Long-term Survival Rate Of Patients Research Articles

Allogeneic hematopoietic stem cell transplantation in acute leukemia patients with the SET-NUP214 fusion gene: Efficacy and survival analysis

Objective: To investigate the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with acute leukemia who are positive for the SET-NUP214 fusion gene (SET-NUP214+AL). Methods: This was a retrospective case series study. Clinical data of 18 patients with SET-NUP214+AL who received allo-HSCT in the First Affiliated Hospital of Soochow University and Soochow Hongci Hematology Hospital from December 2014 to October 2021 were retrospectively analyzed to investigate treatment efficacy and prognosis. The Kaplan-Meier method was used for survival analysis. Results: Of the 18 patients, 12 were male and 6 were female, and the median age was 29 years (range, 13-55 years). There were six cases of mixed phenotype acute leukemia (three cases of myeloid/T, two cases of B/T, one case of myeloid/B/T), nine cases of acute lymphoblastic leukemia (ALL) (one case of B-ALL and eight cases of T-ALL), and three cases of acute myeloid leukemia. All patients received induction chemotherapy after diagnosis, and 17 patients achieved complete remission (CR) after chemotherapy. All patients subsequently received allo-HSCT. Pre-transplantation status: 15 patients were in the first CR, 1 patient was in the second CR, 1 was in partial remission, and 1 patient did not reach CR. All patients were successfully implanted with stem cells. The median time of granulocyte and platelet reconstitution was +12 and +13 days, respectively. With a median follow-up of 23 (4-80) months, 15 patients survived, while 3 patients died. The cause of death was recurrence of SET-NUP214+AL after transplantation. After allo-HSCT, 5 patients relapsed. The estimated 3-year overall survival (OS) and relapse-free survival (RFS) rates were 83.3%±15.2% and 55.4%±20.7%, respectively. Among the 15 patients who achieved CR before transplantation, there was no significant difference in OS and RFS between haploidentical HSCT and matched sibling donor HSCT (all P>0.05). Conclusions: Allo-HSCT can improve the prognosis and long-term survival rate of patients with SET-NUP214+AL. Disease recurrence is the most important factor affecting long-term survival.

Long-term prognosis of patients with chronic heart failure and reduced left ventricular ejection fraction receiving cardiac contractility modulation therapy: the impact of comorbidity burden on outcomes

Aim . To investigate the association between comorbidity burden and long-term clinical outcomes of patients with reduced left ventricular ejection fraction (HFrEF) undergoing cardiac contractility modulation (CCM). Methods . Our study included 59 patients with HFrEF, functional class II/III (NYHA), sinus rhythm, who underwent implantation of CCM system between September 2015 and December 2018 and were further followed by a multidisciplinary team. A mean follow-up period was 1916±102 days. All-cause mortality and heart transplantation were considered as primary composite endpoint. The secondary composite endpoint included all-cause mortality, heart transplantation, im- plantable cardioverter defibrillator shocks due to ventricular tachyarrhythmia and hospitalizations due to decompensated HF. Predicted survival rate were calculated using MAGGIC Risk Calculator and Seattle Heart Failure Model (SHFM). Initially, the Charlson comorbidity index (CCI) was calculated for all patients. Results. Three- and five-year survival rates were 79,7% and 66,1%, respectively, which were significantly higher than predicted by MAGGIC (p=0.02) and SHFM (p=0.01). The median time to the primary endpoint was 1494 days and the annual mortality was 7%. Patients with HF NYHA class III, chronic kidney disease and CCI ≥7 points had worse prognosis (p 1 =0.002, p 2 =0.003, p 3 =0.04 (log-rank test). There was a significant decrease in number of hospitalized pa- tients due to HF decompensated during CCM (p˂0.001) compared with the six-month period before the system implantation. Patients with CCI value ≥ 7 points reached secondary composite endpoint faster (p=0.002 and p=0.004 for three-year and five-year follow-up periods, respectively (log-rank test)). Conclusion . Long-term survival rates of patients with HFrEF II/III (NYHA) receiving CCM and managed on multidisciplinary team were significantly higher than predicted. The heavy comorbidity burden negatively impacts on the clinical course and outcomes of HF patients following CСM implantation. Applying the Charlson index can be useful in a comprehensive assessment of the prognosis and determining the target population for the expensive implantable devices, including CCM, in risk stratification and decision-making algorithms.

