Independent Survival Research Articles

Extracorporeal Cardiopulmonary Resuscitation Among Patients with Structurally Normal Hearts.

Extracorporeal cardiopulmonary resuscitation (eCPR) has been well described as a rescue therapy in refractory cardiac arrest among patients with congenital heart disease. The purpose of this retrospective analysis of data from the Extracorporeal Life Support Organization was to evaluate outcomes of eCPR in patients with structurally normal hearts and to identify risk factors that may contribute to mortality. During the study period, 1,431 patients met inclusion criteria. Median age was 16 years. Overall survival to hospital discharge was 32%. Conditional logistic regression demonstrated an independent survival benefit among smaller patients, patients with a lower partial pressure of carbon dioxide (PaCO2) on cannulation, and those with a shorter duration from intubation to eCPR cannulation. A diagnosis of sepsis was independently associated with a nearly threefold increase in odds of mortality, whereas the diagnosis of myocarditis portended a more favorable outcome. Neurologic complications, pulmonary hemorrhage, disseminated intravascular coagulation, CPR, pH less than 7.20, and hyperbilirubinemia after eCPR cannulation were independently associated with an increase in odds of mortality. When utilizing eCPR in patients with structurally normal hearts, a diagnosis of sepsis is independently associated with mortality, whereas a diagnosis of myocarditis is protective. Neurologic complications and pulmonary hemorrhage while on extracorporeal membrane oxygenation (ECMO) are independently associated with mortality.

Prognostic value of three different staging schemes based on pN, MLR and LODDS in patients with T3 esophageal cancer

Objective: To evaluate the prognostic value of three different staging schemes based on positive lymph nodes (pN), metastatic lymph nodes ratio (MLR) and log odds of positive lymph nodes (LODDS) in patients with T3 esophageal cancer. Methods: From 2007 to 2014, clinicopathological characteristics of 905 patients who were pathologically diagnosed as T3 esophageal cancer and underwent radical esophagectomy in Zhejiang Cancer Hospital were retrospectively analyzed. Kaplan-Meier curves and Multivariate Cox proportional hazards models were used to evaluate the independent prognostic factors. The values of three lymph node staging schemes for predicting 5-year survival were analyzed by using receiver operating characteristic (ROC) curves. Results: The 1-, 3- and 5-year overall survival rates of patients with T3 esophageal cancer were 80.9%, 50.0% and 38.4%, respectively. Multivariate analysis showed that MLR stage, LODDS stage and differentiation were independent prognostic survival factors (P<0.05 for all). ROC curves showed that the area under the curve of pN stage, MLR stage, LODDS stage was 0.607, 0.613 and 0.618, respectively. However, the differences were not statistically significant (P>0.05). Conclusions: LODDS is an independent prognostic factor for patients with T3 esophageal cancer. The value of LODDS staging system may be superior to pN staging system for evaluating the prognosis of these patients.

Response by Bereczki to Letter Regarding Article, “Hope Dies Last—Evidence Again Fails to Support a Neuroprotectant: Cerebrolysin for Acute Ischemic Stroke”

In clinical trials and in systematic reviews, major issues are the selection of the primary end point and the method of data analysis and interpretation. After stroke, the rate of those with independent survival is of upmost importance. I fully agree with the comment of Vester et al that case fatality is not the only important outcome measure after stroke.1 In the review of Ziganshina et al,2 none of the included trials reported on the combined outcome of death or dependence. As individual patient data meta-analysis was also not possible, the review authors chose to analyze death from any cause and did not find significant difference between the cerebrolysin-treated and …

Effect of biology on the outcome of female melanoma patients.

