Independent Risk Factors For Recurrence Research Articles

Longitudinal Analysis of Recurrence and Risk Factors of Early-Stage Resected Adenocarcinoma With Common EGFR Mutations: A Multicenter Retrospective Cohort Study in South Korea.

Despite curative surgery for lung cancer, 30% to 55% of patients experience recurrence or death, which highlights the importance of adjuvant treatment. Adjuvant osimertinib therapy effectively prolongs disease-free and overall survival in patients with lung cancer harboring common epidermal growth factor receptor (EGFR) mutations. To identify potential candidates for adjuvant osimertinib, it is crucial to understand the rates and identify risk factors of recurrence. This multicenter, retrospective cohort study was conducted in the Republic of Korea and enrolled patients who, between 2010 and 2017, underwent resection of stages I-III adenocarcinomas, with common EGFR mutations. The primary outcomes comprised the rate and risk factors of postoperative recurrence. Among the 759 participants, the overall recurrence rate and median recurrence-free survival were 39.1% and 59.8 (interquartile range [IQR], 26.3-84.2) months, respectively, during a median follow-up of 73.0 (IQR, 55.4-95.0) months. The recurrence rates for stages IA, IB, IIA, IIB, IIIA, and IIIB were 14.7%, 45.5%, 53.8%, 72.5%, 80.3%, and 93.3%, respectively. Multivariate analysis revealed that age ≥ 65 years, body mass index < 18.5 kg/m², the Del19 subtype of EGFR mutation, tumor size ≥ 2.3 cm, N1 involvement, N2 involvement, predominantly micropapillary or solid pattern, and the presence of visceral pleural invasion were independently associated with recurrence. This multicenter cohort study demonstrated that stages I-III EGFR-mutated adenocarcinoma has a postoperative recurrence rate of 39.1%, and identified 7 independent risk factors for recurrence.

Long-term clinical outcomes after salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy.

This study aimed to evaluate the clinical outcomes of patients who developed prostate-specific antigen failure after radical prostatectomy and were treated with salvage radiotherapy (SRT). This retrospective study included 167 patients who received SRT between January 2008 and August 2017 at a single center. Cumulative and periodic genitourinary and gastrointestinal adverse events and the chronologic changes in quality of life were evaluated before and 1, 3, 6, 12, 24, 36, 48, and 60months after SRT. The median follow-up duration after SRT was 83months. The 5- and 7-year biochemical recurrence-free rates were 52.6% and 47.9%, respectively. Multivariate analysis revealed the following independent risk factors for recurrence after SRT: higher total Gleason score (≥8), higher pathological T stage, negative resection margin, and shorter period between radical prostatectomy and biochemical recurrence-free. The cumulative incidence rates of grade 2 or higher genitourinary and gastrointestinal adverse events after SRT were 27.4% and 9.4%, respectively. Bowel function worsened after SRT and showed significant deterioration 5years after SRT, compared with pre-treatment. Five years post SRT, the rates of patients whose physical and mental component scores were<50 were 44.1% and 34.3%, respectively. Prostate-specific antigen recurrence occurred in approximately half of the patients after SRT, with a higher Gleason score, higher pathological T stage, negative resection margin, and shorter period between radical prostatectomy and first biochemical recurrence identified as risk factors. Besides the adverse events, careful attention to long-term quality-of-life deterioration must be considered when considering indications for SRT.

Impact of upper tract urothelial carcinoma history on patients with non-muscle invasive bladder cancer undergoing intravesical chemotherapy