Treatment of bilateral Wilms’ tumor in children: how to improve the application of nephron-sparing surgery

To summarize the experience of nephron-sparing surgery (NSS) for bilateral Wilms tumors (BWT) in children. This study included children with BWT admitted to our hospital between January 2008 and June 2022. The details of the treatments and outcomes were analyzed. In all, 70 patients (39 males and 31 females) were enrolled, including 66 patients with synchronous tumors and 4 patients with metachronous tumors. The median age at diagnosis was 13 (3-75) months. Overall, 59 patients received preoperative chemotherapy and 45.8% (54/118) of the 118 sides of WT achieved a partial response (PR). Of the 70 patients, 48 (68.6%) underwent bilateral NSS and 22 (31.4%) underwent unilateral NSS and contralateral total nephrectomy. The proportion of bilateral NSS in the preoperative chemotherapy group was significantly higher than in the non-chemotherapy group (P = 0.031). Additionally, there were 26, 25, 14, and 5 cases of stage I, stage II, stage III, and stage IV, respectively. Among the 70 children, 16 had a recurrence, and 8 died. The 4years EFS and OS were 67.9% and 89.3%, respectively. The long-term survival rates of patients with BWT improved. Hence, preoperative chemotherapy should be administered to enhance the use of NSS in BWT.

Clinical factors affecting the long-term survival of breast cancer patients.

The average 5-year survival rate of breast cancer (BC) patients has been significantly prolonged with new therapeutic methods. However, their effects on BC patient long-term survival rates are unclear. Therefore, this study aimed to analyze the specific clinical factors that can affect BC long-term survival. Here, we conducted a retrospective study and analyzed long-term survival using data of 3,240 BC patients from 1977 to 2005 from the Genotype-Tissue Expression (GTEx) database using the Kaplan-Meier method. Breast tumor size and stage were negatively correlated with long-term survival, but age showed no significant correlation. Estrogen receptor (ER) and progesterone receptor (PR) expression were each positively correlated with patient survival time, while ERBB2 receptor (HER2) expression was negatively correlated with survival time. Patients with high Nottingham prognostic index (NPI) values did not benefit from available therapies. Furthermore, breast-conserving surgery is more conducive to BC patient long-term survival than mastectomy. Early detection and breast-conserving surgery may support long-term survival for BC patients. Elevated expression of ER and PR were both associated with longer patient survival time, while positive expression of HER2 showed the opposite trend. The long-term survival rates of patients with high NPI values can potentially be increased.

Family Knowledge, Attitudes, and Practices Toward Severe Congenital Neutropenia.

Severe congenital neutropenia is a rare disorder. The survival and quality of life of patients radically improved through infection prevention, use of granulocyte colony-stimulating factor, and the appropriate use of antibiotics during infections. The aim of this study was to evaluate the precautions taken by families to prevent infections, the level of knowledge regarding the disease, and the impact of external factors such as education and economic status on behavior and compliance in patients and caregivers in terms of the following treatment protocols. Questionnaires were designed with the aim of determining how the social, cultural, and economic conditions of the families of children with severe congenital neutropenia affected their behavior and knowledge levels. They were completed using one-on-one video interviews with the caregivers. Thirty-one patients from 25 families were enrolled into the study. No correlations between family disease knowledge, parent education levels, working status of the mother, sibling numbers, economic status, ease of hospital access, and/or residential location were found. An increase in disease knowledge of patients and caregivers, as well as proven approaches to living with the disease, would directly correlate to increased life quality and long-term survival rates of patients.

Evaluation of clinical and prognostic factors for primary gastric diffuse large B-cell lymphoma: Single-center experience.