The aim of the present study was to investigate plausible explanations for the favorable outcome of female melanoma patients and determine the effect of biology on this outcome. Data from 1,169 cutaneous melanoma patients were retrospectively analyzed. Cox proportional hazards models were used and the confounding factors on the survival difference were analyzed by a forward step multivariate modification method. The majority of the factors contributing to poor prognosis were significantly more pronounced in male melanoma patients. After the survival advantage of female patients (P=0.0001 on univariate analysis) was confounded (P=0.708 on multivariate analysis) following adjustment for the prognostic factors, two factors (neurotropism and vertical growth phase) were identified as the confounders, and this effect was attributed to the small number of patients in the groups of these two variables. The already known female advantage in melanoma survival was not affected by other prognostic factors, and female sex remained an independent predictor of good survival in melanoma. This sex-related independent survival advantage was attributed to a biological characteristic that has not yet been fully elucidated, but may be more closely associated with host-related rather than melanoma-related factors.

Age-specific impact on the survival of gastric cancer patients with distant metastasis: an analysis of SEER database.

The age-specific impact on the survival of gastric cancer patients with distant metastasis is still unclear. In this study, we identified 11, 299 gastric cancer patients with distant metastasis between 2004 and 2013 from Surveillance, Epidemiology, and End Results population-based dataset. Patients were divided into young (≤60) and elderly groups (>60). Kaplan-Meier methods and multivariable Cox regression were used for the analysis of long-term survival outcomes and risk factors. There were significant differences between the two groups in terms of race, primary site, grade, histologic type, surgery, marital status and clinical T stage (P<0.05). The 1- and 3-year cancer specific survival rates were 29.0% and 6.2% in young group and 22.8% and 4.8% in elderly group in both univariate (X2=116.430, P<0.001) and multivariate analysis (P<0.001). Young patients had significantly better 1- and 3-year cancer specific survival than elderly patients in each T stage. Age was further validated as an independent survival factor in all T stages (T1, T2, T3, T4 and TX, P<0.05). In conclusion, age was an independent prognostic factor for gastric cancer patients with distant metastasis.

Urban migrant women’s everyday food insecurity coping strategies foster alternative urban imaginaries of a more democratic food system

ABSTRACTUrban migrant women worldwide utilize a creative combination of food insecurity coping strategies to procure food for themselves and their families. Using in-depth interviews with 72 migrant women in Medellín, Colombia, and Washington, DC, this paper argues that in low-income urban communities these everyday strategies can further their demands for autonomy in determining what foods they produce and consume. Relying on feminist geography and food sovereignty literature, this research explores how migrant women living in poverty rely on informal networks for growing and sharing food, seek out organic, fresh foods, and utilize independent survival strategies to counter exclusionary rhetoric and a food system they view as unhealthy. In doing so, they devise alternative urban imaginaries of a more democratic food system. This research contributes a more nuanced understanding of the food insecurity experiences of urban migrant women.

Tailor-Made Setting of Radiation Doses Owing to the MGMT Gene Promoter Methylation for the Treatment of IDH Wild-Type Primary Glioblastoma

