Follow-up Status Research Articles

Predictors of recurrence in oral cavity cancer with clear surgical margins

Introduction: Oral cancers recur in a significant proportion of patients, in spite of aggressive treatment strategies. The presence of a clear surgical margin is an important predictor of recurrent disease, among others. Since oral cancers often recur in the absence of compromised margins, there is a need to study the factors affecting recurrence and overall survival outcomes where clear surgical margins have been achieved during upfront surgery. This study attempts to identify the significant predictors of locoregional recurrence in oral squamous cell carcinoma (OSCC) with pathologically clear surgical margins. Methodology: This retrospective study was done to study the clinicopathological parameters associated with recurrence of oral cavity squamous cell carcinoma (SCC) in patients with clear surgical margins operated in our unit between January 2010 and December 2015. A total of 526 cases of oral cavity SCC were analyzed and records of 160 cases with clear surgical margins were reviewed for clinical details, histopathological data, and follow-up status. Age, gender, subsite, T–N clinical and pathological staging, tumor depth of invasion, grade of differentiation, lymphovascular invasion, perineural spread, adjuvant therapy, and recurrence details were analyzed. Results: Lymphovascular Invasion was found to be a significant predictor for local recurrence in OSCC in both univariate and multivariate analysis. Median recurrence-free survival was 53.6 months. Conclusion: Despite the best efforts of the surgeon in obtaining adequate tumor-free margins and the most comprehensive adjuvant treatment, recurrence patterns in oral cancers continue to defy accurate prediction. Lymphovascular invasion could be an important predictor of recurrence for oral cavity cancers in patients with clear surgical margins that require aggressive management.

MP33-08 PENILE CANCER CARE IN THE NETHERLANDS OVER THREE DECADES: INCREASED INCIDENCE, CENTRALISATION OF CARE, AND OVERALL SURVIVAL

You have accessJournal of UrologyCME1 Apr 2023MP33-08 PENILE CANCER CARE IN THE NETHERLANDS OVER THREE DECADES: INCREASED INCIDENCE, CENTRALISATION OF CARE, AND OVERALL SURVIVAL Manon Vreeburg, Hielke-Martijn de Vries, Henk van der Poel, and Oscar Brouwer Manon VreeburgManon Vreeburg More articles by this author , Hielke-Martijn de VriesHielke-Martijn de Vries More articles by this author , Henk van der PoelHenk van der Poel More articles by this author , and Oscar BrouwerOscar Brouwer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The process of centralization of Penile Squamous Cell Carcinoma (PSCC) care in the Netherlands was initiated around 1990 and based on acknowledgement of one national center of expertise. Other regional PSCC centers should have an annual caseload of ≥10 T1aG1 patients per year and experience in high-level multidisciplinary care. The aim of this study was to evaluate incidence and centralization trends, and the potential benefit on overall survival of centralization of PSCC care in the Netherlands. METHODS: All new PSCC diagnoses between 1990-2020 were retrospectively identified from the Netherlands Cancer Registry (NCR), a population-based cancer registry with nationwide coverage. Cancer diagnoses are reported by registry of histology after which the NCR can provide per-patient data on age, clinical and pathological tumor staging, follow-up and vital status. All patients that were treated in the national referral center (NCI, Amsterdam) were known, all other patients were treated at one of the regional centers (anonymity kept by NCR). Overall survival (OS) was calculated with multivariate cox regression analysis, with T- and N-stage, treatment at the NCI (y/n) and age as independent variables. RESULTS: In total, 3276 patients were diagnosed with PSCC in the Netherlands. There was a significant incidence increase, from 0.92 per 100,000 men in 1990 to 1.83 per 100,000 men in 2020. The percentage of NCI-patients increased from 1% to 63% during this period, while in other centers it decreased from 99% to 37%. The median age of NCI-patients was 68 years and 70 years in other centers. At the NCI, 27% of the patients had lymph node metastases (pN+), compared to 10% in other centers (p-value<0.001). Despite of this, and corrected for T-, N-stage and age, the OS of NCI-patients was higher compared to patients in other centers (HR 1.29, 95% CI 1.13–1.47, p-value=0.001). The median OS at the NCI is 10 years (IQR 9–11 years) and in other centers 7 years (IQR 7–8 years). CONCLUSIONS: PSCC incidence in the Netherlands is rising and centralization of care has increased. Despite a relatively higher N-stage at presentation, patients treated at the national referral center of expertise seem to have higher OS, suggesting a beneficial effect of centralized care. Source of Funding: No conflict of interest to declare © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e453 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manon Vreeburg More articles by this author Hielke-Martijn de Vries More articles by this author Henk van der Poel More articles by this author Oscar Brouwer More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcome comparison of pyrotinib with current standard of care in the second/third line setting in advanced non-small cell lung cancer patients with HER2 mutation.

