Multivariate Analysis Research Articles

Clinical outcomes in older adults treated outside clinical studies: highlighting the octogenarian experience.

Clinical outcomes in older adults treated outside clinical studies: highlighting the octogenarian experience.

Parental presence in the pediatric intensive care unit reduces postoperative sedative requirements: A retrospective study

BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation, it can cause side effects and even iatrogenic complications. Since pediatric patients cannot adequately express the intensity or location of the pain, discriminating the cause of their irritability and agitation can be more complicated than in adults. Thus, sedation therapy for children requires more careful attention. AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit (PICU) postoperatively. METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan. The internal parental care protocol was developed and implemented by critical care team. During the pandemic, restrictions were also placed on parental presence in the PICU. We compare two groups: During restriction and after return to normal. The level of agitation was evaluated using the Richmond Agitation-Sedation Scale. Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy. RESULTS A total of 289 patients were included in the study. Of them, 167 patients were hospitalized during and 122 after the restrictions of parental care. In multivariate analysis, parental care was associated with lower odds of prescribing diazepam (odds ratio = 0.11, 95% confidence interval: 0.05-0.25), controlling for age, sex, cerebral palsy, and type of surgery. CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs, while no differences were observed for analgesics.

Cannabis use disorder and severe sepsis outcomes in cancer patients: Insights from a national inpatient sample

BACKGROUND The burden of cannabis use disorder (CUD) in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear. AIM To address this knowledge gap, especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer. METHODS By applying relevant International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes to the National Inpatient Sample database between 2016-2020, we identified CUD(+) and CUD(-) arms among adult cancer admissions with severe sepsis. Comparing the two cohorts, we examined baseline demographic characteristics, epidemiological trends, major adverse cardiac and cerebrovascular events, respiratory failure, hospital cost, and length of stay. We used the Pearson χ 2 d test for categorical variables and the Mann-Whitney U test for continuous, non-normally distributed variables. Multivariable regression analysis was used to control for potential confounders. A P value ≤ 0.05 was considered for statistical significance. RESULTS We identified a total of 743520 cancer patients admitted with severe sepsis, of which 4945 had CUD. Demographically, the CUD(+) cohort was more likely to be younger (median age = 58 vs 69, P < 0.001), male (67.9% vs 57.2%, P < 0.001), black (23.7% vs 14.4%, P < 0.001), Medicaid enrollees (35.2% vs 10.7%, P < 0.001), in whom higher rates of substance use and depression were observed. CUD(+) patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities. There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+) and CUD(-) cohorts on multivariable regression analysis. However, the CUD(+) cohort had lower all-cause mortality (adjusted odds ratio = 0.83, 95% confidence interval: 0.7-0.97, P < 0.001) and respiratory failure (adjusted odds ratio = 0.8, 95% confidence interval: 0.69-0.92, P = 0.002). Both groups had similar median length of stay, though CUD(+) patients were more likely to have higher hospital cost compared to CUD(-) patients (median = 94574 dollars vs 86615 dollars, P < 0.001). CONCLUSION CUD(+) cancer patients with severe sepsis, who tended to be younger, black, males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure. Future research should aim to better elucidate the underlying mechanisms for these observations.

Risk Factors for Postoperative Cognitive Dysfunction Following Multilevel Lumbar Spinal Fusion.

