Nonparametric Survival Analysis Research Articles

Survival and longevity among male Australian elite athletes: A retrospective cohort study.

To quantify and compare survival and longevity in three populations of male Australian elite athletes, relative to sex- and age-matched referents from the general population. Retrospective cohort study. This study comprised a census of three populations of male Australian elite athletes (i.e. N = 10,502 Australian Football League players, N = 803 national team rugby union players, and N = 1527 Olympic athletes) who debuted from 1-JAN-1921 to 31-DEC-2023. Nonparametric relative survival analysis was conducted using the Kaplan-Meier estimator to generate survival curves, the Pohar Perme method and a log-rank type test to estimate and compare net survival, and the life years difference measure to estimate longevity gains or losses. Olympic athletes had a continuous gain in net survival post-debut, with an average life years difference of 3.40 (95 % confidence interval 2.30 to 4.49) years at the maximum follow-up time. Australian football and rugby union players initially had modest gains in net survival post-debut, followed by a gradual decline in net survival, with average life years differences of 0.31 (95 % confidence interval -0.03 to 0.65) and -0.67 (95 % confidence interval -1.87 to 0.53) years at the maximum follow-up time, respectively. Net survival was significantly different across the three cohorts (test statistic 21.8; degrees of freedom = 2; p < 0.001). Expected survival benefits were offset in elite male Australian football and rugby union players. Further research examining cause-specific mortality is warranted to elucidate the underlying reasons for the observed lack of expected survival benefit in Australian football and rugby union players.

Comparison of oncological and functional outcomes in Lower-limb osteosarcoma pediatric patients: a large single-center retrospective cohort study.

Treating pediatric osteosarcoma in long bones is challenging due to skeletal immaturity, which restricts the generalizability of insights derived from adult patients. Are there disparities in outcomes? How should surgical protocols be tailored for children of varying ages? What are the specific postoperative complications? A large single-center retrospective cohort study of 345 patients under 14 years old with lower-limb osteosarcoma treated in our department since 2000 was conducted to address these inquiries. A retrospective analysis of 345 pediatric patients with lower-limb osteosarcoma admitted to our department between 2000 and 2019 was conducted. Clinical and functional outcomes were compared based on age groups, surgical methods, type of prosthesis, and primary tumor location. Patients were divided into the low-age group (≤10y old) and the high-age group (>10y old). Overall survival rate (OS), progressionfree survival rate (PFS), and prosthesis survival rate were assessed using Kaplan-Meier curves, nonparametric survival analysis (log-rank test), and Univariate cox regression were used for comparison. The incidence of complications, local relapse rate (LRR), metastasis rate, final limb-salvage, and amputation rate, and Musculoskeletal Tumor Society (MSTS) score of different independent groups were further evaluated using χ2 test or Fisher's exact test, and t -test was employed to evaluate the measurement data. The average age of the patients was 11.10±2.32 years ranging from 4 to 14y, with an average follow-up duration of 48.17 months. The 5, 10, and 15-year OS rates were 50.3%, 43.8%, and 37.9%, respectively. The progression-free survival rate was 44.8% at 5 years and 41.1% at 10 years. The final limb salvage rate was 61.45%, while the final amputation rate was 38.55%. The low-age group had a higher amputation rate compared with the high-age group (48.00% vs. 33.18%, P =0.009). The overall LRR was 9.28%, and the incidence of metastasis was 28.99%. The LRR of the limb-salvage group was higher than the amputation group ( P =0.004). The low-age group experienced more prosthesis-related complications than the high-age group ( P =0.001). The most common prosthesis-related complication in the low-age group was soft-tissue failure, while the periprosthetic infection was most frequent in the high-age group. The high-age group had a higher cumulative prosthesis survival compared with the low-age group ( P =0.0097). Modular prosthesis showed better MSTS scores and higher cumulative prosthetic survival than expandable prosthesis in pediatric patients ( P <0.05). Limb preservation in pediatric patients becomes increasingly efficacious with advancing age, while consideration of amputation is warranted for younger patients. The prevailing postoperative complications associated with prosthesis encompass soft tissue failure and periprosthetic infection. Younger patients diagnosed with lower limb osteosarcoma exhibit a heightened amputation rate and a greater incidence of prosthesis-related complications.

Predicting Long-Term Childhood Survival of Newborns with Congenital Heart Defects: A Population-Based, Prospective Cohort Study (EPICARD).

