One-year Patient Survival Rates Research Articles

The state of cancer care in Russia: liver cancer - (From 22). Age-related features of the observed and relative one-year and five-year survival of patients. (clinical and population-based study). Part 2.

Survival rate calculations for liver cancer patients at the federal level in the Russian Federation are only conducted in the North-Western Federal District and a few other individual administrative territories. In the first part of our study, we presented a detailed analysis of the prevalence of liver cancer, noting that the levels of standardized incidence and mortality rates in Russia and the North-Western Federal District are virtually identical, allowing us to consider the results of our study as nationally representative. The conducted research confirmed the seriousness of the issue of liver cancer among the population. However, certain advancements in patient treatment were recorded, with a significant increase in survival rates, primarily for one-year survival. For example, in the North-Western Federal District, one-year survival increased from 13.6% in 2000 to 23.1% in 2022, representing a 69.8% increase. At the same time, five-year survival rates remained largely unchanged. Increases in survival rates were observed in most age groups. A significant deficiency in the initial patient record-keeping was identified - insufficiently accurate determination of the stage of liver cancer. One-year survival rates for male and female liver cancer patients (22.7% and 22.1%) were nearly equal, as were the survival rates for liver cancer patients residing in urban and rural areas. Therefore, further improvement in the outcomes of treatment for this complex patient group can only be achieved through the implementation of regional and federal screening and epidemiological surveillance programs among populations at high and extremely high risk of developing hepatocellular carcinoma.

Additive and Dose-Dependent Effect of Rituximab on Pediatric Patients’ Outcomes Concurrently Receiving Immunosuppressive Chemotherapy, A Prospective Cohort Study

Background: Rituximab (RTX) is approved for treating CD20-positive B-cell malignancies, including non-Hodgkin lymphoma, when used alongside chemotherapy. It has the potential to interact with and alter the host immune system, putting patients at a heightened risk of infection. Therefore, the use of RTX necessitates a meticulous assessment of infectious risks based on the latest evidence. Objectives: We conducted a prospective investigation into infectious complications and mortality among children undergoing RTX treatment over the observation period of the study. Methods: In this observational cohort study, we included 61 pediatric patients treated with RTX for malignancy and immune thrombocytopenic purpura (ITP), as well as 122 cancer patients who had never received RTX (the unexposed group). These patients were prospectively monitored for febrile neutropenia (FN), bloodstream infection (BSI), invasive fungal infection (IFI), and mortality. All infectious complications were documented starting from the initial dose of RTX and continuing for at least six months following the last dose. Logistic regression and Cox regression analyses, with consideration for the proportional hazards assumption, were utilized to evaluate the impact of covariates on mortality and infection-related outcomes. Results: Infectious complications were observed in 52.5% of children treated with RTX. These complications were notably more prevalent in children with malignancy compared to those with chronic ITP (89.5% versus 10.5%, respectively). RTX was found to be associated with an increased likelihood of mortality in children with malignancy (OR [95% CI]: 1.54 [0.41, 5.69]). According to Cox regression analysis, RTX was linked to a higher risk of IFIs, death, FN events, and BSIs over a 36-month observation period (4.33 [1.21, 15.52], 3.26 [1.008, 10.59], 1.68 [0.83, 3.41], and 1.59 [0.27, 9.17], respectively). The total dose of RTX administered was also associated with adverse patient outcomes, with the odds of infectious events and death increasing in the second, third, and fourth quartiles of the total RTX dose administered. Furthermore, the estimated one-year and two-year survival rates for cancer patients treated with RTX were 77% and 58%, respectively. Conclusions: RTX treatment, when used concurrently with immunosuppressive chemotherapy for hematologic malignancies in children, showed additive and dose-dependent effects on clinical outcomes.

Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry.

The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline-directed heart failure (HF) medical therapy (GDMT) and one-year survival rate in patients who are post-CS. FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in-hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P<0.001 and 29% versus 37%, P<0.001, respectively). In the overall cohort, the one-year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one-year all-cause mortality compared with non-triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19-0.80]; P=0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one-year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P<0.001). In survivors of CS, the one-year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS.

Meta analysis of the second course of radiotherapy for recurrent esophageal cancer1.