Retrospective observational cohort. To determine incidence of and risk factors for Post-operative Cognitive Dysfunction (POCD) following multilevel spine fusion. POCD is a serious, common and under-recognized complication in elderly patients undergoing surgery. Risk factors for POCD vary in the literature and include preoperative as well as intraoperative factors. A retrospective cohort of 566 thoracolumbar fusion cases with a minimum of 4 surgical levels were identified. Chart review was performed for occurrence of POCD and known risk factors for POCD. Anesthetic and surgical data included operative time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial line based mean arterial pressure (MAP) data was collected at 1-minute intervals and cumulative duration of MAP<65mmHg was recorded. Univariate and multivariate statistical analysis was used to investigate the relationship between demographic, preoperative and intraoperative risk factors and the occurrence of POCD. Overall, 70 out of 566 patients (12.4%) experienced POCD described most commonly as Encephalopathy (57, 81%), Delirium (8, 11%), Hallucinations (3, 4%) and Altered Mental Status (2, 3%). Patients who developed POCD were older (68.7yrs vs. 59.6yrs, P<0.001), had a worse ASA scores (2.9 vs. 2.7, P=0.004), higher BMI (32.0 vs. 30.0, P=0.007), a higher incidence of diabetes (31% vs. 16%, P=.002), and sleep apnea (47% vs. 28%, P=0.002). Intraoperatively patients who experienced POCD had greater fluid shifts and hemodynamic instability in terms of blood loss (800cc vs. 660cc, P=0.047), blood transfusion (350cc vs. 201cc, P=0.014), minutes of intraoperative hypotension (11.6 vs. 6.4, P=0.043) and vasopressor use (10604mcg vs. 6823mcg, P=0.029). Post-Operative Cognitive Dysfunction is associated with age, preoperative comorbidities and greater intraoperative hemodynamic instability. These factors present targets for optimization prior to surgery to lower the incidence of Post-Operative Cognitive Dysfunction.

Predictive Value of Pre-Transplant Monocyte-to-Lymphocyte Ratio for Delayed Graft Function in Kidney Transplant Recipients

Background: Delayed graft function (DGF) after kidney transplantation (KT) negatively impacts long-term allograft survival. Inflammatory and immune response markers in transplant recipients have been linked to allograft outcomes. However, the association between the pre-transplant monocyte-to-lymphocyte ratio (MLR) and DGF following KT has not been previously investigated.Methods: This study included 162 patients who underwent KT between January 1989 and December 2023. The optimal pre-transplant MLR cutoff for predicting DGF was identified using receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression analyses were performed to identify factors associated with DGF.Results: DGF occurred in 58 patients (35.8%). The optimal MLR cut-off for predicting DGF was 0.255 (Area under the curve (95% confidence interval) = 0.686 (0.603–0.769), P &lt; 0.001), with a sensitivity of 81.0% and specificity of 55.8%. In multivariate analysis, MLR ≥ 0.255 was independently associated with DGF (Odds ratio (95% confidence interval) = 3.74 (1.55–9.02), P = 0.003). Higher MLR values were also correlated with longer hospital stays.Conclusions: An elevated pre-transplant MLR was a significant predictor of DGF following KT. MLR may serve as a useful, non-invasive biomarker for risk stratification and prediction of post-transplant outcomes.

Correlations of vancomycin trough concentration and its efficacy and toxicity in patients in the intensive care unit

BACKGROUND Plasma concentration monitoring is crucial for optimizing vancomycin use, particularly in patients in the intensive care unit (ICU). However, the reference interval for vancomycin plasma concentration remains undetermined. AIM To evaluate the correlations of area under the curve (AUC0-24) and trough concentration (Cmin) with efficacy and nephrotoxicity in patients in the ICU. METHODS A total of 103 patients treated with vancomycin for methicillin-resistant Staphylococcus aureus infections were analyzed in this study. The associations of clinicodemographic characteristics (including sex, age, weight, infection sites, main etiologies of ICU cases, comorbidities, acute physiological chronic health evaluation II score, and mechanical ventilation) and pharmacokinetics (daily dose, Cmin, AUC0-24, and AUC0-24/minimum inhibitory concentration) with efficacy and nephrotoxicity of vancomycin were evaluated with univariate and multivariate logistic regression analyses. AUC0-24 was calculated using VCM-TDM software based on vancomycin population pharmacokinetics and Bayesian feedback method. RESULTS Cmin over 9.4 μg/mL and AUC0-24 exceeding 359.6 μg × hour/mL indicated good efficacy against infection. Cmin below 14.0 μg/mL predicted no significant nephrotoxicity. CONCLUSION In this study, the effective and safe concentration interval for vancomycin in patients in the ICU was Cmin 9.4-14.0 μg/mL. Close attention should be paid to adverse effects and renal function during vancomycin treatment.

Antiseizure medication in patients with meningioma: a retrospective cohort study on the long-term impact on depression, anxiety and neurocognitive functioning.