Hypofractionated high-dose irradiation had shown excellent local control of glioblastomas (GBMs) but it also had high risk of radiation necrosis even with IMRT technique. Concurrent and adjuvant temozolomide (TMZ) also had prolonged the survival of patients with GBM, but its’ efficacy was depending upon methylation status of MGMT gene promoter. In this study, we evaluated the efficacy and safety of tailor-made setting of prescribed doses owing to the methylation status of MGMT in the treatment of GBM patients by hypofractionated high-dose IMRT with TMZ. Newly diagnosed GBMs without mutation of IDH were enrolled. Methylation status of MGMT was evaluated with methylation specific PCR. In all cases, residual enhanced lesions plus surgical cavity were defined as GTV, and 3-layered CTVs were contoured surrounding the GTV: CTV1 = GTV, CTV2 was 15mm surrounding GTV, and CTV3 was defined as high-intensity volume on FLAIR images. PTV1, PTV2, and PTV3 were defined by expanding CTVs with 5mm margin. Prescribed total doses for PTV2 and PTV3 were unified as 40 Gy and 32 Gy, but the dose for PTV1 was settled as 48 Gy for MGMT methylated (Met) but 68 Gy for unmethylated (UnMet) cases. These doses were delivered by 8 fractions in 10 days. Concurrent and adjuvant TMZ was administrated in all cases. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS), time to radiation necrosis (TRN), and independent survival (IS) which was defined as the time to KPS<70%. We used the Kaplan-Meier method to estimate survival distribution and a Cox proportional hazard model to calculate hazard ratios (HRs). From April 2008 through November 2015, 73 GBMs, 20 Met and 53 UnMet cases, were enrolled. There was no significant difference between Met and UnMet cases in patients’ age, sex, tumor volume, extent of resection, and KPS at registration. The median OS was 22.4 m. The OS of Met cases (median: 39.9 m) was significantly longer than that of UnMet cases (19.8 m, HR = 0.43, P = 0.007). The median local PFS was 38.5 m. Reduced-dose IMRT for Met cases still showed similar local PFS to high-dose IMRT for UnMet cases (HR = 0.73, P = 0.466). CSF dissemination-free survival was significantly longer in Met cases (not reached) than UnMet cases (14.1 m, HR = 0.36, P = 0.03). The TRN of Met cases (13.5m) was similar to that of UnMet cases (13.6 m, HR: 1.02, P = 0.945). The median IS was 14.6m. The IS of Met cases (21.3 m) was significantly longer than that of UnMet cases (11.7 m, HR = 0.49, P = 0.023). IMRT of 48 Gy/8 fractions for Met GBMs showed similar effect on tumor control and similar risk for radiation necrosis to 68 Gy/8 fractions for UnMet GBMs. With significant effect of TMZ on prevention of CSF dissemination, reduced dose IMRT showed favorable survival and functional outcome of patients after treatment. From these results, tailor-made setting of prescribed doses owing to the methylation status of MGMT thought to be desirable for the treatment of GBM patients.

Favorable Impact of Thoracic Endovascular Aortic Repair on Long-Term Survival in Patients With Acute Uncomplicated Type B Aortic Dissection

Standard nonoperative medical therapy for uncomplicated type B dissection has been questioned by recent studies demonstrating improved outcomes in those treated with thoracic endovascular aortic repair (TEVAR). This study assessed long-term survival after acute uncomplicated type B dissection comparing medical therapy (MED), open repair (OPEN), and TEVAR. The California Office of Statewide Hospital Planning Development database was analyzed from 2000 to 2010. Patients with emergent admission for aortic dissection were identified, and those with type A dissection, trauma, bowel ischemia, lower extremity ischemia, acidosis, or shock were excluded. The cohort was stratified by treatment type at index admission into MED, OPEN, and TEVAR. Bivariate, multivariable, and survival analyses were used to evaluate the impact of treatment type on long-term overall survival. There were 9165 uncomplicated type B dissections admitted, of which 95% were MED, 2.0% OPEN, and 2.9% TEVAR. Mean age was 66 ± 15 years, with 39% female, 2.4% cocaine users, 18% with congestive heart failure, and 17% with a Charlson comorbidity score >3. Mean length of stay was 6.7 ± 8.9 days in MED, 15 ± 15 days in OPEN, and 12 ± 10 days in TEVAR (P < .001); mean inpatient costs were $57,000 MED, $200,000 OPEN, and $130,000 TEVAR (P < .001). Overall inpatient mortality was 6.5%, 6.3% for MED, 14% for OPEN, and 7.1% for TEVAR (P < .001). Overall 30-day, 1-year, and 5-year survival rates were 86% ± 0.4%, 76% ± 0.4%, and 60% ± 0.6%; in MED, they were 86% ± 0.4%, 84% ± 2%, and 60% ± 0.6%; in OPEN, they were 83% ± 3%, 76% ± 0.5%, and 67% ± 4%; and in TEVAR, they were 93% ± 2%, 85% ± 2%, and 76% ± 4% respectively (Fig; log-rank, P < .01). On risk-adjusted multivariable analysis, TEVAR improved survival (hazard ratio, 0.68 [95% confidence interval, 0.55-0.83]; P < .01) compared with MED. This study assessing statewide survival after acute uncomplicated type B dissections shows an independent survival advantage for TEVAR over the long-standing practice of medical therapy. These data add further evidence for a paradigm shift in acute management of type B dissection and support initiation of randomized controlled trials of TEVAR for acute uncomplicated type B dissections.