Primary gastric lymphomas, which make up the vast majority of extranodal non-Hodgkin lymphoma, are rare and the most common subtype is primary gastric diffuse large B-cell lymphoma (PG-DLBCL). In our study, we investigated the clinical and prognostic factors of this lymphoma type as a single-center experience. Between January 2001 and February 2021, 91 patients aged ≥18 years, registered with the diagnosis of primary gastric DLBCL, diagnosed histopathologically, and whose evaluation parameters were reached, were retrospectively scanned. The median age of 91 patients with a diagnosis of PG-DLBCL was 58 (20-81, minimum-maximum) years. Of the patients, 64.8% were men and 35.2% were women. While the number of patients with an International Prognostic Index (IPI) score of 0-2 (low-low-intermediate risk) was 54 (59.4%), the number of patients with an IPI score of 3 (high intermediate) was 19 (20.9%), and the number of patients with an IPI score of 4-5 (high risk) was 18 (19.8%). While 52.7% of the patients had a complete response, 20.9% had a partial response, 3.3% had stable disease, and 23.1% had progressive disease. The 10-year event-free survival (EFS) and overall survival (OS) rates for all patients, respectively, were 52.1% and 53.2%. We found factors affecting survival in univariate analysis; age groups (≤60/>60), ECOG groups (0-1/≥2), Lugano stage (I-II/III-IV), LDH level (normal/high), IPI risk groups (low/low-intermediate/high-intermediate/high) and radiotherapy (yes/no). In multivariate analysis, only; age groups (≤60/>60) and IPI risk groups (low/low-intermediate/high-intermediate/high) were found to be independent factors affecting survival. In addition, in our study, we determined that the division of the IPI intermediate risk group into low intermediate and high intermediate is one of the factors predicting prognosis. Few studies of PG-DLBCL have investigated the long-term survival rates of patients and primarily examined small patient groups because of the low incidence of the disease. In our study, we think that detailed evaluation of age and especially IPI risk groups play a role in predicting survival.

Long-term Survival Rate Following Myocardial Infarction and the Effect of Discharge Medications on the Survival Rate.

The evaluation of the risk factors associated with the long-term survival rate of patients with myocardial infarction (MI) and the effects of discharge medications can significantly help select the most effective strategies for improving treatment. A retrospective cohort study. The participants of this retrospective cohort study were 21,181 patients who suffered from MI and were hospitalized in the cardiac care unit (CCU) of different public, private, and military hospitals in Iran from 20 March 2013 to 20 March 2014. Participants were followed up until February 2020 for any cardiovascular disease (CVD) mortality. To evaluate survival rate, the differences between groups, and the factors related to MI death, Kaplan-Meier, log-rank test, and Cox proportional-hazards model were used, respectively. One, three, five, and seven-year survival rates of patients were 88%, 81%, 78%, and 74%, respectively. Regarding the interaction effect of prescribed medical drugs, the highest 7-year survival rate of 86% (95% CI: 72%, 93%) was related to people who consumed anticoagulants, aspirin, clopidogrel, beta blockers, angiotensin-converting enzymes (ACEs), and angiotensin II receptor antagonist simultaneously. Considering the effect of other variables, the consumption of anticoagulants was associated with a decrease in survival rate (HR=1.13 CI: 1.06, 1.19). As evidenced by the results of this study, different combinations of prescribed medication drugs had protective effects on long-term mortality compared to the group without any drug. Nonetheless, according to the drugs in each combination therapy, this protective effect ranged from HR=0.27 to HR=0.89. It is recommended that further studies compare the long-term effects of different drug combinations and also consider adherence to treatment in evaluating the effects of these combinations.

Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy.

Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. The need for an upgrade was the leading indication for TLE in only 36-66% of patients. In 42.0-57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1-76.4% of patients, functional leads were retained in 20.2-31.9%, non-functional leads were left in place in 0.0-1.1%, and non-functional superfluous leads were extracted in 3.6-8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death.