Patients with meningiomas often suffer from brain tumor-related epilepsy for which they are prescribed antiseizure medication (ASM). ASMs have been associated with neuropsychiatric side effects such as depression, anxiety, and cognitive impairments. However, the association between ASM use and mood and cognition in meningioma patients remains unclear. In this study, we aimed to investigate the association of ASM use, and specifically the use of levetiracetam, with depression, anxiety, and neurocognitive functioning. In this multicentre retrospective study, data from 187 meningioma patients were collected from neurocognitive tests, the HADS questionnaire, and medical records. Multivariable logistic regression analyses were used to evaluate the association between ASM use, and depression, anxiety and neurocognitive impairment. Potential confounders were included based on the existing literature. Due to sample size limitations, the association of levetiracetam use with depression, anxiety and neurocognitive impairment could not be statistically analyzed. The prevalence of depression, anxiety and cognitive impairment did not differ significantly for patients using ASM (n = 41) as compared to patients not using ASM (n = 146) (aOR = 0.81; 95% CI 0.26-2.54; aOR = 0.63; 95% CI 0.22-1.82; aOR = 1.42; 95% CI 0.51-3.98). Our findings show no significant association between ASM use and mood and neurocognitive dysfunction in meningioma patients.

Consumers’ preferences for choosing alternative proteins and their switching intentions in Taiwan

PurposeThe food industry continuously develops alternative proteins (APs) to mitigate environmental harm caused by traditional agricultural methods. However, consumers are reluctant to adopt these APs due to ingrained dietary habits and risk aversion to novel food. We developed a pull-push-mooring (PPM) model to investigate consumers’ preferences and switching intentions for plant-based meat (PBM), cultured meat (CM), and edible insects (EI).Design/methodology/approachWe tested hypotheses using structural equation modelling (SEM) and multivariate analysis with online survey data (n = 530) recruited in Taiwan via a professional survey company. Consumers were classified by how many APs they were willing to accept/switch into four segments: none, one, two, and all three APs.FindingsFindings show that the pull factors, particularly consumers’ nutritional knowledge, influence switching intentions more strongly than push factors. Meat aversion and the desire for dietary variety emerge as significant motivators for behavioral change in the high-frequency AP adoption cluster. The mooring factors, i.e. food technology and food neophobia, negatively impact switching intentions. This research found that the mooring factors stop the first consumer segment, the second segment struggles with the pushing factor, and the pull factors hinder the third group. The challenge for the fourth cluster is to enhance their frequencies when consuming APs.Originality/valueThis research segmented consumers into 4 clusters and found their different reluctances and tendencies to adopt each AP in line with the distinct PPM factors, and thus could develop separate marketing strategies accordingly.

Nomograms for predicting prognosis in postoperative lip squamous cell carcinoma patients

BackgroundLip squamous cell carcinoma (LSCC) is the most commonly occurring oral cavity cancer. This study aimed to establish and validate comprehensive nomograms for predicting the prognosis in postoperative LSCC patients.MethodsA total of 136 postoperative LSCC patients diagnosed between June 2012 and June 2018 were enrolled from two medical institutions and randomly divided into the training and validation groups at a ratio of 7:3. According to the results of the univariate and multivariate Cox regression analyses, six independent indicators concerning overall survival (OS) were identified, including age, grade, T-stage, lymph node metastasis (LNM), perineural invasion (PNI), vascular invasion (VI), surgical margin. Besides, age, grade, T-stage, LNM, perineural invasion (PNI), and surgical margin were independent predictors of disease-free survival (DFS) in LSCC patients. The two nomograms for predicting OS and DFS were developed based on the above results.ResultsThe univariate and multivariate Cox regression analysis showed that higher pathological grade, age ≥ 70 years, higher T-stage, positive LNM, PNI, VI, and positive surgical margin were independent predictors of inferior OS. Meanwhile, higher pathological grade, age ≥ 70 years, higher T-stage, LNM, PNI, and positive surgical margin were independent predictors of inferior DFS. Based on the results above, two nomograms were constructed to predict 3- and 5-year OS and DFS in patients with LSCC. The C-indexes of the OS and DFS nomograms were 0.865 and 0.801 in the training group, and 0.915 and 0.815 in the validation group. The calibration curves showed satisfactory consistency between predicted and actual observed survival rates. The outperformance of the nomogram compared with the other predictors involved was shown by the decision curve analysis (DCA).ConclusionTwo nomograms for predicting OS and DFS in patients with postoperative LSCC developed in this study perform well, which may be helpful for oncologists and surgeons to choose proper individual therapeutic schedules and design appropriate follow-up strategies.

