Independent Predictor Of Long-term Survival Research Articles

Gender differences in long-term survival after coronary artery bypass surgery is womens cardiovascular health at risk?

Abstract Introduction Cardiovascular healthcare for women tends to be influenced by various factors. This patient group is generally associated with a worse prognosis following coronary artery bypass surgery (CABG). Aims To assess the impact of gender on long-term survival after CABG and the potential effect of age on this association; to compare the survival of these patients with the expected survival of the general national population, and to compare immediate postoperative outcomes between genders. Methods Longitudinal, retrospective, single center study, involving consecutive patients who underwent isolated primary CABG between 2004 and 2014. Exclusion criteria included emergency/salvage surgeries or the use of extracorporeal circulation without aortic clamping. Included patients were categorized into age subgroups: ≤60, 60-70, and ≥70 years. All-cause mortality was assessed in February 2023, and a time-to-event analysis was performed using Kaplan-Meier curves, Log-Rank tests, and multivariable Cox regressions. To compare expected mortality (matched for sex and age with the general population) with observed mortality in the patient cohort, survival tables for the years 2004-2022 were consulted. Kaplan-Meier curves for the reference population, stratified by gender, were constructed and compared to the surgical cohort using one-sample Log-Rank tests with specific software. Standardized mortality ratios (SMR) were estimated. The mean follow-up time was 11 years, with a maximum of 19 years. Results From 3978 patients included patient’s, 21% were women (W). W were older (mean age 67±9 vs. 63±10 years, p<0.001) and had a higher prevalence of cardiovascular risk factors and severe chronic kidney disease compared to men (M). M more frequently had peripheral arterial disease and smoking habits. Although three-vessel disease was similar between sexes (p=0.111), W were less frequently implanted with ≥3 grafts (p<0.001). At 5,10 and 15 years of follow-up, cumulative survival for MvsW was 89%vs88%, 73%vs68%, and 57%vs46%, respectively (Log-rank test p<0.001). After stratification by age, Log-Rank tests showed no differences between sexes. Multivariable adjustment did not identify gender as an independent predictor of long-term survival in any age subgroup. However, a time-stratified analysis at 10 years of follow-up in the ≥70 years subgroup showed that W had a higher risk than M after 10 years of follow-up (HR:0.7[0.5-0.9],p=0.03). Comparing with the survival of the Portuguese population, CABG allowed M to equalize the risk of mortality to what was expected (SMR =1.1;95%CI:0.9-1.1), but W showed a higher risk of mortality after CABG than W in the reference population (SMR =1.6,95%CI:1.3-1.8). Conclusion Women undergoing isolated primary CABG at an age >70 years, with longest periods follow-up, exhibited poorer long-term survival than men of the same age.Women demonstrated inferior survival outcomes compared to the general population.

AWGC2023 cachexia consensus as a valuable tool for predicting prognosis and burden in Chinese patients with cancer.

The Asian Working Group for Cachexia (AWGC) proposed the first consensus report on diagnostic criteria for cachexia in Asians in 2023. However, the current consensus lacks cohort evidence to validate its effectiveness and practicality. We aimed to explore the value of the AWGC2023 criteria for predicting the prognosis and medical burden of patients with cancer through a retrospective post hoc cross-sectional analysis of the Investigation on Nutrition Status and its Clinical Outcome of Common Cancers (INSCOC) project in China. Cox regression analyses were performed to assess the independent association between cachexia and long-term survival. We utilized C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), inflammatory burden index (IBI), albumin (ALB) and Glasgow prognostic score (GPS) as diagnostic markers for cachexia, designating them as CRP-based cachexia, NLR-based cachexia, IBI-based cachexia, ALB-based cachexia and GPS-based cachexia, respectively. Additionally, we diagnosed cachexia using body mass index (BMI) cutoff values of 18.5, 20, 21 and 22kg/m2, respectively, and subsequently compared their prognostic predictive value through Harrell's concordance index (C-index). Logistic regression models were used to assess the association between cachexia and medical burden. A total of 5426 patients with cancer were enrolled in this study. Cox regression analysis confirmed that cachexia based on the AWGC2023 criteria was an independent predictor of long-term survival in patients with cancer. Patients with cachexia had significantly poorer long-term survival than patients without cachexia (66.4% vs. 49.7%, P<0.001). Inflammatory biomarker-based cachexia was as an independent predictor of prognosis in patients with cancer, with inflammatory burden index (IBI)-based cachexia demonstrating the optimal prognostic discriminatory ability. The C-index indicated that cachexia based on BMI cutoff values of 18.5, 20, and 22kg/m2 did not perform as well as a BMI cutoff value of 21kg/m2. Logistic regression models revealed that using the AWGC2023 criteria, patients with cachexia had a 16.6% higher risk of prolonged hospitalization and a 16.0% higher risk of high medical expenses than patients without cachexia. The AWGC2023 criteria represent a valuable tool for predicting survival and medical burden among Chinese patients with cancer. Encouragement for further validation in other Asian populations is warranted for the AWGC2023 criteria.