Gender differences in longevity in free-living older adults who eat-with-others: a prospective study in Taiwan

ObjectivesSocial activities such as ‘eating-with-others’ can positively affect the ageing process. We investigated the gender-specific association between eating arrangements and risk of all-cause mortality among free-living older adults.SettingA representative sample...

Performance of Patient-Generated Subjective Global Assessment (PG-SGA) in Patients With Advanced Cancer in Palliative Care.

The purpose of this study was to evaluate the prognostic significance of the Patient-Generated Subjective Global Assessment (PG-SGA) in patients receiving palliative care for advanced cancer. The PG-SGA was used to assess nutrition status of 120 patients admitted to the Palliative Care Unit at the National Cancer Institute in Brazil. According to the PG-SGA, 94.2% (n = 113) of the patients were evaluated as malnourished. The PG-SGA evaluated that xerostomia was the only symptom associated with a short survival (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.2-5.38; P = .014). Survival was found to be significantly higher in well-nourished (PG-SGA A) than malnourished (PG-SGA B [ P = .021] or C [ P = .013]) patients. Total PG-SGA score (hazard ratio [HR], 1.06; 95% CI, 1.001-1.09; P = .045) and Karnofsky Performance Status of 20%-30% (HR, 15.4; 95% CI, 1.63-92.9; P = .001) and 40%-50% (HR, 10.0; 95% CI, 1.22-64.9; P = .031) were found to be independent prognostic survival factors. The scored PG-SGA is an independent prognostic factor of survival and thus can be a useful tool for nutrition evaluation in palliative care.

Relationship of platelet count with clinicopathological features and prognosis of patients with breast cancer

Objective To investigate relationship of platelet (PLT) count with clinicopathological features and prognosis of patients with breast cancer, and explore the susceptibility index to evaluate prognosis of patients with breast cancer. Methods A retrospective analysis of clinical data of 498 patients with breast cancer in January 1995 to December 2005 was carried out. PLT count was tested. Those patients were divided into group A (PLT 250×109/L) according to PLT count level. The relationship of platelet count with clinicopathological features was analyzed. Kaplan-Meier and Cox proportional hazards model were used for univariate analysis and multivariate analysis of PLT impact on survival time. Results There was positively correlated between PLT count and clinicopathological features (Pearson coefficient>0, P<0.05). There was negative correlated between PLT count and survival time (Pearson coefficient=-0.583, P<0.05). The survival time of groups A, B and C were significantly different (P=0.018). Cox proportional hazards model multi-factor analysis showed that PLT count was an independent factors affecting survival time (OR=2.256, P<0.05). Conclusions Patients with breast cancer associated with increased emphasis and PLT count. PLT count had negative correlation with survival time. PLT count could be a susceptible index to predict the prognosis of patients with breast cancer. Key words: Breast neoplasms; Platelet count; Prognosis

Predictors of Independent Aging and Survival: A 16-Year Follow-Up Report in Octogenarian Men.

To examine the longitudinal associations between aging with preserved functionality, i.e. independent aging and survival, and lifestyle variables, dietary pattern and cardiovascular risk factors. Cohort study. Uppsala Longitudinal Study of Adult Men, Sweden. Swedish men (n=1,104) at a mean age of 71 (range 69.4-74.1) were investigated, 369 of whom were evaluated for independent aging 16years later, at a mean age of 87 (range 84.8-88.9). A questionnaire was used to obtain information on lifestyle, including education, living conditions, and physical activity. Adherence to a Mediterranean-like diet was assessed according to a modified Mediterranean Diet Score derived from 7-day food records. Cardiovascular risk factors were measured. Independent aging at a mean age of 87 was defined as lack of diagnosed dementia, a Mini-Mental State Examination score of 25 or greater, not institutionalized, independence in personal activities of daily living, and ability to walk outdoors alone. Complete survival data at age 85 were obtained from the Swedish Cause of Death Register. Fifty-seven percent of the men survived to age 85, and 75% of the participants at a mean age of 87 displayed independent aging. Independent aging was associated with never smoking (vs current) (odds ratio (OR)=2.20, 95% confidence interval (CI)=1.05-4.60) and high (vs low) adherence to a Mediterranean-like diet (OR=2.69, 95% CI=1.14-6.80). Normal weight or overweight and waist circumference of 102cm or less were also associated with independent aging. Similar associations were observed with survival. Lifestyle factors such as never smoking, maintaining a healthy diet, and not being obese at age 71 were associated with survival and independent aging at age 85 and older in men.