Outcome comparison of pyrotinib with current standard of care in the second/third line setting in advanced non-small cell lung cancer patients with HER2 mutation.

Investigation of long-term COVID-19 patients' quality of life and affecting factors: Data from single COVID-19 follow-up center.

Patients with COVID-19 experienced changes in their quality of life. However, far less is known about how quality of life changes in long-term COVID-19 follow-ups. This article aims to explore the relationship between quality of life change and long-term COVID-19 patient status in the COVID-19 follow-up center. This study was designed retrospectively with patients admitted to the COVID-19 follow-up center between January and May 2021. The single group consisted of 125 patients. Their status and 36-Item Short-Form Health Survey (SF-36) variables were compared at two different time intervals. The first admission indicates the first 3 months, and the second admission covers 3-6 months after being diagnosed with COVID-19. Cough and chest pain increased in the second admission (P < 0.001). No significant differences were found in SF-36 change according to age. The general health subgroup scores were lower in females than males (P = 0.004). The SF-36 Form's subgroups for physical function, physical role, emotional role, bodily pain, energy, mental health, general health, and social function showed improvement (P = 0.001, P = 0.001, P = 0.026 P < 0.001, P = 0.007, P = 0.031, P <0.001, P <0.001, respectively). In addition, comparing with the SF-36 subgroups in terms of treatment places, a significant result was found between the inpatient and intensive care unit (ICU) in the general health subgroup (P = 0.044). The results show that quality of life may worsen during follow-up for COVID-19. In summary, these findings have significant implications for understanding long-term COVID-19 patients with a multidisciplinary approach and the necessity of follow-up centers to detect the unpredictable results of long-term COVID-19.

Unemployment Status Subsequent to Cancer Diagnosis and Therapies: A Systematic Review and Meta-Analysis.

The purpose of our study is to examine whether cancer and treatments are associated with job loss or changes in employment status. Eight prospective studies were included in the systematic review and meta-analysis, with a population aged 18-65 years, analyzing treatment regimen and psychophysical and social status in post-cancer follow-up of at least 2 years. In the meta-analysis, a comparison was made between recovered unemployed cases and cases from a standard reference population. Results are summarized graphically using a forest plot. We showed that cancer and subsequent treatment are risk factors for unemployment with an overall relative risk of 7.24 (lnRR: 1.98, 95% CI: 1.32-2.63) or for change in employment status. Individuals undergoing chemotherapy and/or radiation treatment and those with brain and colorectal cancers are more likely to develop disabilities that negatively affect the risk of unemployment. Finally, variables such as low level education, female sex, older age, and being overweight before starting therapy are associated with higher risk of unemployment. In the future, it will be necessary for people with cancer to have access to specific health, social welfare, and employment support programs. In addition, it is desirable that they become more involved in their choice of therapeutic treatment.

Abstract NS1: Depression Vs Psychiatry Appointments Post Stroke Discharge Phone Call

Background: Post-stroke depression (PSD) affects up to one-third of stroke survivors and remains under-recognized. The optimal time for PSD screening seems to be about 30-45 days post-stroke. However, screening and follow up remains insufficient. Methods: Our stroke certified registered nurse contacted stroke patients admitted to Kaiser Permanente Los Angeles in 2021 to assess depression within 30-45 days post discharge using the Patient Health Questionnaire Screening Tool (PHQ9). Two call attempts were made. Based on the PHQ9 scores, patients were referred to different clinical care pathways. Patients who scored10-19 were referred to depression care management (DCM), while 20 and above were referred to psychiatry directly. We collected the demographics, stroke types and discharge disposition inpatients who were lost to follow up and patients who completed the follow up. Data were analyzed using R-Statistics. Results: Among 92 patients, 41 (45%) had follow-up depression screening completed; 13 (32%)received psychiatry referral given severity of depression, and 28 (68%) received a depression care management referral. Of 51 patients who did not complete follow-up screening, 27 (53%)declined to participate in screening, while 22 (43%) could not be reached. Patients who did not receive follow-up screening were older (P=0.02). Race, gender, discharge mRS or length of acute hospital stay did not have a significant effect on patient’s depression screening follow-up status. Patients discharged home with home health showed a trend for better completed follow-ups despite not reaching statistical significance (P=0.07). Conclusion: Raising awareness about the necessity of depression screening and its treatment is of utmost importance for reaching optimal recovery and rehabilitation potential in stroke patients. Post-discharge follow-up and education can be implemented to narrow the PSD recognition gap.