Estimating the long-term survival of unresectable stage III non-small cell lung cancer based on cure model analysis

BackgroundThe predictors of long-term survival and appropriate surrogate endpoints in unresectable stage III non-small cell lung cancer (NSCLC) treated with radiotherapy remain unclear, especially in the immune therapy era. MethodsThis study retrospectively analyzed a prospective cohort of 822 patients treated at the Chinese National Cancer Center from 2013 to 2022. Cure fractions, surrogates for long-term survival, and associated factors were assessed using a mixture cure model, with validation against a matched Surveillance, Epidemiology, and End Results (SEER) dataset. Results27.3% of patients with unresectable stage III NSCLC can achieve long-term survival after treated by radiotherapy. 4-year PFS and 5-year OS, when 80% of patients were considered cured, showed significant correlations with cure rates based on background mortality-adjusted PFS and relative survival, with R-squared values exceeding 0.85. Independent predictors of long-term survival included non-squamous cell carcinoma (non-SCC) pathological type, N category, gross tumor volume, and treatment combination with immune checkpoint inhibitors (ICIs). ConclusionsRadiotherapy, especially when combined with ICIs, offers a potential cure for a proportion of patients with unresectable stage III NSCLC. Tumor burden and ICIs are key predictors of long-term survival. The study suggested 4-year PFS and 5-year OS as surrogate endpoints for cure and long-term survival assessment.

Serum Albumin as an Independent Predictor of Long-Term Survival in Patients with Recurrent and Metastatic Head and Neck Squamous Cell Carcinoma Treated with Nivolumab.

Background: Nivolumab has been shown to improve the overall survival (OS) of patients with recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, there is a need to identify factors associated with long-term survival (beyond 2 years) in these patients. This study investigated the relationship between pretreatment factors and long-term survival in patients with R/M HNSCC treated with nivolumab. Methods: Forty-nine patients with R/M HNSCC who were treated with nivolumab were retrospectively reviewed. Baseline characteristics, clinical data, and survival outcomes were evaluated. Univariate and multivariate analyses were performed to identify factors associated with long-term survival (OS ≥ 2 years). Results: The median OS in the overall cohort was 11.0 months, and the 2-year survival rate was 34.7%. Long-term survivors (OS ≥ 2 years) had significantly higher proportions of patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores of 0 or 1, serum albumin levels ≥ 3.5 g/dL, and neutrophil-to-eosinophil ratio (NER) < 32.0 compared to non-long-term survivors. On multivariate analysis, serum albumin levels ≥ 3.5 g/dL, in addition to ECOG-PS score of 0 or 1, were independent predictors of long-term survival. Conclusions: Pretreatment serum albumin levels may be useful for predicting long-term survival in R/M HNSCC patients treated with nivolumab.

Survival outcomes of surgical resection in perihilar cholangiocarcinoma in endemic area of O. Viverrini, Northeast Thailand

BackgroundPerihilar cholangiocarcinoma (pCCA) is an intractable malignancy and remains the most challenge for surgeon. This study aims to investigate survival outcomes and prognostic factors in pCCA patient. MethodsFrom October 2013 to December 2018, 240 consecutive patients with pCCA underwent surgical exploration were retrospectively reviewed. The clinicopathological parameters and surgical outcomes were extracted. Patients were divided into two groups: unresectable and resectable group. The restricted mean survival time between two groups were analyzed. Factors associated with overall survival in resectable group were explored with multivariable Cox regression analysis. ResultsOf the 240 patients, 201 (83.75%) were received surgical resection. The survival outcomes of resectable group were better than unresectable group significantly. The restricted mean survival time difference were 0.5 (95%CI 0.22–0.82) months, 1.8 (95%CI 1.15–2.49) months, 4.7 (95%CI 3.58–5.87) months, and 9.1 (95%CI 7.40–10.78) months at four landmark time points of 3, 6, 12 and 24 months, respectively. The incidence of major complications and 90-day mortality in resectable group were 35.82% and 11.44%, respectively. Multivariable analysis revealed that Bismuth type IV (HR:4.43, 95%CI 1.85–10.59), positive resection margin (HR:4.24, 95%CI 1.74–10.34), and lymph node metastasis (HR:2.29, 95%CI 1.04–4.99) were all independent predictors of long-term survival. For pM0, R0 and pN0 patients, the median survival time was better than pM0, R1 or pN1/2 patients and pM0, R1 and pN1/2 patients (32.4, 10.4 and 4.9 months, respectively; p < 0.001) ConclusionSurgical resection increased survival in pCCA. Bismuth type IV, positive resection margin and lymph node metastasis were independent factors for long-term survival.