How to improve efficacy and reduce side effects in treating recurrent esophageal cancer by applying the second course of radiotherapy alone and its combination with chemotherapy has been attracting broad research interest. This review paper aims to systematically evaluate efficacy and side effects of applying the second course of anterograde radiotherapy alone and its combination with chemotherapy in treating recurrent esophageal cancer. First, the relevant research papers are retrieved from PubMed, CNKI and Wanfang databases. Next, Redman 5.3 software is used to calculate the relative risk and 95% confidence interval to evaluate the efficacy and adverse reactions of applying the single-stage radiotherapy with and without combining single/multi dose chemotherapy to treat recurrent esophageal cancer. Then, a meta data analysis is applied to examine the effectiveness and side effects of radiation alone and re-course radiotherapy plus chemotherapy in treating esophageal cancer recurrence after the first radiotherapy. Fifteen papers are retrieved, which included 956 patients. Among them, 476 patients received radiotherapy combined with single drug/multi drug chemotherapy (observation) and others received only radiotherapy (control). Data analysis results show that the incidence of radiation induced lung injury and bone marrow suppression is high in the observation group. Subgroup analysis also shows the higher effective rate or one-year overall survival rate of patients treated with the second course radiotherapy combined with single drug chemotherapy. The meta-analysis result demonstrates that combining the second course of radiotherapy with single-drug chemotherapy has advantages in treating recurrent esophageal cancer with the manageable side effects. However, due to insufficient data, it is not possible to conduct the further subgroup analysis comparing the side effects of restorative radiation with the combined chemotherapy using between a single drug and multiple drugs.

Liver Transplantation from Brain-Dead Donors with Hepatitis B or C in South Korea: A 2014-2020 Korean Organ Transplantation Registry Data Analysis.

BACKGROUND According to the current guidelines for liver transplantation (LT) of brain-dead donors with hepatitis B or C virus (HBV or HCV) in Korea, grafts from hepatitis B surface antigen (HBsAg)(+) or HCV antibody (anti-HCV)(+) donors must be transplanted only to HBsAg(+) or anti-HCV(+) recipients, respectively. We aimed to determine the current status and outcomes of brain-dead donor LT with HBV or HCV in Korea. MATERIAL AND METHODS This retrospective observational study included all LTs from brain-dead donors in the Korean Organ Transplantation Registry between April 2014 and December 2020. According to donor hepatitis status, 24 HBV(+), 1 HCV(+), and 1010 HBV(-)/HCV(-) donors were included. RESULTS Baseline/final model for end-stage liver disease score (MELD) for HBV(+), HCV(+), and HBV(-)/HCV(-) were 22.4±9.3/27.8±7.8, 16/11, and 33.0±15.4/35.5±7.1, respectively. MELD score of HBV (+) were lower than those of HBV(-)/HCV(-) (P<0.01). Five-year graft and patient survival rates of HBV(+) and HBV(-)/HCV(-) recipients were 81.7%/85.6%, and 76.6%/76.7%, respectively (P=0.73 and P=0.038). One-year graft and patient survival rates of HCV (+) graft recipients were both 100%. CONCLUSIONS No differences in graft and patient survival rates between HBV(+) and HBV(-)/HCV(-) groups were observed. Although accumulating the results of transplants from HBV (+) or HCV(+) grafts to HBV(-) or HCV(-) recipients is not possible owing to domestic regulations, Korea should conditionally permit transplantations from HBV(+) or HCV(+) grafts to HBV(-) or HCV(-) recipients by considering the risks and benefits based on foreign studies. Thereafter, we can accumulate the data from Korea and analyze the outcomes.

The Journey to Diagnosis of Light Chain Amyloidosis: A Real-World Experience from a Single Center in Latin America

