Non-elevated Group Research Articles

Lateral Lumbar Interbody Fusion at L4-5: A Morphometric Analysis of Psoas Anatomy and Cage Placement

The ventral elevation (VE) of the psoas from the vertebral column as seen on axial magnetic resonance imaging has been suggested as a preclusion of a safe working zone for lateral lumbar interbody fusion (LLIF) at L4-5. However, no quantitative study has been conducted to verify this. L4-5 LLIF was attempted using 22-mm wider cages whenever feasible over 18-mm standard cages in a consecutive series of 62 patients. The degree of VE of the psoas measured from the anterior border of the L5 endplate and the anteroposterior cage position measured from the posterior vertebral border to the center of the cage normalized to the anteroposterior width of the L5 endplate were recorded on axial images. LLIF was successfully performed in all cases despite 18 patients (29%) harboring elevated psoas. Standard cage was applied in 25 (40%) patients due to nerve proximity. Wider cage was applied equally frequent in both elevated (56%) and nonelevated groups (60%, P= 0.78). The mean cage position was found to be 0.54 ± 0.10 (standard deviation) and no difference was detected between the elevated (0.54 ± 0.11) and nonelevated (0.53 ± 0.10, P= 0.78) groups. Multivariate analyses and receiver operating characteristic analysis demonstrated that VE displayed low performance in predicting the choice of cages. LLIF is feasible in patients with ventrally elevated psoas, and the choice of cages does not appear to be influenced by the location of the psoas. Relying on the rising psoas sign on magnetic resonance imaging as a case selection criterion may unjustly exclude patients from LLIF.

787-P: Mental Health Discussions during Routine Diabetes Care Visits with Adolescents and Young Adults

Background: Adolescents and young adults (AYAs) with T1D are at risk for elevated depressive symptoms. Health care providers (HCPs) are in a unique position to discuss mental health (MH) and T1D self-care during routine diabetes medical visits. Objective: Evaluate the frequency and content of MH discussions during medical visits. Methods: Data were drawn from a longitudinal study of AYA-HCP communication and T1D care. Secondary analyses include evaluation of 108 medical visits (M duration=22.5 min; n=8 HCPs) with 33 AYAs with T1D (48.5% male; 45.5% non-Hispanic White; M age=17.5±1.1 yrs; M clinic visits=3.27). 22 AYAs self-reported elevated depressive symptoms using the Center for Epidemiologic Studies-Depression scale (M CES-D score=22.6±8.3); a matched sample of 11 AYAs without elevated depressive symptoms was selected for comparison (M CES-D score=5.7±3.9). Medical visits were audio-recorded, transcribed, and coded by trained coders to identify and characterize MH discussions. Results: Coding of transcripts identified 43/108 medical visits (39.8%) with ≥ 1 MH discussion. AYAs with elevated depressive symptoms were as likely to have a MH discussion (42.6%) as AYAs without elevated depressive symptoms (35.0%; p=.43); the elevated group had 2.48 distinct MH conversations/visit compared to 1.64 distinct MH conversations/visit for the non-elevated group (p=.10). MH discussions were initiated most often by HCPs (67.4%), followed by AYAs (23.3%) and parents (9.3%). MH resources were provided in 60.5% of all visits with MH discussion, including: referral for MH services (76.9%), general MH education (30.8%), and recommendation to continue current MH services (26.9%). Discussion: MH content is commonly discussed in routine T1D care. Results suggest a need to increase HCP-delivered resources for AYAs with MH concerns. Evaluation of MH discussions can improve the quality of AYA-HCP communication around MH symptoms and, ultimately, improve diabetes care. Disclosure M. Monaghan: Research Support; Self; American Diabetes Association. C. Wong: None. D.L. Polyakov: None. M. Rose: None. Funding American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.); National Institutes of Health (R03DK110259)

Schlemm Canal and Trabecular Meshwork Features in Highly Myopic Eyes With Early Intraocular Pressure Elevation After Cataract Surgery

