Long-term Survival Outcomes In Patients Research Articles

Impact of unplanned readmission to the same facility within 30 days following robot-assisted and laparoscopic hemicolectomy for early-onset non-metastatic colon cancer.

111 Background: Colon cancer in younger populations has risen in recent years, prompting changes in screening guidelines. Hemicolectomy remains integral for standard treatment for non-metastatic early-onset colon cancer, and many institutions have adopted robot-assisted approaches for this procedure. However, high costs associated with this technology along with mixed data regarding survival benefits and post-surgical complications warrant further investigations on the specific advantages of robot-assisted surgery. This study aims to examine the impact of unplanned readmission to the same facility within 30 days following surgery for patients receiving robot-assisted and laparoscopic hemicolectomy on long-term survival for early-onset non-metastatic colon cancer to see how current paradigms of colon cancer treatment extend to early-onset patients. Methods: The National Cancer Database was used to identify patients under the age of 50 receiving a minimally invasive hemicolectomy for primary non-metastatic colon cancer diagnosed between 2016-2020. Patients were stratified based on surgical approach and whether they underwent an unplanned readmission to the same facility within 30 days following surgery, and survival differences were calculated log-rank test and Cox regression analysis that included co-variates related to tumor characteristics, patient demographics, and facility characteristics. Results: 5,076 patients were identified, with 577 receiving a robot-assisted approach and 4,499 receiving a laparoscopic approach. Multivariate analysis found no significant difference in long-term survival between patients receiving a laparoscopic versus robot-assisted approach (HR: 0.893, 95% CI: 0.687-1.161, p=0.398). Additionally, multivariate analysis found that unplanned readmission within 30 days did not have a significant impact on long-term survival outcomes for patients receiving a robot-assisted approach (HR: 0.856, 95% CI: 0.257-2.848, p=0.800), but it did find worsened survival outcomes for the laparoscopic approach (HR: 1.535, 95% CI: 1.070-2.203, p=0.020). Conclusions: Patients receiving laparoscopic hemicolectomy for early-onset non-metastatic colon cancer appear to have worsened overall long-term survival outcomes when undergoing an unplanned readmission to the same facility within 30 days of surgery when compared to patients receiving a robot-assisted surgical approach. However, it also appears that overall, both surgical approaches have similar overall long-term survival. Further research on how robot-assisted surgery impacts survival and post-surgical complications in patients with early-onset non-metastatic colon cancer is warranted to examine how this advancing technology could improve cancer care.

Total intravenous or inhalational volatile anaesthesia and survival after colorectal cancer surgery: a Swedish national registry study.

Retrospective studies suggest that inhalational volatile anaesthetic agents may contribute to an increased risk of metastasis and reduction in survival rates when used during cancer surgery. This relationship may vary between cancer types due to different tumour biology and differences in surgical procedures. This study aimed to investigate the relationship between the type of anaesthetic used for maintenance of anaesthesia (propofol or inhalational volatile anaesthetic agent) and survival in patients with stage 1-3 colorectal cancer who underwent resection surgery under general anaesthesia in Sweden between 2014 and 2019. We identified patients from the Swedish Colorectal Cancer Registry. Their data, including cancer characteristics and adjuvant treatment, were then merged with information from the Swedish Peri-operative Registry. The primary outcome was overall survival, with disease-free survival as a secondary outcome. Of the 11,598 patients included, 8161 had colon cancer and 3437 had rectal cancer. General anaesthesia was maintained with propofol in 2346 (20%) patients, while 9252 (80%) received an inhalational volatile anaesthetic agent. In the unmatched cohort, patients who had general anaesthesia maintained with propofol for colon cancer surgery showed improved survival compared with those receiving an inhalational volatile anaesthetic agent (hazard ratio 0.83, 95%CI 0.72-0.95, p = 0.008). After 1:2 propensity score matching, we observed no significant difference in survival rates in this group (hazard ratio 0.89, 95%CI 0.76-1.04, p = 0.127). In the rectal cancer group, there was no difference in survival in either the unmatched cohort (hazard ratio 0.83, 95%CI 0.65-1.08, p = 0.166) or after propensity score matching (hazard ratio 0.95, 95%CI 0.71-1.25, p = 0.702). There was no significant difference in disease-free survival in either type of cancer. We found no association between the choice of agent for maintenance of anaesthesia and long-term survival outcomes in patients with colorectal cancer.

Prognostic importance of an indicator related to systemic inflammation and insulin resistance in patients with gastrointestinal cancer: a prospective study.