Retracted: Effect of Apatinib Combined with Seggio on the Expression of Serum AFP and CA724 and Long-Term Survival Rate in Patients with Advanced Gastric Cancer Undergoing Comfortable Nursing Intervention.

[This retracts the article DOI: 10.1155/2022/2004973.].

Does Examined Lymph Node Count Influence Survival in Surgically Resected Early‑stage Pulmonary Typical Carcinoid Tumors?

We aimed to evaluate the prognostic impact of the number of examined lymph nodes (ELNs) in resected early‑stage pulmonary typical carcinoid tumors (TC). Patients who underwent sublobar resection and lobectomy for stage T1N0M0 TC between 2004 and 2016 were identified from the Surveillance, Epidemiology, and End Results database and enrolled in the ELNs≥4 or ELNs<4 groups (optimal cutoff using X-tile). Propensity score matching balanced baseline intergroup characteristics. Kaplan-Meier curve and log-rank test were used to calculate and compare overall survival (OS) rates. Cox proportional hazard model analysis was used to identify independent prognostic factors. Among 2234 participants, 961 (43.02%) and 1273 (56.98%) had ELNs <4 and ≥4, respectively. The 5-year OS was significantly higher in the ELNs≥4, compared with ELNs<4, group, both before and after propensity score matching (95.41% vs. 89.71%, P<0.001 and 95.24% vs. 90.28%, P=0.004), respectively. Surgical subgroup analysis confirmed this survival trend in the lobectomy and sublobar resection groups. Tumor size-based subgroup analysis revealed superior OS with ELNs≥4 than ELNs<4 for tumors measuring 1.1-3.0cm but not for tumors <1.0cm. Multivariate Cox analysis showed that ELN≥4 contributed to improved OS. The higher the ELNs, the greater the long-term survival rate in patients with early‑stage TC. Therefore, we recommend at least 4 ELNs as the cutoff value for evaluating the prognosis of early‑stage TCs, especially for patients with a tumor size of 1.1 to 3.0cm.

Home Mechanical Ventilation in Children: Experience of Paediatric Pulmonology Divisions in Istanbul

Advances in technology in recent years increased the long-term survival rate of patients with chronic respiratory failure. As a result, the number of patients receiving long-term home mechanical ventilation (LTHV) support is increasing worldwide. The most important step in the management of patients with home mechanical ventilation (HMV) is to ensure adequate oxygenation and ventilation. Successful care at home requires the presence of trained caregivers and accessibility to medical devices and a care team. The aims of this study were, to describe the characteristics of children on LTHV in Istanbul, to compare the patients receiving non-invasive ventilation (NIV) and invasive ventilation, and to evaluate the frequency and risk factors of hospital admission in this population.

Prediction of one-year adverse clinical outcomes by macrophage migration inhibitory factor in stemi patients

Biomarkers have taken one of the first places as diagnostic and prognostic tools in ST-segment elevation myocardial infarction (STEMI) and are consequently widely used as predictors of short-term and long-term prognosis. One of the promising biomarkers for early cardiovascular outcomes prediction is the pro-inflammatory cytokine macrophage migration inhibitory factor (MIF).&#x0D; The aim of the study was to elucidate a plausible predictive value of the MIF levels for one-year clinical outcomes in STEMI patients who underwent primary percutaneous coronary intervention (PCI).&#x0D; Materials and methods. 134 STEMI patients were enrolled in the study after receiving voluntary informed consent. All patients underwent conventional investigations, and additionally, the MIF levels were determined at baseline, directly before and after PCI. During 1-year follow-up, 37 % of patients reached the endpoint, which was composite and included all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for unstable angina, heart failure decompensation, and urgent revascularization.&#x0D; Results. We have found that pre-PCI MIF levels &gt; 3934 pg/mL (AUC=0.7; 95 % CI 0.578 to 0.753; Youden index=0.31; p=0.008) might be an independent predictor of composite endpoints with sensitivity 54 % and specificity 82 %. A positive correlation between MIF and inflammatory biomarkers was revealed (WBC count r=0.33, p=0.0001; CRP r=0.19, p=0.032). Adverse outcomes associated with higher pre- and post-PCI MIF levels (OR 1.0, 95 % CI 1.0001–1.0008; p=0.013 and OR 1.0, 95 % CI 1.0001–1.0009; p=0.019) and CRP that determined during the first week after the event (OR 1.0, 95 % CI 1.005–1.2, p=0.03). Kaplan-Meier analysis has shown a substantially lower long-term survival rate in patients with a MIF level &gt; 3493 pg/ml compared to a MIF level ≤ 3493 pg/ml (Log rank=0.00025).&#x0D; Conclusions. The MIF levels exceeding 3934 ng/ml were associated with a higher risk of one-year adverse clinical outcomes in STEMI patients who underwent primary PCI.

