Multivariate OR Research Articles

The association of the type and number of D'Amico high-risk criteria with rates of pathologically non-organ-confined prostate cancer.

The aim of this study was to assess the association between the type and number of D'Amico high-risk criteria (DHRCs) with rates of pathologically non-organ-confined (NOC) prostate cancer in patients treated with radical prostatectomy (RP) and pelvic lymphadenectomy (PLND). In the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 12961 RP and PLDN patients with at least one DHRC. We relied on descriptive statistics and multivariable logistic regression models. Of 12 961 patients, 6135 (47%) exclusively harboured biopsy Gleason score (GS) 8-10, 3526 (27%) had clinical stage ≥T2c, and 1234 (9.5%) had prostate-specific antigen (PSA) >20 ng/mL. Only 1886 (15%) harboured any combination of 2 DHRCs. Finally, all 3 DHRCs were present in 180 (1.4%) patients. NOC rates increased from 32% for clinical T stage ≥T2c to 49% for either GS 8-10 only or PSA >20 ng/mL only and to 66-68% for any combination of 2 DHRCs, and to 84% for respectively all 3 DHRCs, which resulted in a multivariable logistic regression OR of 1.00, 2.01 (95% CI 1.85-2.19; p <0.001), 4.16 (95% CI 3.69-4.68; p <0.001), and 10.83 (95% CI 7.35-16.52; p <0.001), respectively. Our study indicates a stimulus-response effect according to the type and number of DHRCs. Hence, a formal risk-stratification within high-risk prostate cancer patients should be considered in clinical decision-making.

Breaking with a dogma: persisting diffusion restrictions (pDWI) in follow-up after endovascular treatment for stroke

BackgroundPost-stroke diffusion weighted imaging (DWI) signal transformation of the infarct core, which results in high apparent diffusion coefficient (ADC) values and variable DWI signal intensity, is completed no later than...

Abstract 15281: Patient and System-Related Delays in Presentation and Invasive Coronary Angiography in Patients Presenting With Acute Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection: A Report of the ISCAD Registry

Introduction: Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome especially in young patients. Factors associated with delays in presentation and care delivery are not well understood. Methods: We used data from the iSCAD Registry which is a prospective multicenter US registry of patients with SCAD. Early vs. delayed hospital presentation (&lt; 24 vs. ≥ 24 hours), and early vs. delayed coronary angiography (time from hospital presentation to coronary angiography &lt; 24 vs. ≥ 24 hours) for SCAD patients with AMI were assessed. Patient characteristics, and in-hospital events were compared between the two groups. Factors associated with delayed presentation and angiography were explored using multivariable logistic regression. Results: A total of 346 SCAD (294 white, 52 non-white) patients presented with STEMI (34%) or NSTEMI; 57 had a delayed presentation to the hospital after symptoms onset. No significant factors were identified for delays in seeking care. However, white race was less likely to have delayed invasive coronary angiography (multivariable OR=0.38; 95% CI 0.19 to 0.76; p=0.0059). Patients undergoing delayed angiography were also more likely to be medically managed (91.7% vs. 69.8%, p=0.0008), but less likely to receive dual antiplatelet therapy (57.0% vs. 73.1%, p=0.007). In-hospital outcomes were similar between the two groups. Conclusion: In this study, no patient-related variables were identified that predicted a delay in presentation with AMI secondary to SCAD. On the other hand, non-white race was associated with delays in performing invasive coronary angiography. Further investigation is required to determine the factors contributing to this potential disparity.

Plasma Concentrations of Gut Hormones Acyl Ghrelin and Peptide YY and Subsequent Risk of Colorectal Cancer and Molecular Tumor Subtypes.

The findings of this study do not support a major role for the metabolic gut hormones ghrelin and PYY in colorectal cancer development but suggest the possibility of an involvement for ghrelin in specific tumor subtypes. Elucidating subtype-specific risk factors and mechanisms of carcinogenesis may have implications for precision prevention.

Labor market participation and depression during the COVID-19 pandemic among young adults (18 to 30 years): A nationally representative study in France.