To investigate the morphologic features of the Schlemm canal and trabecular meshwork in highly myopic eyes with early intraocular pressure (IOP) elevation after cataract surgery. Retrospective case-control study. Eighty-eight highly myopic eyes of 88 patients after uneventful cataract surgery were included, 31 of which had early postoperative IOP elevation and 57 of which did not. The morphologic features of the Schlemm canal and trabecular meshwork, collected with swept-source optical coherence tomography before surgery, were reviewed. Backwards stepwise multiple linear regression was used to investigate the anatomic risk factors for early IOP elevation in highly myopic eyes. Highly myopic eyes with early postoperative IOP elevation had smaller Schlemm canal vertical diameter and area, as well as smaller trabecular meshwork thickness and width, in each quadrant than the non-elevation group. There was no significant difference in Schlemm canal horizontal diameter between the IOP elevation and non-elevation groups. In the highly myopic eyes, average Schlemm canal vertical diameter, Schlemm canal area, trabecular meshwork thickness, and width were all correlated negatively with the IOP elevation. A multivariate analysis showed that average Schlemm canal vertical diameter (β=-0.262, P= .004) and trabecular meshwork thickness (β=-0.173, P < .001) were significantly associated with early transient IOP elevation in highly myopic cataract eyes. A smaller vertical diameter of Schlemm canal and a thinner trabecular meshwork are 2 anatomic risk factors for early IOP elevation after cataract surgery in highly myopic eyes.

Elevated eosinophil level predicted long time to next treatment in relapsed or refractory myeloma patients treated with lenalidomide.

Lenalidomide is an immunomodulatory drug that is administered commonly in patients with relapsed or refractory multiple myeloma (RRMM). Eosinophils have immunological functions, for instance, in allergic diseases and asthma. The purpose of this study was to investigate the clinical significance of elevated eosinophil levels in patients with RRMM treated with lenalidomide. A total of 59 patients were included. Elevated eosinophil level was defined as an increase in the eosinophil count of ≥250/µL from the eosinophil count on day 1 during the first cycle. The percentage of patients with elevated eosinophil levels was 22.0%. The overall response ratio in the elevated eosinophil group and nonelevated eosinophil group was 84.6% and 63.0% (P = .189), respectively. The median time to next treatment (TTNT) in the elevated eosinophil group was significantly longer than that in the nonelevated group (40.3 months vs 8.4 months; P = .017). Additionally, TTNT in the elevated eosinophil group with partial response (PR) or better was significantly longer than that in the nonelevated eosinophil group with PR or better (40.3 months vs 11.9 months; P = .021). We concluded that elevated eosinophil levels were frequently observed and might predict a longer TTNT in patients with RRMM treated with lenalidomide.

Clinical Impact of High-Sensitivity Cardiac Troponin T on the Chronic Phase of Stable Angina after a Successful Initial Percutaneous Coronary Intervention.

The purpose of this study was to investigate the clinical significance of elevated plasma high-sensitivity troponin T (hs-TnT) in the chronic phase in patients with stable angina pectoris (SAP) who underwent a successful percutaneous coronary intervention (PCI). This study enrolled 158 consecutive SAP patients who underwent routine follow-up coronary angiography 9 months after a successful PCI with the implantation of a second-generation drug-eluting stent. Patients with previous coronary artery bypass graft and renal dysfunction were excluded. Patients were divided into two groups according to hs-TnT plasma level at follow-up: elevated hs-TnT (≥ 0.015 ng/ml) group and non-elevated hs-TnT group. Among the 158 subjects, 42 had an elevated hs-TnT level at follow-up. The elevated hs-TnT group had a significantly higher rate of any coronary lesion (in-stent restenosis and de novo lesions) in follow-up CAG (coronary angiography) than the non-elevated group (28.6% vs. 10.3%, p < 0.05). Multivariate analysis also showed that hs-TnT elevation was independently associated with the presence of significant coronary stenosis in the chronic phase (odds ratio: 3.99, 95% confidence interval: 1.38 to 11.53). The best cut-off value of the hs-TnT level at 9 months after a successful PCI to predict the presence of significant coronary stenosis was 0.016 ng/ml (sensitivity: 50.0%; specificity: 82.1%; area under the receiver operating characteristic curve: 0.67). hs-TnT elevation was independently associated with the presence of coronary stenosis in the chronic phase in SAP patients with successful PCI. Routine measurement of hs-TnT in the chronic phase may be useful to refine the risk of patients after PCI.