The Effect of PD-1 Inhibitor Combined with Chemotherapy on the Level of Peripheral Blood T Lymphocytes among Patients with Non-Small-Cell Lung Cancer and Its Relationship with Prognosis.

Objective To explore the effect of combined treatment of PD-1 inhibitor and chemotherapy on the level of peripheral blood T lymphocytes in non-small-cell lung cancer (NSCLC) patients and its relationship with prognosis. Methods Retrospective analysis was conducted on 150 NSCLC patients treated in Guangxi Medical University Affiliated Tumor Hospital from June 2018 to September 2020, including 77 patients treated with PD-1 inhibitor combined with chemotherapy as the observation group (OG) and 73 patients with chemotherapy alone as the control group (CG). Therapeutic efficacy, immune function indexes, serum tumor markers, incidence of adverse reactions during hospitalization, 1-year survival rate, and life quality after 6 months of treatment were observed and compared between two groups. Results Compared to the CG, the therapeutic effect of OG was evidently better. Six months after treatment, levels of CD4+/CD8+, NK cells, and CD4 + in two groups were elevated markedly, and indexes of OG were notably and comparatively higher than those in the other group. After treatment, OG was observed with a marked decline regarding levels of CYFRA21-1, CEA, and CA125 compared to those in the CG; and there was no notable difference in terms of adverse reaction occurrence between two groups, but the 1-year survival rate and 6-month life quality in OG over ranked those in CG. Conclusion For NSCLC patients, the PD-1 inhibitor given on the basis of chemotherapy can further improve the clinical efficacy and improve immune function and long-term survival rate of patients on the premise of ensuring the safety of treatment, which is worth promoting in clinical practice.

Expression Levels and Clinical Significance of Serum miR-497, CEA, CA24-2, and HBsAg in Patients with Colorectal Cancer.

The objective of the current study was to look at the levels of blood micro ribonucleic acid- (miR-) 497, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 24-2, and hepatitis B surface antigen (HBsAg) in patients with colorectal cancer (CRC), as well as the clinical importance of these markers in CRC patients. The serum levels of miR-497, CEA, CA24-2, and HBsAg were compared between 60 patients with CRC (observation group) and another 60 patients with colorectal polyps (control group). The 4 indicators in patients with lymph node metastasis and liver metastasis were compared. The diagnostic effects of 4 detection methods and the combined detection were analyzed, and the influence of 4 indicators on the 5-year cumulative survival rate of patients was discussed. The results showed that the serum levels of miR-497 and HBsAg were lower, and the levels of CEA and CA24-2 were higher in the observation group (P < 0.05). The combined detection had the best diagnostic effect, and CEA alone had the best prediction effect. The serum level of miR-497 was significantly lower in patients with lymphatic metastasis, with the significantly higher levels of CEA and CA24-2 (P < 0.05). The HBsAg level of patients with liver metastases was greatly lower than that of patients without liver metastases (P < 0.05). The 5-year cumulative survival rate of patients with high levels of CEA and CA24-2 was significantly lower than that of patients with low level of CEA. The 5-year cumulative survival rate was lower in patients with low level of HBsAg, but the difference was small. The 5-year cumulative survival rate of patients with elevated serum miR-497 was observably lower. In conclusion, combined detection could diagnose CRC more accurately. Serum miR-497, CEA, and CA24-2 were important in the diagnosis of lymph node metastasis of CRC. HBsAg did a better job of predicting liver metastases in CRC patients. High level of CEA significantly reduced the cumulative survival rate of CRC patients and could predict the long-term survival rate of patients. Serum levels of miR-497, CEA, CA24-2, and HBsAg played a positive role in the diagnosis and evaluation of CRC and could identify lymph node and liver metastases, having a high clinical guidance value.