To examine the relationship between young adults' labor force participation and depression in the context of the COVID-19 pandemic. Data come from the nationally-representative EPICOV cohort study set up in France, and were collected in 2020 and 2021 (3 waves of online or telephone interviews: 02/05/2020-12/06/2020; 26/10/2020-14/12/2020; 24/06/2021-09/08/2021) among 2,217 participants aged 18-30 years. Participants with prior mental health disorder (n = 50) were excluded from the statistical analyses. Using Generalized Estimating Equation (GEE) models controlled for participants' socio-demographic and health characteristics and weighted to be nationally-representative, we found that compared to young adults who were employed, those who were studying or unemployed were significantly more likely to experience depression assessed using the PHQ-9 (multivariable ORs, respectively: OR: 1.29, 95% CI 1.05-1.60 and OR: 1.50, 1.13-1.99). Stratifying the analyses by age, we observed that unemployment was more strongly associated with depression among participants 25-30 years than among those who were 18-24 years (multivariable ORs, respectively, 1.78, 95% CI 1.17-2.71 and 1.41, 95% CI 0.96-2.09). Being out of the labor force was, to the contrary, more significantly associated with depression among participants 18-24 years (multivariable OR: 1.71, 95% CI 1.04-2.82, vs. 1.00, 95% CI 0.53-1.87 among participants 25-30 years). Stratifying the analyses by sex, we found no significant differences in the relationships between labor market characteristics and depression (compared to participants who were employed, multivariable ORs associated with being a student: men: 1.33, 95% CI 1.01-1.76; women: 1.19, 95% CI 0.85-1.67, multivariable ORs associated with being unemployed: men: 1.60, 95% CI 1.04-2.45; women: 1.47, 95% CI 1.01-2.15). Our study shows that in addition to students, young adults who are unemployed also experience elevated levels of depression in the context of the COVID-19 pandemic. These two groups should be the focus of specific attention in terms of prevention and mental health treatment. Supporting employment could also be a propitious way of reducing the burden of the COVID-19 pandemic on the mental health of young adults.

The visceral and liver fat are significantly associated with the prevalence of hyperuricemia among middle age and elderly people: A cross-sectional study in Chongqing, China.

BackgroundThe prevalence of hyperuricemia (HUA) has been increasing in recent years. HUA is a crucial risk factor for gout and an independent risk factor for cardiovascular diseases (CVDs). Identifying potentially modifiable factors of HUA is vital for preventing gout and even CVDs. This study aimed to explore the associations of fat distribution with HUA among middle-aged and elderly people in Chongqing, China.Materials and methodsA cross-sectional study was conducted between July 2020 and September 2021. People who underwent quantitative computed tomography (QCT) scans were invited to participate in the study. A total of 3,683 individuals whose clinical characteristics and QCT-based fat distribution measurements included visceral fat area (VFA), subcutaneous fat area (SFA), and liver fat content (LFC) were well-recorded were included. HUA was defined as having a serum uric acid level greater than 420.0 μmol/L. Multivariate logistic regression models were used to evaluate the association between these adipose variables and HUA prevalence.ResultsThe HUA prevalence was 25.6% (943/3,683), which was 39.6% (817/2,063) in men and 7.8% (126/1,620) in women. In the fully adjusted model (model 4), the comparison of the highest one with the lowest quartiles of adipose variables showed that the multivariable OR (95% confidence intervals) of HUA were 2.08 (1.36–3.16; P for trend = 0.001) for VFA, 0.89 (0.63–1.25; P for trend = 0.651) for SFA, and 1.83 (1.42–2.34; P for trend < 0.0001) for LFC. For VFA, the association was more evident in men than in women.ConclusionHigher VFA and LFC were significantly associated with the increased prevalence of HUA in middle-aged and elderly Chinese individuals. VFA and LFC may have a predictive effect on HUA. Controlling visceral and liver fat accumulation may be beneficial for middle-aged and older people. HUA can be prevented with specific effective healthy physical activity and balanced diet guidelines.

The triglyceride glucose index is associated with future cardiovascular disease nonlinearly in middle-aged and elderly Chinese adults

ObjectiveWe aimed to investigate the association between triglyceride glucose index and cardiovascular disease (CVD) development in the Chinese middle-aged and elderly population using the China Health and Retirement Longitudinal Study dataset 2011–2018.MethodsBasic characteristics of participants, including sociodemographic information, and health conditions, were acquired. Logistic regression analyses and restricted cubic spline regression analyses were conducted to investigate the association between the triglyceride glucose index and future CVD risks. Subgroup analyses were performed to evaluate potential interaction.ResultsSeven hundred fifty-three of 6114 (12.3%) participants have developed CVD in 2018 over an approximately 7-year follow-up. The logistic regression analysis exhibited that compared to the lowest triglyceride glucose index group, the multivariable OR for future CVD was 0.985 (95%CI 0.811–1.198) in the T2 triglyceride glucose index group and 1.288 (95%CI 1.068–1.555) in the T3 TyG index (P for trend 0.006). The restricted cubic spline regression analysis showed the nonlinear association between triglyceride glucose index and CVD incidence; the cut-off values were 8.07 and 8.57, respectively, after total adjustment. Gender, fast blood glucose, and triglycerides interacted with triglyceride glucose index and CVD except for BMI.ConclusionThe triglyceride glucose index was nonlinearly related to the risk of future cardiovascular disease in the middle-aged and elderly Chinese population.

DIFFERENCES IN PROLONGED MECHANICAL VENTILATION ACROSS RACIAL IDENTITY

DIFFERENCES IN PROLONGED MECHANICAL VENTILATION ACROSS RACIAL IDENTITY

Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections.