Inflammation and nutritional status indicators as prognostic indicators for patients with locally advanced gastrointestinal stromal tumors treated with neoadjuvant imatinib

BackgroundPrevious studies have confirmed that preoperative nutritional-inflammatory indicators can predict prognosis in various malignancies. However, to the best of our knowledge, no study has investigated the assessment of systemic inflammatory immunity index (SII) combined with prognostic nutritional index (PNI) scores to predict prognosis after neoadjuvant treatment with imatinib in locally advanced gastrointestinal stromal tumours (LA-GIST). The aim of this study was to evaluate the predictive value of pretreatment SII-PNI scores in predicting recurrence after neoadjuvant therapy with imatinib in patients with LA-GIST.MethodsWe retrospectively analyzed 57 patients with LA-GIST who received imatinib neoadjuvant from January 2013 to March 2019. Patients were divided into recurrence and non-recurrence groups according to their follow-up status, and SII and PNI cut-offs were calculated by receiver operating characteristic. The SII-PNI score ranged from 0 to 2 and were categorized into the following: score of 2, high SII (≥ 544.6) and low PNI (≤ 47.2); score of 1, either high SII (≥ 544.6) or low PNI (≤ 47.2); score of 0, no high SII (≥ 544.6) nor low PNI (≤ 47.2).ResultsAll patients received imatinib neoadjuvant therapy for a median treatment period of 8.5 months (ranging from 3.2 to 12.6 months), with 8 patients (14.04%) and 49 patients (85.96%) developing recurrence and non-recurrence, respectively. Patients with a high SII-PNI score had a significantly worse recurrence-free survival time than those with a low SII-PNI score (P = 0.022, 0.046), and had a poorer pathological response (P = 0.014). Multivariate analysis demonstrated that the SII-PNI score was an independent prognostic factor for prediction of recurrence-free survival (P = 0.002).ConclusionThe pre-treatment SII-PNI score can be used to predict the efficacy after neoadjuvant treatment with imatinib in patients with LA-GIST, which may be a promising predictor of recurrence-free survival time for patients.

Primary colorectal diffuse large B-cell lymphoma: A report of eighteen cases in a tertiary care center

Primary colorectal diffuse large B-cell lymphoma (DLBCL) is very rare colon malignancy. It is important to know the main demographic and clinical characteristics of these patients. We conducted a retrospective analysis of 18 patients diagnosed with primary colorectal DLBCL during a 17-year period at the National Cancer Institute of Brazil (INCA) between 2000 and 2018. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) levels, treatment modality and follow-up status were obtained from medical records. Survival was estimated from the date of diagnosis until death. There were 11 male and seven female patients in our cohort, the median age at diagnosis was 59.5 years and four patients were HIV positive. Tumor was mainly localized in the right colon. Patients were treated with chemotherapy (CT) and/or surgical resection. Eleven patients died during a median follow-up of 59 months and the median survival time was 10 months. Six or more cycles of CT (HR=0.19; CI 95% 0.054–0.660, p = 0.009), LDH levels below 350 U/L (HR=0.229; CI 95% 0.060–0.876, p = 0.031) and surgical resection (HR=0.23; CI 95% 0.065–0.828, p = 0.030) were associated with reduced risk of death in univariate analysis. Patient's age and DLBCL right colon localization should be considered at diagnosis to distinguish between DLBCL and other diseases for differential diagnosis. Six cycles of CT, LDH levels below 350 U/L and surgical resection were associated with better survival. Our results are consistent with previous publications and address the importance of correct colorectal DLBCL diagnosis and treatment.

Current Status and Physicians' Perspectives of Childhood Cancer Survivorship in Korea: A Nationwide Survey of Pediatric Hematologists/Oncologists.

Data on the status of long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) in Korea is lacking. This study was conducted to evaluate the current status of LTFU care for CCSs and relevant physicians' perspectives. A nationwide online survey of pediatric hematologists/oncologists in the Republic of Korea was undertaken. Overall, 47 of the 74 board-certified Korean pediatric hematologists/oncologists currently providing pediatric hematology/oncology care participated in the survey (response rate = 63.5%). Forty-five of the 47 respondents provided LTFU care for CCSs five years after the completion of primary cancer treatment. However, some of the 45 respondents provided LTFU care only for CCS with late complications or CCSs who requested LTFU care. Twenty of the 45 respondents oversaw LTFU care for adult CCSs, although pediatric hematologists/oncologists experienced more difficulties managing adult CCSs. Many pediatric hematologists/oncologists did not perform the necessary screening test, although CCSs had risk factors for late complications, mostly because of insurance coverage issues and the lack of Korean LTFU guidelines. Regarding a desirable LTFU care system for CCSs in Korea, 27 of the 46 respondents (58.7%) answered that it is desirable to establish a multidisciplinary CCSs care system in which pediatric hematologists/oncologists and adult physicians cooperate. The LTFU care system for CCS is underdeveloped in the Republic of Korea. It is urgent to establish an LTFU care system to meet the growing needs of Korean CCSs, which should include Korean CCSs care guidelines, provider education plans, the establishment of multidisciplinary care systems, and a supportive national healthcare policy.