Backgroud: Congenital heart defects (CHDs) are the most frequent group of major congenital anomalies, accounting for almost 1% of all births. They comprise a very heterogeneous group of birth defects in terms of their severity, clinical management, epidemiology, and embryologic origins. Taking this heterogeneity into account is an important imperative to provide reliable prognostic information to patients and their caregivers, as well as to compare results between centers or to assess alternative diagnostic and treatment strategies. The Anatomic and Clinical Classification of CHD (ACC-CHD) aims to facilitate both the CHD coding process and data analysis in clinical and epidemiological studies. The objectives of the study were to (1) Describe the long-term childhood survival of newborns with CHD, and (2) Develop and validate predictive models of infant mortality based on the ACC-CHD. Methods: This study wasbased on data from a population-based, prospective cohort study: Epidemiological Study of Children with Congenital Heart Defects (EPICARD). The final study population comprised 1881 newborns with CHDs after excluding cases that were associated with chromosomal and other anomalies. Statistical analysis included non-parametric survival analysis and flexible parametric survival models. The predictive performance of models was assessed by Harrell's C index and the Royston-Sauerbrei RD2, with internal validation by bootstrap. Results: The overall 8-year survival rate for newborns with isolated CHDs was 0.96 [0.93-0.95]. There was a substantial difference between the survival rate of the categories of ACC-CHD. The highest and lowest 8-year survival rates were 0.995 [0.989-0.997] and 0.34 [0.21-0.50] for "interatrial communication abnormalities and ventricular septal defects" and "functionally univentricular heart", respectively. Model discrimination, as measured by Harrell's C, was 87% and 89% for the model with ACC-CHD alone and the full model, which included other known predictors of infant mortality, respectively. The predictive performance, as measured by RD2, was 45% and 50% for the ACC-CHD alone and the full model. These measures were essentially the same after internal validation by bootstrap. Conclusions: The ACC-CHD classification provided the basis of a highly discriminant survival model with good predictive ability for the 8-year survival of newborns with CHDs. Prediction of individual outcomes remains an important clinical and statistical challenge.

OP34 Risk of Disease Recurrence and Re-resections in Crohn's Disease Patients Undergoing Primary Bowel Resection: A Population-Based Study

Abstract Background The rate of having a resection for patients with Crohn's disease (CD) have decreased over decades, while the rates of re-resections seem to have been stable around 1/3 in historic cohorts. Re-resection rates might be influenced by targeted therapies. We aimed to investigate the re-resection rates and risk of recurrence in a contemporary cohort and the effect of medical treatment on these parameters. Methods This population-based cohort included all CD patients undergoing primary intestinal resection between 2010 and 2020 in Eastern Denmark, with a background population of 2,730,000 (46% of the Danish population). Individual clinical characteristics, medication, surgical procedures, and complications, as well as imaging, and endoscopy results were collected. Disease recurrence was defined as a colonoscopy with SES-CD≥3, Rutgeerts score ≥2i, inflammation or stenosis on imaging (MRI, CTA, or IUS), fecal calprotectin ≥ 250 mg/kg, starting corticosteroids after resection or re-resection due to disease activity. We characterized the cohort using nonparametric statistics (median, IQR, percentages) and survival analysis. A Cox regression analysis with propensity score incorporating Montreal classification, age, gender, smoking, and types of resection (colon, ileocecal, or small bowel) was conducted to assess the effect of initiating prophylactic biologic treatment within the first year from resection. Results A total of 631 patients had a primary resection due to disease activity, with a median follow-up from time from diagnosis of 118 months (IQR: 69-170) (Table 1). Prior to the first resection 337 (53%) patients received immunomodulators and 249 (39%) biologics; the same numbers post-surgery were 314 (50%) and 264 (42%), respectively. A total of 256 (41%) patients were resected within two years from diagnosis while this proportion increased to 424 (67%) and 533 (84 %) after 5 and 10 years, respectively. Re-resection rates due to disease activity 5 and 10 years after primary resection were 5% and 10%. The median time from primary resection to disease recurrence was 11,3 months (IQR: 4.7-24.8) (Figure 1). Median time from first to second and second to third resection were 37 months (IQR: 15-64) and 38 months (IQR: 26-55), respectively. We found no significant difference regarding prophylactic biologic therapy within the first year of resection (n 45) based on recurrence or re-resection compared to patients not starting biologics within the first year (HR 0.40, 95%CI(0.12-1.34), p=0.14). Conclusion Most patients undergoing primary resection face post-surgery disease recurrence, yet 1 in 4 remain relapse-free for decades. Despite extensive biologic therapy, 15% still require further resections due to disease activity.