A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD. This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD. We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68-97.6, P = 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91-136.1, P = 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33-29.3, P = 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs. Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings. UMIN 000030898.

Negative Pressure Wound Therapy Becomes the Treatment of Choice of Deep Sternal Wound Infection.

Sternal wound infection, especially deep sternal wound infection, is a serious complication after open heart surgery. It leads to a marked increase in hospital stay, financial expenses, and mortality. Treatment is primarily surgical and may be divided into conventional treatment methods and negative pressure wound therapy. Between 2010 and 2021, 77 patients presenting back after cardiac surgery with deep sternal wound infection were treated surgically. Conventional treatment methods were utilized in 45 patients and included wound revision with primary closure, continuous wound irrigation, and open treatment with secondary closure. Negative-pressure wound therapy (NPWT) was applied in 32 patients. The two treatment arms were compared by two primary outcomes - rate of recurrent infection and hospital mortality. Predictors of mortality and infectious recurrence were identified using multivariate logistic regression. Recurrent infection occurred in 18.2% of cases and mortality was 13% in the whole group. NPWT was more successful in preventing recurrent infection OR: 5.4 (95% CI: 1.1-27.5; P = 0.044) than conventional treatment and more than moderate left ventricular systolic dysfunction (EF<40%) predisposed to infectious recurrence - OR: 4.7 (95% CI: 1.05-22.1; P = 0.049). Recurrent infection itself was the strongest predictor of mortality in the multivariate model OR: 0.14 (95% CI: 0.03 - 0.58; P = 0.007). NPWT as an initial method of wound preconditioning followed by definitive wound closure effectively reduces the rate of infectious recurrence and patient mortality. It may become the modality of first choice when dealing with complicated incisional infections following heart surgery.

COVID-19 in Iran

Background: Today, people all over the world are suffering from COVID-19 pandemic. Certainly, exploring the characteristics of the corona virus and making an effective vaccine are important efforts in preventing and controlling the disease. At the same time, it is necessary to conduct studies to identify high-risk groups and protect them against disease. Method: This study's research population was 281 people with fever, coughing, and respiratory disorder admitted to an educational hospital affiliated with the Hormozgan University of Medical Sciences in the south of Iran. If RT-PCR test was positive, the patients were considered infected. Infected patients were hospitalized if they had impaired respiratory function. The main kinds of lifestyle information collected from patients were: physical activity data, emotional or spiritual status, tobacco/opium/alcohol use status, sleep, and nutritional data, comorbidity disease data. Multivariable OR (95% CI) regression tests were applied to detect the relation between some important lifestyle variables with the probability of infection by coronaviruses and hospitalization due to respiratory disorder findings. Results: it was identified that 22 from 28 covariates had significant associations with the risk of infection and hospitalization.

Abstract LB120: Comprehensive biomarkers analysis to explain resistances to PD1-L1 ICIs: The precision immuno-oncology for advanced non-small cell lung cancer (PIONeeR) trial