High MBL-expressing genotypes are associated with deterioration in renal function in type 2 diabetes.

Accumulating evidence support that mannan-binding lectin (MBL) is a promising prognostic biomarker for risk-stratification of diabetic micro- and macrovascular complications. Serum MBL levels are predominately genetically determined and depend on MBL genotype. However, Type 1 diabetes (T1D) is associated with higher MBL serum levels for a given MBL genotype, but it remains unknown if this is also the case for patients with T2D. In this study, we evaluated the impact of MBL genotypes on renal function trajectories serum MBL levels and compared MBL genotypes in newly diagnosed patients with T2D with age- and sex-matched healthy individuals. Furthermore, we evaluated differences in parameters of insulin resistance within MBL genotypes. In a cross-sectional study, we included 100 patients who were recently diagnosed with T2D and 100 age- and sex-matched individuals. We measured serum MBL levels, MBL genotype, standard biochemistry, and DEXA, in all participants. A 5-year clinical follow-up study was conducted, followed by 12-year data on follow-up biochemistry and clinical status for the progression to micro- or macroalbuminuria for the patients with T2D. We found similar serum MBL levels and distribution of MBL genotypes between T2D patients and healthy individuals. The serum MBL level for a given MBL genotype did not differ between the groups neither at study entry nor at 5-year follow-up. We found that plasma creatinine increased more rapidly in patients with T2D with the high MBL expression genotype than with the medium/low MBL expression genotype over the 12-year follow-up period (p = 0.029). Serum MBL levels did not correlate with diabetes duration nor with HbA1c. Interestingly, serum MBL was inversely correlated with body fat percentage in individuals with high MBL expression genotypes both at study entry (p=0.0005) and 5-years follow-up (p=0.002). Contrary to T1D, T2D is not per se associated with increased MBL serum level for a given MBL genotype or with diabetes duration. Serum MBL was inversely correlated with body fat percentage, and T2D patients with the high MBL expression genotype presented with deterioration of renal function.

Endoscopic intradural extramedullary lesion excision: Results of augmented duroplasty with artificial dura.

Prevailing techniques of dural closure in endoscopic spine surgery (ESS) for intradural extramedullary (IDEM) tumor excision increase the steep learning curve and operative time. We aimed to assess the efficacy of augmented duroplasty with artificial dura and share our initial experience of ESS for IDEM excision. We retrospectively analyzed 18 (n = 18) consecutive patients of IDEM tumors operated by ESS using Destandau's endoscopic system. The pre-operative, post-operative, and at the latest follow-up clinical status were recorded in terms of Nurick's grades and the Oswestry Disability Index. Immediate post-operative complications and intraoperative findings were noted from hospital information system and patient records. The mean (± SD) age of patients was 40.3 ± 14.9 (range 19-64) years, with M: F ratio of 2:1. All the lesions were intradural and present at lumber (n = 6), thoracic (n = 9), and cervical (n = 3) regions. The average duration of surgery, blood loss, hospital stay, and duration of follow-up were 157 ± 45.3 (90-240) min, 168.8 ± 78.8 (30-300) mL, 4.29 ± 1.4 (2-7) days, and 19.3 ± 7.2 (7-36) months, respectively. There were no CSF leaks, wound-related complications, or material-induced adverse events. In endoscopic IDEM excision, dural closure with artificial dura is efficient in preventing CSF leak. It shortens the steep learning curve and improves the surgical outcome due to technical ease.

Impact of Statins on Survival and Limb Salvage in Patients Undergoing Peripheral Endovascular Intervention for Chronic Limb-Threatening Ischemia