Following up with Forest Inheritors: A Survival Analysis of Recently Inherited and Recently Sold Non-Industrial Forest Land in the State of Washington, USA

A growing body of literature shows that the transfer of forest land from one owner to another in the US is associated with events such as parcelization of forest land and/or the subsequent conversion of the land away from forestry land use. For individuals and families who own forest land, a key driver of ownership transfer is the eventual or actual mortality of forest owners themselves. In the State of Washington as well as the US nationally, studies on forest legacy planning reveal that most forest owners want their children or grandchildren to own their forest properties after they no longer own the forest. In contrast, the same surveys also show that a majority of US forest owners acquired their forest land by purchasing the land from a non-relative. We utilize the Washington State Forestland Database to conduct a non-parametric survival analysis of how long recently inherited forest properties remain fully owned by the new owners (i.e. there is no subsequent sale associated with the property) compared to forest land that was sold. Results show that inherited parcels have a significantly lower survival probability as measured by remaining solely within the ownership of the new owner relative to parcels that were sold within an 8-year period. This study quantifies how the mode of forest transfer influences the duration of the following ownership lifecycle and indicates that stewardship efforts should be tailored for owners who have recently inherited forest lands.

Analysis of the survival of technology-based companies linked to business incubators

ABSTRACT Technology-Based Enterprises (TBE) contribute to the economic development of nations through the diffusion of knowledge and innovation, thus being important for the economic growth and competitiveness of territo-ries and countries. Studies point out the difficulties in creating EBTs as well as the high mortality rate. Thus, this study aimed at analysing the survival of incubated and graduated EBTs linked to business incubators in the state of Minas Gerais, Brazil, considering the explanatory variables at the company, incubator, and municipality levels. Non-parametric and semi-parametric survival analysis statistical methods were used to, first, perform a descriptive analysis of survival characteristics and, second, evaluate the relationship of explanatory variables with survival time. A sample of 603 companies was used, obtained from the InovaData-MG platform, with a record of being active or inactive from January 1990 to December 2019, according to the Brazil-ian IRS website. The results pointed out that when disengaging from incuba-tors, graduated companies are subject to a higher risk of failure, and that in-cubated ventures that also went through an acceleration programme have a higher chance of survival. Failure rates showed a non-linear relationship with firm age. Firm-specific, microeconomic, and industry specifications have important implications for the survival of the studied EBTs. This study used a new data set and a statistical technique not usually employed, which allowed us to offer an important contribution to the prediction of the mortality of EBTs, helping the formulation of more assertive public policies for the growth and development of these companies.

Non-parametric survival analysis in seed germination of forest species

ABSTRACT: In statistical analyses of seed germination experiments, it is essential to ensure that the assumptions of the chosen methods are not violated to obtain valid and reliable results. When these assumptions are violated, alternative methods should be considered, one of which is survival analysis. This study aimed to evaluate the application of this methodology, using a nonparametric approach, to assess the germination of Cecropia pachystachya and Jacaranda caroba. In the first experiment, alternating temperatures of 30/20 °C and 25/15 °C were applied under two light conditions (light and darkness). In the second, germination was assessed at constant temperatures ranging from 15 to 35 °C. Germination reached or exceeded 50% in both species under alternating temperatures and light conditions. In continuous darkness, J. caroba exhibited a higher germination speed and percentages, whereas C. pachystachya was unaffected by light conditions. The recommended alternating temperature for both species was 30/20 °C. The optimal constant temperatures were 25 °C for J. caroba and 30 °C for C. pachystachya. It is concluded that the nonparametric survival analysis technique effectively discriminates seed germination of the studied species.

Serum Calretinin and Genetic Variability as a Prognostic and Predictive Factor in Malignant Mesothelioma.