Abstract Background: Resistance to PD1/L1 immune checkpoint inhibitors (ICIs) in advanced NSCLC patients is observed in about 80% of individuals with no robust predictive biomarker yet. The PIONeeR trial (NCT03493581) aims to predict such resistances through a comprehensive multiparametric biomarkers analysis. Methodology: Among the &amp;gt;300 advanced NSCLC patients (pts) recruited in PIONeeR, we focused on the first 137 ≥2nd line ECOG PS0-1 pts treated with single-agent nivolumab, pembrolizumab or atezolizumab. Tumor tissue was collected at baseline and pts were re-biopsied at 6 weeks, and blood-sampled every cycle throughout the 24 weeks post C1D1. Response to PD1/L1 ICIs was assessed by RECIST 1.1 every 6 weeks. Immune contexture was characterized in tumor &amp; blood of each pt through FACS for circulating immune cell subtypes quantification and endothelial activation, blood soluble factors dosage, dual- &amp; multiplex IHC/digital pathology to quantify immune cells infiltrating the tumor, WES for TMB &amp; ICI plasma dosage, leading to 331 measured biomarkers in addition to routine clinical parameters. Multivariable (MV) logistic regression was used to examine the association of each biomarker (controlled by sex, age, smoking status, histological type &amp; PDL1+ Tumor Cells) with the risk of Early Progression (EP), i.e. within 3.5 months of treatment. Multivariable Cox regression analysis was conducted for association with PFS and OS. Results: Overall, the 137 pts were mainly male (64%), smokers (92%) and &amp;lt;70yrs (68%). Tumors were mainly non-squamous (79%) with &amp;gt;1% PDL1+ TC in 36% of the cases, and 21% of pts were still on treatment at data cut-off. Archived samples were available for 80% of pts at inclusion and re-biopsy was available in 52.9% of these cases. The median follow up was 19.8 months, 22.5% of pts did not progress at data cut-off while 62% presented EP. Tumor Cytotoxic T-cells density, especially PD1+ were lower in EP (MV OR=0.45, p=0.022); conversely, higher proportions of circulating cytotoxic T-cells and activated T-cells (HLA-DR+) were observed in EP (MV OR=3.8, p&amp;lt;0.001). Among other biomarkers, Tregs (MV OR=0.44, p=0.018), NK cell subsets (MV OR≤0.44, p&amp;lt;0.05), albumin (MV OR=0.4, p&amp;lt;0.01) and PDL1 TC % (MV OR=0.27, p&amp;lt;0.01) were decreased whereas alkaline phosphatase was increased (OR=3, p=0.018). &amp;gt;65% inter-pt variability was observed in plasma exposures for all ICIs, with 8-10% of pts displaying trough levels below the target engagement threshold. Data will be presented through unsupervised clustering algorithms &amp; multi-modal supervised learning methods. Changes after 6 weeks of treatment will be analyzed to further investigate drugs mechanisms of action. Conclusion: The PIONeeR trial provides with the 1st comprehensive biomarkers’ analysis to establish predictive models of resistance in advanced NSCLC pts treated with PD1/L1 ICIs and highlights how tumor and circulating biomarkers are complementary. Citation Format: Laurent Greillier, Florence Monville, Vanina Leca, Frédéric Vely, Stephane Garcia, Joseph Ciccolini, Florence Sabatier, Gilbert Ferrani, Nawel Boudai, Lamia Ghezali, Marcellin Landri, Clémence Marin, Mourad Hamimed, Laurent Arnaud, Melanie Karlsen, Kevin Atsou, Sivan Bokobza, Pauline Fleury, Arnaud Boyer, Clarisse Audigier-Valette, Stéphanie Martinez, Hervé Pegliasco, Patrice Ray, Lionel Falchero, Antoine Serre, Nicolas Cloarec, Louisiane Lebas, Stephane Hominal, Patricia Barre, Sarah Zahi, Ahmed Frikha, Pierre Bory, Maryannick Le Ray, Lilian Laborde, Virginie Martin, Richard Malkoun, Marie Roumieux, Julien Mazieres, Maurice Perol, Eric Vivier, Sebastien Benzekry, Jacques Fieschi, Fabrice Barlesi. Comprehensive biomarkers analysis to explain resistances to PD1-L1 ICIs: The precision immuno-oncology for advanced non-small cell lung cancer (PIONeeR) trial [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 LB120.

The rate of venous thromboembolism in patients with non-small cell lung cancer treated with chemotherapy or check point inhibitors.

e21053 Background: Treatment with immune checkpoint inhibitors (CPI) targeting PD-1 or PD-L1 significantly improves progression free survival and overall survival in patients with non-small cell lung cancer (NSCLC). Emerging literature suggests that the proinflammatory state of CPIs may increase the risk of thromboembolism, both venous (VTE) and arterial (ATE), which is of great concern as thromboembolism remains a major cause of mortality in patients with NSCLC. We performed a retrospective cohort study to evaluate thromboembolic outcomes in patients on immunotherapy for NSCLC. Methods: We reviewed the records of all patients diagnosed with stage IV NSCLC between December 2016 and December 2019 and treated with chemotherapy, CPIs, or both in one of the largest integrated academic health systems in Western Pennsylvania. Khorana scores (to predict the risk of future VTE) were calculated for each patient based on available data at the time of diagnosis. Logistic regression analyses were done to evaluate clinical predictors of VTE. Survival outcomes were analyzed using Kaplan-Meier estimates and a log rank test was used to compare survival estimates. Data was analyzed using SPSS v26 (IBM Corp). Results: A total of 110 patients with stage IV NSCLC were identified, 87.1% had ECOG ≤2, 67.0% had adenocarcinoma and 25.7% had squamous cell carcinoma, and 39.1% had PD-L1 staining ≥50%. Immunotherapy related adverse events (IrAE) of any grade were found in 28.2%. Overall, 25.5% received chemotherapy only, 27.7% received CPIs alone, and 45.5% received chemo + CPIs. A Khorana score of ≥2 was found in 43.6% of patients. Prophylactic anticoagulation was used in 0.9% of patients. VTE was detected in 18.3% and ATE in 10.0% of the cohort; therapeutic anticoagulation was given in 14.7% of patients. Median overall survival was 25.5 months (95% CI 18.7-32.3) in patients without VTE versus 13.7 months (95% CI 3.1-24.3) in patients with a VTE diagnosis (HR 1.96, 95% CI 1.11-3.45; p = 0.02). Khorana score of ≥2 was not a significant predictor of VTE in this cohort (univariate OR 1.34, p = 0.53, multivariate OR 1.13, p = 0.81), but was associated with worse survival (HR 2.38, 95% CI 1.48-3.83, p &lt; 0.001). Conclusions: In this retrospective cohort, VTE was associated with decreased overall survival. While no significant association between elevated Khorana score and VTE was identified, elevated Khorana score at the time of diagnosis was an independent predictor of survival in patients with NSCLC. Of note, there was a low rate of prophylactic anticoagulation in this cohort.