Systemic inflammation (SI) and insulin resistance (IR) are correlated to the progression of gastrointestinal (GI) cancer. Therefore, this study aimed to analyze the potential clinical value of the C-reactive protein-triglyceride-glucose index (CTI) in relation to SI and IR in patients with GI cancer. This prospective cohort study included patients with GI cancer. Patient data were collected from Fujian Cancer Hospital as an external validation cohort. Prognostic AUC, time-dependent ROC curve, C-index, and calibration curve analyses were used to predict the efficacy and accuracy of CTI survival prediction. Multivariate survival analysis was performed to evaluate the potential prognostic value of the CTI. Multiple logistic regression was performed to evaluate the relationship between the CTI and 90-day and 180-day mortalities. We divided 1520 patients with GI cancer (mean age, 60.39 ± 11.3 years; male sex, 67%) into a training cohort and internal validation cohort; the external validation cohort included 476 patients. Prognostic AUC, time-dependent ROC curve, C-index, and calibration curve analyses of all cohorts indicated that the CTI could reliably and accurately predict the short- and long-term survival outcomes of patients with GI cancer. Multivariate survival analysis showed that for each standard deviation increase in the CTI, the risk of death increased by 32%, 21%, and 40% in the training, internal validation, and external validation cohorts, respectively. A high CTI was correlated to worse survival in patients with GI cancer (training cohort, hazard ratio [HR]=1.67, 95% confidence interval [CI]=1.35-2.08; internal validation cohort, HR=1.51, 95% CI=1.07-2.14, and external validation cohort, HR=1.59, 95% CI=1.18-2.13). In different tumor subgroups, a high CTI predicted worse survival outcomes for upper GI cancer (HR=1.54, 95% CI=1.18-2.01) and lower GI cancer (HR=1.98, 95% CI=1.36-2.86). Multivariate logistic regression analysis showed that a high CTI was positively correlated with 90-day (odds ratio [OR]=3.25, 95% CI=1.75-6.23) and 180-day mortalities (OR=2.66, 95% CI=1.72-4.15). The CTI is related to SI and IR and can predict the short- and long-term prognosis of patients with GI cancer. Evaluation of the CTI could provide clinicians with an effective tool for predicting the prognosis of patients with GI cancer. https://www.chictr.org.cn/showproj.html?proj=31813, identifier ChiCTR1800020329.

Association Between Hypoglycemia Agents and Long-term Survival Outcomes for Patients with Non-muscle-invasive Bladder Cancer Treated with Intravesical Bacillus Calmette-Guérin Immunotherapy.

There is a lack of data on the impact of hypoglycemia agents, especially metformin, on prognosis for non-muscle-invasive bladder cancer (NMIBC). Our aim was to investigate the association between hypoglycemia agents, especially metformin, and long-term survival outcomes for patients with NMIBC treated with bacillus Calmette-Guérin. All patients with NMIBC treated with intravesical BCG therapy from 2001 to 2020 were identified in a territory-wide database in Hong Kong. Patients were stratified into two groups according to whether or not they were taking a hypoglycemia agent at BCG treatment initiation. We analyzed data for overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and progression-free survival (PFS) using the Kaplan-Meier method. Multivariable Cox regression analysis was used to adjust for potential confounding factors and estimate hazard ratio (HRs) and 95% confidence intervals (CIs). Subgroup analyses were conducted to assess the specific influence of metformin on survival outcomes. Of 2602 patients with NMIBC treated with intravesical BCG, 19.5% (n=507) were taking a hypoglycemia agent at BCG initiation (treatment group) and 80.5% (n=2095) were not (control group). At median follow-up of 11 yr, Kaplan-Meier analysis revealed a significant difference in OS between the groups (p<0.01), but not in CSS (p=0.36), RFS (p=0.19), or PFS (p=0.05). Subgroup analysis comparing outcomes for patients taking metformin, patients taking a hypoglycemia agent other than metformin, and control subjects revealed significant differences in OS (p<0.01) and RFS (p=0.02), but not in CSS (p=0.59) or PFS (p=0.08). Multivariable Cox regression analysis identified metformin-based treatment for hypoglycemia as an independent risk factor for RFS (HR 1.22, 95% CI 1.02-1.46), whereas hypoglycemia agents other than metformin were not significantly associated with RFS (HR 0.71, 95% CI 0.47-1.06). Metformin-based hypoglycemia treatment was an independent risk factor for RFS in BCG-treated NMIBC. Hypoglycemia treatment with an agent other than metformin was not related to long-term survival outcomes. We investigated the relationship between treatment for high blood sugar and long-term survival for patients with intermediate-risk or high-risk non-muscle-invasive bladder cancer. The patients had received BCG (bacillus Calmette-Guérin) treatment in Hong Kong for their bladder cancer over the past two decades. Our results show that metformin, but not other drugs used to treat high blood sugar, was associated with poorer survival free from bladder cancer recurrence for these patients.

Successful long-term outcome of neoadjuvant sequential targeted therapy and chemotherapy for stage III non-small cell lung carcinoma: 10 case series.