Statin therapy is recommended in all patients with peripheral arterial disease (PAD). Its impact on reduction in mortality has been well-documented, yet effect on limb-specific outcomes has been less conclusive. Differences among PAD subgroups or variability of statin use may contribute to the inconsistent findings. We evaluated statin use in patients who underwent peripheral endovascular intervention (PVI) for chronic limb-threatening ischemia (CLTI) and its impact on overall survival (OS), amputation-free survival (AFS) and limb salvage (LS). The national Vascular Quality Initiative was queried for the index PVI for CLTI during the period 2010-2016; follow-up (FU) through 2020. Demographics, comorbidities, operative details, and FU status were recorded. Patients were categorized as E-Statin: statin use pre-PVI through discharge (D/C) and FU or N-Statin: No statins pre-PVI, at D/C or any time during FU. The propensity score matched model (PSM) was constructed. Groups were compared using chi-square, Kaplan-Meier survival and Cox regression analysis. There were 9,089 index PVI in 8,402 patients; E-Statin: 7149 index PVI in 6,591 patients; and N-Statin: 1940 index PVI in 1811 patients. The mean age was 69±12years and 58% were male. Statin use was associated with improved 3-year OS-E Statin: 92.9%±0.9 versus N Statin: 91.1%±2.2%; P=0.003; hazard ratio (HR): Exp (B) (95% confidence interval): 0.66 (0.44-0.99); P=0.047 and remained significant following PSM: E Statin: 95.1%±0.2% versus 90.8%±0.3%; P=0.02; HR: 0.50 (0.27-0.92); P=0.025. No significant differences in 3-year LS or AFS were noted between the prematched groups; LS: E Statin: 83.7%±0.8 versus N Statin: 84.0%±1.7%; P=0.89; HR: 1.09 (0.88-1.35); P=0.44; AFS-E Statin: 77.2%±1.1% versus 76.1%±2.5%; P=0.17; HR: 0.97 (0.79-1.18); P=0.74. or following PSM: AFS: 80.2%±2.8% vs. 74.7%±3.9%; P=0.53, HR: 0.92 (0.72-1.19); P=0.54; LS 85.3%±1.9% vs. 83.5%±2.6%; P=0.51, HR: 1.08 (0.83-1.4); P=0.57. Statins significantly improved LS among those with renal failure: 67.8%±2.6% vs. 59.7%±4.4%; P=0.003; HR: 56 (0.40-0.79); P=0.001. Statins are independently associated with improved OS in patients who undergo PVI for CLTI and should be considered for all barring intolerance. Statin use was associated with improved LS in patients with end-stage renal disease. Additional research is needed in this area, particularly, the impact of statin therapy in high-risk CLTI subgroups.

Blunted rest-activity circadian rhythm increases the risk of all-cause, cardiovascular disease and cancer mortality in US adults

To examine whether rest-activity circadian rhythm parameters can predict all-cause, cardiovascular disease and cancer mortality in a general adult population of the US. We further compared the mortality predictive performance of these parameters with that of traditional risk factors. This study included 7,252 adults from US National Health and Nutrition Examination Surveys (NHANES) 2011–2014, who had wrist accelerometer data obtained at baseline and follow-up status linked to the National Death Index records (2011–2019). During a median of 81 months (interquartile range, 69–94 months) of follow-up, 674 (9.3%) deaths occurred. There were inverse associations between relative amplitude (RA) and all-cause mortality, cardiovascular disease and cancer mortality with increased quartiles RA associated with lower mortality risk (all P < 0.05). The Hazard Ratios ranged from 0.61 to 0.79. Furthermore, RA outperformed all the tested traditional predictors of all-cause mortality with the exception of age. This study suggests that participants with blunted rest-activity circadian rhythms had a higher risk of all-cause, cardiovascular disease and cancer mortality. Future studies will be needed to test whether interventions that regulate rest-activity circadian activity rhythms will improve health outcomes.

C-Reactive Protein Pretreatment-Level Evaluation for Ewing's Sarcoma Prognosis Assessment-A 15-Year Retrospective Single-Centre Study.

A pathological/inflamed cellular microenvironment state is an additional risk factor for any cancer type. The importance of a chronic inflammation state in most diffuse types of tumour has already been analysed, except for in Ewing's sarcoma. It is a highly malignant blue round cell tumour, with 90% of cases occurring in patients aged between 5 and 25 years. Worldwide, 2.9 out of 1,000,000 children per year are affected by this malignancy. The aim of this retrospective study was to analyse the role of C-reactive protein (CRP) as a prognostic factor for Ewing's sarcomas. This retrospective study at Klinikum rechts der Isar included 82 patients with a confirmed Ewing's sarcoma diagnosis treated between 2004 and 2019. Preoperative CRP determination was assessed in mg/dL with a normal value established as below 0.5 mg/dL. Disease-free survival time was calculated as the time between the initial diagnosis and an event such as local recurrence or metastasis. Follow-up status was described as death of disease (DOD), no evidence of disease (NED) or alive with disease (AWD). The exclusion criteria of this study included insufficient laboratory values and a lack of information regarding the follow-up status or non-oncological resection. Serum CRP levels were significantly different in patients with a poorer prognosis (DOD) and in patients who presented distant metastasis (p = 0.0016 and p = 0.009, respectively), whereas CRP levels were not significantly different in patients with local recurrence (p = 0.02). The optimal breakpoint that predicted prognosis was 0.5 mg/dL, with a sensitivity of 0.76 and a specificity of 0.74 (AUC 0.81). Univariate CRP analysis level &gt;0.5 mg/dL revealed a hazard ratio of 9.5 (95% CI 3.5-25.5). In Ewing's sarcoma cases, we consider a CRP pretreatment value &gt;0.5 mg/dL as a sensitive prognostic risk factor indication for distant metastasis and poor prognosis. Further research with more data is required to determine more sensitive cutoff levels.