This study was designed to evaluate the impact of upper tract urothelial carcinoma (UTUC) history on prognosis in patients with non-muscle-invasive bladder cancer (NMIBC) receiving intravesical chemotherapy. We conducted a single center, retrospective, cohort study of 444 NMIBC patients who received intravesical chemotherapy after transurethral resection of the bladder cancer (TURBT) at Peking University People’s Hospital from 2000 to 2015. Patients were divided into UTUC-NMIBC group (with UTUC history) and primary NMIBC group (without UTUC history) by presence of previous UTUC. Demographic, clinical and pathologic factors were analyzed. Kaplan–Meier curves and the log-rank test were used to depict and compare recurrence-free survival (RFS) and progression-free survival (PFS) between the two groups. Multivariable Cox regression models were constructed to determine the variables associated with RFS and PFS. Compared to the primary NMIBC group (n = 410), the UTUC-NMIBC group (n = 34) had an older median age [72.0 (65.0–81.0) vs. 66.0 (58–75) years; P = 0.007], a higher incidence of multiple tumors (52.9% vs. 33.9%; P = 0.026) and a higher recurrence rate (52.9% vs. 30.7%; P = 0.008) and worse RFS (P < 0.001). In multivariate analysis, UTUC history was an independent risk factor for recurrence (hazard ratio = 2.242; P = 0.001), but not for progression. Interestingly, subgroup analysis indicated patients with recent UTUC history (≤ 24 months between UTUC and NMIBC diagnoses) were associated with increased recurrence rates (73.7% vs. 26.7%; P = 0.014). Presence of UTUC history was an independent risk factor for recurrence in patients with NMIBC who received intravesical chemotherapy, especially in those with a shorter interval between UTUC and NMIBC diagnoses.

Investigating the impact of persistent HPV infection on recurrence of lesions post-surgery for early-stage cervical cancer and related influencing factors.

To explore the influencing factors of recurrence after surgical treatment for early-stage cervical cancer (stages IA1-IIA1) and to investigate the relationship between human papillomavirus (HPV) infection and postoperative recurrence of lesions. A retrospective analysis was conducted on the clinical data of 242 patients who underwent surgical treatment for early-stage cervical cancer (FIGO stages IA1-IIA1) at the Second Affiliated Hospital of Dalian Medical University between 2015 and 2022. Cox regression analysis was employed to evaluate the relationship between persistent postoperative HPV infection and lesion vaginal local recurrence while identifying the associated risk factors for persistent HPV infection following surgery. Within 12 months postoperatively, the HPV clearance rate was 88.11%. HPV infection persisted beyond 12 months in 19 patients (7.9%), with 3 cases demonstrating the same HPV genotypes (types 52, 58) as those identified preoperatively. Multivariate analysis identified persistent postoperative HPV infection (odds ratio [OR] 1.72, 95% confidence interval [CI] -1.14 to 5, p=0.001*) as an independent risk factor for recurrence. Additionally, smoking (OR 7.49, 95% CI 1.19 to 47.13, p=0.032), abnormal vaginal microbiota (OR 0.663, 95% CI 0.403 to 1.088, p=0.001*), and the type of surgical procedure (OR 0.32, 95% CI 0.11 to 0.91, p=0.033) were significantly associated with a higher rate of persistent HPV infection. Persistent HPV infection after surgery is an independent risk factor for postoperative recurrence in early-stage cervical cancer. Surgical approach, abnormal vaginal microbiota, and smoking are associated factors for persistent HPV infection after surgery.

Large L5-S1 Lordosis is an Independent Risk Factor for recurrENCE AFTER BOne Union of Pediatric Lumbar Spondylolysis at L5: A Retrospective Case-control Study.

Retrospective case-control study. To determine risk factors for recurrence of pediatric lumbar spondylolysis at L5 after return to sport in patients who achieved bone union with conservative treatment. Pediatric lumbar spondylolysis is a stress fracture commonly observed in adolescent athletes, particularly at the L5 vertebra. Because some patients experience a recurrence of spondylolysis after bone fusion with conservative treatment, identifying risk factors for recurrence may help athletes continue sports activities, maintain performance levels, and preserve mental health. Of the 375 pediatric patients (<18 years of age) who received conservative treatment for lumbar spondylolysis at L5 between 2015 and 2021, 296 patients who achieved bone fusion and returned to their original sports activities were analyzed. Recurrence rate, sports, pathological stage of spondylolysis at initial examination, presence of spina bifida occulta (SBO), duration of conservative treatment for initial spondylolysis, and radiological parameters including lumber lordosis, L5-S1 lordosis, and sacral slope were examined. Recurrence and non-recurrence groups were compared using univariate and multivariate analyses to investigate risk factors for recurrence. A receiver operating characteristic (ROC) curve was drawn to determine cut-off values of the parameters to predict spondylolysis recurrence. Recurrence was observed in 52 out of 296 patients (17.6%). Multivariate logistic regression analysis revealed that a large L5-S1 lordosis was a significant independent risk factor for recurrence. ROC analysis demonstrated a cut-off value of 24.5° for L5-S1 lordosis. Age, sex, SBO, and duration of conservative treatment for initial spondylolysis were not significant predictors of recurrence. We identified large L5-S1 lordosis as an independent risk factor for recurrence of pediatric lumbar spondylolysis at L5 following conservative treatment. Intensive athletic rehabilitation to prevent recurrence and follow-up measures to monitor and detect recurrence are recommended for patients with large L5-S1 lordosis.