Clinical Characteristics of Patients with Intra-Abdominal Infection Caused by Stenotrophomonas maltophilia.

Background: Intra-abdominal infections (IAIs) caused by Stenotrophomonas maltophilia have rarely been reported. This study aimed to describe the clinical characteristics and risk factors for mortality among patients with S. maltophilia IAIs. Methods: A retrospective study was conducted on inpatients with IAIs caused by S. maltophilia at Tri Service General Hospital from 2004 to 2017. Clinical and microbiologic data of the included cases were reviewed via medical charts and microbiology databases. Multivariable logistic regression analyses were performed to identify risk factors for in-hospital death. Results: In total, 110 patients were diagnosed with S. maltophilia IAIs. Malignancy (56.3%) and liver cirrhosis (35.3%) were the most commonly identified underlying diseases. The major causes of S. maltophilia IAIs were biliary tract infection (42.7%), recent abdominal surgery (35.4%), and spontaneous bacterial peritonitis (20.0%). Polymicrobial infections were observed in 84 (76.4%) patients. In addition to S. maltophilia, co-cultured bacteria (n = 140) included Enterobacterales, representing 19.3% (27/140) of the total isolates, and non-fermentative aerobes, comprising 29.3% (41/140). In addition, anaerobic bacteria and fungi accounted for 9.2% (13/140) and 10% (14/140), respectively. The overall mortality rate was 40.9%. Multivariable logistic regression analysis revealed that high Sequential Organ Failure Assessment scores and malignancies were independent risk factors for mortality, while the immediate administration of appropriate antibiotics targeting S. maltophilia was a protective factor (p < 0.05). Conclusions: Patients with an underlying malignancy or liver cirrhosis were at risk for IAIs caused by S. maltophilia. The prompt initiation of effective antibiotics against S. maltophilia is critical for achieving favorable outcomes.

Assessing Occlusion and Recovery in Large and Giant Intracranial Aneurysms: A Comparative Retrospective Study of Flow Diversion Alone Versus Combined With Coiling and the Role of Packing Density.

Flow diversion (FD) is a conventional treatment of large and giant intracranial aneurysms. The aim of this study was to explore the impact of combining FD with coiling and analyze the required packing density (PD) for optimal aneurysm occlusion. This retrospective study compared large (10-15 mm), very large (15-25 mm), and giant (≥25 mm) intracranial aneurysm treatment with FDs alone vs FD + coiling at 2 large institutions from 2015 to 2023. Outcomes included aneurysm occlusion (Raymond-Roy classification), retreatment, complications, and modified Rankin Scale at last follow-up. Coiling PDs were analyzed, and receiver operator curve area under the curve was used to assess their association with occlusion rates. Propensity score matching and multivariable logistic regression adjusted for confounders. After propensity score matching, 130 patients were matched to the FD-only group, whereas 65 were matched to the FD + coiling group. The FD + coiling group showed higher complete aneurysm occlusion rates (72.3% vs 57.7%; P = .06), with OR = 2.03; 95% CI: 1.04-4.05; P = .02 in multivariate analysis. Hemorrhagic complications occurred only in FD-only patients (3.1%) whereas infarct complications were only observed in FD + coiling patients (6.2%). Nevertheless, FD + coiling demonstrated superior functional outcomes with all patients achieving modified Rankin Scale 0-1 at the last follow-up vs 86.2% in FD-only (P = .03). Receiver operator curve analysis determined that the optimal PD for coiling to achieve aneurysm occlusion is 12% to 14%, with an area under the curve of 0.65. Increasing the PD beyond this does not significantly improve occlusion rates, except in very large or giant aneurysms (OR = 8.6; 95% CI: 1.33-18.58; P = .02). In this study, FD with minimal coiling at a PD of 12% to 14% significantly enhanced complete aneurysm occlusion and functional recovery in patients with large aneurysms compared with using FD alone. PD above 12% to 14% threshold up to 26% impact on occlusion rates is particularly pronounced in very large or giant aneurysms.