Tumour necrosis factor-alpha serum level is an independent predictor of medium-term all-cause mortality after transcatheter aortic valve replacement

Background Transcatheter aortic valve implantation (TAVI) is a suitable treatment for patients with severe aortic stenosis and severely increased operative risk. There is need for a better preoperative risk assessment for TAVI candidates. Aim To determine whether Tumour necrosis factor-alfa (TNFα) is an independent predictor of survival 500 days after TAVI. Methods Sixty patients undergoing TAVI were enrolled in the study. TNFα was determined. The CT measured low-density muscle fraction (LDM%) of the psoas muscle was determined. Operative risk assessment by Logistic EuroSCORE, EuroSCORE II, and STS score was performed. Frailty scores (FRAIL scale and Barthel index) were determined. Results Mean age was 81.01 ± 7.54 years. Twenty-six (43.3%) of the patients were males. In the univariable analyses, FRAIL scale and Barthel index were no predictors of survival after TAVI. In the multivariable analysis, including EuroSCORE II, LDM% and TNFα serum concentration, TNFα serum level was an independent predictor of survival 500 days after TAVI (HR: 3.167; 95%: 1.279–7.842; p = 0.013). The multivariable analysis, including TNFα as a categorical variable, showed that compared to patients in the conjugated first and second TNFα serum level tertile, patients in the third tertile had a hazard ratio (HR) of 10.606 (95%CI: 1.203 − 93.467) (p = 0.033). Conclusion TNFα is an incremental independent predictor of long-term survival after TAVI.

Short- and long-term results of total arch replacement for acute type I aortic dissection in comparison to hemiarch replacement: a 10-year follow-up analysis

Abstract Background Optimal management of the arch in cases of acute type-A aortic dissection (ATAAD) involving the aortic arch (DeBakey type I) is still controversial. Extended total arch replacement (TAR) to address re-entries increases the complexity of surgery and may be associated with worse short-term outcome. We aimed in this study to compare short- and long-term outcomes of TAR compared to hemiarch replacement. Methods We retrospectively analyzed data of patients operated for ATAAD in our center. The study was approved by the ethics committee. We used Student’s t-test or Mann-Whitney U test to compare continuous variables. We performed univariate Chi-square and multivariate logistic regression analysis. Log-rank test was used to compare long-term mortality between the two groups. In addition, hazard ratio (HR) with 95% confidence interval (CI) was reported. Results Between July 2007 and November 2021, 396 patients underwent surgery for ATAAD in our center. Among them, 326 (82%) presented with DeBakey type I dissection and were included in further analyses. TAR was performed in 103 (32%) patients, while hemiarch in 221 (68%) patients. Patients who received TAR were significantly younger (59.2±12.3 vs 64.0±13.5 years), had more frequently peripheral arterial disease (24% vs 15%, p=0.065), and presented more frequently preoperatively with neurological deficits (32% vs 18%, p=0.046). Patients in the TAR group received more aortic repair/replacement (29% vs 17%, p=0.018). New permanent postoperative neurological deficits (stroke or paraplegia) occurred in 10% of the TAR group and in 15% of the hemiarch group (p=0.463). Mortality at 30 days was higher in the TAR group but the difference was not statistically significant (27% vs 20%, p=0.198). In the multivariate analyses TAR was not an independent predictor for 30-day mortality (OR: 1.71, 0.91-3.19, p=0.092) or post operative neurological complications (OR: 0.66, 0.28-1.55, p=0.337). The estimated 10-year survival for patients with TAR was 56% compared to 63% for the hemiarch group (Logrank=0.450). In the multivariate Cox regression analysis, TAR was not an independent predictor for long-term survival (adjusted HR: 1.24, 0.79-1.94, p=0.348). Conclusions Total arch replacement was not an independent predictor for postoperative neurological complications, short-, or long-term mortality. Putting a potential surgeon bias aside, our results suggest that the fear of TAR may be overestimated.