A novel nomogram for predicting post-operative recurrence for patients with intermediate and high-risk non-muscle invasive bladder cancer after thulium laser resection of bladder tumors or conventional transurethral resection of bladder tumors followed by intravesical bacille Calmette-Guérin immunotherapy.

Post-operative recurrence for patients with intermediate and high-risk non-muscular invasive bladder cancer (NMIBC) is common. This study aims to evaluate the potential factors of tumor recurrence, and construct a novel nomogram to predict the probability of tumor recurrence. We retrospectively enrolled patients with intermediate and high-risk NMIBC who received thulium laser resection of bladder tumors (TmLRBT) or transurethral resection of the bladder tumor (TURBT) followed by intravesical bacille Calmette-Guérin (BCG) immunotherapy. The risk factors were screened by the least absolute shrinkage and selection operator (LASSO) regression method. And multivariate logistic regression was applied to recognize the independent risk factors of bladder cancer recurrence. A nomogram was established, and the recurrence probability was calculated based on the model scores. A total of 90 patients with intermediate and high-risk NMIBC were included in this study, of whom 53 underwent TURBT and 37 underwent TmLRBT. During the follow-up period, 22 patients (24.4%) experienced bladder cancer recurrence. Three variables were screened out in the LASSO regression. The multivariate logistic analysis suggested that surgery of TURBT [odds ratio (OR) =6.86760; 95% confidence interval (CI): 1.5048-31.34300] and previous bladder tumor (OR =14.73600; 95% CI: 2.81180-77.23000) were independent risk factors of recurrence, while more BCG treatment sessions (OR =0.26504; 95% CI: 0.12455-0.56398) was independent protective factor of recurrence. Patients with TURBT and previous bladder tumor history were more likely to develop recurrent bladder cancer, while more BCG treatment sessions was independent protective factor of recurrence.

Prognostic Impact of Potentially Curative Resection for Synchronous Peritoneal Carcinomatosis with Lavage Cytology Positivity in Colorectal Cancer: A Retrospective Observational Study

Although curative resection for synchronous peritoneal carcinomatosis has been reported to improve prognosis, cases with positive intraoperative lavage cytology have not been reported. In this study, we investigated the prognostic value of potentially curative resection based on colorectal cancer and lavage cytology positivity in patients with synchronous peritoneal carcinomatosis. We retrospectively evaluated 72 patients who underwent intraoperative lavage cytology and one-stage potentially curative resection of primary and metastatic lesions (lavage cytology-positive, n = 21; lavage cytology-negative, n = 51) between July 2004 and December 2019. We compared the 5-year overall survival and 3-year recurrence rates between the lavage cytology-positive and lavage cytology-negative groups. No significant differences were observed in the 5-year overall survival (48.2% vs. 45.5%, P = 0.924) or 3-year recurrence rates (74.5% vs. 62%, P = 0.143) between the two groups. Univariate analysis for 3-year recurrence revealed that lavage cytology-positive status was not an explanatory variable (hazard ratio: 1.552, 95% confidence interval: 0.83-2.902, P = 0.169). Multivariate analysis identified colon cancer as an independent risk factor of recurrence. In resectable cases, the resection of synchronous peritoneal carcinomatosis from colorectal cancer can be considered even if intraoperative lavage cytology is positive.

Clinical Characteristics and Prognostic Factors Affecting Clinical Outcomes in Cytomegalovirus Retinitis Following Allogeneic Hematopoietic Stem Cell Transplantation.