P5417Splenic volume changes as a hemodynamic parameter in advanced heart failure with left ventricular assist device

Abstract Background The spleen has been recognized as an important organ to reserve 20–30% of the total blood volume. Generally, splenomegaly has been thought to be related to congestion. However, in the setting of hypovolemic shock or hypoxemia, it has been reported that spleen contracted and splenic volume decreased. On the other hand, in advanced heart failure (HF), the hemodynamics is characterized by both low cardiac output (LO) and systemic congestion, and patients sometimes need support of left ventricular assist device (LVAD). However, it remains unclear about the association between spleen size and hemodynamic parameters in patients with LO who need LVAD support. Purpose The purpose of this study was to investigate the relationship between spleen size and hemodynamic parameters in advanced HF before and after LVAD implantation. Methods We enrolled 12 advanced HF patients with LVAD (11 males, 45±10 years). All patients underwent blood test, echocardiography, right heart catheterization, and computed tomography (CT) before and after LVAD implantation. Spleen size was measured by CT volumetry. We excluded patients with splenic infarction, or any infections, or mean right atrial pressure (RAP) &lt;5mmHg because of a possibility of hypovolemic status. LO was defined as CI less than 2.2L/min/m2. Results At pre- and post-LVAD implantation, cardiac output, cardiac index (CI), mean RAP, and mean pulmonary capillary wedge pressure were 3.1±0.6 vs. 4.9±0.9L/min, p=0.002; 1.7±0.3 vs. 2.8±0.3L/min/m2, p=0.002; 14±5 vs. 9±3mmHg, p=0.059; and 30±7 vs. 10±3mmHg, p=0.002, respectively. The serum brain natriuretic peptide level had significantly decreased (1101 [517–1446] vs 74 [35–216] pg/mL, p=0.002). In all patients, CI had increased to over 2.2L/min/m2. The splenic volume significantly increased from pre- to post-LVAD implantation (172±48 vs. 233±78mL, p=0.002) (Figure). Furthermore, all patients were divided into two groups; elevated RAP group (n=4) and non-elevated RAP group (n=8) after LVAD support. In elevated RAP group, there were no significant changes in the spleen size between pre- and post-LVAD implantation (167±45 vs. 223±111mL, p=0.068). On the other hand, in non-elevated RAP group, the spleen volume had significantly increased from pre- to post-LVAD support (172±53 vs. 231±62mL, p=0.011). In addition, there was one patient whose hemodynamic state had changed to LO again because of LVAD failure due to pump thrombosis. In this case, the splenic volume was 212mL before LVAD implantation with LO, and increased to 418mL after LVAD implantation with non-LO, although decreased to 227mL after LVAD pump failure with LO again. Splenic volume changes Conclusions The spleen may change its size in order to keep cardiac output by regulating cardiac preload depending on the systemic perfusion in advanced HF with LVAD. Acknowledgement/Funding None

The elevation of eosinophils could prolong the time to the next treatment in patients with RRMM who are treated with lenalidomide

Lenalidomide (LEN) directly targets myeloma cells and stimulates an immunological response. Eosinophils (Eo) have a variety of immunological functions and play roles in the development of allergic diseases and asthma. Eo level elevations have been shown to represent immunological activity in patients with myeloma who are treated with LEN. The purpose of this study was to investigate the clinical significance of Eo level elevation in patients with relapsed or refractory multiple myeloma (RRMM) who were treated with LEN. We reviewed the medical records of patients with RRMM who were treated with LEN-containing regimens at the Jikei Kashiwa Hospital, between November 2010 and June 2018. The included patients were followed-up until March 2019, and the median follow-up period was 24.4 months. Fifty-nine patients with RRMM who were treated with LEN were analyzed, and median patient age was 73 years. An elevation of Eo was defined as an increase in Eo count of 250 /microL or more during the first cycle, compared to the level on day one of the first cycle. As salvage chemotherapy, 39, 8, 4, 3, 3, and 2 patients received LEN plus dexamethasone (Rd), elotuzumab plus Rd (ERd), daratumumab plus Rd (DRd), ixazomib plus Rd, bortezomib plus Rd, and LEN, melphalan, plus prednisone, respectively. The median time from diagnosis to the start of LEN was 25.9 months. The median number of prior regimens was two. The percentage of patients with the Eo elevation was 22.0%. There were no a significant relationships among Eo elevation and age, sex, M protein type, international staging system (ISS), serum lactate dehydrogenase level, serum C-protein level, number of prior chemotherapies, prior bortezomib, dose of lenalidomide, and dose of corticosteroid. The overall response rate (ORR) in the groups with Eo level elevation and non-elevation were 84.6% and 63.0%, respectively (P = 0.189). The elevation of Eo was not related to any grade of skin rash (P = 0.713). The median time to next treatment (TTNT) of the Eo elevation group was significantly longer than that of the Eo non-elevation group (40.3 vs 8.4 months, P = 0.017). In addition, the median TTNT in the Eo elevation group with partial response (PR) or better was significantly longer that of the Eo non-elevation group with a PR or better (40.3 vs 11.9 months, P = 0.021). In the multivariate analysis, the Eo elevation was a significant good prognostic factor for TTNT (hazard ratio 0.401, P = 0.043). The overall survival was similar between the Eo elevation and non-elevation groups (P = 0.334). From our findings, we conclude that Eo level elevations are common and can prolong TTNT in patients with RRMM who are treated with LEN.