Characteristics of survivors with peritoneal mesothelioma.

e16325 Background: Peritoneal mesothelioma (PM) is a rare, fatal malignancy. The aim of the study is to determine the clinical and sociodemographic characteristics associated with long-term survival (LTS). Methods: The 2004 - 2019 National Cancer Database was queried for patients with PM. LTS was defined as having survived at least 5 years following diagnosis. Univariate and multivariate logistic analyses were performed to identify characteristics associated with LTS. A nomogram predicting the likelihood of LTS was developed. Results: 3,636 patients were identified, of which, 18% experienced LTS. The median overall survival (OS) for the entire study population was 17.7 months. The median OS for the LTS cohort was 92 months and 11.7 months for non-long-term survivors (NLTS). In univariate analysis, LTS was more likely to occur in younger (&lt; 50 years), healthy (Charlson-Deyo = 0), female and privately insured patients that traveled farther for care, were treated at an academic or very high-volume center, had epithelial histology, underwent radical surgery and received chemotherapy (p &lt; 0.001). Interestingly, among those who were treated non-operatively, LTS was associated with a longer time-to-chemotherapy (LTS = 50 days, NLTS = 32 days, p &lt; 0.001). Although not statistically significant, among those who received surgery, results suggest that LTS was more likely achieved in those who received hyperthermic intraperitoneal chemotherapy (HIPEC) (p = 0.086). Patients who underwent surgery plus HIPEC experienced the longest median OS (65.9 months) when compared those who underwent surgery plus systemic therapy (38 months) or surgery alone (9.6 months) (p &lt; 0.001). Multivariate logistic regression analysis suggests that age, female gender, and surgical margins are independent predictors of LTS. Based on our nomogram, patients with favorable characteristics resulted in a total score of at least 19 and had an approximate 50% chance of LTS. Conclusions: Age, gender and surgical margins were found to be independent predictors of LTS. Additionally, our nomogram may help predict LTS among patients with PM.

The effect of obesity on the outcome of surgical aortic valve replacement for aortic stenosis

Our objective was to investigate the effect of obesity on short-term complications and long-term survival after surgical aortic valve replacement (SAVR) for aortic stenosis (AS). A retrospective study on 748 patients who underwent SAVR for AS in Iceland 2003-2020. Patients were divided into groups based on body mass index (BMI): normal (18.5-24.9 kg/m2, n=190), overweight (25-29.9 kg/m2, n=339), obese (30-34.9 kg/m2, n=165) and severely obese (≥35 kg/m2, n=54). Six patients with BMI p<18,5 kg/m2 were excluded. Clinical information regarding patient history, risk factors, together with complications and 30-day mortality were collected from patient records. The four BMI groups were compared and long-term survival estimated with Kaplan-Meier plots and risk factors for long-term survival evaluated with Cox multivariate analysis. Severely obese patients were on average four years younger than patients with normal BMI, more often had risk factors for cardiovascular disease, and their EuroSCORE II was higher (5.3 vs. 4.4%, p=0.03). On the other hand, severely obese patients bled less the first 24 hours post-surgery, compared to normal BMI-patients (558 vs. 1091 ml, p<0.001), stroke was less frequent (0 vs 6.4%, p=0.03), but they more often experienced sternum dehiscence (5.6 vs 2.7%, p=0.04), deep sternal wound infection (3.7 vs 0%, p=0.04) and acute kidney injury (26.4 vs 15.2%, p=0.005). Thirty-day mortality and long-term survival did not differ significantly between the groups and BMI was not an independent predictor of long-term survival in multivariate analysis. The outcome for obese patients undergoing SAVR for AS is good and both short-term complications and long-term survival do not differ significantly from patients with a normal BMI. Therefore, a high BMI itself should not be a contraindication for SAVR due to AS.

Ki67 and E-cadherin Are Independent Predictors of Long-term Survival in Endometrial Carcinoma.

In previous studies, we identified estrogen receptor, progesterone receptor, Ki67, p53, c-erb-B2, and E-cadherin to be individually associated with the prognosis of endometrial carcinoma. In the present study, we aimed to identify which of the aforementioned are associated with survival after long-term follow-up. A total of 106 patients were followed until their demise, or for a median of 120 months in the case of survival (range=84-240 months). At the end of the study, 38 patients had died, and 68 were alive. The association of the studied variables with survival was analyzed by means of a Weibull regression model. A final, restricted model adjusted for age, stage, and histological variety showed both Ki67 and E-cadherin to be independent predictors of a shorter and a longer survival, respectively. Immunohistochemistry for Ki67 and E-cadherin is a cheap and relatively easy-to-interpret laboratory procedure for predicting survival of patients with endometrial carcinoma in clinical practice.