Background/Objectives: This study aimed to evaluate the clinical characteristics and identify the prognostic factors affecting visual outcomes, retinal detachment, and recurrence in cytomegalovirus retinitis (CMVR) patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: A retrospective analysis of 54 CMVR patients (84 eyes) who underwent allo-HSCT between 2015 and 2024 was conducted. Ophthalmologic and systemic evaluations were performed. The visual outcomes were classified as improvement, stabilization, and deterioration. Logistic regression and LASSO regression models were used to identify the prognostic factors. Results: Improved or stabilized visual outcomes were found in 22 eyes, while 62 eyes suffered from deterioration. Larger lesion areas were independently associated with poorer visual outcomes (OR 0.989, p = 0.002). Eight (9.5%) eyes had rhegmatogenous retinal detachment and thirteen (15.5%) eyes suffered from recurrence. Retinal detachment was significantly predicted by higher baseline aqueous CMV DNA load (OR 5.087, p = 0.026). Macula involvement (OR 5.322, p = 0.032) and more intravitreal injections (IVs) (OR 1.263, p = 0.008) were independent risk factors for recurrence. No systemic factors were found to be associated with the clinical outcome of eyes with CMVR. Conclusions: Ocular characteristics, rather than systemic factors, were more useful to predict the clinical outcome of eyes with CMVR. Routine ophthalmic screening and early intervention are essential to improving outcomes in this vulnerable population.

The Role of hCG Expression in Endometrial Cancer Prognosis.

This study aims to investigate the expression pattern of human chorionic gonadotropin (hCG) in the tissue of endometrioid type endometrial cancer (EEC) using immunohistochemistry, and also to investigate the effect of hCG expression pattern on prognosis and survival in EEC. We evaluated patients who were operated between 2010 and 2020 in the obstetrics and gynecology clinic of our center due to EEC. In total, 194 women were determined to be in either the hCG-negative group (n=137) or the hCG-positive group (n=57). The detection rate of deep myometrial invasion (16.8% vs. 36.8%; P=0.002), lymphovascular space invasion (10.9% vs. 24.6%; P=0.015), and metastatic lymph node (6.7% vs. 21.8%; P= 0.003) in patients with hCG-positive staining were analyzed to be significantly higher. Five-year disease-free survival (DFS) (P= 0.015) and overall survival (OS) (P= 0.024) rates were found to be higher in the hCG-negative group. hCG expression was found to be an independent risk factor for recurrence, and DFS in grade I-II EEC was limited to the uterus and with superficial myometrial invasion (low risk). No independent risk factors for OS were analyzed. hCG positivity is a risk factor with poor prognostic factors in endometrial cancer. It was concluded that hCG expression in low-risk EEC is a valuable negative prognostic factor for recurrence and DFS.

Relationship between serum ECP and TIgE levels and the risk of postoperative recurrence in patients with chronic rhinosinusitis with nasal polyps.

This study was undertaken to assess the association between the likelihood of surgical recurrence and serum ECP and TIgE levels in chronic rhinosinusitis with nasal polyps (CRSwNP). Clinical information was gathered retrospectively from 166 cases of surgically treated CRSwNP as well as 60 cases of chronic rhinosinusitis without nasal polyps (CRSsNP). A comparative analysis on serum levels of total immunoglobulin E (TIgE) and eosinophil cationic protein (ECP) was carried out between the two groups. The CRSwNP patients were assigned into recurrence and non-recurrence groups based on the absence/presence of disease recurrence after a 2-year follow-up. An analysis was conducted on the correlation between the patients' clinical data and their serum ECP and TIgE levels. Receiver operating characteristic (ROC) curves were utilized to assess the clinical utility of these two biomarkers. The CRSwNP participants had higher serum levels of ECP and TIgE (4.28 ± 0.81 > 3.58 ± 0.77 ng/L, P < 0.001; 52.99 ± 8.62 > 15.65 ± 3.25 KU/L, P < 0.001) compared to CRSsNP participants. Univariate analysis indicated that neutrophil ratio, lymphocyte ratio, Lund-Kennedy score, Lund-Mackay score, SNOT-22 score, olfactory function score, and postoperative recurrence were significantly correlated with serum ECP and TIgE levels. Higher serum levels of TIgE and ECP (4.89 ± 0.79 < 4.11 ± 0.72, P < 0.001; 58.74 ± 8.27 < 51.40 ± 8.04, P < 0.001) were detected in the recurrence groups vs. the non-recurrence group. Multivariate analysis showed that serum ECP and TIgE were independent risk factors for recurrence of CRSwNP. Serum ECP and TIgE levels were found to be predictive of postoperative recurrence risk in CRSwNP patients (AUC: 0.77, 0.74, 0.84; P < 0.05) according to ROC curve analysis. Significant differences were not observed in any general clinical data. The findings suggest that elevated serum ECP and TIgE levels in patients with CRSwNP can be as good predictors for the risk of recurrence after endoscopic sinus surgery.