Association of TP53 polymorphisms with the acquisition of EGFR T790M mutations in patients with first- or second-generation EGFR-TIK progression.

e20560 Background: Lung cancer is the leading cause of cancer death worldwide. EGFR tyrosine kinase inhibitors (TKIs) has transformed management in those patients. However, the majority of patients will become resistant to EGFR-TKIs after a period of time. The T790M acquired mutation in exon 20 of the EGFR is the predominant molecular mechanism of acquired resistance. In first-line treatment of global patients with NSCLC, osimertinib had better efficacy compared to first-generation TKIs. In the FLAURA study, the median PFS with first-line osimertinib in Asians was only 16.5 months, compared to 18.6 months in the global population. Moreover, the OS benefit in the Asian population was relatively small. At the same time, the mechanism of resistance to osimertinib is very complex and patients have limited treatment options after first-line osimertinib resistance. A variety of factors can influence the decision for first-line treatment in EGFR mutation-positive patients, including follow-up regimens, the presence of brain metastases, and tolerability, all of which should be considered in the long-term treatment plan. Knowing in advance whether patients are likely to acquire EGFR T790M mutations will help in making treatment decisions. Previous studies have shown that TP53 Arg72Pro polymorphism (rs1042522) is associated with the risk and prognosis of lung cancer. Currently, the association between EGFR mutations and TP53 polymorphisms is unclear, but previous reports have suggested that patients with EGFRmutation demonstrated a higher rate of TP53 mutation than EGFR wild type patients. Therefore, this study aim to explore the association of TP53 polymorphisms (rs1042522) with EGFR T790M acquired mutations, considering the value of T790M in lung cancer treatment. Methods: We analyzed two independent cohorts of patients with EGFR-mutant NSCLC who progressed after first-line EGFR-TKIs treatment from 2013 to 2021 (cohort 1: n=108; cohort 2: n=148). All patients were tested with plasma next-generation sequencing (NGS). Results: The acquired T790M mutation rate was 36%, 30% and 43% in all patients (n = 256), cohort 1 and cohort 2, respectively. Logistic regression analysis showed that TP53 rs1042522 polymorphism was significantly associated with an increased risk of T790M acquired mutation in cohort 1 (GG versus CC: OR (95% CI) = 3.57 (1.15-12.2), P = 0.033) and cohort 2 (GG versus CC: univariable OR (95% CI) = 3.53 (1.30-10.3), P = 0.016; multivariable OR (95% CI) = 2.94 (1.04-8.87), P= 0.047). Conclusions: We found that the TP53 rs1042522 polymorphism GG was associated with EGFR T790M acquired mutations. Knowing in advance whether patients are likely to acquire EGFR T790M mutations will help in making treatment decisions.

Predictors of Vision Loss after Surgery for Macula-Sparing Rhegmatogenous Retinal Detachment

Purpose To determine factors associated with loss of good vision (defined as Snellen visual acuity [VA] < 20/40) after surgery among eyes presenting with macula-on primary rhegmatogenous retinal detachment (RRD) with initial VA ≥20/40. Methods Multicenter, retrospective, cohort study of eyes undergoing scleral buckle (SB), pars plana vitrectomy (PPV), or combined pars plana vitrectomy/scleral buckle (PPV/SB) for non-complex macula-on RRD with initial VA ≥20/40. Results Among 646 eyes with macula-on RRDs with initial VA ≥20/40, 106 (16.4%) had VA <20/40 (i.e. lost good vision) at final follow-up. Eyes losing good vision had slightly worse pre-operative logMAR VA (mean 0.15 ± 0.10 [20/28]) compared to eyes that preserved good vision (mean 0.11 ± 0.10 [20/26]) (p = 0.004). RRDs extending greater than 6 clock-hours were more likely to lose good vision than smaller detachments (multivariate OR 4.57 [95% CI 1.44–14.51]; p = 0.0099). Compared to eyes repaired with SB alone, eyes undergoing PPV (multivariate OR 7.22 [95% CI 2.10–24.90]; p = 0.0017) or PPV/SB (multivariate OR 10.74 [95% CI 3.20–36.11]; p = 0.0001) were each more likely to lose good vision. Eyes requiring further RRD-related (multivariate OR 8.64 [95% CI 1.47–50.66]; p < 0.017) and non-RRD related vitreoretinal surgery (multivariate OR 14.35 [95% CI 5.39–38.21]; p < 0.0001) were more likely to lose good vision. Conclusion Among macula-on RRDs, loss of good vision was associated with worse vision on presentation, vitrectomy-based procedures, greater extent of detachment, and lack of single surgery success. Understanding predictors of visual outcome in macula-on RRD repair may guide pre-operative counseling regarding visual prognosis.