Conversion study of hepatocellular carcinoma using HAIC combined with lenvatinib and PD-1/L1 immunotherapy under the guidance of BCLC staging

ObjectiveThis study aimed to assess the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with lenvatinib and immunotherapy and explore its potential as a conversion treatment for unresectable hepatocellular carcinoma (uHCC).MethodsA retrospective analysis was performed on clinical data from patients with uHCC who underwent HAIC, lenvatinib, and PD-1/PD-L1 immunotherapy. Data were collected from our hospital between November 2018 and December 2022. Efficacy was assessed based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST). The primary endpoints were overall survival (OS), progression-free survival (PFS), and conversion therapy rate. Additionally, survival status curves were plotted using the Kaplan-Meier method. Lastly, prognostic risk factors affecting conversion therapy and survival outcomes were evaluated using Logistic and Cox regression models.ResultsAs of December 2022, 318 patients were included, comprising 40 patients (12.6%) in BCLC stage A, 123 patients (38.7%) in BCLC stage B, and 155 patients (48.7%) in BCLC stage C. The overall objective response rate (ORR) was 47.1%, whilst the disease control rate (DCR) was 85.5%. Meanwhile, the median overall survival (mOS) for the entire cohort was 21.7 months (95% CI: 19.7-24.3), with a median progression-free survival (mPFS) of 11.4 months (95% CI: 9.4-13.4). A total of 110 patients (34.6%) underwent conversion surgery. Multivariate logistic regression analysis identified BCLC stage as the sole independent risk factor affecting eligibility for conversion therapy. Subgroup analysis revealed that BCLC-B stage patients who achieved successful conversion therapy demonstrated significantly superior outcomes compared to those who did not undergo successful conversion therapy (median OS: 29.3 months [95% CI: 24.3-NA] vs. 19.7 months [95% CI: 17.2-24.6], P = 0.0013). Multivariate regression analysis identified the BCLC stage, the presence of distant metastasis, and receipt of conversion therapy as independent prognostic factors influencing OS. Among the cohort, 169 (53.1%) experienced grade 3-4 adverse events (AEs), with the most commonly reported AEs being fatigue, fever, and pain.ConclusionThe combination of HAIC with lenvatinib and immunotherapy yielded a high ORR, improved the conversion therapy rate, and prolonged both OS and PFS in patients with uHCC while maintaining a favorable safety profile. BCLC stage was identified as an independent prognostic factor influencing the success of conversion therapy, with patients in stage B deriving significant survival benefits post-conversion.

Characteristics and predictors of mortality among infants and toddlers hospitalized with tuberculosis: a ten-year case series study in Sichuan, China

BackgroundResearch on tuberculosis (TB) in infants and toddlers is limited in China. This study aims to describe the epidemiology of TB in this age group and identify predictors of mortality during hospitalization.MethodsA retrospective study was conducted at the Chengdu Public Health Clinical Medical Center (CDPHCC), focusing on 252 children aged 3 years or younger who were treated for TB between January 2013 and December 2023. Epidemiological and clinical data were collected for analysis. Simple and multiple logistic regression models were used to identify factors associated with mortality during hospitalization in infants and toddlers.ResultsThe study included 97 infants and 155 toddlers. A smaller proportion of infants lived in rural areas compared to toddlers (76/97 vs. 140/155, P = 0.008). Additionally, more families of toddlers had two or more TB patients compared to families of infants (19/155 vs. 2/97, P = 0.008). A higher number of individuals from minority ethnic groups were unvaccinated with Bacille Calmette–Guérin (BCG) compared to Han individuals in both the infant (16/37 vs. 45/60, P = 0.002) and toddler (18/41 vs. 83/114, P = 0.001) groups. The most common symptoms reported were cough (n = 190, 75.4%) and fever (n = 187, 74.2%), with polypnea showing significant differences between the groups (P = 0.000). Significant differences were observed in the prevalence of miliary pulmonary TB and TB meningitis (TBM) (P < 0.05). The mortality rate was higher in infants compared to toddlers (13.4% vs. 5.2%, P = 0.021) during hospitalization. Multivariate analysis indicated that miliary pulmonary TB (PTB), hydrocephalus, and hypoproteinemia were associated with increased in-hospital mortality.ConclusionsInfants with TB are more likely to develop miliary PTB and TBM than toddlers, resulting in higher in-hospital mortality rates. Miliary PTB, hydrocephalus, and hypoproteinemia are significant prognostic factors for mortality among hospitalized infants and toddlers with TB in China.