Perioperative treatment of locally advanced non-small cell lung cancer (NSCLC) is attracting attention. The effect of neoadjuvant tyrosine kinase inhibitor (TKI) therapy on postoperative long-term outcomes in patients with driver gene mutations remains unclear. The aim of this study was to clarify the long-term survival outcomes of patients with stage III NSCLC harboring driver gene mutations who received preoperative TKI therapy. Between January 2016 and December 2018, 10 patients with clinical stage III NSCLC with driver gene mutations were treated with TKIs [epidermal growth factor receptor (EGFR) mutation, n=9; anaplastic lymphoma kinase (ALK) fusion, n=1]. One patient refused surgery. The remaining nine patients received sequential chemotherapy followed by surgery. Postoperatively, six patients received adjuvant chemotherapy, and TKIs were readministered in four patients. The main adverse events of TKIs were grade 3 liver damage and grade 3 skin rash, which required a change in the drug from gefitinib to afatinib and dose reduction, respectively. In all 10 patients, the radiological response to TKIs was greater than the partial response, and nine patients underwent radical surgery. Although viable cancer cells remained in all patients with EGFR mutations, a pathological complete response was obtained in the patient with ALK fusion. No mortality or major morbidity was observed perioperatively. Of the patients who underwent surgery, 3 were alive without recurrence, while 6 had distant metastasis, including 5 with brain metastasis. Seven of the nine patients who underwent surgery were still alive after a median follow-up period of 77.2 months. Successful long-term outcomes were achieved after sequential targeted therapy and chemotherapy, followed by surgery for stage III NSCLC. However, it is noteworthy that postoperative treatment may have also contributed to minimizing postoperative recurrence.

Tislelizumab for consolidation therapy in patients with pathologically residual Esophageal Squamous Cell Carcinoma after definitive concurrent Chemoradiotherapy: a multicenter, randomized, controlled phase II trial.

Although concurrent Chemoradiotherapy (cCRT) is presently the standard intervention for patients with inoperable, locally advanced Esophageal Squamous Cell Carcinoma (ESCC), it has been associated with poor long-term survival outcomes. Notably, Immune Checkpoint Inhibitors (ICIs) improve the long-term survival of Esophageal Cancer (EC) patients, with manageable Adverse Effects (AEs). Herein, 90 patients with residual pathology after radical simultaneous Radiotherapy (RT) for inoperable/refused-to-operate ESCC were enrolled and randomized into two treatment groups (Chemotherapy+immunotherapy and chemotherapy alone) in a 2:1 ratio. This study will also discuss the value of immunotherapy in improving long-term survival outcomes in patients with pathological residuals after concurrent RT for locally advanced, inoperable ESCC.Clinical trial registration: http://www.chictr.org.cn/identifier is ChiCTR2200063345.

Clinical Presentation and Long-Term Survival Outcomes of Patients With Monoclonal Gammopathy of Renal Significance (MGRS): A Multicenter Retrospective Study.

MGRS are new rare clinical entities, whose recognition and optimal management is evolving. To implement real-life data, we retrospectively analysed a multicentre cohort of 60 patients with renal biopsy-proven MGRS receiving mainly novel treatments (between 2006 and 2021) in eight Italian centres. Based on renal biopsy, patients were divided into two subgroups: AL amyloidosis (70%, n = 42) and other-MGRS (30%, n = 18). Baseline characteristics follow typical manifestations of MGRS disorders in terms of small clonal burden, laboratory and clinical features. More patients with AL amyloidosis had monotypic lambda light-chain disease, estimated glomerular filtration rate (eGFR) ≥ 60 mL/min and nephrotic proteinuria than other-MGRS group. The most widely used drug was bortezomib, and about one-third of patients underwent ASCT. Overall response rate was 86% with no differences in the two subgroups. However, high-quality hematologic responses ≥very good partial response (VGPR) were greater in AL amyloidosis than in other-MGRS group (67% vs 28%, p = 0.015). The depth of haematological response influenced renal response, obtained in 32 (59%) of evaluable patients, similarly in the subgroups. Indeed, 75% patients with ≥ VGPR (p = 0.049) and none with stable disease (p ≤ 0.001) obtained a renal response. No association between renal response and histotypes (p = 0.9) or type of first-line therapy (p = 0.3) was found. At a median follow-up of 54.4 months (IQR 24.8-102.8), median progression-free survival (PFS) was 100.1 months (95% CI 34.9-NR), and median overall survival not reached (95% CI 129.8-NR). No significant difference emerged between the two groups in terms of survival outcomes. Achieving ≥ VGPR was confirmed as the main independent predictor of prolonged PFS in the general population (HR = 0.29, p = 0.023) and AL amyloidosis group (HR 0.23; p = 0.023). Preserved renal function at diagnosis was predictive of improved PFS in the AL amyloidosis group (eGFR ≥ 60 mL/min: HR = 0.003; p = 0.018; eGFR 30-60 mL/min: HR = 0.04, p = 0.046). Further research is warranted to develop standardised response criteria and treatment strategies to improve MGRS management.