MP24-09 RISK OF PSEUDOANEURYSM AND COMPLICATIONS AFTER PARTIAL NEPHRECTOMY: COMPARISON OF TUMOR ENUCLEATION TO STANDARD MARGIN TECHNIQUE

You have accessJournal of UrologyCME1 May 2022MP24-09 RISK OF PSEUDOANEURYSM AND COMPLICATIONS AFTER PARTIAL NEPHRECTOMY: COMPARISON OF TUMOR ENUCLEATION TO STANDARD MARGIN TECHNIQUE Nicholas Elliott, Jae Han Lee, Hiten Patel, Whitney Halgrimson, Keshava Gali, Nicholas Lanzotti, Goran Rac, Marcus Quek, and Gopal Gupta Nicholas ElliottNicholas Elliott More articles by this author , Jae Han LeeJae Han Lee More articles by this author , Hiten PatelHiten Patel More articles by this author , Whitney HalgrimsonWhitney Halgrimson More articles by this author , Keshava GaliKeshava Gali More articles by this author , Nicholas LanzottiNicholas Lanzotti More articles by this author , Goran RacGoran Rac More articles by this author , Marcus QuekMarcus Quek More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is the gold standard for the resection of amenable small renal masses. Some surgeons have adopted tumor enucleation (TE) over the standard margin PN (SPN) technique based on preservation of healthy renal parenchyma by following the tumor pseudocapsule. However, TE may also confer additional advantages due to avoidance of sharp incision including reduction in perioperative and bleeding complications. Therefore, we evaluated the rate of pseudoaneurysms and other complications following TE vs SPN. METHODS: A retrospective cohort study of patients undergoing PN (TE and SPN) between 2008 and 2020 was conducted. Baseline characteristics, comorbidities including chronic kidney disease and Charlson Comorbidity Index (CCI), prior surgical history, tumor size, clinical stage, and RENAL nephrometry score were captured. Clavien-Dindo complications including pseudoaneurysm were compared between the TE and SPN cohorts with univariable and multivariable logistic regression models. RESULTS: A total of 467 patients were included, 176 (37.7%) receiving TE and 291 (62.3%) SPN. There were no differences in baseline characteristics such as comorbidity, tumor size, clinical stage, or nephrometry score between groups. Conversion rates were similar but Clavien-Dindo complication rates were significantly less likely for TE with 19 (10.8%) compared to SPN with 68 (23.4%) (multivariable OR 2.55 (95%CI 1.45-4.51), p=0.001). Major Clavien-Dindo grade ≥3 complications were infrequent, but with notably lower rates for TE vs. SPN (2 (1.1%) vs. 22 (7.6%), multivariable OR 8.83 (95%CI 1.84-42.46), p=0.01). Reduction in bleeding complications was a major driver (1.7% vs. 6.2%, p=0.02) with no pseudoaneurysm events following TE compared to 13 following SPN (0.0% vs 2.8%, p=0.004). Need for interventional radiology largely reflected pseudoaneurysm differences (0 (0.0%) TE vs 14 (3.0%) SPN, p=0.003). Readmission occurred less often after TE vs. SPN (3.4% vs. 8.6%, p=0.03). CONCLUSIONS: Patients receiving TE experienced no clinically significant pseudoaneurysm formation and were less likely to have any bleeding complication or major Clavien-Dindo complication postoperatively. TE is a safe option for PN with avoidance of sharp excision optimizing perioperative parameters along with known benefits in renal function. TE may be preferred when minimizing morbidity aligns with patient selection and preferences. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e396 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Elliott More articles by this author Jae Han Lee More articles by this author Hiten Patel More articles by this author Whitney Halgrimson More articles by this author Keshava Gali More articles by this author Nicholas Lanzotti More articles by this author Goran Rac More articles by this author Marcus Quek More articles by this author Gopal Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

WITHDRAWN: Incidence and outcome of surgical site infections in thoracic-organ transplant recipients registered in the Swiss Transplant Cohort Study