Unraveling key determinants of cranial decompression in isolated severe traumatic brain injury: insights from a national trauma database

ABSTRACT Background Severe isolated traumatic brain injury (TBI) represents a complex and understudied population. Limited evidence exists on predictors of cranial decompression. This study aims to quantify the rate and identify factors associated with cranial decompression in severe isolated TBI using a large national database. Methods Data from the 2019–2021 American College of Surgeons Trauma Quality Program was analyzed. Severe TBI was defined as a head Abbreviated Injury Scale (AIS) score ≥ 3. Demographics, vitals, comorbidities, and in-hospital complications were assessed using multivariable models to identify predictors of cranial decompression. Results A total of 303,766 adults with severe isolated TBI were included (mean age 59.8; 64.2% male; 75.0% white). Cranial decompression was performed in 13.5% (n = 41,045). Univariate analysis showed significant differences in demographics, mechanism of injury, ICU admission, CT findings, midline shift, cerebral monitoring, blood product use, and complications. Multivariable analysis revealed that males, younger age, falls as the mechanism of injury, higher GCS, ICU admission, CT findings, need for cerebral monitoring, presence of midline shift, thromboembolism prophylaxis, and requirement for blood product transfusions, were strong predictors of cranial decompression. Conclusion This study provides valuable insights into the independent predictors for the need of cranial decompression in severe isolated TBI patients.

Predictive biomarkers for patients with head and neck squamous cell carcinoma (HNSCC) treated with immune check point inhibitors (ICIs).

e18000 Background: HNSCC patients present challenges for clinicians, especially in recurrent/metastatic (R/M) cases. ICIs show promise survival outcome but require predictive biomarkers to identify responsive patients. In Keynote-048, pembrolizumab improved overall survival (OS) in PD-L1 expression with combined positive score (CPS) ≥ 1. Other studies have explored biomarkers such as the neutrophil-to-lymphocyte ratio and pan-immune-inflammation value (PIV), which have shown associations with clinical outcomes; however, response rates were not reported. This study aims to identify clinical factors that can better predict which patients will benefit from ICI therapy. Methods: This retrospective study was conducted at three medical centers in Taiwan. Eligible patients included those with histologically confirmed HNSCC and R/M disease who received ICI therapy. The study endpoints consisted of the overall response rate (ORR) and OS. The ORR was evaluated by the RECIST rules. Prognostic factors for OS were analyzed using univariate analysis followed by multivariate Cox proportional hazards analysis. Clinical response to ICI therapy was categorized as good response (CR/PR) and not good response (SD/PD). Univariate and binary logistic regression analyses were performed to determine the association of the variables with good response, and the association was evaluated by odds ratio (OR). All statistical tests were considered significant at a p-value &lt; 0.05, and analyses were performed using SAS version 9.4. Results: A total of 318 patients were enrolled from January 2017 to September 2023, with a median follow-up of 473 days. Among them, 60% received ICI-based second-line treatment, while 40% underwent first-line treatment. In univariate analyses, not good response of ICI therapy was associated with M1 stage, cisplatin intervals &lt; 6 months, cetuximab before ICI therapy and high PIV. The primary tumor location of oropharynx is related to good response. In multivariable analysis, the probability of having no response increased with M1 stage, cetuximab before ICI therapy and high PIV. The primary tumor location of oropharynx is related to good response. For OS, univariate analyses indicated that shortened OS was linked to M1 stage, prior cetuximab therapy, CPS &lt; 1, high PIV, and poor clinical response to ICI. The primary tumor location in the oropharynx was associated with prolonged OS. In multivariable analysis, CPS &lt; 1, high PIV, and poor clinical response to ICI were identified as independent unfavorable prognostic factors for OS. Conclusions: In conclusion, our findings demonstrate that M1 disease, prior cetuximab therapy, and high PIV are independently associated with poorer responses to ICI therapy. Additionally, CPS &lt; 1, high PIV, and suboptimal clinical responses to ICI therapy have a significant negative impact on prognosis.