Peak VO2 is associated with cardiac functional response and long-term survival in patients with heart failure and atrial fibrillation undergoing catheter ablation

Abstract Background Contemporary guidelines recommend Catheter Ablation (CA) in patients with persistent Atrial Fibrillation (AF) with Heart Failure with reduced ejection fraction (HFrEF). It is challenging to prospectively predict who will respond. We have previously described the long-term survival outcomes of patients in this cohort.(1) However, the clinical characteristics associated with HF response and long-term clinical outcomes have not been reported. Objective To evaluate the association of HF parameters with cardiac functional response to CA and long-term survival after CA. Methods Post-hoc, long-term follow-up of mortality was undertaken in patients enrolled in the CAMTAF and ARC-HF RCTs. Both studies enrolled patients with persistent AF and HFrEF between 2005 and 2012 and randomised to first-time CA or medical therapy alone. Left ventricular ejection fraction (LVEF) and peak VO2 were measured in both studies at baseline and 12-month follow-up. The Universal Definition of HF response (LVEF improves by &amp;gt;10% points or to an LVEF &amp;gt;50%) was used.(2,3) Multi-variate logistic regression was used to determine features associated with HF response and Cox proportional hazards modelling for survival. Results 102 patients underwent randomisation with 52 assigned to CA. The mean age was 60.2 ±10.7 years with 93 (91.2%) male. The mean Baseline LVEF was 31 ±11% and peak VO2 was 1815 ±642mlmin-1. Baseline LVEF did not correlate significantly with Minnesota Living with Heart Failure (MLWHF) score (r=-0.11, p=0.29) whereas baseline peak VO2 did (r=-0.28, p&amp;lt;0.01). In patients randomised to CA, the median (IQR) improvement in LVEF was +8.4% (0, 15%). 22/52 (42.3%) patients were classified as Responders based on the Universal Criteria. Responders were younger (54.7 ±10.6 years vs 61.8 ±11.4, p=0.03) and had a higher mean HR on baseline Holter monitoring (89 ±14bpm vs 79 ±11bpm p&amp;lt;0.01) than non-responders. There was no significant difference in sex, baseline MLWHF scores, BNP levels or LVEF between groups (28±9% vs 31 ±9%, p=0.19). Responders had a significantly higher peak VO2 at baseline than Non-Responders (1972 ±668mlmin-1 vs 1556 ±580mlmin-1, p=0.03). On multivariate analysis, mean heart rate on Holter monitoring and peak VO2 were significantly associated with Responder status post-ablation. (Table 1a) During a median follow-up of 7.8 (3.9 –9.9) years, 34 (33.3%) patients died, including 17 (32.7%) patients in the CA arm. On univariate analysis, baseline peak VO2 was significantly greater of survivors at 5 years (1867 ±624 mlmin-1 vs 1259 ±497 mlmin-1, p&amp;lt;0.01). On multivariate Cox regression analysis, the peak VO2 at baseline was the only significant predictor of survival (Table 1b). Conclusion Peak VO2 at baseline was associated with baseline symptom status, the short-term LVEF response to CA and long-term survival and may be a useful stratification tool to aid patient selection for CA.1a. Regression for 6-month LVEF response1b. Regression for long-term mortality

Comparative Analyses of the Outcomes Between Lobectomies and Trisegmentectomies/Lingulectomies in the Surgical Management of Clinical Stage I Left Upper Lobe Non-small Cell Lung Cancer.

Lobectomies are the standard surgical intervention for lung cancer; however, recently, surgeons have considered segmentectomies for smaller tumors, with their potential for favorable survival outcomes while preserving lung function. The surgical outcomes of trisegmentectomies/lingulectomies and lobectomies for clinical stage I left upper lobe (LUL) non-small cell lung cancers (NSCLCs) remain undetermined. Thus, our study aimed to assess the differences between the short-term surgical and long-term survival outcomes in patients with clinical stage I LUL NSCLC who underwent trisegmentectomies/lingulectomies and those who underwent lobectomies. Between 2011 and 2021, we retrospectively reviewed the data of 377 patients with clinical stage I NSCLC who had undergone LUL lobectomies or trisegmentectomies/lingulectomies. Patients were categorized into two subcohorts according to tumor size, i.e. 0-2 and 2-4 cm. To ensure preoperative demographic comparability, 1:1 propensity-score matching (PSM) was performed. This study focused on the 2-4cm subcohort. Post-PSM, patients who underwent trisegmentectomies/lingulectomies had quicker operations and shorter postoperative hospital and intensive care unit lengths of stay than those who underwent lobectomies. Post-PSM, no statistically significant differences in progression-free survival (PFS) or overall survival (OS) were observed between the segmentectomy and lobectomy groups in both the0-2 and 2-4cm subcohorts. The multivariate analysis revealed that different surgical methods were not statistically significant factors for either PFS or OS. Trisegmentectomies/lingulectomies are a feasible option for clinical stage I NSCLC, with better perioperative outcomes and similar survival rates when compared with LUL lobectomies.