Association of NT-proBNP with clinical outcomes in children with systemic inflammatory response syndrome

N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been reported to have an association with increased morbidity and mortality in adults with septic shock. The relationship between NT-proBNP levels and morbidity/mortality in children with systemic inflammatory response syndrome (SIRS) has not been studied. This was a retrospective study. The inclusion criteria were children (<18 years of age) who met the SIRS criteria and had NT-proBNP obtained between 2011 and 2017. Patients with final primary diagnoses related to cardiac disease were excluded. Patients were divided into 2 groups based on the value of NT-proBNP levels. Our cohort consisted of 44 patients after screening 4004 patients. Primary diagnoses were bacterial infection (n = 35, 80%), viral infection (n = 6, 14%), and Kawasaki disease (n = 3, 7%). Between elevated (n = 26) and non-elevated (n = 18) groups, there was no difference in age groups, gender, race, or final diagnoses. There were 5 deaths (11%). Children in the elevated group were more likely to require intensive care unit admission (odds ratio 20.0), mechanical ventilation (5.0), and inotropic support (9.4). Using receiver operator characteristic curve, the optimal cut-off values of NT-proBNP were 3034 pg/mL for inotropic support and mechanical ventilator use, 818 pg/mL for ICU admission, and 29,988 pg/mL for mortality. NT-proBNP levels were associated with increased morbidity in children with SIRS.

Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients.

e16065 Background: The later-line treatment of metastatic renal cell carcinoma (mRCC) has been drastically changing by the development of immune-oncology drugs and molecular targeted treatment in recent years. Although the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model is useful for second-line setting, this model has the problem that over 50% patients are classified as intermediate risk group. The aim of this study is to evaluate whether the serum C-reactive protein (CRP) levels prior to second-line treatment could divide intermediate risk group patients. Methods: We retrospectively reviewed 150 mRCC patients received second-line molecular targeted therapy. We assessed the prognostic impact of serum CRP levels prior to second-line treatment initiation to predict overall survival (OS) especially in intermediate risk group. Results: The median OS from second-line treatment of whole cohort and intermediate risk group were 24.6 (95%confidence interval, 95%CI:18.2-31.0) and 23.6 (95%CI:15.1-32.1) months. Thirty-three out of 82 (40%) intermediate risk patients demonstrated elevated baseline CRP levels. The median OS of elevated and non-elevated CRP group were 13.4 (95%CI:5.9-20.8) and 29.4 (95%CI:25.5-33.5) months, respectively (p = 0.001). The serum CRP elevation could predict prognosis in intermediate risk patients treated with second-line treatment (HR 2.5,95%CI:1.4-4.2, p = 0.001). Conclusions: The serum CRP levels at second-line treatment initiation could divide intermediate risk mRCC patients into two prognostic subgroups.

Preoperative Carcinoembryonic Antigen as a Poor Prognostic Factor in Stage I-III Colorectal Cancer After Curative-Intent Resection: A Propensity Score Matching Analysis.

