relationship between the immunological parameters and survival, as well as response to chemotherapy. We found that TIM-3, PD-1 and PD-L1 were expressed on both immune and tumor cells. Strikingly, PD-1 and PD-L1 expression on tumor cells was only seen in unpretreated samples. No LAG-3 expression was observed. CD45RO expression in the stroma was an independent negative predictive factor for response on chemotherapy, while CD4 and TIM-3 expression in lymphoid aggregates were independent prognostic factors for better outcome. Our data propose TIM-3 as a promising new target in mesothelioma. Chemotherapy influences the expression of immune checkpoints and therefore further research on the best combination treatment schedule is required.

Liver transplantation (LT) versus resection for small intrahepatic cholangiocarcinoma (iCCA) or hepatocholangiocarcinoma (HCA) on cirrhosis

Introduction: This multicentric study aimed to evaluate the long-term outcome of cirrhotic patients transplanted or resected with iCCA or HCA. Methods: Between 2002 and 2014, all cirrhotic patients transplanted for incidental iCCA or HCA were identified in 3 centers and compared with cirrhotic patients resected for small iCCA or HCA inferior to 5 cm. Results: 60 cirrhotic patients were identified with iCCA (n = 44–73%) or HCA (n = 16–26%). The tumor was either resected (RS) (n = 22) or incidentally discovered in the explant after LT (n = 38). MELD score was significantly higher in LT patients. Number of nodules was higher in LT patients (2 [1–11] versus 1 [1–9] p = .0001), diameter of the biggest lesion was larger in RS patients (31 [15–50] versus 19 [5–40] p = .0001). Median follow-up was 59 [30–88] months, similar in the 2 groups. The 3 months mortality was nil. Overall survival at 3 and 5 years was significantly better after LT (79% and 74% versus 59% and 34% respectively, p = .030). Recurrence at 3 and 5 years was significantly lower in LT (16% and 21% versus 58% and 66%, respectively p = .001). In the multivariate analysis, LT was the only independent predictive factor of better outcome. Conclusion: Survival and recurrence rate after LT ascertained this strategy iCCA and/or HCA on cirrhotic patient.

The Impact of Donor Age on Outcome after Unrelated Bone Marrow Transplantation: Comparison with Unrelated Cord Blood Transplantation

Background: Donor selection is one of key factors for better outcomes after hematopoietic stem cell transplantation (HSCT). It is shown that increased donor age is associated with high mortality. In the era of high-resolution typing of HLA and various methodological options in HSCT (e.g. conditioning regimens or cell source), however, the significance of donor age in the selection of donor or cell source is unclear. Here we examined the impact of donor age on clinical outcome after unrelated bone marrow transplantation (UBMT) and compared to the outcome after unrelated cord blood transplantation (UCBT).Patients and methods: For this retrospective cohort study, clinical data of donors and recipients were obtained from the registry data of the Japan Society of Hematopoietic Cell Transplantation (JSHCT). This study included 6035 adult patients 16 years of age or older with AML, MDS, ALL, or CML who received the first HSCT between 2000 and 2010. Among them, 3304 recipients received UBMT from 8/8 HLA-matched or 7/8 HLA-matched for HLA-A, -B, -C, and -DRB1 allele-level donor and 2731 recipients received single-unit UCBT from maximum 2-antigen (HLA-A, -B, -DR antigen-level) mismatched donor. 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 ages of UBMT and UCBT recipients were 42 years (range, 16-77) and 50 years (range, 16-82), respectively. The median age of UBMT donor was 34 years (range, 20-55). Among 3304 UBMT recipients, older donor age (≥40 years) was a significant risk factor for overall mortality (adjusted HR, 1.14; 95% CI, 1.03-1.27, p=0.015) and grades II-IV acute graft-versus-host disease (aGVHD) (adjusted HR, 1.27; 95% CI, 1.13-1.43, p<0.001) after adjusting for other significant factors in the multivariable model. Similar results were obtained using donor age as a continuous variable (overall mortality: adjusted HR, 1.01; 95% CI, 1.00-1.02, p=0.007, aGVHD: adjusted HR, 1.02; 95% CI, 1.01-1.03, p<0.001). The effect of donor age on overall mortality was strongly detected in patients with the standard risk disease (interaction p=0.058) or recipients from 7/8 HLA-matched donor (interaction p=0.078). Therefore, we compared outcomes of the five groups including UCBT by donor types (8/8 matched younger donor, 8/8 matched older donor, 7/8 matched younger donor, 7/8 matched older donor and cord blood) only among the standard risk group (Figure). Survival in recipients from 8/8 matched older donor was similar to that in recipients from 7/8 matched younger donor (adjusted HR, 1.03; 95% CI, 0.83-1.28, p=0.790). In recipients from 7/8 matched older donor, the survival was comparable to that in recipients of cord blood (adjusted HR, 0.91; 95% CI, 0.73-1.13, p=0.398).Conclusions: The outcome of HSCT recipients with older donor (≥40 years) was worse compared with that of recipients with younger donor, especially in the standard risk group or HLA-mismatched donors. A 7/8 matched younger donor is a viable option as well as an 8/8 matched older donor in the absence of an 8/8 matched younger donor. In addition, UCBT is a reasonable option in the absence of these donors. Intensive GVHD prophylaxis in recipients with older donor might improve outcome, but further studies are needed to test this hypothesis. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Optimal Patient Selection for Trastuzumab Treatment in HER2-Positive Advanced Gastric Cancer.