Pankreas kanseri hastalarında pankreatikoduodenektomi sonrası sistemik immün-inflamasyon indeksi ile uzun dönem mortalite arasındaki ilişki

Aim: Systemic immune-inflammation (SII) index may provide more promising prognostic information in patients with cancer surgery. However, to the best of our knowledge, the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy has not been studied. Thus, this study aimed to evaluate and compare the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy.&#x0D; &#x0D; Materials and Methods: All patients over 18 years-old that underwent successful pancreaticoduodenectomy due to pancreatic cancer between February 20, 2019 and June 30, 2021 at Ankara City Hospital Department of General Surgery were included. The main predictor of interest was SII index which was measured by neutrophil*platelet / lymphocyte count. The main outcome of the study was long-term all-cause mortality.&#x0D; &#x0D; Results: A total of 223 patients were included in the current study. Multivariable cox regression analysis revealed that history of congestive heart failure [HR (95%CI): 3.682 (1.140-11.892)], and SII index [HR (95%CI): 1.001 (1.001-1.001)] were independently associated with all cause long-term mortality. The accuracy of predicting mortality for SII index was assessed by the area under the ROC curve which was = 0.77. A higher value of 1305 of SII index was found with 76% sensitivity and 67% specificity for predicting all-cause long-term mortality.&#x0D; &#x0D; Conclusions: The results of the study suggest that measurement of the SII index, an easily available and relatively cheap marker, is an independent predictor of long-term survival after pancreaticoduodenectomy in patients with pancreatic cancer.

P-73 Survival outcomes of surgical resection in perihilar cholangiocarcinoma in endemic area of O. Viverrini, Thailand

Perihilar cholangiocarcinoma is an intractable malignancy and still remain the most challenge for surgeon. This study aims to investigate survival outcomes and prognostic factors in perihilar cholangiocarcinoma patient receiving surgical treatment in single center in Thailand, endemic area of O. Viverrini. From October 2013 to December 2018, 240 consecutive patients with perihilar cholangiocarcinoma underwent surgical exploration with or without adjuvant treatment at Sunpasitthiprasong hospital were retrospectively reviewed from medical recording system. The clinicopathological parameters and surgical outcomes were extracted. Patients were divided into two groups: unresectable and resectable group. The restricted mean survival time between two groups were analyzed. Factors associated with overall survival in resectable group were explored with multivariable Cox regression analysis. Of the 240 patients, 201 (83.75%) were received surgical resection. The survival outcomes of resectable group was better than unresectable group significantly. The restricted mean survival time difference were 0.5 (95%CI 0.22-0.82) months, 1.8 (95%CI 1.15-2.49) months, 4.7 (95%CI 3.58-5.87) months, and 9.1 (95%CI 7.40-10.78) months at four landmark time points of 3, 6, 12 and 24 months, respectively. The incidence of major complications and 90-day mortality in resectable group were 35.82% and 11.44%, respectively. Bismuth type IV, vascular resection, positive resection margin, lymph node metastasis, and distant metastasis were all predictive factors for long-term survival in univariable analysis. However, multivariable analysis revealed that Bismuth type IV (HR:4.43, 95%CI 1.853-10.599), positive resection margin (HR:4.24, 95%CI 1.741-10.342), and lymph node metastasis (HR:2.29, 95%CI 1.046-4.999) were all independent predictors of long-term survival. For pM0, R0 and pN0 patients, the median survival time was better than pM0, R1 or pN1/2 patients and pM0, R1 and pN1/2 patients (32.4, 10.4 and 4.9 months, respectively; p < 0.001). Surgical resection increased survival in perihilar cholangiocarcinoma. Bismuth type IV, positive resection margin and lymph node metastasis were independent factors for long-term survival. Patients with R0 and pN0 had a good prognosis, but those with R1/2 and/or pN1/2 had a bad prognosis. As a result, aggressive resection are essential.

Long-Term Survival of Adult Patients With Atrial Septal Defect With Regards to Defect Closure and Pulmonary Hypertension.

BackgroundAtrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether to perform ASD closure, especially in elderly patients with PH, is a complex dilemma. The aim of our study was to compare long-term survival in patients with closed and open ASD.MethodsA retrospective cohort study was performed on 427 patients with ASD (median age at diagnosis 38 years, IQR 18–56) out of which 186 patients (44%) manifested PH. ASD closure in patients with PH was only considered in patients without Eisenmenger syndrome with pulmonary vascular resistance < 5 WU. Median follow-up duration was 18 years (IQR 9–31 years). Kaplan-Meier and Cox proportional hazards survival analyses were performed to evaluate 12 potential predictors of survival.ResultsDefect closure was associated with improved long-term survival in ASD patients both with (P < 0.001) and without PH (P = 0.01) and this association was present also in patients over 40 years. The 20-year survival since diagnosis was significantly higher in patients with PH and closed ASD compared to those with PH and open ASD (65% vs. 41%). ASD closure was a significant independent predictor of long-term survival (P = 0.003) after accounting for age at diagnosis, PH, NYHA class, Eisenmenger syndrome, and mitral regurgitation. Significant negative independent predictors of survival were older age at diagnosis (P < 0.001), Eisenmenger syndrome (P < 0.001), and PH (P = 0.03).ConclusionASD closure appears to be associated with improved long-term survival independently of age, PH, and other clinical variables.