<h2>Abstract</h2><h3>Background</h3> Transplant-related surgical site infections (SSI) pose a relevant threat for heart (HTx) and lung transplant recipients (LuTx). Considering the paucity of data, we analyzed HTx and LuTx within the Swiss Transplant Cohort Study (STCS). <h3>Methods</h3> The STCS dataset was used to identify adult HTx and LuTx with a follow-up of at least 90 days post-transplant between 2008 and 2020. Risk factors for SSIs were investigated with logistic regression. Cox proportional hazard models, one model starting from transplantation with 365 days follow-up and one model starting 90 days post-transplant with unrestricted follow-up, were applied to address the impact of SSIs on patient and graft survival. <h3>Results</h3> Of 356 HTx 31 (8.7%) and of 450 LuTx 21 (4.7%) individuals experienced SSIs. In both HTx and LuTx, the majority of SSIs were caused by bacteria, most frequently coagulase-negative staphylococci and <i>Enterococcus</i> spp.. In HTx, diabetes mellitus (multivariable OR 2.4, 95%CI 1.02-5.8, <i>P</i>=0.04) and maintenance immunosuppression without calcineurin or mTOR inhibitor in the first week post-transplant (multivariable OR 3.9, 95%CI 1.3-11.4, <i>P</i>=0.01) were independent risk factors for SSIs. In multivariable Cox proportional hazard models, SSIs were associated with reduced patient and graft survival in LuTx (365-day model: HR 5.0, 95%CI 1.9-13.0; <i>P</i>=0.009; 90-day baseline model: HR 2.2, 95%CI 1.2-4.1, <i>P</i>=0.02), whilst we did not detect an association in HTx. <h3>Conclusions</h3> Gram-positive bacteria predominated in SSIs after both HTx and LuTx. LuTx with SSI had impaired failure-free survival as compared to those without SSI.

MP50-11 HEAD TO HEAD COMPARISON BETWEEN OFF-CLAMP VS ON-CLAMP RAPN IN HIGH-RISK RENAL SCORE KIDNEY TUMORS

You have accessJournal of UrologyCME1 May 2022MP50-11 HEAD TO HEAD COMPARISON BETWEEN OFF-CLAMP VS ON-CLAMP RAPN IN HIGH-RISK RENAL SCORE KIDNEY TUMORS Rocco Simone Flammia, Umberto Anceschi, Antonio Tufano, Gabriele Tuderti, Alexander Kutikov, Robert G. Uzzo, Francesco Porpiglia, Cristian Fiori, Andrea Minervini, Umberto Capitanio, Riccardo Autorino, Michele Gallucci, Costantino Leonardo, and Giuseppe Simone Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Antonio TufanoAntonio Tufano More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert G. UzzoRobert G. Uzzo More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Cristian FioriCristian Fiori More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The CLOCK trial found no differences between on clamp vs off-clamp RAPN. However, investigators relied mostly on cT1 patients with RENAL score ≤ 10. In consequence, their results are not applicable to more complex and larger renal masses. To address this void we tested the association of off-clamp vs on-clamp RAPN with perioperative and functional outcome within a selective cohort of kidney tumor with high-risk RENAL score. METHODS: Within a multi-institutional database (2012-2019), we identified 116 patients treated with RAPN for kidney tumor harboring RENAL score ≥ 10. Multivariable logistic regression models addressing trifecta achievement, linear regression model addressing postoperative eGFR and Cox regression models and Kaplan-Meier plots addressing any upstaging to CKD ≥ 3a (CKD-upstaging) were applied according to off-clamp vs on-clamp RAPN. Covariates were preoperative eGFR, ASA, age, clinical tumor size and preoperative Hb. Trifecta was defined as the absence of any major complication plus negative surgical margin plus absence of postoperative AKI. RESULTS: Baseline characteristic are reported in Table 1. Overall 55 vs 66 patients were treated with off-clamp vs on-clamp RAPN, respectively. Off-clamp RAPN patients exhibited higher rate of trifecta achievement, that translated into a multivariable OR of 2.78 (1.25-6.46, p=0.014). Moreover, off-clamp RAPN were associated with higher postoperative eGFR at last follow up (linear coefficient +9.8, 95%CI 3.2-16.3, p=0.004). Kaplan-Meier plots depicted 3-years CKD-upstaging-free survival rates of 91% for off-clamp RAPN vs 60% for on-clamp RAPN, which translated in a protective multivariable HR of 0.23 (95%CI 0.08-0.63, p=0.005) in favor of off-clamp RAPN. CONCLUSIONS: In patients treated for high-risk RENAL score kidney tumors, off-clamp RAPN is associated with better perioperative and mid-term functional outcome than their on-clamp counterparts. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e869 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rocco Simone Flammia More articles by this author Umberto Anceschi More articles by this author Antonio Tufano More articles by this author Gabriele Tuderti More articles by this author Alexander Kutikov More articles by this author Robert G. Uzzo More articles by this author Francesco Porpiglia More articles by this author Cristian Fiori More articles by this author Andrea Minervini More articles by this author Umberto Capitanio More articles by this author Riccardo Autorino More articles by this author Michele Gallucci More articles by this author Costantino Leonardo More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...