Analysis of postoperative complications and long term survival following radical gastrectomy for patients with gastric cancer

This study aimed to analyze the complications and long-term survival outcomes in patients who underwent radical gastrectomy for gastric cancer, as well as to identify the risk factors associated with postoperative complications. After conducting a comprehensive search within the medical records system, a total of 2508 patients who underwent radical gastrectomy and met the inclusion criteria were enrolled. Of the 2508 patients, 301 were diagnosed with postoperative complications. The pathological data, postoperative recovery, and survival outcome were compared between complication and control group. Subsequently, univariate and multivariate logistic regression analyses were conducted to identified the risk factors. According to the Clavien-Dindo grading criteria for postoperative complications, the proportions of grade I, II, III, IV, and V complications following radical gastrectomy were observed to be 28.2%, 42.9%, 19.6%, 8.0%, and 1.3%, respectively. The presence of postoperative complications significantly prolonged the duration of gastrointestinal decompression (P < 0.001), catheter retention (P < 0.001), fasting (P < 0.001), and hospitalization (P < 0.001). Additionally, it had a detrimental impact on survival outcomes. Age > 65years [odds ratio (OR) = 1.378, P = 0.020], presence of diabetes (OR = 2.042, P < 0.001), operative duration > 215 min (OR = 1.450, P = 0.006), intraoperative blood loss > 275 ml (OR = 1.474, P = 0.004), and Roux-en-Y anastomosis for both whole stomach (OR = 1.567, P = 0.021) and distal gastric cancer (OR = 2.083, P = 0.003) were identified as independent risk factors for postoperative complications. This study analyzed the complications and survival outcomes following radical gastrectomy, and investigated the predictors for postoperative complications, thereby providing valuable guidance on the prevention and management of surgical complications in gastric cancer.

Rapid response system and outcomes in patients who underwent cranial neurosurgery: a nationwide cohort study.

Hospitals use rapid response systems (RRSs) to identify and treat patients whose conditions rapidly worsen after admission. However, no study has examined the effects of RRS deployment on the clinical outcomes of patients undergoing cranial neurosurgery. Thus, the authors investigated whether use of RRS affects clinical outcomes in these patients. This nationwide, retrospective, population-based cohort study included adult patients who underwent cranial neurosurgery in South Korea between January 1, 2019, and December 31, 2021. The authors classified patients admitted to hospitals that operated RRS into the RRS group and those admitted to hospitals that did not operate RRS into the non-RRS group. Overall, 73,600 hospitalized patients who underwent cranial neurosurgery were included in this study. These patients were divided into 2 groups: 38,544 (52.4%) were included in the RRS group and 35,066 (47.6%) in the non-RRS group. After propensity score matching, 40,058 patients (20,029 in each group) remained. The in-hospital mortality rate was 10.1% (2022/20,029) for the non-RRS group and 8.9% (1792/20,029) for the RRS group. In the logistic regression analysis, the in-hospital mortality rate of the RRS group was 12% (OR 0.88, 95% CI 0.82-0.94, p < 0.001) lower than that of the non-RRS group. The 1-year all-cause mortality rate was 26.5% (5300/20,029) in the non-RRS group and 24.6% (4921/20,029) in the RRS group. In the Cox regression analysis, the 1-year all-cause mortality rate of the RRS group was 9% (HR 0.91, 95% CI 0.88-0.95; p < 0.001) lower than that of the non-RRS group. This population-based cohort study revealed that implementing RRS was associated with enhanced short- and long-term survival outcomes in patients who underwent cranial neurosurgery. The authors' findings indicate that the introduction of RRS can enhance patient survival rates after cranial neurosurgery.

Retrospective Analysis of Radiofrequency Ablation in Patients with Small Solitary Hepatocellular Carcinoma: Survival Outcomes and Development of a Machine Learning Prognostic Model.

The effectiveness of radiofrequency ablation (RFA) in improving long-term survival outcomes for patients with a solitary hepatocellular carcinoma (HCC) measuring 5 cm or less remains uncertain. This study was designed to elucidate the impact of RFA therapy on the survival outcomes of these patients and to construct a prognostic model for patients following RFA. This study was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2017, focusing on patients diagnosed with a solitary HCC lesion ≤5 cm in size. We compared the overall survival (OS) and cancer-specific survival (CSS) rates of these patients with those of patients who received hepatectomy, radiotherapy, or chemotherapy or who were part of a blank control group. To enhance the reliability of our findings, we employed stabilized inverse probability treatment weighting (sIPTW) and stratified analyses. Additionally, we conducted a Cox regression analysis to identify prognostic factors. XGBoost models were developed to predict 1-, 3-, and 5-year CSS. The XGBoost models were evaluated via receiver operating characteristic (ROC) curves, calibration plots, decision curve analysis (DCA) curves and so on. Regardless of whether the data were unadjusted or adjusted for the use of sIPTWs, the 5-year OS (46.7%) and CSS (58.9%) rates were greater in the RFA group than in the radiotherapy (27.1%/35.8%), chemotherapy (32.9%/43.7%), and blank control (18.6%/30.7%) groups, but these rates were lower than those in the hepatectomy group (69.4%/78.9%). Stratified analysis based on age and cirrhosis status revealed that RFA and hepatectomy yielded similar OS and CSS outcomes for patients with cirrhosis aged over 65 years. Age, race, marital status, grade, cirrhosis status, tumor size, and AFP level were selected to construct the XGBoost models based on the training cohort. The areas under the curve (AUCs) for 1, 3, and 5 years in the validation cohort were 0.88, 0.81, and 0.79, respectively. Calibration plots further demonstrated the consistency between the predicted and actual values in both the training and validation cohorts. RFA can improve the survival of patients diagnosed with a solitary HCC lesion ≤5 cm. In certain clinical scenarios, RFA achieves survival outcomes comparable to those of hepatectomy. The XGBoost models developed in this study performed admirably in predicting the CSS of patients with solitary HCC tumors smaller than 5 cm following RFA.