Constructing individualized follow-up strategies for locally advanced esophageal squamous cell carcinoma patients based on dynamic recurrence risk changes

The aim of this study was to explore the high-risk factors for recurrence in patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing definitive chemoradiotherapy or radiotherapy (dCRT or dRT). Conditional survival (CS) was used to evaluate the dynamic survival and recurrence risk of patients after treatment, and individualized monitoring strategies were developed for patients. Logistic regression analysis was performed to determine independent recurrence risk factors. Calibration curves and receiver operating characteristic (ROC) curve were used to evaluate nomogram models. Kaplan–Meier curves were used to compare survival rates in different groups and to calculate CS rate. A total of 677 patients were included. Multivariate logistic analyses demonstrated that chemotherapy cycles, tumor length, body mass index (BMI), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) were independent recurrence risk factors (p < 0.05). Subsequently, we constructed nomogram models to predict recurrence and risk stratification. Kaplan–Meier curves showed that conditional locoregional recurrence-free survival and distant metastasis-free survival of patients in different risk groups and clinical stages progressively increased with survival time, whereas local recurrence and distant metastasis annual recurrence rates decreased yearly with increasing survival time. Finally, we developed an individualized follow-up strategy based on CS at different frequencies. Individualized follow-up strategies developed on the basis of CS can better monitor the changes in patients’ conditions and contribute to timely salvage treatment and rational allocation of healthcare resources.

Female sex is an independent risk factor for recurrence after ethanol Marshall bundle elimination in atrial fibrillation ablation.

Atrial fibrillation (AF) exhibits gender disparities in prevalence, complications, pharmacological management, and ablation efficacy. Ethanol infusion of the vein of Marshall (EIVOM) is promising for enhancing AF ablation success rate, yet sex differences of EIVOM are lacking evidence. This was a non-randomized, single-center, retrospective observational study. Patients with AF received stepwise ablations composed of EIVOM, pulmonary vein isolation, and linear ablation. The primary endpoint was defined as the recurrence of atrial tachycardia over 30 s. Propensity score matching (PSM) was performed to reduce selection bias. From April 2020 to May 2022, 432 patients were included, comprising 288 male patients and 144 female patients. Compared with the male patients, the female patients were older, with worse heart function class. EIVOM success rate was significantly lower in the female patients compared with the male patients (86.1% vs. 93.4%). No significant differences in major procedural complications were observed between the male and female patients. During a median follow-up of 12 months, the female patients had significantly higher AF recurrence. Multivariate Cox regression analysis showed that female sex, body mass index <21.62, left atrial diameter >47 mm, and complex fractionated atrial electrogram ablation are independent risk factors for AF recurrence. After PSM, the AF recurrence rate remained statistically higher in the female patients compared with the male patients. Compared with the male patients, the female patients were older, more symptomatic, and had worse heart function. The female patients had significantly higher AF recurrence after EIVOM combined with catheter ablation.

Predictors of recurrence and survival after salivary gland cancer surgery: A multicenter, retrospective study in northern Japan

Predictors of recurrence and survival after salivary gland cancer surgery: A multicenter, retrospective study in northern Japan

Comparative analysis of the effects of microscopic vs. neuroendoscopic transsphenoidal surgery on visual and pituitary function and postoperative recurrence factors in patients with pituitary tumors.

To compare the effects of microscopic and neuroendoscopic transsphenoidal surgeries on visual function, pituitary function, and factors influencing postoperative recurrence in patients with pituitary tumors. A retrospective analysis was conducted on 164 patients with pituitary tumors who underwent surgery at The First People's Hospital of Xianyang from March 2020 to March 2022. Based on the surgical approach, patients were divided into an observation group (n=93) and a control group (n=71). The observation group underwent neuroendoscopic transsphenoidal pituitary tumor resection, while the control group underwent microscopic transsphenoidal pituitary tumor resection. General clinical data, perioperative indicators, hormone levels, quality of life, and olfactory function were compared between the two groups. Postoperative recurrence was recorded, and logistic regression analysis was performed to identify factors influencing postoperative recurrence in the patients. The control group exhibited a greater amount of intraoperative bleeding and a longer postoperative hospital stay compared to the observation group (P<0.0001). The total tumor resection rate was significantly lower in the control group than that in the observation group (P=0.002). Additionally, the numbers of patients in the control group who experienced improvements in vision (P=0.013), headache (P=0.004), and sexual dysfunction (P=0.047) were lower than those in the observation group. One month after surgery, levels of prolactin, human growth hormone, adrenocorticotropic hormone, and thyroid-stimulating hormone were higher in the observation group than those in the control group. The quality of life score one month after surgery was higher in the observation group than that in the control group (P<0.0001). In addition, the olfactory function score one month after surgery was lower in the observation group compared to the control group (P<0.0001). The overall incidence of postoperative complications was higher in the control group (P=0.034). There was no statistically significant difference in recurrence rates between the two groups (P=0.102). Multivariate logistic regression analysis identified tumor size (P=0.001, OR=7.227), Knosp classification (P=0.005, OR=0.238), and Ki-67 index (P=0.001, OR=4.969) as independent risk factors for recurrence within two years in patients with pituitary tumors. For patients with pituitary tumors, neuroendoscopic transsphenoidal surgery is more effective than microscopic transsphenoidal surgery in reducing operative time and improving postoperative visual and pituitary function, and therefore, should be promoted in clinical practice.