The number of lymph node dissections related to survival of patients with locally advanced esophageal squamous cell carcinoma after neoadjuvant therapy: A single-center study.

e16009 Background: The number of lymph node dissection (LND) in locally advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant therapy remains controversial. This study aimed to clarify the relationship between the number of LND and left tracheobronchial lymph node (106tbL) dissection and the survival in these patients, and determine the optimal threshold of the number of dissected lymph nodes. Methods: Patients with locally advanced ESCC after neoadjuvant therapy were included in this study between January 1, 2017 and December 31, 2023. All the patients received minimally invasive McKeown esophagectomy. The postoperative follow-up was carried out every three or six months until death or August 31, 2024. The Kaplan-Meier method and log-rank test were used for univariate analysis, while the Cox proportional hazard model was used for multivariate analysis. Results: A total of 162 patients were included in this study. The median follow-up time was 36.5 months. Five-year overall survival (OS) and disease-free survival (DFS) with the number of LND more than 45 but not more than 60 (45 &lt; LND ≤ 60) were significantly better than those with fewer LND (LND ≤ 45, OS: 73.0% vs 48.5%, P = 0.017; DFS: 72.0% vs 54.1%, P = 0.026) or more (LND &gt; 60, OS: 73.0% vs 36.0%, P = 0.010; DFS: 72.0% vs 33.0%, P = 0.003) . The five-year OS with more thoracic LND was significantly better (&gt; 30 vs ≤ 30: 73.2% vs 46.7%, P = 0.018), and the five-year DFS had a better trend (&gt; 30 vs ≤ 30: 65.2% vs 54.4%, P = 0.134), but not statistically significant. Multivariate analysis showed better OS with a higher number of thoracic LND (HR, 0.317; 95% CI, 0.154-0.650; P = 0.002；Table 1), and better DFS with a total number of LND more than 45 but not more than 60 (HR, 0.373; 95% CI, 0.182-0.765; P = 0.007). The 106tbL lymph node metastasis rate was 6.8% (10/147). The patients with 106tbL metastasis had worse OS and DFS. Fewer or no dissecting of 106tbL reduced five-year DFS (&lt; 5 vs ≥ 5: 49.5% vs 68.8%, P = 0.056), but the difference was of borderline significance. Conclusions: The number of lymph node dissection is related to the OS and DFS in locally advanced ESCC patients after neoadjuvant therapy. The number of LND between 45 and 60, and the number of thoracic LND more than 30 are recommended, which may improve survival and local disease control. The 106tbL lymph node metastasis is related to poor prognosis and patients may benefit from more 106tbL lymph node dissection. Univariate and multivariate Cox regression analysis of factors for OS. Variables Univariate Analysis Multivariate Analysis HR (95% CI) P HR (95% CI) P ypN stage &lt; 0.001 N0 Reference Reference N1 3.392 (1.496-7.689) 0.003 4.049 (1.773-9.248) 0.001 N2 4.469 (1.902-10.498) 0.001 5.105 (2.169-12.017) &lt; 0.001 N3 6.283 (2.227-17.727) 0.001 8.877 (3.100-25.419) &lt; 0.001 Thoracic LND ≤ 30 Reference Reference &gt; 30 0.428 (0.211-0.867) 0.019 0.317 (0.154-0.650) 0.002 Abbreviations: OS, overall survival; HR, hazard ratio; CI, confidence interval; LND, lymph node dissection; 106tbL, left tracheobronchial lymph node.