The Silent Threat: A Retrospective Cohort Study on the Impact of Prediabetes on ST-Elevation Myocardial Infarction Survival-A Call to Action!

Background: Prediabetes is frequently underdiagnosed and undertreated, yet it poses significant cardiovascular risks. This study investigates the impact of prediabetes on short- and long-term survival outcomes in patients who experienced ST-elevation myocardial infarction (STEMI). Methods: In this retrospective, single-center cohort study, we evaluated 725 STEMI patients stratified into non-diabetic, prediabetic, and diabetic groups based on HbA1c levels at presentation. A Kaplan-Meier survival analysis was employed to compare long-term outcomes over a three-year follow-up period. Cardiovascular risk factors, including hypertension and dyslipidemia, were analyzed across the groups. The discriminatory power of HbA1c for predicting all-cause mortality was assessed using an Area Under the Receiver Operating Characteristic (AUROC) analysis. Results: Of the 725 patients, 407 (56.1%) were non-diabetic, 184 (25.4%) were prediabetic, and 134 (18.5%) were diabetic. Prediabetic patients exhibited significant additional cardiovascular risk factors, such as arterial hypertension (67.4%) and dyslipidemia (78.3%), with prevalence rates between those of non-diabetic and diabetic patients. The Kaplan-Meier analysis revealed that at a three-year follow-up, prediabetic patients faced a survival disadvantage, with a significant decrease in survival rates compared to non-diabetic patients (log-rank p = 0.016); their survival outcomes approached those of diabetic patients (p = 0.125). The AUROC analysis demonstrated that HbA1c was a significant predictor of short- and long-term mortality, with a cut-off value of 5.75% and an Area Under the Curve (AUC) of 0.580-0.617 (95% CI: 0.458-0.721), indicating a moderate ability to predict survival in patients with STEMI. Conclusions: Prediabetes significantly worsens survival outcomes following STEMI, nearly approaching the risk level of diabetes. Integrating rigorous cardiovascular risk management strategies for prediabetic individuals, including lifestyle interventions and potentially pharmacological treatments, could prevent the progression to diabetes and mitigate associated cardiovascular risks.

Measurable residual disease monitoring in AML: Prospects for therapeutic decision-making and new drug development.

Measurable residual disease (MRD) is strongly associated with risk of relapse and long-term survival outcomes in patients with acute myeloid leukemia (AML). Apart from its clear prognostic impact, MRD information is also increasingly used to guide therapeutic decision-making, including selection of appropriate patients for stem cell transplant, use of post-transplant maintenance, and candidacy for non-transplant maintenance therapies or MRD-directed clinical trials. While much progress has been made in accurately assessing MRD and understanding its clinical importance, many questions remain about how to optimize MRD testing and guide treatment decisions for individual patients. In this review, we discuss the common methods to assess MRD in AML and the prognostic impact of MRD across common clinical scenarios. We also review emerging and investigational strategies to target MRD and discuss some of the important unanswered questions and challenges in the field.

Characteristics and outcomes of salvage surgery after immune checkpoint inhibitor therapy for initially unresectable non-small cell lung cancer.

Immune checkpoint inhibitors (ICIs) improved the long-term survival outcomes in patients with advanced non-small cell lung cancer (NSCLC), whereas the role of salvage surgery after ICIs was unknown. The object of this study was to investigate characteristics and outcomes of patients who underwent salvage surgery after ICIs. Retrospective chart review was performed on the basis of our multi-institutional database in search of consecutive patients who underwent salvage surgery after ICIs for initially unresectable NSCLC between 2016 and 2022. Patient characteristics, intraoperative findings, perioperative outcomes, histopathological findings, progression-free survival (PFS), and overall survival (OS) were investigated. Fifteen patients with a median age of 71 years were included in the study. The surgical approach was open thoracotomy in 5 and robotic or thoracoscopic surgery in 10 patients. Resection was performed for primary lesions in 8 and metastatic lesions in 7 patients. Postoperative complication was noted in 1 patient with grade 1 phrenic nerve palsy. The median PFS was 47.9 months, and the median OS was not reached. Three-year PFS was 0% in those with metastatic lesions and 87.5% in those with primary lesions (P=0.12). Salvage surgery after ICIs may be associated with low perioperative morbidity and acceptable long-term outcomes in selected patients. Salvage resection of primary lesions may be associated with more favorable PFS than of metastatic lesions.