Preoperative carcinoembryonic antigen (CEA) has yet to be used as a prognostic or adjuvant chemotherapy factor for colorectal cancer (CRC). This retrospective cohort study included all stage I-III CRC patients with different preoperative serum CEA levels (≤ 5, 5-10, and > 10ng/ml) at a single center between 1995 and 2010. Propensity score matching was performed in a 1:1 ratio between the two elevated CEA groups (5-10ng/ml and > 10ng/ml) and in a 1:2 ratio between the elevated and non-elevated groups (≤ 5ng/ml), with a caliper of 0.05. After exclusion and matching, 3857 patients had preoperative CEA levels ≤ 5ng/ml, 1121 patients had CEA levels between 5 and 10ng/ml, and 1121 patients had CEA levels > 10ng/ml. Elevated preoperative CEA showed an increased risk of overall survival (5-10ng/ml: hazard ratio [HR] 1.376; > 10ng/ml:HR1.523; both p < 0.001), cancer-specific survival (5-10ng/ml: HR 1.404; > 10ng/ml:HR1.712; both p < 0.001), and recurrence free interval (5-10ng/ml: HR 1.190; > 10ng/ml:HR 1.468; both p < 0.05). Patients with negative lymph node staging (LNs) and CEA > 10ng/ml, as well as those with positive LNs and CEA ≤ 5ng/ml, showed similar overall survival (5-year survival: 72% vs. 69%; p = 0.542) and recurrence free intervals (19.9 vs. 21.72months; p = 0.662). A preoperative CEA level can be an independent prognostic factor for stage I-III CRC after curative resection. Patients with negative LNs and preoperative CEA level > 10ng/ml should be considered for intensive follow-up or adjuvant chemotherapy.

Impact of early inflammatory cytokine elevation after commencement of PD-1 inhibitors to predict efficacy in patients with non-small cell lung cancer.

Early elevation of inflammatory cytokines, such as IL-6 or TNF-α, or CRP, which is a surrogate marker for IL-6, following commencement of PD-1/L1 inhibitors (PD1-I) may represent early activation of immune-cells. Serum IL-6 and TNF-α were measured in 10 non-small cell lung cancer patients who were evaluable within the 7 days before and after commencement of PD1-I. For CRP, medical records were reviewed and 34 patients with measured CRP within the 7 days before and after the treatment were evaluated. In the 10 patients analyzed for IL-6/TNF-α, the serum levels of IL-6/TNF-α were not significantly different between pre- and post-initial PD1-I [IL-6 20.3 (2.6-49.9) and 22.9 (3.6-96.1) pg/mL, p = 0.453; TNF-α 1.6 (0.7-6.3) and 3.3 (0.7-9.6) pg/mL, p = 0.329]; however, all four responses were observed among the 7 IL-6-elevated cases, resulting in a response rate of 57%. In the 34 patients analyzed for CRP, CRP was significantly increased after initial PD1-I [1.8 (0.1-17.8) mg/dL, 2.4 (0.0-27.8), p = 0.001]. Notably, in the 31 evaluable cases, all responses were again observed in either the IL-6 or CRP elevated groups and the response rate was 46% (11 of 24). The median overall survival time was not reached in the elevated group and was 112 days in the non-elevated group (p = 0.069). The early increase in inflammatory cytokines with PD1-I was indicated to be predictive for the efficacy in patients with non-small cell lung cancer.

Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma.

ABSTRACTPurpose:To elucidate the prognostic value of systemic inflammatory response in patients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics.Materials and Methods:A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated.Results:A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivariate analysis showed that CRP and NLR kinetics were independent prognostic indicators. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ2 test (79.9% vs. 44.9%).Conclusion:Our study suggests that dynamic changes in CRP can better predict survival in patients with mRCC who are treated with sunitinib. Routine assessment of CRP before and after targeted therapy would help identify patients at risk of a poor outcome.

Impact of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Objective: To investigate the effect of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: From March 2011 to March 2016, 72 cases with CRSwNP were treated by endoscopic sinus surgery in Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital. The clinical records were retrospectively reviewed, and the cases were divided into eosinophilia elevated and non-elevated group according to blood eosinophils, and nasal polyps were evaluated for histopathology eosinophil count. Statistical analysis was performed to compare two groups' pre- and post-operative symptoms of VAS score, sinus computed tomography (CT) scans scores according to the Lund-Mackay system and the outcome of surgery. Both groups' factors that might have affected their outcome were analyzed by t-test, Chi square, Pearson Correlation Coefficient and Willcoxon rank sum test. Results: Seventy two cases were followed up from 24 to 78 months.The average follow-up time was 56 months. The VAS score in the eosinophilia elevated group (n=16) was higher than that in the non-elevated group(n=56), and the difference was statistically significant (11.44±7.13 vs 4.98±5.64, t=3.726, P<0.05). The control of symptoms in the peripheral blood eosinophilia elevated group was less than that in the non-elevated group, and the difference was statistically significant (Z=-1.979, P<0.05). There was a positive correlation between eosinophil counts in peripheral blood and tissues of 72 cases (r=0.429, P<0.05). Conclusion: There is a significant correlation between tissue and blood eosinophil counts, and eosinophilia group has poorer outcomes.