An independent survival prognostic role for human epidermal growth factor receptor 2 in gastric cancer: evidence from a meta-analysis.

Some studies have suggested that human epidermal growth factor receptor 2 (HER2) positive is associated with poor outcomes in gastric cancer (GC), whereas another inconsistent studies make the situation confused. This meta-analysis was performed to determine whether HER2 played an independent prognostic role in clinicopathological characteristics and survival outcomes of GC. Combination of GC and human epidermal growth factor 2 or HER2 or HER2/neu or erbB-2 or cerbB-2 or c-erbB2 or CD340 or p185 were used as key words. Data were compared according to the HER2 status. Time-to-event outcomes of overall survival (OS) were analyzed using Hazard Ratios (HRs) with fixed effect, while 5-year survival rate and clinicopathological factors were performed using odd ratios (OR) with random effect. Nighteen trials, from 1986 to October 2013, were identified by two independent authors. A total of 6344 GC patients were included in this meta-analysis, with 1148 HER2 protein overexpression or gene amplification. Comparison of 5-year survival of patients with HER2-positive status versus HER2-negative status showed that OR was 0.58 [95% confidence interval (CI), 0.37-0.91], and the result was significant (P=0.02). The survival outcome of HER2 protein overexpression or gene amplification patients was worse than those with normal HER2 (HR 1.15; 95% CI 1.12-1.18; P<0.00001). However, the difference of III-IV stage ratio between HER2-positive and HER2-negative patients was not significant (OR 1.44; 95% CI 0.95-2.18; P=0.09) even in the subgroup analysis of Asia (P=0.12 and Europe (P=0.51). HER2 protein overexpression or gene amplification in GC patients is associated with a poor survival outcome, and may play a role in GC tumorigenesis.

Abstract 3269: Impact of gender on survival of the patients with esophageal squamous cell carcinoma at a single institute in China

Abstract Esophageal cancer (EC) has been well documented with predominant occurrence in male and with major histopathological type of esophageal squamous cell carcinoma (ESCC) in China. However, the influence by gender on ESCC survival is largely unknown in China. The present study was thus undertaken to elucidate the impact by gender on survival of Chinese patients with ESCC. A total of 17,969 ESCC patients was enrolled in this study, including 11,127 males with a mean age of 60.2±8.6 and 6842 females with a mean age of 61.0±8.4.All the patients were from ESCC database in Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University (1975 to 2015). Only the patients with T2–4N0–1M0–1 were enrolled in this study. Based on the diagnosed time, the patients were classified into two groups, group I (1996–2005, 6885/38.3%) and group II (2006–2015, 11084/61.7%). The followed–up was undertaken until October, 2016. Kaplan–Meier models were for describing the survival curves and Cox proportional hazards models were undertaken to observe the risk of death of male and female. The results demonstrated that the male patients had a poor survival than female (X2=58.17, P&amp;lt;0.001). Furthermore, similar results were observed for the two different periods of 1996–2005 (X2=21.08, P&amp;lt;0.001) and 2006–2015 (X2=34.67, P&amp;lt;0.001). The present results indicate that gender is an independent survival factor for ESCC and the female patients with ESCC have a dramatic prolonged survival than male patients in China. [Supported by Doctoral Team Foundation of the First Affiliated Hospital of Zhengzhou University (2016-BSTDJJ-03), Natural Science Foundation of Henan Province (20161110) and Correspondening author: Li Dong Wang, email:ldwang2007@126.com] Note: This abstract was not presented at the meeting. Citation Format: Jian Liang Lu, Jian Liang Lu, Rui Ping Xu, Bei Li, Li Xin Wan, Ming Yao Chen, Chun Jiang Liu, Zhan Qiang Han, Fang Fang Shen, Jian Bo Zhao, Hai Zhou Guo, Wei Cao, Bing Yu Fan, Li Dong Wang. Impact of gender on survival of the patients with esophageal squamous cell carcinoma at a single institute in China [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3269. doi:10.1158/1538-7445.AM2017-3269