Exploration of the amino acid metabolic signature in anthracycline-induced cardiotoxicity using an optimized targeted metabolomics approach based on UPLC-MS/MS.

Although anthracyclines improve the long-term survival rate of patients with cancer, severe and irreversible myocardial damage limits their clinical application. Amino acid (AA) metabolism in cardiomyocytes can be altered under pathological conditions. Therefore, exploring the AA metabolic signature in anthracycline-induced cardiotoxicity (AIC) is important for identifying novel mechanisms. We established mouse and cellular models of Adriamycin (ADR)-induced cardiac injury. We observed a decreased expression of troponins I (cTnI) after ADR treatment and ADR accelerated the degradation of cTnI, implying that AA metabolism could be altered in AIC. Using a targeted AA metabolomics approach based on ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), the AA metabolic signatures in the sera of AIC mice and supernatant samples of ADR-treated H9c2 cardiomyocytes were analyzed. The levels of 14 AA metabolites were altered in ADR-treated mice (p < 0.05). Via bioinformatics analysis, we identified nine differential AA metabolites in mice and five differential AA metabolites in ADR-treated H9c2 cardiomyocytes. Three AAs with increased levels (L-glutamate, L-serine, and L-tyrosine) overlapped in the two models, suggesting a possible mechanism of AA metabolic impairment during AIC. The metabolic pathways perturbed by AIC involved aminoacyl-tRNA biosynthesis and alanine, aspartate, and glutamate metabolism. Our data suggests that ADR perturbed AA metabolism in AIC models. Moreover, the targeted AA metabolomics approach based on UPLC-MS/MS can be a unique platform to provide new clues for the prevention and treatment of AIC.

Abstract 1491: Investigation of differentially expressed miRNAs in patients with gastric adenocarcinoma

Abstract Gastric cancer (GC) is one of the most common cancers and one of the leading causes of cancer related death worldwide. Although the treatment of GC patients has improved during the last decades, thanks to advancements in surgery, radiotherapy and chemotherapy, the long-term survival rates of patients with GC remains around 20%. In addition, late diagnosis usually occurs due to the absence of symptoms or the presence of non-specific symptoms in early stages of the disease. Thus, the continuous study of new strategies for early diagnosis and identification of novel therapeutic approaches is of great interest, to reduce the need for mutilating surgeries and morbid adjuvant therapies. Next-generation sequencing technologies unveiled new roles and functions of RNAs, particularly, non-coding RNAs. Among the most studied molecules, microRNAs (miRNAs) have been reported to play important roles in different physiological and pathological processes, including cancer. Therefore, the goals of this project are (1) to determine the miRNA profile of patients with GC using tumor tissue samples using next-generation sequencing; and (2) to validate the expression profile of differentially expressed (DE) miRNAs in serum from patients with GC. To identify DE microRNAs between GC tissues and gastric tissues from individuals without cancer, 24 samples (17 cancer and 7 controls) were sequenced using the Ion Torrent PGM (Thermo Fisher Scientific) sequencing equipment. Preliminary results indicate that there are 54 DE miRNAs among the 269 known human miRNAs identified, where 44 were upregulated, while 10 were downregulated in samples from GC patients when compared to samples from individuals without cancer. As expected, Over-Representation Analysis (ORA) revealed that the disease most frequently associated with these DE miRNAs is the digestive system neoplasm. Moreover, Gene Set Enrichment Analysis (GSEA) showed that neoplasm metastasis is the phenotype most associated with this subset of DE miRNAs, indicating that these miRNAs possibly contribute to cell invasion and migration in gastric tumors. To confirm these findings, further experiments are now being performed, such as validation of the DE miRNAs by qRT-PCR in tissue and serum of GC samples, as well as functional studies. Thereby, the identification of a circulating signature of miRNAs will allow a better understanding of physiopathology of gastric carcinogenesis and the identification of possible biomarkers, which may help in early diagnosis, prognosis, and development of novel anticancer therapies.Funding: MACS, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) grant # 2016/25562-0; MACS, Conselho Nacional de Pesquisa (CNPq) grant # 2018/301127-2; MACS, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) 23038051640/2009-01; BTRK, Postdoctoral Fellowship, FAPESP 2019/20592-6; CAP, CAPES Doctoral Fellowship 88882.430351/2019-01. Citation Format: Bruno Takao Real Karia, Camila Albuquerque Pinto, Leonardo Caires, Yeda Beatriz Louredo dos Santos, Fernanda Wisnieski, Carolina Gigek, Marilia de Arruda Cardoso Smith. Investigation of differentially expressed miRNAs in patients with gastric adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1491.

Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy.

The spread of SARS-CoV-2 caused a worldwide healthcare threat. High critical care admission rates related to Coronavirus Disease 2019 (COVID-19) respiratory failure were observed. Medical advances helped increase the number of patients surviving the acute critical illness. However, some patients require prolonged critical care. Data on the outcome of patients with a chronic critical illness (CCI) are scarce. Single-center retrospective study including all adult critically ill patients with confirmed COVID-19 treated at the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf, Germany, between 1 March 2020 and 8 August 2021. We identified 304 critically ill patients with COVID-19 during the study period. Of those, 55% (n = 167) had an ICU stay ≥21 days and were defined as chronic critical illness, and 45% (n = 137) had an ICU stay <21 days. Age, sex and BMI were distributed equally between both groups. Patients with CCI had a higher median SAPS II (CCI: 39.5 vs. no-CCI: 38 points, p = 0.140) and SOFA score (10 vs. 6, p < 0.001) on admission. Seventy-three per cent (n = 223) of patients required invasive mechanical ventilation (MV) (86% vs. 58%; p < 0.001). The median duration of MV was 30 (17–49) days and 7 (4–12) days in patients with and without CCI, respectively (p < 0.001). The regression analysis identified ARDS (OR 3.238, 95% CI 1.827–5.740, p < 0.001) and referral from another ICU (OR 2.097, 95% CI 1.203–3.654, p = 0.009) as factors significantly associated with new-onset of CCI. Overall, we observed an ICU mortality of 38% (n = 115) in the study cohort. In patients with CCI we observed an ICU mortality of 28% (n = 46) compared to 50% (n = 69) in patients without CCI (p < 0.001). The 90-day mortality was 28% (n = 46) compared to 50% (n = 70), respectively (p < 0.001). More than half of critically ill patients with COVID-19 suffer from CCI. Short and long-term survival rates in patients with CCI were high compared to patients without CCI, and prolonged therapy should not be withheld when resources permit prolonged therapy.

Long-term survival rates of patients with nasopharyngeal carcinoma treated by radiochemotherapy: a retrospective cohort study

BackgroundNasopharyngeal cancer (NPC) is showing an increasing incidence in Iran. Radiation is the main treatment of this cancer. Use of new techniques such as intensity-modulated radiotherapy (IMRT) is on the rise. Here, we aimed to evaluate the oncological outcomes of NPC patients treated with three-dimensional conformal radiotherapy (3DCRT) for a more reliable comparison with IMRT in the future.ResultsWe reviewed the medical records of 106 patients with NPC treated by definitive radiotherapy from 2007 to 2016. Patients were treated with 70 Gy in 2-Gy fractions. Twenty-one patients died during the follow-up period. Twenty-nine patients suffered from locoregional or distant recurrences. Of these, 6 recurred after 2 years of treatment completion. The 2-year and 5-year overall survival rates were 81% and 76%, respectively. The 2-year and 5-year progression-free survival rates were 72% and 63%, respectively. The 5-year locoregional recurrence and distant metastasis-free survival rates were 68% and 69%, respectively.ConclusionDue to high survival rates of NPC and the importance of receiving planned total dose of RT, the treatment-related toxicity and quality of life are critical considerations both for patients during active treatment and for survivors.