Calretinin is a promising diagnostic biomarker for malignant mesothelioma (MM), but less is known about its prognostic role. Our aim was to evaluate the association between serum calretinin concentration or genetic factors and the survival or outcome of cisplatin-based chemotherapy in MM. Our study included 265 MM patients. Serum calretinin concentration was determined using ELISA. Patients were genotyped for seven polymorphisms in CALB2, E2F2, MIR335, NRF1, and SEPTIN7 using competitive allele-specific PCR. Nonparametric tests, logistic regression, and survival analysis were used for statistical analysis. Higher serum calretinin concentration was associated with shorter progression-free (PFS) (HR = 1.18 (1.02-1.37), p = 0.023) and overall survival (OS) (HR = 1.20 (1.03-1.41), p = 0.023), but the association was not significant after adjusting for clinical factors (HR = 1.05 (0.85-1.31), p = 0.653 and HR = 1.06 (0.84-1.34), p = 0.613, respectively). SEPTIN7 rs3801339 and MIR335 rs3807348 were associated with survival even after adjustment (HR = 1.76 (1.17-2.64), p = 0.007 and HR = 0.65 (0.45-0.95), p = 0.028, respectively). Calretinin concentration was higher in patients who progressed after treatment with cisplatin-based chemotherapy (1.68 vs. 0.45 ng/mL, p = 0.001). Calretinin concentration above 0.89 ng/mL was associated with shorter PFS and OS from the start of chemotherapy (HR = 1.88 (1.28-2.77), p = 0.001 and HR = 1.91 (1.22-2.97), p = 0.004, respectively), even after adjusting for clinical factors (p < 0.05). MIR335 rs3807348 was associated with a better response to chemotherapy (OR = 2.69 (1.17-6.18), p = 0.020). We showed that serum calretinin is associated with survival and chemotherapy treatment outcomes in MM and could serve as a predictive biomarker.

KAPLAN-MEIER AND NELSON-AALEN ESTIMATORS FOR CREDIT SCORING

Financial institutions use credit scoring analysis to predict the probability that a customer will default. In this paper, we determine the probability of default using nonparametric survival analysis that are Kaplan-Meier and Nelson-Aalen. The analysis is based on survival function curves, cumulative hazard function curves, mean survival time, and standard error of estimators. Based on the curves of survival function for both Kaplan Meier and Nelson Aalen estimators relatively the same. Based on the curves of cumulative hazard function, mean survival time, and standard error the Nelson-Aalen estimators are slightly higher than Kaplan-Meier.

Intermediate and Long-Term Outcomes of the Universal 2 Total Wrist Replacement.

Introduction Arthritis of the wrist can lead to severe functionally debilitating pain which, after failed conservative measures, may require treatment with total wrist replacement (TWR). Various prosthetic designs, such as the Universal 2 implant, have been developed in attempts to combat the multitude of complications faced with replacing a complex and highly mobile joint. Having previously published short-term outcome results for the Universal 2 prosthesis, we now present the long-term survival data. Materials and Methods 19 patients underwent 21 TWR using the Universal 2 prosthesis between September 2004 and March 2008. Outcome data were collected in the form of Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires at short- (mean 4.8 years), intermediate- (mean 11.1 years), and long-term (mean 15.6 years) intervals. Nonparametric and Kaplan-Meier survival analysis was performed. Results At long-term follow-up, 7 out of the original 21 TWRs had required a revision or fusion procedure, or 7 out of 11 when excluding those lost to follow-up or who had died. At the intermediate follow-up, only one patient had required a revision procedure. Kaplan-Meier survival analysis demonstrated a median survival of 12.9 years and a 10-year survival probability of 68.1%. There was a statistically significant improvement from preoperative PRWE at short-term ( p = 0.001) and intermediate ( p = 0.01) follow-ups. This was not seen at the long-term follow-up ( p = 0.068). After an initial improvement in DASH score at short-term follow-up ( p = 0.003), the intermediate and long-term DASH scores were not significantly different from preoperative. Conclusion The Universal 2 poses a reasonable TWR implant choice for patients with debilitating arthritis. However, despite excellent short-term follow-up outcomes, longer term follow-up shows the design does continue to be plagued by implant failure and instability.