Abstract 5715: Gene body methylation and expression of SHOX2 gene are potent prognostic markers for survival in intermediate grade gliomas and renal cancers

Abstract Background: Previous data indicated that low level of promoter methylation of the SHOX2 gene was a prognostic marker for worse progression-free survival for non-small cell lung cancer. Purpose: (a) to determine the relationship between SHOX2 gene methylation and expression; b) to determine whether SHOX2 gene methylation and expression were prognostic markers for other cancers. Methods: We examined multiple methylation and expression datasets available from The Cancer Genome Atlas (TCGA) and other previously published studies. Data from a total of more than 1000 intermediate grade gliomas and 1100 renal cancer cases were examined, along with smaller number of corresponding non-malignant tissues. We performed Kaplan-Meier survival analyses and univariate and multivariate Cox regression model analyses. Results: SHOX2 gene contains three CpG islands encompassing the promoter region and body. Methylation of various regions of SHOX2 gene body was significantly positively correlated with its expression in gliomas and renal cancer. Aberrantly high methylation and expression of SHOX2 gene, which were significantly higher than the corresponding nonmalignant tissues, were identified in subsets of gliomas and renal cancers. Survival analysis of patients indicated that the methylation and expression of SHOX2 gene in gliomas and renal cancer (both clear cell and papillary cell carcinomas) were highly potent markers for poor survival. We further investigated the combination of SHOX2 with other known clinically relevant glioma markers (IDH genotype status, TERT expression, 1p/19q chromosome co-deletion, MGMT methylation, ATRX mutation and NES expression). When combined with SHOX2 expression, we identified subsets of glioma patients with significantly favorable survival outcomes, especially in the subgroup (i.e., IDH wild-type) associated with worse prognosis for each individual marker. Multivariate analysis demonstrated that SHOX2 was a potent independent survival marker for gliomas. Conclusion: Gene body methylation and expression of SHOX2 gene are tightly positively correlated and are potent new markers for overall survival prognosis for intermediate grade gliomas and renal cancer. The combination of IDH or other relevant prognostic markers with SHOX2 identified intermediate grade glioma subsets with improved survival outcomes. Citation Format: Yu-An Zhang, Yunyun Zhou, Xin Luo, Guanghua Xiao, Adi F. Gazdar. Gene body methylation and expression of SHOX2 gene are potent prognostic markers for survival in intermediate grade gliomas and renal cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5715. doi:10.1158/1538-7445.AM2017-5715

Development of a Ki-67-based clinical trial assay for neoadjuvant endocrine therapy response monitoring in breast cancer

PurposeThe recent publication of the ACOSOG Z1031 trial results demonstrated that Ki-67 proliferation marker-based neoadjuvant endocrine therapy response monitoring could be used for tailoring the use of adjuvant chemotherapy in ER+HER2-negative breast cancer patients. In this paper, we describe the development of the Ki-67 clinical trial assay used for this study.MethodsKi-67 assay assessment focused on reproducing a 2.7% Ki-67 cut-point (CP) required for calculating the Preoperative Endocrine Prognostic Index and a 10% CP for poor endocrine therapy response identification within the first month of neoadjuvant endocrine treatment. Image analysis was assessed to increase the efficiency of the scoring process. Clinical outcome concordance for two independent Ki-67 scores was the primary performance metric.ResultsDiscordant scores led to a triage approach where cases with complex histological features that software algorithms could not resolve were flagged for visual point counting (17%). The final Ki-67 scoring approach was run on T1/2 N0 cases from the P024 and POL trials (N = 58). The percent positive agreement for the 2.7% CP was 87.5% (95% CI 61.7–98.5%); percent negative agreement 88.9% (95% CI: 65.3–98.6%). Minor discordance did not affect the ability to predict similar relapse-free outcomes (Log-Rank P = 0.044 and P = 0.055). The data for the 10% early triage CP in the POL trial were similar (N = 66), the percentage positive agreement was 100%, and percent negative agreement 93.55% (95% CI: 78.58–99.21%). The independent survival predictions were concordant (Log-rank P = 0.0001 and P = 0.01).ConclusionsWe have developed an efficient and reproducible Ki-67 scoring system that was approved by the Clinical Trials Evaluation Program for NCI-supported neoadjuvant endocrine therapy trials. Using the methodology described here, investigators are able to identify a subgroup of patients with ER+HER2-negative breast cancer that can be safely managed without the need of adjuvant chemotherapy.