Coronary Artery Bypass Grafting in Patients with Chronic Kidney Disease: Chronic Kidney Disease Has an Independent Adverse Effect on the Long-Term Outcome of Coronary Artery Bypass Grafting.

We examined short- and long-term outcomes of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and the effect of renal function on these outcomes. We included 2783 patients who underwent primary elective CABG at a single institution between 2002 and 2020 (age: 67.6 ± 10.2 years; male: 2281 male). They were stratified based on their preoperative estimated glomerular filtration rate and underwent off-pump CABG (completion rate, 98.1%); 57.6% cases used bilateral internal thoracic arteries (BITA). In-hospital mortality rate was 1.0%. Logistic regression analysis revealed that low left ventricular function (<40%), but not chronic kidney disease (CKD) severity, was an independent predictive risk factor for postoperative hospital mortality. Significant differences existed in respiratory complications, infections, and hospitalization duration according to CKD severity. Deep sternal wound infection rate was 0.5%. The mean follow-up period was 7.1 (0–18.5) years. Estimated 10-year survival rates were negatively correlated with CKD severity; in the Cox hazard model, severe CKD was an independent predictor of long-term survival. We examined the relationship between preoperative and intraoperative factors and their effects on long-term survival using propensity score matching by dividing the renal function severity into G1–2 and G3–5. Renal function severity, age, and operative time were independent risk factors. No prognostic improvement was observed with BITA grafts; graft patency was superior in the right internal thoracic artery (52/52; 100%) than in the great saphenous vein (48/59; 81.4%) in G5. Post-CABG in-hospital mortality was unrelated to renal function, but CKD severity strongly influenced long-term survival. Operation time was an important predictor of long-term prognosis in patients with impaired renal function. Treatment plans, including graft and anastomosis-site selections, should be designed to shorten the operation time. In conclusion, using the right internal thoracic artery in CABG is more beneficial in patients with CKD and cardiovascular comorbidities.

Reduced Recurrence Rates Are Associated with Photodynamic Diagnostics Compared to White Light after Extended Transurethral Resection of Bladder Tumors.

One pillar in treating non-muscle-invasive bladder cancer (NMIBC) is the complete and high-quality transurethral resection of the primary tumor (TURBT). However, even after a high-quality primary resection, the residual tumor risk is considerable, thus requiring a re-TURBT. Resections performed with the aid of a photodynamic diagnostics report improved recurrence-free survival rates and increased detection rates of carcinoma in situ (CIS). This monocentric retrospective study reports on patients treated with an extended TURBT procedure using conventional white-light cystoscopy or photodynamic diagnostics (PDD). Only patients undergoing a TURBT resection for their primary tumor were included in the statistical analysis. Recurrence-free survival and overall survival were the clinical endpoints. Mann–Whitney U tests and chi-squared tests were used for descriptive intergroup comparisons. The associations with overall survival and recurrence-free survival were determined by univariate and multivariate analyses. The test results were considered significant when p was < 0.05. In comparison to conventional white-light cystoscopy, PDD increased the detection rates of CIS (p = 0.004) and tumor multifocality (p = 0.005) and led to reduced residual tumor incidence at the primary resection site (p < 0.001). Likewise, tumor recurrence rates were reduced in the PDD cohort (p < 0.001). Patient age and the presence of residual tumor at the primary resection site were identified as independent predictors of overall survival. For recurrence-free survival, only the PDD resection method was an independent predictor (HR = 0.43; p < 0.001). In summary, we demonstrated that the utilization of PDD techniques was associated with improved detection rates of CIS and multifocal tumors and with reduced recurrence rates. The extended resection protocol allowed us to determine that PDD resections lead to a reduced residual tumor rate at the initial resection site. This residual tumor state at the resection site, determined by extended TURBT, became an independent predictor of long-term survival. On the other hand, the PDD technique was confirmed as the only independent predictor of recurrence-free survival.

35: DOES CARDIOPULMONARY TESTING HELP PREDICT LONG-TERM SURVIVAL AFTER OESOPHAGECTOMY?