Effect of interference electrotherapy combined with rotary traction manipulation on cervical function and recurrence in patients with cervical spondylotic radiculopathy.

To evaluate the clinical efficacy of combining interference electrotherapy with rotary traction manipulation in treating cervical spondylotic radiculopathy (CSR), and to assess its impact on cervical function and prognosis. A retrospective analysis was conducted on the clinical data from 214 CSR patients who were treated at Yueyang Central Hospital, Hunan University of Chinese Medicine, from April 2021 to October 2023. The observation group (n=110) received combined therapy using interference electrotherapy and rotary traction manipulation, while the control group (n=104) received rotary traction manipulation alone. Before treatment, and at 2 and 4 weeks post-treatment, cervical function was assessed using the Neck Disability Index (NDI), and pain intensity was measured using components of the Simplified McGill Pain Questionnaire (SF-MPQ), including Visual Analog Scale (VAS), Present Pain Intensity (PPI), and Pain Rating Index (PRI). Clinical efficacy was evaluated using the modified Macnab criteria, and treatment safety was assessed. Both groups were followed up for one year to record recurrence rates. Logistic regression was used to identify risk factors for recurrence. Baseline characteristics were similar between groups (P>0.05). After 2 and 4 weeks, the observation group showed significantly greater improvements in NDI, VAS, PRI, and PPI scores compared to the control group (P<0.001). The total effective rate was higher in the observation group (92.7%) than in the control group (80.8%) (P=0.017). However, the recurrence rate was significantly higher in the observation group (7.3%) compared to the control group (20.2%) (P=0.006). Logistic regression identified treatment regimen, patient age, and pillow height as independent risk factors for recurrence (P<0.05). A recurrence risk scoring model based on these factors achieved an AUC of 0.897 (95% CI: 0.844-0.951). Combining interference electrotherapy with rotary traction manipulation significantly improves cervical function and alleviates pain in CSR patients, yielding higher overall efficacy. However, this combination is associated with an increased risk of recurrence, influenced by treatment method, patient age, and pillow height.

Analysis of the efficacy and factors affecting the prognosis of intracranial dissecting aneurysm treated with multi-stent overlap technique

ObjectiveThe study aims to identify characteristics that impact the postoperative prognosis and recurrence of intracranial dissecting aneurysms (IDA) patients treated using multi-stent overlapping techniques.MethodsClinical data from 69 IDA patients treated with multistate-assisted spring coil embolization at the hospital between January 2017 and October 2023 were retrospectively reviewed, including clinical and imaging data gathered at admission and discharge. The prognosis was determined based on mRS grade at discharge, and the patients were divided into excellent prognosis (mRS 0–2 points) and poor prognosis (mRS 3–6 points). They were split into two groups: recurrence and no-recurrence, based on whether the patients had recurrence during surgical follow-up. The patient’s clinical information and aneurysm data were compared between the two groups to better understand the efficacy of multi-stenting for IDA and to investigate the factors that influence the good or negative prognosis of multi-stenting for IDA and recurrence.ResultsThe prognosis was poor in 10 patients, 7 of whom died, while 59 had an excellent prognosis. Hunt-Hess classification (χ2 = 25.503a, P = < 0.01), hospitalization days (t=-3.873, P < 0.01), operation time (t=-1.970, P = 0.049), and aneurysm height (t=-1.969, P = 0.049) were all significant. 62 patients were discharged with 4 postoperative recurrences and 58 without recurrences in patients treated with multiple stents, with significant differences in the largest diameter (t=-2.235, P = 0.025), basal length (t=-2.149, P = 0.032), and position(located in pica base or not ) (χ2 = 10.955a, P = 0.001). The postoperative recurrence rate was 5.8%, but 85.8% reported satisfactory neurologic function (mRS ≤ 2). The case fatality rate was 10.1%.ConclusionHunt-Hess grading on admission, aneurysm high, and operation time affect the prognosis of IDA, Hunt-Hess grade was an independent risk factor for prognosis. Aneurysm size, longest diameter, basal length, and location at the base of the pica affect recurrence. Located in pica base by the dissecting aneurysm is an independent risk factor for recurrence.