THE RELATIONSHIP BETWEEN BETA-AMYLOID AND VASCULAR HEALTH IN OLDER ADULTS

To assess the relationship of beta-amyloid (Aβ) burden with peripheral vascular endothelial function and central cerebrovascular resistance among cognitively normal older adults. We enrolled eighty-three participants aged 65 to 87. Global Aβ burden was quantified using [18F] Florbetapir. All individuals classified as elevated had global Aβ burden >1.1 standard uptake value ratio (SUVR). Using Doppler ultrasound, we examined a measure of vascular endothelial function, brachial artery flow-mediated dilation (FMD). Cerebrovascular resistance measured by pulsatility index (PI) and middle cerebral artery blood flow velocities were recorded by transcranial Doppler ultrasound during 8 minutes of rest. White matter lesions (WML) total volume and count, common indices of cerebral small vessel health, were quantified by MRI. After adjusting for age and cardiovascular risk factors, there was a significant negative association between Aβ burden and FMD (p<0.01), such that for each 0.1 increase in Aβ burden, FMD decreased by 0.8%. Decreased brachial artery FMD response was found in individuals with elevated Aβ compared with the non-elevated group (p<0.01). The optimal cut point of FMD predicting Aβ elevation was 5% (AUC=0.836, p<0.01, 95%CI: 0.742 - 0.930), with 81.8% sensitivity and 75.4% specificity. Higher PI was demonstrated in elevated Aβ individuals (p=0.04), but was not correlated with Aβ burden. WML were not associated with Aβ.

MP16-06 EARLY RESPONSE AT FOUR WEEKS OF C-REACTIVE PROTEIN PREDICTS SURVIVAL IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH TYROSINE KINASE INHIBITORS

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II1 Apr 2017MP16-06 EARLY RESPONSE AT FOUR WEEKS OF C-REACTIVE PROTEIN PREDICTS SURVIVAL IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED WITH TYROSINE KINASE INHIBITORS Yosuke Yasuda, Kazutaka Saito, Naoko Kawamura, Sho Uehara, Takeshi Yuasa, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Shinya Yamamoto, Shunji Takahashi, Tetsuo Okuno, Junji Yonese, Kazunori Kihara, and Yasuhisa Fujii Yosuke YasudaYosuke Yasuda More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Naoko KawamuraNaoko Kawamura More articles by this author , Sho UeharaSho Uehara More articles by this author , Takeshi YuasaTakeshi Yuasa More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Shinya YamamotoShinya Yamamoto More articles by this author , Shunji TakahashiShunji Takahashi More articles by this author , Tetsuo OkunoTetsuo Okuno More articles by this author , Junji YoneseJunji Yonese More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.512AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES C-reactive protein (CRP) is a potential biomarker for renal cell carcinoma (RCC) (Saito K, Nat Rev Urol, 2011). The dynamic change of CRP levels, CRP kinetics, is associated with survival of patients with metastatic RCC (mRCC) in the cytokine era. We previously reported that early CRP response could predict overall survival (OS) for mRCC patients treated with tyrosine kinase inhibitors (TKI) in EAU congress 2016. In this study, we further explored whether the early CRP response could predict progression-free survival (PFS) and response rates (RR) with more number of cases. METHODS A total of 103 patients (80 men and 23 women) were treated with TKI for mRCC from 2008 to 2013 at our institutions. Overall, 43 and 60 patients were treated with sunitinib and sorafenib, respectively. Fifty patients (49%) had received prior immunotherapy, and 69 patients (67%) had undergone nephrectomy previously. Baseline CRP elevation was defined as a level of 10 mg/L or more. Patients were divided into three groups according to their early CRP kinetics: patients whose baseline CRP levels were <10 mg/L (non-elevated group), patients whose baseline CRP levels were 10 mg/L or more and had decreased by more than 20% 4 weeks after the initiation of TKI (early CRP responder), and the remaining patients (non-early CRP responder). The endpoints were OS, PFS and RR. RESULTS The median follow up period was 21 months (range 1 to 79 months). Baseline CRP levels were elevated in 41 patients (40%). Among these 41 patients, 19 (18%) were early CRP responder. The 1-year OS and PFS rates for the entire cohort were 69% and 40%, respectively. The 1-year OS rates of non-elevated group, early CRP responder, and non-early CRP responder were 79%, 62%, and 36% (p < 0.001). The 1-year PFS rates of these three groups were 50%, 23%, and 10% (p < 0.001). In multivariate analysis, the early CRP kinetics assessment was a significant independent factor for OS and PFS. Though there were no significant differences in the objective response rates between these three groups (p = 0.56), significantly more patients had progressive disease in the non-early CRP responder (p = 0.02). CONCLUSIONS Early CRP response at 4 weeks is predictive of survival for patients with mRCC treated with TKI. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e181 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yosuke Yasuda More articles by this author Kazutaka Saito More articles by this author Naoko Kawamura More articles by this author Sho Uehara More articles by this author Takeshi Yuasa More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Shinya Yamamoto More articles by this author Shunji Takahashi More articles by this author Tetsuo Okuno More articles by this author Junji Yonese More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Eosinophil percentage elevation as a prognostic factor for overall survival in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitor.