Minimally invasive mitral valve annuloplasty confers a long-term survival benefit compared with state-of-the-art treatment in heart failure with functional mitral regurgitation

BackgroundClinical impact of the minimally invasive surgical mitral valve annuloplasty (MVA) of functional mitral regurgitation (FMR) in systolic heart failure on top of the state-of-the-art standards of care remains controversial. Therefore, we aimed to compare clinical outcomes of isolated MVA using the mini-invasive videothoracoscopic approach versus the state-of-the-art (CON=conservative) treatment in patients with chronic systolic heart failure and symptomatic FMR. MethodsThe study population consisted of 379 patients (age 68.9±11.0years, 62.8% males) with left ventricular (LV) systolic dysfunction, symptomatic FMR and previous heart failure hospitalization. A total of 167 patients underwent undersized MVA and 212 patients were treated conservatively. A concomitant MAZE was performed in 53 (31.7%) patients. ResultsIn the MVA group, the periprocedural and the 30-day mortality were 1.2% and 4.8%, respectively. During the median follow-up of 7.1years (IQR 3.5–9.8years) a total of 74 (44.3%) and 138 (65.1%) died in the MVA and the CON group, respectively (p<0.001). The lowest mortality was observed in MVA combined with MAZE (22.6%; p<0.01). In Cox regression analysis, age, MVA with MAZE emerged as independent predictors of both all-cause mortality and rehospitalizations for heart failure (all p<0.05). MVA was associated with significantly greater symptomatic improvement and reduction of FMR than the conservative treatment (both p<0.001). Reverse LV remodeling was observed only in the MVA combined with MAZE group (p<0.01). ConclusionsIn patients with symptomatic FMR, minimally invasive MVA, in particular in combination with MAZE, confers an independent long-term survival benefit compared with the state-of-the-art treatment.

Predictors of overall and recurrence-free survival after neoadjuvant chemotherapy for gastroesophageal adenocarcinoma: Pooled analysis of individual patient data (IPD) from randomized controlled trials (RCTs)

BackgroundNeoadjuvant chemotherapy improves prognosis of patients with locally advanced gastroesophageal adenocarcinoma. The aim of this study was to identify predictors for postoperative survival following neoadjuvant therapy. These could be useful in deciding about postoperative continuation of chemotherapy. MethodsThis meta-analysis used IPD from RCTs comparing neoadjuvant chemotherapy with surgery alone for gastroesophageal adenocarcinoma. Trials providing IPD on age, sex, performance status, pT/N stage, resection status, overall and recurrence-free survival were included. Survival was calculated in the entire study population and subgroups stratified by supposed predictors and compared using the log-rank test. Multivariable Cox models were used to identify independent survival predictors. ResultsFour RCTs providing IPD from 553 patients fulfilled the inclusion criteria. (y)pT and (y)pN stage and resection status strongly predicted postoperative survival both after neoadjuvant therapy and surgery alone. Patients with R1 resection after neoadjuvant therapy survived longer than those with R1 resection after surgery alone. Patients with stage pN0 after surgery alone had better prognosis than those with ypN0 after neoadjuvant therapy. Patients with stage ypT3/4 after neoadjuvant therapy survived longer than those with stage pT3/4 after surgery alone. Multivariable regression identified resection status and (y)pN stage as predictors of survival in both groups. (y)pT stage predicted survival only after surgery alone. ConclusionAfter neoadjuvant therapy for gastroesophageal adenocarcinoma, survival is determined by the same factors as after surgery alone. However, ypT stage is not an independent predictor. These results can facilitate the decision about postoperative continuation of chemotherapy in pretreated patients.