Short-term and mid-term effects of thoracoscopic repair of esophageal atresia: No anastomotic leaks or conversions to open technique.

The frequency rate of esophageal anastomosis leaks after thoracoscopic correction of esophageal atresia (EA) in the current literature is reported as 5.6%-24.7% and a conversion rate of 2%-53%. The objective of this retrospective study was to examine the characteristics of EA and analysis of the safety and efficacy of EA repair with the use of the thoracoscopic approach in a single academic center, as well as risk factors analysis in the context of short-term and mid-term follow-up status. A retrospective analysis of the management of all consecutive newborns affected by EA hospitalized in our department over a period between 2013 and 2022, including preoperative, perioperative, and postoperative management, together with the outcome, complications and long-term follow-up status was performed. A total of 38 patients with a median birth weight of 2,570 g (range; 1,020-3,880) were treated over the study period, including 30/38 (78.9%) with additional congenital anomalies. Overall, 30 patients underwent primary anastomosis of the esophagus and eight underwent a multistaged procedure, with or without an initial ligation of the tracheoesophageal fistula and delayed primary anastomosis. Overall survival for all patients was 0.894 ± 0.050, with a median follow-up of 4.5 years. We noted neither anastomotic leaks nor conversions to open technique in our cohort. Implementation of vancomycin prophylaxis was successful in preventing postoperative central venous access-related infectious complications. At the end of the follow-up, 85% of patients have a Lansky performance score ≥80. Risk factors analysis for length of hospitalization, overall survival, Lansky performance status, and neurological impairment were analyzed. In conclusion, we have found that the outcome of thoracoscopic repair of EA in terms of surgery-dependent morbidity (anastomosis leakage, conversion rate to open surgery), provides benefit to those previously reported in the literature, regardless of the prognostic criteria of the classification system.

Time to Diagnosis and Treatment in an Underserved, Predominantly Hispanic Population of Adults in East Los Angeles- a Retrospective Study of Acute T- Lymphoblastic Leukemia/Lymphoma (T-ALL/LBL) Patients

Introduction Acute T-lymphoblastic leukemia/lymphoma (T-ALL/LBL) comprises approximately 25% of adult ALL cases, while early T cell precursor ALL/LBL (ETP-ALL/LBL) is a small subset of T-ALL/LBL comprised of only early T cell precursors with a specific immunophenotype. Due in part to its rarity, limited data exists on underserved T-ALL patients specifically. Underserved patients face unique barriers in accessing healthcare and studies have found that these patients are at risk of delayed presentation for both acute and chronic conditions. Our study investigates duration from symptom onset to diagnosis and treatment in a predominantly underserved population of adults treated in East Los Angeles. Methods A retrospective chart review was performed of all patients with a confirmed pathologic diagnosis of T-ALL/LBL at two hospitals serving the population of East Los Angeles: Los Angeles County +USC Medical Center and Norris Comprehensive Cancer Center. We identified thirty-one patients diagnosed with T-ALL/LBL between January 1st, 2011 and January 1st, 2020. Demographic, clinical, and pathologic data were abstracted from medical records. Two patients were excluded from the analysis of extramedullary and mediastinal disease as this information was missing in their medical records. The primary aim of the study was to determine time from symptom onset to diagnosis and treatment. SAS software was used to conduct Kaplan-Meier analysis, in which six patients with unknown follow-up status are censored. Results In this study, 26 out of 31 patients (84%) had a non-ETP-ALL phenotype (T-ALL/LBL), while the remaining 5 (16%) were classified as ETP-ALL. The majority of the patients in this cohort were male (19/31; 61%) and Hispanic (17/31; 55%). The median age at diagnosis was 32 years (13-66). The median duration from symptom onset to diagnosis was 19 (2-192) days. The median duration from symptom onset to treatment was 29 days (3-240). The median duration from time of diagnosis to initiation of treatment was 6 days (1-48). The median white blood cell count at presentation was 8.1 per microliters (1.8 to 526.0 × 10^9/L). The median peripheral blood blasts at presentation was 35% (0%-91%). The median bone marrow blast percentage at diagnosis was 68%(0%-97%). Extramedullary disease at diagnosis was present in 76% (22/29), with the majority (59%; 17/29) presenting with bulky mediastinal disease. CNS disease was present in one patient (3%) at the time of diagnosis. USC-ALL was the most common induction regimen, received by 68% (21/31); followed by Hyper-CVAD, received by 23% (7/31). Two patients (6%) received alternative regimens and one patient (3%) did not undergo chemotherapy. Hematopoietic stem cell transplantation was performed in 48% (15/31). Currently, 55% (17/31) of patients are known to be alive, 26% (8/31) are deceased, and 19% (6/31) had unknown outcome, as they were lost to follow-up. One-year overall survival (OS) was 76% in T-ALL/LBL and 75% in ETP ALL/LBL patients, while both 3-year and 6-year OS were 65% and 75%, respectively. Conclusions Our study reveals that a predominantly underserved cohort of patients was diagnosed and treated within comparable timeframes to the general population reported in the existing literature. One study of mixed hematologic malignancies found a median interval from onset of symptoms to presentation of 30 days, whereas our patients presented within a median of 19 days after symptom onset. The same study showed a median of five days from time of diagnosis to initiation of treatment, as compared to a median of six days in our cohort. Studies have reported worse outcomes and complications in patients who presented later in their disease process, so our data is reassuring in that this underserved population is establishing care and being treated promptly. This underserved patient population in East Los Angeles is unique, however; many underserved patients do not have access to a major comprehensive cancer center, such as the patients in this study, who received care at Norris Comprehensive Cancer Center. Underserved T-ALL/LBL patients are an understudied population, and more research needs to be undertaken to evaluate the impact of the timing of diagnosis and treatment on the outcomes in this vulnerable patient population.

