High Risk For Late Events Research Articles

Extended Arch Procedures for Acute Type A Aortic Dissection: A Downstream Problem?

Current discussion regarding the management of acute type A aortic dissection is focused on whether to perform a standard hemiarch resection or perform an extended repair, in hopes of improving long-term outcomes by avoiding late, distal aortic sequelae. Critical to this discussion is an estimation of the short-term risks of an extended procedure and the magnitude of the late "downstream problem." Extension of the hemiarch to a total arch plus frozen elephant trunk does not improve survival; carries some increased perioperative risk, not the least of which is paraplegia; but decreases late aortic events, the most common of which is reoperation on the distal aorta. However, these reoperations are low frequency, primarily elective, low-risk events and it should be noted that extended index repairs do not eliminate or necessarily decrease the incidence of late reoperations. Routine extension of the index procedure puts 100% of patients at risk in order to protect a minority that may benefit. Therefore, it is important to select patients at high risk for reoperation if an extended repair is to be performed. Predictors that may identify this high-risk group include the size and location of the entry tear, aortic and luminal dimensions, degree of luminal flow and thrombosis, and the presence of a connective tissue disorder. Timing may also be important and, in patients at high risk for late events, early complications may be minimized by strategies that delay an extension of the proximal repair until the subacute period.

Long-term survival outcomes of triple-receptor negative breast cancer survivors who are disease free at 5 years and relationship with low hormone receptor positivity

Background:We counsel our triple-negative breast cancer (TNBC) patients that the risk of recurrence is highest in the first 5 years after diagnosis. However, there are limited data with extended follow-up on the frequency, characteristics, and predictors of late events.Methods:We queried the MD Anderson Breast Cancer Management System database to identify patients with stage I–III TNBC who were disease free at 5 years from diagnosis. The Kaplan–Meier method was used to estimate yearly recurrence-free interval (RFI), recurrence-free survival (RFS), and distant relapse-free survival (DRFS), as defined by the STEEP criteria. Cox proportional hazards model was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs).Results:We identified 873 patients who were disease free at least 5 years from diagnosis with median follow-up of 8.3 years. The 10-year RFI was 97%, RFS 91%, and DRFS 92%; the 15-year RFI was 95%, RFS 83%, and DRFS 84%. On a subset of patients with oestrogen receptor and progesterone receptor percentage recorded, low hormone receptor positivity conferred higher risk of late events on multivariable analysis for RFS only (RFI: HR=1.98, 95% CI=0.70–5.62, P-value=0.200; RFS: HR=1.94, 95% CI=1.05–3.56, P-value=0.034; DRFS: HR=1.72, 95% CI=0.92–3.24, P-value=0.091).Conclusions:The TNBC survivors who have been disease free for 5 years have a low probability of experiencing recurrence over the subsequent 10 years. Patients with low hormone receptor-positive cancers may have a higher risk of late events as measured by RFS but not by RFI or DRFS.