BackgroundWe tried to investigate the prognostic significance of post-treatment eosinophil percentage(Eo %) in metastatic renal cell carcinoma(mRCC) patients undertaking sorafenib.ResultsThe median OS for the entire sorafenib treatment period was 21.9 months (95% CI: 17.2–25.9 months). Of the 282 mRCC patients, 101 patients experienced an elevated post-treatment Eo % within two months. Median OS of post-treatment Eo % elevated group and non-elevated group were 42.9 months and 16.8 months(p=0.000). After adding post-treatment Eo % into a modified MSKCC model or Heng's model, 43 and 41 patients were reclassified into favorable group, 5 and 9 patients were reclassified to intermediate group respectively.MethodsmRCC patients treated with sorafenib from 2006 to 2015 in were evaluated. Pre- and post-treatment Eo % were assessed. Oncologic outcomes were analyzed by overall survival and tumor response rate. Predictive parameters were assessed in a Cox proportional hazard model.ConclusionsOur study demonstrates that an early elevation of Eo % after sorafenib treatment is a strong predictor of good prognosis. Eo % can be a good supplementary for prognostic models using pre-treatment parameters.

Multivariate Statistical Analysis of High Background Radiation Area on the Hadhramout Coast

This work focuses on the radiometric characteristics of beach sand along the Hadhramout coast, Gulf of Aden, Yemen. Beach sands samples were collected from 27 locations. The activity concentrations of the terrestrial radionuclides 226Ra, 232Th, and 40K were determined. The results obtained provide pioneering data on the radioactivity levels in the coastal areas of Hadhramout. The radioactivity concentration of 232Th was found to be a major contributor to the enhanced level of radiation in some beaches. The radiological data were processed using one-way analysis of variance to find out the differences between the elevated and non-elevated 232Th groups of locations and multivariate statistical analysis, i.e., principal component analysis, discriminant analysis, and clustering analysis, to find similarities and correlation between the various samples and to discriminate between the two groups of locations. From the radiation hazard point of view, the outdoor annual effective dose for the region varied from 5.1 to 155.5 mSv with a mean value of 34.9 ± 31.9 mSv. The highest radiation level was found in Al-Jraf beach, where the highest absorbed dose rate of 126.8 nGyh−1 was recorded and the radiation hazard index exceeded twice the recommended limit of unity.