AI-detected tumor-infiltrating lymphocytes and response to PD-1 based treatment in advanced melanoma.

9541 Background: Biomarkers to predict response to immune checkpoint inhibition (ICI)-treated melanoma are limited. This study evaluates AI-detected tumor-infiltrating lymphocytes (TILs) on pretreatment metastatic pathology specimens as a biomarker for response and survival in ICI-treated patients. Methods: Patients treated with first-line anti-PD1 ± anti-CTLA4 for advanced melanoma were retrospectively identified from 11 Dutch melanoma centers. Pre-treatment TILs were quantified on H&amp;E stained slides using the Hover-NeXt algorithm trained on an independent melanoma dataset with 166.718 pathologist checked manually annotated cells. The average percentage of TILs per 200 µm² tumor area was calculated. The primary outcome was response to ICI per RECIST 1.1 with overall survival (OS) and progression free survival (PFS) as secondary outcomes. Univariable and multivariable logistic and Cox regression analyses assessed associations between a 10% increase in TILs present in pre-treatment metastatic slides and clinical outcomes. Multivariable analyses were adjusted for age, sex, disease stage, BRAF mutation, LDH and performance score. Objective response rate and Kaplan Meier survival analysis were stratified by TIL tertiles. Results: Metastatic melanoma specimens were available for 1246 patients, 441 received anti-PD1 + anti-CTLA4. Median TIL percentage was 10.2% (interquartile range 5.5% – 17.2%). A 10% higher baseline TIL percentage was associated with response (adjusted OR 1.39 [95% 1.21-1.58]), PFS (adjusted HR 0.87 [95% CI 0.81 – 0.94]) and OS (adjusted HR 0.84 [95% CI 0.77 – 0.93] in univariable and multivariable analysis (Table 1). Stratified analysis showed significant associations between TILs, response, and survival in both anti-PD1 monotherapy and combination therapy. Conclusions: AI-quantified TILs in pre-treatment melanoma metastases are correlated with improved response rates and survival in ICI treated patients. This correlation is independent of known clinical predictors. Outcome ICI Lowest Tertile Middle Tertile Highest Tertile Univariable OR / HR [95% CI] Multivariable OR / HR [95% CI] Response (%) All 47.9% 57.8% 64.5% 1.35 [1.21 – 1.52] 1.39 [1.21 – 1.58] Anti-PD1 45.2% 57.1% 66.7% 1.42 [1.24 – 1.64] 1.37 [1.17 – 1.60] Anti-PD1 + Anti-CTLA4 51.4% 62.2% 58.7% 1.23 [1.00 – 1.53] 1.48 [1.13 – 1.94] PFS (months) All 5.4 9.7 15.3 0.87 [0.81 – 0.93] 0.87 [0.81 – 0.94] Anti-PD1 5.4 11.8 16.5 0.85 [0.79 – 0.92] 0.89 [0.81 – 0.97] Anti-PD1 + Anti-CTLA4 5.3 11.0 10.2 0.89 [0.78 – 1.02] 0.80 [0.69 – 0.94] OS (months) All 21.4 38.4 49.2 0.81 [0.75 – 0.88] 0.84 [0.77 – 0.93] Anti-PD1 21.1 36.5 51.4 0.79 [0.71 – 0.87] 0.86 [0.77 – 0.96] Anti-PD1 + Anti-CTLA4 21.4 77.8 46.4 0.88 [0.75 – 1.03] 0.82 [0.69 – 0.97]

Risk factors for mild cognitive impairment in type 2 diabetes mellitus older adult: a systematic review and meta-analysis.

Risk factors for mild cognitive impairment in type 2 diabetes mellitus older adult: a systematic review and meta-analysis.

Association of preoperative spirometry with postoperative pulmonary complications and prolonged length of hospital stay following coronary artery graft surgery.

Association of preoperative spirometry with postoperative pulmonary complications and prolonged length of hospital stay following coronary artery graft surgery.

Outcomes of Elderly Patients with Node-Positive Colon Cancer. A Multi-Center Population-Based Cohort Study

Outcomes of Elderly Patients with Node-Positive Colon Cancer. A Multi-Center Population-Based Cohort Study