Machine learning for survival analysis in cancer research: A comparative study

OverviewSurvival analysis is at the basis of every study in the field of cancer research. As every endeavor in this field aims primarily and eventually to improve patients’ survival time or reduce the potential for recurrence. This article presents a summary of some cancer survival analysis techniques and an up-to-date overview of different implementations of Machine Learning in this area of research. This paper also presents an empirical comparison of selected statistical and Machine Learning approaches on different types of cancer medical datasets. MethodsIn this paper we explore a selection of recent articles that: review the use of Machine Learning in cancer research and/or benchmark the different Machine Learning techniques used in cancer survival analysis. This search resulted in 12 papers that were selected following certain criteria. Our aim is to assess the importance of the use of Machine Learning for survival analysis in cancer research, compared to the statistical methods, and how different Machine Learning techniques may perform in different settings in the context of cancer survival analysis. The techniques were selected based on their popularity. Cox Proportional Hazards with Ridge penalty, Random Survival Forests, Gradient Boosting for Survival Analysis with a CoxPh loss function, linear and kernel Support Vector Machines were applied to 10 different cancer survival datasets. The mean Concordance Index and standard deviation were used to compare the performances of these techniques and the results of these implementations were summarized and analyzed for noticeable patterns or trends. Kaplan-Meier plots were used for the non-parametric survival analysis of the different datasets. ResultsCox Proportional Hazards delivers comparable results with Machine Learning techniques thanks to the Ridge penalty and the different methods for dealing with tied events but fails to produce results in higher dimensional datasets. All techniques benchmarked in the study had comparable performances. The use of prognostic tools when there is a mismatch between the patients and the populations used to train the models may not be advisable since each dataset provides a differently shaped survival curve even when presenting a similar cancer type.

TRAJECTORIES OF SERUM 25(OH)D IN CHILDREN WITH PARALYTIC SYNDROMES WHEN USING VITAMIN D FROM DIFFERENT MANUFACTURERS AND IN DIFFERENT DOSES

The prevalence of vitamin D deficiency and insufficiency varies significantly in different subpopulations of children depending on age and diseases, and recommendations for their correction in children with paralytic syndromes are limited.Aim. Empirical determination of blood 25(OH)D trajectory in children with paralytic syndromes when using vitamin D from different manufacturers and in different doses.Material and methods. The 25(OH)D (ng/ml) of blood serum was analyzed by immune-enzymatic method "Labline-90" (Austria) with the test system "Monobind Inc." (ELISA, USA) in 77 children with paralytic syndromes aged 1-18 years, a repeat study after vitamin D3 supplementation was conducted in 36 children. The rate of increase in 25(OH)D concentration per month was calculated. Methods of descriptive statistics, non-parametric correlation analysis and Kaplan-Meier survival analysis were used with MedCalc Statistical Software (Belgium).This study was approved by the Ethics Committee (protocol No. 5, October 2021), which was conducted with the involvement of minor patients and did not contain measures that could harm their health.The research was carried out within the framework of the Department of Pediatrics of Kharkiv National Medical University "Medical and social aspects of adaptation of children with somatic pathology in modern conditions" (state registration number 0120U102471, 2020).Results. Vitamin D insufficiency was diagnosed in 17% of children with paralytic syndromes, and vitamin D deficiency in 73%, so daily doses of 2000-4000 IU of vitamin D3 from different manufacturers were recommended at the discretion of the parents for 6 months. In reality, children received doses from 500 to 5000 IU randomly, from 2 to 7 months. Doses were stratified as greater than 2000 IU and less than 2000 IU. If the child received a dose of 2000 IU or more, the rate of increase of 25(OH)D in the blood in children was 3.6 ng/ml per month, if the dose was less than 2000 IU - 1.6 ng/ml per month.Conclusions. Children with paralytic syndromes should be screened and monitored for serum 25(OH)D levels. With a serum 25(OH)D level of less than 20 ng/ml, daily administration of vitamin D3 in a dose of at least 2000 IU for at least 6 months allows reaching a 25(OH)D level of 30 ng/ml in most of them. Further large-scale studies are needed to supplement current recommendations for vitamin D3 supplementation in children with paralytic syndromes.

Comparative Survival Benefits of Surgery and Adjuvant Chemotherapy in Neuroendocrine Carcinoma of the Gallbladder: A Population-Based Study with Insight into Future Personalized Therapeutic Approach.

Neuroendocrine carcinomas of the gallbladder (NECs-GB) are rare tumors, accounting for <0.2% of all neuroendocrine carcinomas of the gastrointestinal tract. They originate from the neuroendocrine cells of the gallbladder epithelium with associated intestinal or gastric metaplasia. The current study is the largest study from the SEER database on NECs-GB that aims to elucidate the demographic, clinical, and pathologic factors influencing the prognosis and comparative survival analysis of different treatment modalities. The data from 176 patients with NECs-GB was abstracted from the Surveillance Epidemiology and End Result (SEER) database (2000-2018). Multivariate analysis, non-parametric survival analysis, and a chi-square test were used to analyze the data. NECs-GB had a higher incidence amongst females (72.7%) and Caucasians (72.7%). Most patients had surgery only (N = 52, 29.5%), (N = 40) 22.7% had chemotherapy only, and (N = 23) 13.1% had chemotherapy with surgery. Only (N = 17) 9.7% had trimodaltiy (surgery, chemotherapy, and radiation therapy), and for (N = 41) 23.3% the status of chemotherapy was unknown, and these cases had neither radiation nor surgery. NECs-GB more frequently affects Caucasian females after the 6th decade of life. The combination of surgery, radiation, and adjuvant chemotherapy was associated with better long-term (5 years) outcomes, while surgery alone was associated with better short-term (<2 years) outcome survival.