The Impact of Baseline Serum C-Reactive Protein and C-Reactive Protein Kinetics on the Prognosis of Metastatic Nasopharyngeal Carcinoma Patients Treated with Palliative Chemotherapy

BackgroundThe aim of this study was to determine whether baseline C-reactive protein (CRP) levels and CRP kinetics predict the overall survival in metastatic nasopharyngeal carcinoma (mNPC) patients.MethodsA total of 116 mNPC patients from January 2006 to July 2011 were retrospectively reviewed. Serum CRP level was measured at baseline and thereafter at the start of each palliative chemotherapy cycle for all patients.ResultsPatients with higher values of baseline CRP (≥ 3.4 mg/L) had significantly worse survival than those with lower baseline CRP values (< 3.4 mg/L). Patients were divided into four groups according to baseline CRP and CRP kinetics: (1) patients whose CRP < 3.4 mg/L and never elevated during treatment; (2) patients whose CRP < 3.4 mg/L and elevated at least one time during treatment; (3) patients whose CRP ≥ 3.4 mg/L and normalized at least one time during treatment; and (4) patients whose CRP ≥ 3.4 mg/L and never normalized during treatment. The patients were further assigned to non-elevated, elevated, normalized, and non-normalized CRP groups. Overall survival rates were significantly different among the four groups, with three-year survival rates of 68%, 41%, 33%, and 0.03% for non-elevated, elevated, normalized, and non-normalized CRP groups respectively. When compared with the non-elevated group, hazard ratios of death were 1.69, 2.57, and 10.34 in the normalized, elevated, and non-normalized groups (P < 0.001).ConclusionsBaseline CRP and CRP kinetics may be useful to predict the prognosis of metastatic NPC patients treated with palliative chemotherapy and facilitate individualized treatment. A prospective study to validate this prognostic model is still needed however.

High level of preoperative carbohydrate antigen 19-9 is a poor survival predictor in gastric cancer

To assess the clinical significance and the prognostic value of preoperative serum carbohydrate antigen 19-9 (CA 19-9) level in gastric cancer. Between January 2005 and December 2006, 1960 patients underwent surgery for histologically confirmed gastric cancer. Of these, 163 patients had elevated serum levels of CA 19-9 preoperatively, and 1628 patients had normal serum levels of CA 19-9 preoperatively. For this study, 325 patients were selected from the group of 1628 patients by age, sex, and cancer stage to serve as controls. Statistically significant differences in survival rates were calculated using the log-rank test. A P value less than 0.05 was considered statistically significant and was determined using SAS software. The baseline characteristics showed some differences between the two groups with regard to histology. Overall survival (OS) in the elevated and non-elevated group was 37.90 and 68.67 mo, respectively (P < 0.001). N stage (P = 0.001) was a significant predictor of disease-free survival by multivariate analysis. Also, N stage (P < 0.001), and the presence of peritoneal metastasis (P < 0.001) remained independent factors in predicting OS by multivariate analysis. Additionally, preoperative serum CA 19-9 levels were significantly associated with OS in univariate (P = 0.009) and multivariate (P = 0.021) analyses. Serum CA 19-9 can be considered an independent prognostic factor in predicting OS in patients anticipating surgery for gastric cancer.

The Influence of Long Term Hydrochlorothiazide Administration on the Relationship between Renin-Angiotensin-Aldosterone System Activity and Plasma Glucose in Patients with Hypertension

Objective. To observe the relationship between changes in renin-angiotensin-aldosterone system (RAAS) activity and blood plasma glucose after administration of hydrochlorothiazide (HCTZ) for one year in patients with hypertension. Methods. 108 hypertensive patients were given 12.5 mg HCTZ per day for one year. RAAS activity, plasma glucose levels, and other biochemical parameters, as well as plasma oxidized low density lipoprotein (oxLDL) levels, were measured and analyzed at baseline, six weeks, and one year after treatment. Results. After one year of treatment, the reduction in plasma glucose observed between the elevated plasma renin activity (PRA) group (−0.26 ± 0.26 mmol/L) and the nonelevated PRA group (−1.36 ± 0.23 mmol/L) was statistically significant (P < 0.05). The decrease of plasma glucose in the elevated Ang II group (−0.17 ± 0.18 mmol/L) compared to the nonelevated Ang II group (−1.07 ± 0.21 mmol/L) was statistically significant (P < 0.05). The proportion of patients with elevated plasma glucose in the elevated Ang II group (40.5%) was significantly higher than those in the nonelevated Ang II group (16.3%) (P < 0.05). The relative oxLDL level was not affected by the treatment. Conclusions. Changes in RAAS activity were correlated with changes in plasma glucose levels after one year of HCTZ therapy.