Do Patient Outcomes Predict Loss to Long-Term Follow-Up After Spine Surgery?

To determine if spine surgery patients with greater improvement in patient-reported outcomes measures (PROMs) at early postoperative follow-up are more likely to be lost to follow-up at the 1-year and 2-year postoperative visits. All patients older than 18 years who underwent primary or revision decompression or fusion surgery for degenerative spinal conditions at an academic institution were retrospectively identified. Univariate analysis compared patient demographics, surgical factors, and changes in short-term and long-term postoperative PROMs (Neck Disability Index, Oswestry Disability Index, visual analog scale [VAS] neck, VAS arm, VAS back, VAS leg, and Short-Form 12 Physical and Mental Component Scores) across groups with and without 1 year and 2 years follow-up. Logistic regression isolated predictors of loss to follow-up. A total of 1412 patients were included. Younger patient age, primary surgery, and single surgical approach independently predicted loss at 1 year follow-up. Female sex predicted loss at 2 years follow-up, whereas multilevel fusion surgery predicted attendance at 2 years clinical follow-up. In patients lost at 1 year follow-up compared with those who attended, preoperative to 3-month Mental Component Score and VAS neck pain improvement was significantly greater. When comparing patients based on 2 years follow-up status, VAS back pain improvement at 1 year postoperatively was significantly greater in patients lost to 2 years follow-up. All other changes in PROMs did not differ significantly by 1 or 2 years follow-up attendance. Overall patient outcomes were not found to affect loss to long-term follow-up after spine surgery. The general lack of association between postoperative follow-up status and clinical outcome may limit bias introduced in retrospective PROM studies.

The impact of early-stage COVID-19 pandemic on the diagnosis and treatment of gastric cancer: A cross-sectional study using a large-scale cancer registry in Hiroshima, Japan.

After the confirmation of coronavirus infection in Japan, a behavioral change caused people and physicians to refrain from visiting hospitals or undergoing examinations. This study aimed to assess how the trend of diagnosis in gastric cancers changed, and how it affected the therapeutic strategies and the interval from diagnosis to treatment during the COVID-19 pandemic. We use 15 cancer-designated hospitals' registries in Hiroshima, Japan. The target period was March to December 2020, and the same period in 2019 was set as the control period. The monthly mean of diagnoses and the interval from diagnosis to treatment were compared overall and separately by age, treatment procedure, diagnostic process, and clinical stage. In 2020, the monthly mean (standard deviation [SD]) of patients was 192.2 (29.9), a significant 20.1% decrease from 240.7 (20.7) in 2019 due to older age and curative treatment groups. By reason for performing endoscopy, the change rate in cancer screening, endoscopic follow-up, and symptomatic status were -27.0%, -18.0%, and -17.3%, respectively. Meanwhile, the interval (days) from diagnosis to treatment (SD) was 37.8 (26.5) in 2020, significantly shorter than 46 (31.5) in 2019. From 2019 to 2020, we observed a significant decrease in the diagnosis of curable early-stage gastric cancer and treatments, although the interval from diagnosis to treatment decreased. This study suggests that cancer screening played a significant role in the decline in cancer diagnosis that occurred during the COVID-19 pandemic. Even under COVID-19 pandemic conditions, there should be an awareness of cancer screening and endoscopic follow-up.