A Comprehensive Analysis of 5-Year Outcomes in Patients with Cancer Admitted to Intensive Care Units.

Background The aim of this study was to evaluate the long-term (5-year) clinical outcomes of patients who received intensive care unit (ICU) treatment using Korean nationwide data.Methods All patients aged >18 years with ICU admission according to Korean claims data from January 2008 to December 2010 were enrolled. These enrolled patients were followed up until December 2015. The primary outcome was ICU mortality.Results Among all critically ill patients admitted to the ICU (n=323,765), patients with cancer showed higher ICU mortality (18.6%) than those without cancer (13.2%, p<0.001). However, there was no significant difference in ICU mortality at day 28 among patients without cancer (14.5%) and those with cancer (lung cancer or hematologic malignancies) (14.3%). Compared to patients without cancer, hazard ratios of those with cancer for ICU mortality at 5 years were: 1.90 (1.87–1.94) for lung cancer; 1.44 (1.43–1.46) for other solid cancers; and 3.05 (2.95–3.16) for hematologic malignancies.Conclusion This study showed that the long-term survival rate of patients with cancer was significantly worse than that of general critically ill patients. However, short term outcomes of critically ill patients with cancer were not significantly different from those of general patients, except for those with lung cancer or hematologic malignancies.

Long-term Survival, Tolerability, and Safety of First-Line Bevacizumab and FOLFIRI in Combination With Ginsenoside-Modified Nanostructured Lipid Carrier Containing Curcumin in Patients With Unresectable Metastatic Colorectal Cancer.

Background:Colorectal cancer is the third most common malignant disease and the second leading cause of death worldwide. Previous studies showed improved bioavailability and cytotoxicity of ginsenoside-modified nanostructured lipid carrier containing curcumin (G-NLC) in human colon cancer cell lines. This study aimed to evaluate the safety and tolerability with long-term survival rates in patients with colorectal cancer with unresectable metastases after treatment with first-line bevacizumab/FOLFIRI (folinic acid, bolus/continuous fluorouracil, and irinotecan) in combination with a dietary supplement of G-NLC.Methods:This study was a prospective, observational, single-group analysis. The enrolled patients had colorectal cancer with unresectable metastases and were administered bevacizumab and FOLFIRI in combination with daily oral G-NLC as first-line treatment. Overall survival, progression-free survival, tumor response, and adverse events were evaluated.Results:A total of 44 patients were enrolled between 2015 and 2019. The median age was 65 (range 45-81) years and the sex ratio was 31:13 (male:female). The primary tumor locations were the colon (31 patients) and rectum (13 patients). The metastatic sites included, liver only (n = 20), lung only (n = 6), both liver and lung (n = 12), and others (n = 6). The median duration of curcumin supply was 7.9 (range 0.9-16.6) months. The most common grade 3 or higher adverse events were neutropenia (n = 15, 34.1%), followed by nausea (n = 4, 9.1%) and vomiting (n = 4, 9.1%). Within the median follow-up period of 22.8 months, the median overall survival was 30.7 months, and the median progression-free survival was 12.8 months. None of the patients achieved complete response (CR); however, 9 patients showed partial response (PR), and 3 patients underwent conversion surgery.Conclusions:Bevacizumab/FOLFIRI with G-NLC as first-line chemotherapy in patients with colorectal cancer with unresectable metastases presented comparable long-term survival outcomes with acceptable toxicity outcomes. Additional randomized controlled studies are needed to establish definitive conclusions regarding this new regimen for metastatic colorectal cancer.