Metaplastic Breast Carcinoma in U.S. Population: Racial Disparities, Survival Benefit of Adjuvant Chemoradiation and Future Personalized Treatment with Genomic Landscape.

In this population-based study, we aim to identify factors that are influential on the survival outcome in MBC and investigate novel molecular approaches in personalized disease management. The data of this study were collected from the SEER database from 2000-2018. A total of 5315 cases were extracted from the database. The data were evaluated for demographics, tumor characteristics, metastasis, and treatment. Survival analysis was completed by using SAS software for multivariate analysis, univariate analysis, and non-parametric survival analysis. The molecular data with the most common mutations in MBC were extracted from the Catalogue of Somatic Mutations in Cancer (COSMIC) database. The mean age at the time of presentation was 63.1 with a standard deviation (SD) of 14.2 years. Most patients were White (77.3%) with 15.7% Black patients, 6.1% Asian or Pacific Islander, and 0.5% American Indian. Histologically, most of the reported tumors were grade III (74.4%); 37% of the cases were triple negative (ER-, PR- and HER2-), whereas the hormone status was unknown in 46% of the cases. Spread was localized in 67.3% of patients while 26.3% had regional spread and 6.3% had distant metastases. Most tumors were unilateral (99.9%) and between 20-50 mm in size (50.6%). The lungs were the most common site for distant metastasis at diagnosis (3.42%) followed by bone (1.94%), liver (0.98%), and brain (0.56%). A combination of surgery, chemotherapy, and radiation therapy was the most common treatment with a cause-specific survival rate of 78.1% (95% CI = 75.4-80.4). The overall survival rate at 5 years was 63.6% (95% confidence interval (CI) = 62.0-65.1) with a cause-specific survival of 71.1% (95% CI = 69.5-72.6). Cause-specific survival was found to be 63.2% (95% CI = 58.9-67.1) in Black patients as compared to 72.4% (95% CI = 70.1-74.1) in White patients. Black patients also presented with higher rates of grade III disease, distant metastasis, and larger tumor size. On multivariate analysis, age > 60, grade III+, metastasis, and tumor size > 50 mm were associated with worse survival. The most common mutations in MBC identified in COSMIC data were TP53, PIK3CA, LRP1B, PTEN, and KMT2C. Though rare, MBC is aggressive, with poor prognosis associated with high-grade tumors, metastasis, tumor size over 50 mm, and advanced age at the time of presentation. Overall, Black women had worse clinical outcomes. MBC is difficult to treat and carries a poor prognosis that affects various races disproportionately. Continued enhancement of treatment strategies to foster more individualized care as well as continued enrollment in clinical trials are needed to improve outcomes among patients with MBC.

TFE3 gene rearrangement and protein expression contribute to a poor prognosis of renal cell carcinoma