Impact of self-expanding metal stents on long-term survival outcomes as a bridge to surgery in patients with colon cancer obstruction: Current state and future prospects.

Since self-expanding metal stents (SEMS) were first introduced in acute colon cancer obstruction, the increased rate of primary anastomosis and improved quality of life following SEMS placement have been clearly shown. However, it was demonstrated that SEMS are associated with higher recurrence rates. Although several trials have shown that overall and disease-free survival in patients following SEMS placement is similar with patients undergoing emergency surgery, obstruction and a high incidence of recurrence imposed many concerns. The optimal time interval from SEMS to surgery is still a matter of debate. Some studies have recommended a time interval of ~2 weeks between SEMS insertion and elective surgery. A prolonged interval of time from SEMS insertion to elective surgery and the administration of neoadjuvant chemotherapy (NAC) has been proposed. SEMS-NAC might have advantages for improving the surgical and long-term survival outcomes of patients with acute colon cancer obstruction, which is an optional approach in the management of acute colon cancer obstruction.

Long-term survival analysis of robotic esophagectomy for esophageal cancer.

Robotic esophagectomy has improved early outcomes and enhanced the quality of lymphadenectomy for esophageal cancer surgery. This study aimed to determine risk factors for long-term survival following robotic esophagectomy and the causes of long-term mortality. We included patients who underwent robotic esophagectomy at our institute between 2010 and 2022. Robotic esophagectomy was defined as a surgical procedure performed robotically in both the abdomen and thorax. Robotic esophagectomy was performed in patients at all stages, including advanced stages, even in patients with stage IV and supraclavicular lymph node metastasis. A total of 340 patients underwent robotic esophagectomy during the study period. Ivor-Lewis operation and McKeown operation were performed on 153 (45.0%) and 187 (55.0%) patients, respectively. The five-year survival rates based on clinical stages were as follows: 85.2% in stage I, 62.0% in stage II, 54.5% in stage III, and 40.3% in stage IV. Risk factors for long-term survival included body mass index, Charlson comorbidity index, clinical stages, and postoperative complications of grade 4 or higher. Among the cases of long-term mortality, recurrence accounted for 42 patients (61.7%), while non-cancer-related death occurred in 26 patients (38.2%). The most common cause of non-cancer-related death was malnutrition and poor general condition, observed in 11 patients (16.2%). Robotic esophagectomy has demonstrated the ability to achieve acceptable long-term survival rates, even in patients with cervical lymph node metastasis. However, addressing high-grade postoperative complications and long-term malnutrition remains crucial for further improving the long-term survival outcomes of patients with esophageal cancer.

Select gene mutations associated with survival outcomes in ER-positive ERBB2-negative early-stage invasive breast cancer: A single-institutional tissue bank study.

The prognostic capability of targeted sequencing of primary tumors in patients with estrogen receptor-positive, human epidermal growth factor receptor-2-negative early-stage invasive breast cancer (EBC) in a real-world setting is uncertain. Therefore, we aimed to determine the correlation between a 22-gene mutational profile and long-term survival outcomes in patients with ER+/ERBB2- EBC. A total of 73 women diagnosed with ER+/ERBB2- EBC between January 10, 2004, and June 2, 2008, were followed up until December 31, 2022. Univariate and multivariate Cox models were constructed to plot the relapse-free survival (RFS) and overall survival (OS). The log-rank test derived p-value was obtained. For external validation, we performed a survival analysis of 1163 comparable patients retrieved from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) dataset. At follow-up, 16 (21.9%) patients had relapsed, while 21 (nearly 29%) harbored mutant genes. Thirty-three missense mutations were detected in 14 genes. The median ages were 51 and 46 years in patients with and without mutations, respectively. Patients with any mutation had a 1.85-fold higher risk of relapse (hazard ratio [HR]: 1.85, 95% confidence interval [CI]: 0.60-5.69) compared to those without any mutation. Patients who harbored any of the six genes (MAP2K4, FGFR3, APC, KIT, RB1, and PTEN) had a nearly 6-fold increase in the risk of relapse (HR: 5.82, 95% CI: 1.31-18.56; p = 0.0069). Multivariate Cox models revealed that the adjusted HR for RFS and OS were 6.67 (95% CI: 1.32-27.57) and 8.31 (p = 0.0443), respectively. METABRIC analysis also demonstrated a trend to significantly worse RFS (p = 0.0576) in the subcohort grouped by having a mutation in any of the six genes. Our single-institution tissue bank study of Taiwanese women with ER+/ERBB2- EBC suggests that a novel combination of six gene mutations might have prognostic capability for survival outcomes.