Abstract Background and aim Oesophagectomy is associated with a high rate of morbidity and mortality. Preoperative cardiopulmonary fitness has been correlated with outcomes within major surgery. Variables derived from CPET have been associated with postoperative outcomes. It is unclear whether preoperative cardiorespiratory fitness of patients undergoing oesophagectomy is associated with long-term survival. The aim of this study was to evaluate whether any of the cardiopulmonary exercise testing (CPET) variables that are routinely derived in patients with oesophageal cancer may aid in predicting long-term survival after oesophagectomy. Methods Patients undergoing CPET followed by trans-thoracic oesophagectomy for oesophageal cancer with curative intent between January 2013 and January 2017 from single high-volume centre were retrospectively analysed. The relationship between predictive co-variables including CPET variables, and survival was studied with a Cox proportional hazard model. Receiver operation curve (ROC) analysis was conducted to find cut-off values for CPET variables predictive of 3-year survival. Results A total of 313 patients were analyzed. The ventilatory equivalent for carbon dioxide (VE/VCO2) at anaerobic threshold was the only CPET variable independently predictive of long-term survival in multivariable analysis (HR 1.049, 95% CI 1.011–1.088, P = 0.011). Pathological stage III and IV disease was the other co-variable found to be independently predictive of survival. ROC analysis of the VE/VCO2 failed to demonstrate a predictive cut-off value of 3-year survival (AUC = 0.564, 95% CI 0.499–0.629, P = 0.056). Conclusion A high VE/VCO2 before oesophagectomy for malignant disease is an independent predictor of long-term survival and may be an important variable for consideration when counselling patients.

Respiratory failure and bioelectrical phase angle are independent predictors for long-term survival in acute heart failure

Background. The assessment of long-term mortality in acute decompensated heart failure (ADHF) is challenging. Respiratory failure and congestion play a fundamental role in risk stratification of ADHF patients. The aim of this study was to investigate the impact of arterial blood gases (ABG) and congestion on long-term mortality in patients with ADHF. Methods and results. We enrolled 252 patients with ADHF. Brain natriuretic peptide (BNP), blood urea nitrogen (BUN), phase angle as assessed by means of bioimpedance vector analysis, and ABG analysis were collected at admission. The endpoint was all-cause mortality. At a median follow-up of 447 d (interquartile range [IQR]: 248–667), 72 patients died 1–840 d (median 106, IQR: 29–233) after discharge. Respiratory failure types I and II were observed in 78 (19%) and 53 (20%) patients, respectively. The ROC analyses revealed that the cut-off points for predicting death were: BNP > 441 pg/mL, BUN > 1.67 mmol/L, partial pressure in oxygen (PaO2) ≤69.7 mmHg, and phase angle ≤4.9°. Taken together, these four variables proved to be good predictors for long-term mortality in ADHF (area under the curve [AUC] 0.78, 95% CI 0.72–0.78), thus explaining 60% of all deaths. A multiparametric score based on these variables was determined: each single-unit increase promoted a 2.2-fold augmentation of the risk for death (hazard ratio [HR] 2.2, 95% CI 1.8–2.8, p< .0001). Conclusions. A multiparametric approach based on measurements of BNP, BUN, PaO2, and phase angle is a reliable approach for long-term prediction of mortality risk in patients with ADHF.

Characteristics and Predictors of Long-Time Survivors in Non-Metastatic Gastric Signet Ring Cell Carcinoma: A Large Population-Based Study.

ObjectiveGastric signet ring cell carcinoma (SRCC) is a distinct entity with a relatively poor prognosis. This study analyzed the clinicopathological characteristics of long-time survivors (LTSs) and identified independent predictors of long-term survival (LTS) in non-metastatic gastric SRCC.MethodsData from 3906 patients with non-metastatic gastric SRCC were retrieved from Surveillance, Epidemiology and End Results according to the inclusion and exclusion criteria. Patients were randomly divided into training and validation cohorts. Predictors of LTS in the training cohort were identified by multivariate logistic regression. A nomogram-based predictive model for LTS was constructed in non-metastatic gastric SRCC.ResultsThere were 800 patients who survived for >5 years and were defined as TLSs. Young age, other race (not black or white population), female gender, married status, small tumor size, low tumor infiltration, and negative lymph node involvement were independent predictors of LTS in non-metastatic gastric SRCC. These seven variables were incorporated into a nomogram model for predicting LTS. The calibration curve showed good consistency between observed and predicted probability of LTS, and the receiver operating characteristic curve showed acceptable discriminative capacity in the training and validation cohorts.ConclusionThis study provides an overview of the features of patients with non-metastatic gastric SRCC. Age, race, sex, marital status, tumor size, tumor infiltration, and lymph node involvement were identified as independent predictors of LTS.