Comparative Analysis of Central and Noncentral Degenerative Mitral Regurgitation Treated With Transcatheter Mitral Valve Edge-To-Edge Repair.

Mitral valve transcatheter edge-to-edge repair (M-TEER) was initially indicated for central degenerative mitral regurgitation (DMR) lesions, but advancements in technology have enabled successful treatment in an increasing number of noncentral DMR patients. This study aims to compare procedural outcomes and prognosis between noncentral DMR patients, outside clinical trial anatomical criteria, and central DMR patients undergoing M-TEER. Drug-refractory moderate-to-severe DMR patients treated with M-TEER at Fuwai Hospital from January 2021 to February 2024 were retrospectively analyzed. Patients were categorized into central (N = 77) and noncentral (N = 59) lesion groups. Baseline characteristics, procedural outcomes, and prognoses were collected and compared. There were no significant differences in baseline characteristics and preoperative echocardiographic parameters between the groups except for left ventricular ejection fraction. Both groups exhibited similar procedural success rates (central: 93.51% vs. noncentral: 91.53%, p = 0.92) with comparable procedural complication rates. The ideal M-TEER success rate at discharge for noncentral DMR patients was similar to that for central DMR patients (83.05% vs. 71.43%, p = 0.11). Kaplan-Meier analysis indicated similar 3-year recurrence-free survival rates (noncentral: 94.9% vs. central: 90.3%, p = 0.46). Cox regression analysis identified higher discharge mitral valve gradient and a leaflet-to-annulus index ≤ 1.2 as independent risk factors for recurrence or death. Noncentral DMR patients undergoing M-TEER achieve similar procedural success rates without increased risk of complications compared to central DMR patients. The seemingly higher success rate in noncentral DMR patients may be due to the smaller impact on valve area, warranting further investigation.

Venous Thromboembolism at Low Risk of Recurrence in Young Women: Stress and Violence Associated with Recurrence. An International Case-Control Study.

In young women with venous thromboembolism (VTE) related to weak transient risk factors, it remains unknown whether stress levels and intimate partner violence (IPV) are associated with recurrence. The VTE-WEAK study aims to investigate the association between perceived stress and IPV with a recurrence of VTE in women with a first episode of VTE due to combined oral contraceptives, pregnancy-puerperium, minor trauma/fracture, brief surgery, infection or brief immobility, and not using antithrombotic prophylaxis. We performed a multicenter, international, observational, retrospective study on women referred for thrombophilia screening who were subsequently monitored. Patients were aged 18 to 55 years old and free of high-risk thrombophilia. When a recurrence of VTE was suspected for the first time, the perceived stress level and IPV were evaluated using self-administrated PSS-10 and Woman Abuse Screening Tool (WAST) questionnaires. We monitored 7,754 women over 43,880 patients-years. A first suspected recurrence occurred in 4,772 women, among whom 1,316 had an objectively confirmed recurrence. The perceived stress level and an IPV situation were both independent risk factors for recurrence: moderate stress: adjusted odds ratio (aOR) 1.630 (1.415-2.468); high perceived stress: aOR 10.03 (7.528-13.36); IPV: 1.953 (1.546-2.468), p < 0.0001. The perceived level of stress and IPV are associated with a recurrence of VTE when suspected. The mechanisms and clinical consequences of a possible stress coagulopathy require investigation.

Analysis of treatment methods and relapse factors of postoperative anastomotic stenosis in colorectal cancer.