Impacts of Tumor Stage at Diagnosis and Adjuvant Therapy on Long-Term Survival Outcomes in Patients With Triple-Negative Breast Cancer Achieving Pathologic Complete Response After Neoadjuvant Chemotherapy

BackgroundIt remains unknown whether the tumor stage at initial diagnosis and adjuvant treatments had any impacts on the long-term survival outcomes of patients with triple-negative breast cancer (TNBC) achieving pathologic complete response (pCR) following neoadjuvant chemotherapy (NACT). MethodsClinical stage II-III patients with TNBC who achieved pCR after NACT were identified from the Surveillance, Epidemiology, and End Results (SEER) program (SEER cohort) and the National Clinical Research Center for Cancer (Tianjin) in China (TMUCIH cohort). Survival analyses were conducted based on tumor stages and the types of adjuvant treatment received by the patients. The outcomes of interest were overall survival (OS) and breast cancer-specific survival (BCSS). ResultsThe TMUCIH cohort comprised 178 patients with a median follow-up of 55.5 months. Two and 3 patients experienced BCSS and OS events, respectively. The SEER cohort included 1218 patients with a median follow-up of 65.5 months, where 53 and 78 patients experienced BCSS and OS events, respectively. Patients diagnosed with stage III disease had significantly higher hazards of death compared to stage II disease (OS: hazard ratio [HR], 3.34; 95% confidence interval [CI], 1.84-6.07; P < .001; BCSS: HR, 2.86; 95% CI, 1.38-5.92; P < .001). Adjuvant systemic and radiation therapy did not confer additional benefits to OS and BCSS. ConclusionTumor stage at initial diagnosis remains an independent predictor of long-term survival outcomes in patients with TNBC achieving pCR after NACT. Postoperative adjuvant chemotherapy and radiation therapy do not appear to provide additional benefit to their long-term prognosis.

Short-term and long-term survival outcomes in patients with invasive lobular carcinoma vs. invasive ductal carcinoma of the breast.

e12564 Background: Invasive lobular carcinoma (ILC) accounts for 10% of all invasive breast cancer and has distinct histological and biological features compared to the most common breast cancer histological subtype, invasive ductal carcinoma (IDC). ILC is more endocrine sensitive and chemotherapy resistant than IDC and has a different metastatic pattern. There is lack of conclusive data on the differences in survival outcomes between ILC and IDC. We aimed to assess the short-term and long-term survival outcomes in patients with ILC and IDC in a large population database. Methods: This is a retrospective, population-based study using data from the Surveillance, Epidemiology, and End Results database. We included women &gt; 18 years with stage I-III ILC or IDC diagnosed from 1992-2020. Multivariable logistic regression was used to assess factors associated with different treatment modalities in patients with IDC vs. ILC. We estimated breast cancer-specific survival (BCSS) using Kaplan-Meier methods and their survival rates were compared using the log-rank test. We analyzed BCSS at different time points using a cox regression model with time-varying coefficients. Results: 343,397 patients with IDC and 39,859 patients with ILC were included in this study. Patients with ILC were older (63.0 ± 12.5 years vs. 59.2 ± 13.5 years, p&lt;0.001). There were more non-Hispanic white patients with ILC vs. IDC (76% vs. 67%, p&lt;0.001). Patients with ILC had more advanced disease: more stage III disease (16% vs. 11%, p&lt;0.001), more T3-T4 disease (15% vs. 6%, p&lt;0.001), and more N2-N3 disease (12% vs. 9%, p&lt;0.001). Patients with ILC also had a higher frequency of hormone receptor positive disease (97% vs. 81%, p&lt;0.001). Fewer patients with ILC had grade 3-4 tumors (9% vs. 36%, p&lt;0.001). Our multivariate analysis showed that compared to patients with IDC, patients with ILC were more likely to undergo mastectomy (OR=1.85, p &lt; 0.001) and radiation (OR=1.20, p&lt;0.001), but less likely to receive chemotherapy (OR= 0.92, p&lt;0.001). After adjusting for clinicopathological features, treatment modalities, and socioeconomic variables; compared to patients with IDC, patients with ILC had better BCSS in the first five years (HR=0.71, p &lt;0.001), but worse BCSS in later years (HR=1.30, p&lt;0.001 in year 6-10; HR=1.75, p&lt;0.001 in year 11-15; HR=2.17, p&lt;0.001 in year 16-20). Annual hazard models show that IDC peaked at recurrence in the first 5 years after diagnoses, and the hazard rate declines gradually after that. ILC peaked at recurrence in the first 5 years after diagnosis with minimal decrease in hazard rates after that. Conclusions: BCSS of patients with ILC is better in early years but worse in later years compared to patients with IDC. Future studies are needed to identify predictors of late relapses in ILC, and novel therapeutic strategies are required for these patients.