Cytoreductive nephrectomy in the era of targeted therapies: a review.

In the pre-targeted therapy era, palliative cytoreductive nephrectomy combined with cytokine immunotherapy was the standard treatment protocol for the management of metastatic renal cell carcinoma. The introduction of targeted therapies has improved response rates, median survival and overall prognosis when compared to immunotherapy. The role of cytoreductive nephrectomy in providing an independent survival advantage when used alongside immunotherapy has been demonstrated by two randomised controlled trials. However, with the new shift in improved treatment outcomes from cytokine immunotherapy to targeted therapies, the continuing role of cytoreductive nephrectomy as a viable surgical treatment method remains controversial.

Biopsy versus resection for the management of low-grade gliomas

This is an updated version of the original Cochrane review published in 2013, Issue 4.Low-grade gliomas (LGG) constitute a class of slow-growing primary brain neoplasms. Patients with clinically and radiographically suspected LGG have two initial surgical options, biopsy or resection. Biopsy can provide a histological diagnosis with minimal risk but does not offer a direct treatment. Resection may have additional benefits such as increasing survival and delaying recurrence, but is associated with a higher risk for surgical morbidity. There remains controversy about the role of biopsy versus resection and the relative clinical outcomes for the management of LGG. To assess the clinical effectiveness of biopsy compared to surgical resection in patients with a new lesion suspected to be a LGG. The following electronic databases were searched in 2012 for the first version of the review: Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 11), MEDLINE (1950 to November week 3 2012), Embase (1980 to Week 46 2012). For this updated version, the following electronic databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 5), MEDLINE (Nov 2012 to June week 3 2016), Embase (Nov 2012 to 2016 week 26). All relevant articles were identified on PubMed and by using the 'related articles' feature. We also searched unpublished and grey literature including ISRCTN-metaRegister of Controled Trials, Physicians Data Query and ClinicalTrials.gov for ongoing trials. We planned to include patients of any age with a suspected intracranial LGG receiving biopsy or resection within a randomized clinical trial (RCT) or controlled clinical trial (CCT). Patients with prior resections, radiation therapy, or chemotherapy for LGG were excluded. Outcome measures included overall survival (OS), progression-free survival (PFS), functionally independent survival (FIS), adverse events, symptom control, and quality of life (QoL). A total of 1375 updated citations were searched and critically analyzed for relevance. This was undertaken independently by two review authors. The original electronic database searches yielded a total of 2764 citations. In total, 4139 citations have been critically analyzed for this updated review. No new RCTs of biopsy or resection for LGG were identified. No additional ineligible non-randomized studies (NRS) were included in this updated review. Twenty other ineligible studies were previously retrieved for further analysis despite not meeting the pre-specified criteria. Ten studies were retrospective or were literature reviews. Three studies were prospective, however they were limited to tumor recurrence and volumetric analysis and extent of resection. One study was a population-based parallel cohort in Norway, but not an RCT. Four studies were RCTs, however patients were randomized with respect to varying radiotherapy regimens to assess timing and dose of radiation. One RCT was on high-grade gliomas (HGGs) and not LGG. Finally, one RCT evaluated diffusion tensor imaging (DTI)-based neuro-navigation for surgical resection. Since the last version of this review, no new studies have been identified for inclusion and currently there are no RCTs or CCTs available on which to base definitive clinical decisions. Therefore, physicians must approach each case individually and weigh the risks and benefits of each intervention until further evidence is available. Some retrospective studies and non-randomized prospective studies do seem to suggest improved OS and seizure control correlating to higher extent of resection. Future research could focus on RCTs to determine outcomes benefits for biopsy versus resection.