BackgroundTFE3-rearranged renal cell carcinoma (TFE3-rearranged RCC) is a type of kidney cancer with a low incidence, with no consensus about whether it has a worse prognosis than clear cell renal cell carcinoma (ccRCC). This study attempted to elucidate the impact of TFE3-rearranged RCC by analyzing its clinical features and prognosis. MethodsPatients treated in Sun Yat-sen Memorial Hospital (SYSMH) who were suspected to be diagnosed with TFE3-rearranged RCC were divided into two groups, TFE3-rearranged RCC and ccRCC with positive TFE3 protein expression on immunohistochemistry [TFE3(+) ccRCC], by dual-color, break-apart fluorescence in situ hybridization (FISH). After balancing the baseline characteristics with TFE3(+) ccRCC using the propensity score matching (PSM) method in a ratio of 2, we selected patients diagnosed with ccRCC with negative TFE3 protein expression on immunohistochemistry [TFE3(−) ccRCC]. The impact of TFE3 gene rearrangement and protein expression on renal cell carcinoma was determined by feature comparison with a nonparametric test and survival analysis with the Kaplan‒Meier method. ResultsAmong 37 patients suspected of having TFE3-rearranged RCC, 13 patients were diagnosed with TFE3-rearranged RCC, and 24 patients had TFE3(+) ccRCC. The recurrence and new metastasis of TFE3-rearranged RCC was relatively common, even if the tumor stage was early at the first diagnosis. Through feature comparison and survival analysis, we found that TFE3-rearranged RCC was quite similar to TFE3(+) ccRCC. Compared with TFE3(−) ccRCC, TFE3(+) ccRCC tended to have a larger tumor diameter (P = 0.011), higher neutrophil/lymphocyte ratio (NLR) (P = 0.017) and metastatic potential (P = 0.022), and worse overall survival (OS) (P = 0.043) and PFS (P = 0.016). The survival analysis showed that TFE3-rearranged RCC had a worse PFS than ccRCC (P = 0.002), and TFE3(+) RCC had a worse PFS than TFE3(−) RCC (P = 0.001). According to the stratification system based on the combination of TFE3 and lymphovascular invasion (LVI), we further found that the prognosis from good to poor was TFE3(−) LVI(−), TFE3(+) LVI(−), TFE3(+) LVI(+) and TFE3(−) LVI(+), with statistically significant differences in both OS (P = 0.001) and PFS (P < 0.001). In addition, we also reported two cases with poor prognosis, of which one was TFE3-rearranged RCC and the other was TFE3(+) ccRCC. ConclusionsThis is a novel finding that both FISH confirmed TFE3 gene rearrangement-mediated TFE3-rearranged RCC and IHC confirmed positive TFE3 protein expression [TFE3(+)] contribute to a poor prognosis in RCC, suggesting more active treatment and careful follow-up for TFE3(+) RCC patients. The combination of TFE3 and LVI may be a new risk stratification system for RCC.

Breast cancer and occupation: Non-parametric and parametric net survival analyses among Swiss women (1990-2014).

Occupation can contribute to differences in risk and stage at diagnosis of breast cancer. This study aimed at determining whether occupation, along with skill level and the socio-professional category, affect the breast cancer survival (BCS) up to 10 years after diagnosis. We used cancer registry records to identify women diagnosed with primary invasive breast cancer in western Switzerland over the period 1990-2014 and matched them with the Swiss National Cohort. The effect of work-related variables on BCS was assessed using non-parametric and parametric net survival methods. Study sample included 8,678 women. In the non-parametric analysis, we observed a statistically significant effect of all work-related variables on BCS. Women in elementary occupations, with low skill level, and in paid employment not classified elsewhere, had the lowest BCS, while professionals, those with the highest skill level and belonging to top management and independent profession category had the highest BCS. The parametric analysis confirmed this pattern. Considering elementary occupations as reference, all occupations but Craft and related trades had a hazard ratio (HR) below 1. Among professionals, technicians and associate professionals, and clerks, the protective effect of occupation was statistically significant and remained unchanged after adjustment for age, calendar period, registry, nationality, and histological type. After adjusting for tumor stage, the HRs increased only slightly, though turned non-significant. The same effect was observed in top management and independent professions and supervisors, low level management and skilled laborers, compared to unskilled employees. These results suggest that work-related factors may affect BCS. Yet, this study was conducted using a limited set of covariates and a relatively small study sample. Therefore, further larger studies are needed for more detailed analyses of at risk occupations and working conditions and assessing the potential interaction between work-related variables and tumor stage.

Surgical, survival and quality of life outcomes in over 1000 pelvic exenterations: lessons learned from a large Australian case series

To determine surgical, survival and quality of life outcomes across different tumour streams and lessons learned over 28 years. Consecutive patients undergoing pelvic exenteration at a single, high volume, referral hospital, between 1994 and 2022 were included. Patients were grouped according to their tumour type at presentation as follows, advanced primary rectal cancer, other advanced primary malignancy, locally recurrent rectal cancer, other locally recurrent malignancy and non-malignant indications. The main outcomes included, resection margins, postoperative morbidity, long-term overall survival, and quality of life outcomes. Non-parametric statistics and survival analyses were performed to compare outcomes between groups. Of the 1023 pelvic exenterations performed, 981 (95.9%) unique patients were included. Most patients underwent pelvic exenteration due to locally recurrent rectal cancer (N= 321, 32.7%) or advanced primary rectal cancer (N= 286, 29.2%). The rates of clear surgical margins (89.2%; P< 0.001) and 30-days mortality were higher in the advanced primary rectal cancer group (3.2%; P= 0.025). The 5-year overall survival rates were 66.3% in advanced primary rectal cancer and 44.6% in locally recurrent rectal cancer. Quality of life outcomes differed across groups at baseline, but generally had good trajectories thereafter. International benchmarking revelled excellent comparative outcomes. The results of this study demonstrate excellent outcomes overall, but significant differences in surgical, survival and quality of life outcomes across patients undergoing pelvic exenteration due to different tumour streams. The data reported in this manuscript can be utilized by other centres as benchmarking as well as proving both subjective and objective outcome details to support informed decision-making for patients.