Thyroid nodules and its association with vitamin D in centenarians

Thyroid Nodules (TNs) and hypovitaminosis D are common conditions in old people. Our objective was to determine the prevalence of benign and malignant thyroid nodules in centenarians and to examine their associations with serum vitamin D levels. A population-based survey of 875 centenarians in Hainan, China was conducted. The thyroid glands and neck areas were scanned by board-certified sonographers using standard procedures. The prevalence of thyroid nodules (TN) was 74.2%, with 58.9% in group of possibly benign thyroid nodules (TIRADS 2, 3) and 15.5% in group of possibly malignant thyroid nodules (TIRADS 4A, 4B, 4C, 5). An analysis of logistic regression revealed that serum vitamin D levels were independently associated with increased thyroid nodule prevalence. We observed an inverse dose-effect relationship between TNs and serum vitamin D status with full adjustments (P for trend=0.025%). For the severely vitamin D deficient group, the deficient group, and the insufficient group, respectively, odds ratios and 95% confidence intervals (OR: CI) for possibly malignant TNs were 3.46 (1.26-9.51), 2.15 (1.08-4.28), and 1.41 (0.72-2.75), compared to the optimal vitamin D status group. The multivariable OR with a 5ng/mL decrease in serum vitamin D levels was 1.16 (95% CI: 1.01-1.33), for possibly malignant TNs in centenarians. Nearly three-quarters of centenarians were found to have thyroid nodules. Most of these nodules were benign and did not possess any suspicious ultrasound findings. Vitamin D deficiency was associated with thyroid nodules as suggestive characteristics of malignancy in this population.

MP51-20 THE ASSOCIATION OF TYPE AND NUMBER OF D’AMICO HIGH-RISK CRITERIA WITH RATES OF PATHOLOGICALLY NON ORGAN CONFINED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP51-20 THE ASSOCIATION OF TYPE AND NUMBER OF D’AMICO HIGH-RISK CRITERIA WITH RATES OF PATHOLOGICALLY NON ORGAN CONFINED PROSTATE CANCER Francesco Chierigo, Rocco Simone Flammia, Gabriele Sorce, Benedikt Hoeh, Lukas Hohenhorst, Zhe Tian, Fred Saad, Markus Graefen, Michele Gallucci, Alberto Briganti, Francesco Montorsi, Felix K.H. Chun, Shahrokh F. Shariat, Guglielmo Mantica, Maro Borghesi, Nazareno Suardi, Carlo Terrone, and Pierre I. Karakiewicz Francesco ChierigoFrancesco Chierigo More articles by this author , Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Benedikt HoehBenedikt Hoeh More articles by this author , Lukas HohenhorstLukas Hohenhorst More articles by this author , Zhe TianZhe Tian More articles by this author , Fred SaadFred Saad More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Felix K.H. ChunFelix K.H. Chun More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Guglielmo ManticaGuglielmo Mantica More articles by this author , Maro BorghesiMaro Borghesi More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Carlo TerroneCarlo Terrone More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002626.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the association between type and number of D’Amico high-risk criteria (DHRCs) with rates of pathologically non-organ confined (NOC) prostate cancer (PCa) in patients treated with radical prostatectomy (RP) and pelvic lymphadenectomy (PLND). METHODS: In the SEER database (2004-2016), we identified 12,961 RP+PLDN patients with at least one DHRC. We relied on descriptive statistics and multivariable logistic regression models. RESULTS: Of 12,961 patients, 6,135 (47%) exclusively harbored biopsy GS 8-10, 3,526 (27%) had clinical stage ≥ T2c, 1,234 (9.5%) had PSA > 20ng/mL. Only 1,886 (15%) harbored any combination of two DHRCs. Finally, all three DHRCs were present in 180 (1.4%) patients. NOC rates increased from 32% for clinical T stage ≥ T2c, to 49%, for either GS 8-10 only or PSA>20ng/mL only, to C)66-68% for any combination of two DHRCs, to 84% for respectively all three DHRCs, which resulted in multivariable logistic regression OR of 1.00, vs 2.01 (95% CI 1.85 - 2.19, p<0.001), vs 4.16 (95% CI 3.69- 4.68, p<0.001), vs 10.83 (95% CI 7.35 - 16.52, p<0.001). CONCLUSIONS: Our study indicates a dose-response effect according to the type and number of DHRCs. Specifically, the effect size doubles from the weakest individual DHRC (cT stage ≥ T2c) to stronger individual DHRCs (either GS 8-10 only or PSA>20ng/mL only), it doubles again in presence of any two DHRCs, and finally doubles again in presence of all three DHRCs. In consequence, a formal risk-stratification within high-risk PCa patients should be considered in clinical decision making. Source of Funding: no funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e884 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Chierigo More articles by this author Rocco Simone Flammia More articles by this author Gabriele Sorce More articles by this author Benedikt Hoeh More articles by this author Lukas Hohenhorst More articles by this author Zhe Tian More articles by this author Fred Saad More articles by this author Markus Graefen More articles by this author Michele Gallucci More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Felix K.H. Chun More articles by this author Shahrokh F. Shariat More articles by this author Guglielmo Mantica More articles by this author Maro Borghesi More articles by this author Nazareno Suardi More articles by this author Carlo Terrone More articles by this author Pierre I. Karakiewicz More articles by this author Expand All Advertisement PDF DownloadLoading ...