Twenty-Year Survival of Patients Operated on for Non-Small-Cell Lung Cancer: The Impact of Tumor Stage and Patient-Related Parameters.

Simple SummarySurgery is the mainstay treatment of non-small-cell lung cancer, but its impact on survival beyond 15 years has never been reported so far. We studied retrospectively clinical characteristics and short and long-term survival of a single-institution patient population whose baseline data were prospectively collected. All patients underwent major lung resection between June 2001 and December 2002. Vital status was obtained by checking INSEE database and verifying if reported as “non-death” by the hospital administrative database and direct phone interviews with patients of families. A total of 345 patients were analyzed; 15-year and 20-year overall survival rates were 12.2% and 5.7%, respectively. At univariate analysis, predictors of worse survivals were increasing age at surgery, lower BMI, weight loss, higher baseline C-reactive protein, pathological stage, and, among patients with adenocarcinoma, higher grade. Increasing age, cumulative smoking, lower BMI, and pathological stage were independent predictors of long-term survival at Cox multivariate analysis. We conclude that very-long-term survivals can be achieved after surgery of NSCLC, and factors classically predicting 5- and 10-years survival also determines longer outcomes suggesting that both initial tumor aggressiveness and host characteristics act beyond the period usually taken into account in oncology.Surgery is the mainstay treatment of non-small-cell lung cancer (NSCLC), but its impact on very-long-term survival (beyond 15 years) has never been evaluated. Methods: All patients operated on for major lung resection (Jun. 2001–Dec. 2002) for NSCL in the Thoracic Surgery Department at Paris-Hôtel-Dieu-University-Hospital were included. Patients‘ characteristics were prospectively collected. Vital status was obtained by checking INSEE database and verifying if reported as “non-death” by the hospital administrative database and direct phone interviews with patients of families. Results: 345 patients were included. The 15- and 20-year survival rates were 12.2% and 5.7%, respectively. At univariate analysis, predictors of worse survivals were: increasing age at surgery (p = 0.0042), lower BMI (p = 0.009), weight loss (p = 0.0034), higher CRP (p = 0.049), pathological stage (p = 0.00000042), and, among patients with adenocarcinoma, higher grade (p = 0.028). Increasing age (p = 0.004), cumulative smoking (p = 0.045), lower BMI (0.046) and pathological stage (p = 0.0026), were independent predictors of long-term survival at Cox multivariate analysis. In another model, increasing age (p = 0.013), lower BMI (p = 0.02), chronic bronchitis (p = 0.03), lower FEV1% (p = 0.00019), higher GOLD class of COPD (p = 0.0079), and pathological stage (p = 0.000024), were identified as independent risk factors. Conclusions: Very-long-term survivals could be achieved after surgery of NSCLC, and factors classically predicting 5- and 10-years survival also determined longer outcomes suggesting that both initial tumor aggressiveness and host’s characteristics act beyond the period usually taken into account in oncology.

P-OGC18 Does cardiopulmonary testing help predict long-term survival after oesophagectomy?

Abstract Background Oesophagectomy is associated with a high rate of morbidity and mortality. Preoperative cardiopulmonary fitness has been correlated with outcomes within major surgery. Variables derived from CPET have been associated with postoperative outcomes. It is unclear whether preoperative cardiorespiratory fitness of patients undergoing oesophagectomy is associated with long-term survival. The aim of this study was to evaluate whether any of the cardiopulmonary exercise testing (CPET) variables that are routinely derived in patients with oesophageal cancer may aid in predicting long-term survival after oesophagectomy. Methods Patients undergoing CPET followed by trans-thoracic oesophagectomy for oesophageal cancer with curative intent between January 2013 and January 2017 from single high-volume centre were retrospectively analysed. The relationship between predictive co-variables including CPET variables, and survival was studied with a Cox proportional hazard model. Receiver operation curve (ROC) analysis was conducted to find cut-off values for CPET variables predictive of 3-year survival. Results A total of 313 patients were analyzed. The ventilatory equivalent for carbon dioxide (VE/VCO2) at anaerobic threshold was the only CPET variable independently predictive of long-term survival in multivariable analysis (HR 1.049, 95% CI 1.011-1.088, p = 0.011). Pathological stage III and IV disease was the other co-variable found to be independently predictive of survival. ROC analysis of the VE/VCO2 failed to demonstrate a predictive cut-off value of 3-year survival (AUC=0.564, 95% CI 0.499-0.629, p = 0.056). Conclusions A high VE/VCO2 before oesophagectomy for malignant disease is an independent predictor of long-term survival and may be an important variable for consideration when counselling patients.