Sex-Specific Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia

Trigeminal neuralgia (TN) is more prevalent among women. However, while microvascular decompression (MVD) is the most effective long-term surgical treatment for TN, it is unclear whether it is equally efficacious for men and women. We sought to characterize the relationship between sex and pain outcomes following MVD for TN. From 2007 to 2020, 938 unilateral TN patients were treated with MVD at our institution. Patient demographics, clinical characteristics, operative features, and pain outcomes were recorded. Differences between men and women were analyzed via t-test and chi-squared analyses. A multivariate ordinal regression was used to establish significant predictors of pain outcome. Differences in time to pain recurrence were assessed via Cox proportional hazards and Kaplan-Meier nonparametric survival analysis. A majority (67%) of the 938 patients analyzed were female. Men and women presented with similar preoperative pain severity (P= 0.17). Female sex (P= 0.048) and younger age (P= 0.03) were independently associated with worsened Barrow Neurological Institute pain scores at 3-month follow-up on multivariate analysis. Women were also more likely to experience recurrence than men (P= 0.01), and time to recurrence was shorter among women (P= 0.02). Only female sex was independently associated with increased risk of postoperative pain recurrence on multivariate Cox proportional hazards regression (P= 0.01). Female TN patients undergoing MVD had worse pain outcomes, more frequent pain recurrence, and shorter time to recurrence. Our results indicate a sex-specific dimorphism in response to MVD among TN patients.

Rooting of forest species mini-cuttings: an application of non-parametric survival analysis

Rooting of forest species mini-cuttings: an application of non-parametric survival analysis

Survival Analysis for Asphalt Pavement Performance and Assessment of Various Factors Affecting Fatigue Cracking Based on LTPP Data

Pavement performance is the ability of pavement to remain in an acceptable condition to serve the intended users over a period of time. There are several principal, combined factors that affect flexible pavement performance such as environmental conditions, pavement materials, and traffic loads. Vehicle overloading is considered one of the most significant causes of accelerating flexible pavement deterioration, reducing the pavement’s design life, and affecting the overall sustainability of the pavement system. Therefore, researchers are continuously examining pavement systems with a view to finding the most suitable solutions for sustainable development in road construction systems in order to reduce both costs and pollution. In this study, we present a framework to conduct nonparametric and parametric survival analysis for asphalt pavement test sections, to assess the influence of using reclaimed asphalt pavement (RAP) on fatigue service life, to indicate the most significant subset of risk factors (covariates), and to study the effect of overweight axles on flexible pavement performance. All the data concerned were extracted from the long-term pavement performance (LTPP) program. The Kaplan–Meier (KM) survival probability curves of multiple pavement distresses were developed to compare the failure probability for various distresses and to determine the median survival time for each distress. The fatigue survival curves for the test sections using RAP and virgin materials were developed separately and the equality of the two survival curves was tested and affirmed. Several parametric survival analyses were conducted to select the most significant subset of covariates. For fatigue cracking and, after dropping the insignificant predictors, a model was developed to show the quantitative relationship between fatigue failure time and potentially influential factors. The analysis indicated that the increase in the percentage of overloaded axles from 0% to 20% can reduce the fatigue survival life of flexible pavement by up to 55%. In the absence of overweight axles, a one-inch increase in asphalt layer thickness can extend the fatigue service life by about half a year. However, in the presence of 20% of overweight axles, a one-inch increase in thickness can extend the fatigue service life by only 0.22 years. Therefore, additional virgin materials and resources are needed to maintain traffic conditions in the road network and to compensate for the reduction in fatigue service life. Moreover, the effect of the increase in overweight axles from 0% to 15% on reducing the fatigue survival life is found to be similar to the effect of increasing the AADTT tenfold. Therefore, the sustainability of pavement is directly affected by the fatigue survival life.