Anastomotic stenosis following surgical intervention for colorectal cancer is a frequently encountered complication. Nevertheless, the optimal approach to effectively manage anastomotic stenosis at varying distances from the anal margin remains uncertain. The primary objective of this research endeavor was to explore the risk factors associated with recurrent anastomotic stenosis subsequent to colorectal cancer surgery, as well as to evaluate potential strategies for its management. The present study retrospectively analyzed the clinical data and treatment outcomes of 244 patients who underwent colorectal surgery and were subsequently diagnosed with anastomotic stenosis. The patients were categorized into two groups based on the location of anastomotic stenosis relative to the anal verge: the low anastomotic stenosis group (n = 107) and the high anastomotic stenosis group (n = 137). The severity of anastomotic stenosis was found to be significantly higher in the low anastomotic stenosis group compared to the high anastomotic stenosis group (71.0% vs 57.7%, P = 0.031). Furthermore, the high anastomotic stenosis group exhibited a greater inclination toward opting for endoscopic treatment when it came to the choice of treatment for anastomotic stenosis (62.8% vs 27.1%, P < 0.001). In addition, logistic regression analysis showed that stenosis length ≥ 0.8cm (odds ratio = 0.481; 95% CI = 0.248-0.936; P = 0.031) and lymph node metastasis (OR = 0.559, 95%CI = 0.313-0.998, P = 0.049) were independent risk factor for recurrence of anastomotic stenosis. Finally further build colorectal surgery of tumor recurrent anastomotic stenosis nomogram prediction model, using the internal validation and calculation model of the receiver-operating characteristic curve (ROC) area under curve (AUC) to evaluate the reliability and accuracy of the model. There exist variations in the severity of anastomotic stenosis, the extent of stenosis, and the selection of treatment modalities across different anatomic locations. Regarding the choice of anastomotic treatment, patients with elevated anastomotic stenosis exhibited a preference for endoscopic intervention. Furthermore, a multivariate analysis showed that stenosis length equal to or greater than 0.8cm and lymph node metastasis were autonomous risk factors for recurrence of benign stenosis after colorectal cancer surgery.

Extended Survival and Prognostic Factors in Endometrial Cancer: A Multivariate Cox Regression Analysis

Background: Endometrial cancer (EC) is the third most prevalent neoplasm among women in Spain and the most frequent malignancy of the female genital tract. The primary risk factors are associated with increased estrogen levels. The objective of our study is to determine the current specific progression-free survival (PFS) and overall survival (OS) in patients with EC at the University Hospital of Puerto Real. Additionally, we aim to understand the independent role of specific factors in the risk of recurrence and mortality from EC through a multivariate analysis. Methods: A retrospective observational survival analysis of a case series was conducted. The study population included all women diagnosed and treated for EC in Spain between January 2010 and December 2021. The Kaplan-Meier method and Cox regression analysis were performed to evaluate survival based on patient age, tumor stage, histological type, and degree of differentiation, and to quantify survival probabilities for each factor. Results: A total of 324 patients were included. The PFS was 86.6% at 5 years and 81.1% at 10 years. The OS was 91.3% at 5 years and 84.8% at 10 years. The tumor-related mortality rate was 9.3% (N = 30) and the tumor recurrence rate was 5.6% (N = 18). The estimated median follow-up using the inverse Kaplan-Meier method was 4.33 years (95% confidence interval (95% CI): 3.72–4.94) for OS and 4.57 years (95% CI: 4.05–5.09) for PFS. The statistically significant factors affecting PFS and OS were age ≥60 years at diagnosis, advanced International Federation of Gynecology and Obstetrics (FIGO) stage (II–IV), non-endometrioid tumor, high tumor grade, and lymphovascular space invasion. Multivariate Cox regression analysis shows that being 60 years or older at the time of diagnosis, advanced FIGO stages, high tumor grade, and serous-papillary tumors are independent risk factors for recurrence or death in EC. Conclusions: Our study shows that being 60 years or older at the time of diagnosis, advanced FIGO stages (II–IV), non-endometrioid EC, higher histological tumor grade, and lymphovascular space invasion are associated with lower OS and PFS. Additionally, multivariate Cox analysis suggests that age ≥60 years at diagnosis, advanced FIGO stages, high tumor grade, and serous-papillary histological type are independent prognostic factors influencing survival and recurrence in EC. This study should serve as a foundation for further research, incorporating relevant aspects of the molecular biology of EC to refine patient prognosis.