Chemotherapy plus trastuzumab is standard of care for HER2-positive advanced gastric cancer (AGC). However, not all patients with HER2-positive AGC seem to benefit from trastuzumab. We evaluated the association between treatment outcomes with trastuzumab and HER2 status in patients with HER2-positive AGC. We enrolled 126 patients with HER2-positive AGC treated with trastuzumab plus chemotherapy in a training cohort. HER2 IHC (N = 126), HER2/CEP17 ratio (N = 66), and HER2 gene copy number (GCN; N = 59) were analyzed, and the optimal values for discriminating overall survival (OS) were determined using receiver operating characteristic (ROC) curve analysis. We validated the findings from the training cohort using an independent validation cohort (N = 72). Patients with HER2 IHC 3+ showed significantly longer OS (29 vs. 15.3 months; P = 0.025) than patients with IHC ≤ 2+. An HER2/CEP17 ratio of 4.48 was the optimal cutoff for predicting longer OS (26.9 vs. 14.7 months; P = 0.027). In subgroup analysis, treatment outcomes of patients with IHC 3+ were not influenced by the level of HER2 gene amplification. However, in patients with IHC ≤ 2+, an HER2/CEP17 ratio more than 3.69 and HER2 GCN more than 7.75 were positive predictive factors for better outcomes with trastuzumab-based chemotherapy. These findings were confirmed in both the validation cohort and the combined cohort. HER2 IHC status, HER2/CEP17 ratio, and HER2 GCN were correlated with clinical outcomes of trastuzumab-based treatment in HER2-positive AGC. Clinical outcomes of patients with IHC ≤ 2+ were strongly dependent on the HER2/CEP17 ratio and HER2 GCN.

Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. Acohort study.

BackgroundDespite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. A steep learning is one of the causes of its limited adoption. Aim of the study is to determine the feasibility and morbidity rate after laparoscopic colorectal surgery in a single institution, “learning curve” experience, implementing a well standardized operative technique and recovery protocol.MethodsThe first 50 patients treated laparoscopically were included. All the procedures were performed by a trainee surgeon, supervised by a consultant surgeon, according to the principle of complete mesocolic excision with central vascular ligation or TME. Patients underwent a fast track recovery programme. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed.ResultsType of resections: 20 left side resections, 8 right side resections, 14 low anterior resection/TME, 5 total colectomy and IRA, 3 total panproctocolectomy and pouch. Mean operative time: 227 min; mean number of lymph-nodes: 18.7. Conversion rate: 8%. Mean time to flatus: 1.3 days; Mean time to solid stool: 2.3 days. Mean length of hospital stay: 7.2 days. Overall morbidity: 24%; major morbidity (Dindo–Clavien III): 4%. No anastomotic leak, no mortality, no 30-days readmission.ConclusionProper laparoscopic colorectal surgery is safe and leads to excellent results in terms of recovery and short term outcomes, even in a learning curve setting. Key factors for better outcomes and shortening the learning curve seem to be the adoption of a standardized technique and training model along with the strict supervision of an expert colorectal surgeon.

Preoperative intensity modulated radiation therapy for retroperitoneal sarcoma.

322 Background: The use of intensity modulated radiation therapy (IMRT) has allowed for the administration high doses to retroperitoneal sarcomas (RSTS) while limiting toxicity to adjacent organs. The purpose of our study is to assess the outcome and toxicities of patients with RSTS treated with neoadjuvant external beam radiation (EBRT) therapy using IMRT. Methods: This is a retrospective study of 21patients treated with preoperative IMRT for primary or recurrent RSTS between 2005 and 2011. Overall survival (OS) and local recurrence free survival (LRFS) were computed using the Kaplan-Meier method (log-rank test). Acute and chronic toxicities were assessed according to the CTCAE v. 3 criteria. Results: The actuarial 3 and 5-year OS and LRFS was 66% and 51%, 57% and 41% respectively. Factors predictive for LRFS were microscopically negative margins (p=0.022), a median tumor diameter &lt; 15 cm (p=0.007) and a pathology of liposarcoma (p=0.021); however, patients treated for recurrent disease fared worse (p=0.04). As for OS, grade 1 histology was a predictive factor for better outcome (p=0.05). EBRT was generally well tolerated. Acute gastrointestinal grade 1 or 2 toxicity occurred in 33% of patients and one patient had unexplained post-radiation grade 2 fever that resolved after tumor resection. As for chronic toxicities 24% of our patients presented grade 1 gastrointestinal toxicity and one patient presented grade 3 small bowel stenosis not clearly due to radiation toxicity. Conclusions: Despite the location and volume of the tumors treated, preoperative IMRT was very well tolerated in our patients with retroperitoneal sarcoma. Unfortunately local recurrences remain common and dose escalation is to be considered.