High Soluble Amyloid-β42 Predicts Normal Cognition in Amyloid-Positive Individuals with Alzheimer's Disease-Causing Mutations.

In amyloid-positive individuals at risk for Alzheimer's disease (AD), high soluble 42-amino acid amyloid-β (Aβ42) levels are associated with normal cognition. It is unknown if this relationship applies longitudinally in a genetic cohort. To test the hypothesis that high Aβ42 preserves normal cognition in amyloid-positive individuals with Alzheimer's disease (AD)-causing mutations (APP, PSEN1, or PSEN2) to a greater extent than lower levels of brain amyloid, cerebrospinal fluid (CSF) phosphorylated tau (p-tau), or total tau (t-tau). Cognitive progression was defined as any increase in Clinical Dementia Rating (CDR = 0, normal cognition; 0.5, very mild dementia; 1, mild dementia) over 3 years. Amyloid-positivity was defined as a standard uptake value ratio (SUVR) ≥1.42 by Pittsburgh compound-B positron emission tomography (PiB-PET). We used modified Poisson regression models to estimate relative risk (RR), adjusted for age at onset, sex, education, APOE4 status, and duration of follow-up. The results were confirmed with multiple sensitivity analyses, including Cox regression. Of 232 mutation carriers, 108 were PiB-PET-positive at baseline, with 43 (39.8%) meeting criteria for progression after 3.3±2.0 years. Soluble Aβ42 levels were higher among CDR non-progressors than CDR progressors. Higher Aβ42 predicted a lower risk of progression (adjusted RR, 0.36; 95% confidence interval [CI], 0.19-0.67; p = 0.002) better than lower SUVR (RR, 0.81; 95% CI, 0.68-0.96; p = 0.018). CSF Aβ42 levels predicting lower risk of progression increased with higher SUVR levels. High CSF Aβ42 levels predict normal cognition in amyloid-positive individuals with AD-causing genetic mutations.

Reliability of Cancer Recurrence Data: Institution Cancer Registry vs. Trained Chart Abstraction

<h3>Purpose/Objective(s)</h3> While large national cancer registries have significant advantages, data regarding cancer outcomes (e.g., recurrence) are often lacking. Although cancer recurrence data are collected by institutional cancer registries, they are often not published without manual review due to large quantities of missing data and inaccuracy. This study aims to compare recurrence data from trained manual chart abstraction to an institutional cancer registry for patients with head and neck (HN) cancer treated with radiation therapy (RT). <h3>Materials/Methods</h3> Cancer recurrence status was collected by a trained research student under the guidance of a radiation oncologist. Recurrence status and type, date, method of detection / confirmation, location of follow-up, treatment location, and survival status were collected and compared with the cancer registry for continuous patients treated with RT for HN cancer at a tertiary cancer center. The sensitivity and specificity of cancer registry data was calculated using manual review as the gold standard. False negatives were compared to true positive recurrences to assess for differences in patient characteristics and compared via chi-square analysis. <h3>Results</h3> A total of 1,337 patient charts were reviewed who were treated from 2010 to 2017. A total of 375 (28%) confirmed cancer recurrences were identified, 45 (3%) had concern for recurrence without radiologic or pathologic confirmation, and 30 had persistent disease (2%). Of those who had confirmed recurrence, most were distant (36%) or distant plus locoregional (27%) while fewer were local (13%), regional (10%), or locoregional (15%). The cancer registry was found to have an accuracy of 82% with a sensitivity of 52% and specificity of 96%. There were 191 false negatives, 208 true positives, 832 true negatives, and 36 false positives. When comparing recurrences correctly identified (true positives) to those missed (false negatives), there was less time from RT to recurrence (283 days vs 748 days), differences between years of diagnosis (p=0.03), and less pathologic confirmation (67% vs 88%, p<0.01). A total of 92% of cancer recurrences identified by the registry occurred within 2 years of RT, versus 66% on manual review (p<0.01). There was no difference in age (63 vs 62 years), percent men (76% vs 79%), or treatment location. <h3>Conclusion</h3> Currently, cancer registries have high specificity and poor sensitivity. It is likely that with longer follow-up of cancer status, sensitivity will improve. Automated data abstraction tools may improve detection of cancer recurrences and minimize manual chart review.