Light chain (AL) amyloidosis is a form of systemic amyloidosis, causing organ dysfunction; mainly affecting heart and kidneys. Due to the non-specific clinical manifestations, diagnosis is challenging and patients experience a long journey and treatment delay. Consequently, AL amyloidosis patients have extensive organ involvement at the time of diagnosis which implies a poor prognosis. Early diagnosis of AL amyloidosis is of paramount importance. There is limited real-world data from Latin America regarding the time from initial patient reported symptom onset to diagnosis. This retrospective cohort study aimed to assess clinical and laboratory characteristics, diagnostic journey, and outcomes of patients with AL amyloidosis treated in a medical care program in Argentina. AL amyloidosis patients were identified using a 12-year follow-up data (January 1, 2010 to December 31, 2022) from the institutional registry of amyloidosis (IRA).The IRA is registered in ClinicalTrials.gov (NCT01347047) and is approved by the IRB (CEPI 1635). Diagnosis of AL amyloidosis was confirmed by tissue biopsy staining positive with Congo red in addition to the demonstration of a monoclonal plasma cell proliferative disorder and the presence of amyloid-related systemic syndrome.The symptoms and signs related to amyloidosis were selected based on previously reported data in the literature. The number of medical consultations and health care resource utilization was collected from electronic medical records of patients in the medical care program. fThe statistical analyses were performed with Stata version 13.0. The continuous variables were presented as mean and standard deviation (SD) or median and interquartile range (IQR), and the categorical variables were presented as absolute frequencies and percentages. The survival rate was estimated by Kaplan-Meier. From 181807 community patients included in the comprehensive health care program, 28 patients were diagnosed with AL amyloidosis and included in the study. The median age at diagnosis was 73 (IQR, 66.5-80.5) years old and 64% (n=18) were female (Table 1).Heart and kidney were the most frequently affected organs. The median time from the first sign and/or symptom related to AL amyloidosis to diagnosis was 15.9 months (IQR, 8.8-38.2). Only 4 patients (14%) were diagnosed within the first six months since the onset of symptoms. Prior to diagnosis, the median number of symptoms and/or signs presented by the patients was 4 (IQR, 3.5-7). The median number of medical consultations prior to diagnosis was 3 (IQR, 1-5). The most consulted medical specialties were internal medicine (n=24, 86%), cardiology (n=14, 50%) and nephrology (n=10, 36%). Twelve patients (43%) were hospitalized at least once before diagnosis and 4 (14%) were hospitalized at least 3 times. Ten (36%) patients were diagnosed during a hospitalization. Involvement of more than three organs was present in 25% (n=7) of the patients. Fifty-seven percent (n=16) had cardiac involvement, mostly in advanced stages. Out of 23 patients that underwent treatment, 22 patients were treated with bortezomib based regimens in first line; 3 in combination with anti CD38. The median overall survival was 21 months (IQR, 4.6-49.8). The one-year overall survival rate after diagnosis was 55% (95% CI 34-71). The one-year overall survival rate for patients diagnosed within the first 12 months from the onset of symptoms was 70% (95% CI 32-89), while for those diagnosed after 12 months from the onset of symptoms, it was 45% (95% CI 20-67). This study provides real-world evidence about the diagnostic journey of AL amyloidosis patients in Latin America. AL amyloidosis is a complex disease with diverse manifestations, leading to diagnostic challenges even with growing awareness among the medical community. Patients often underwent a diagnostic odyssey involving multiple specialists and hospitalizations before the definitive diagnosis is reached.

Standard Risk Assessment Tools Fall Short to Assess Risk in Transplant Patients

Introduction: The HCT-CI (Hematopoietic Cell Transplantation-specific Comorbidity Index) predicts survival after HCT in patients with hematologic malignancies. HCT-CI ≥3 is associated with higher Non-Relapse Mortality (NRM) and lower overall survival in both allogeneic (allo) and autologous (auto)-HCT patients. The Disease Risk Index (DRI) Assessment Tool is a validated tool to categorize patients undergoing allo- transplant into risk categories based on disease status. It was developed to predict overall survival per disease status. This study was done to understand reasons for increased mortality in transplant patients at our center in 2021 compared to 2020 by comparing HCT-CI and DRI of transplant patients between the two years. Methods: The study was approved by our institution's IRB. A retrospective chart analysis of adult patients who underwent auto- or allo-HCT at Henry Ford Hospital in the years 2020 and 2021 was conducted. Relevant patient demographics, comorbidities, disease characteristics, and transplant-related data were collected. HCT-CI scores were calculated on all patients using the online calculator (https://www.mdcalc.com/calc/3980/hematopoietic-cell-transplantation-specific-comorbidity-index-hct-ci). Patients were also risk stratified based on the DRI Assessment Tool (https://cibmtr.org/CIBMTR/Resources/Research-Tools-Calculators/Disease-Risk-Index-DRI-Assignment-Tool). Data was reviewed and collected by investigators and compiled in a confidential platform. Results: A total of 166 patient records between 2020 and 2021 were reviewed. In 2020, 46 patients underwent auto-HCT and 28 underwent allo-HCT. In 2021, 58 patients underwent auto-HCT and 34 patients underwent allo-HCT. The one-year post transplant survival rates for patients are elucidated in Table 1. The median HCT-CI scores amongst the patients who underwent transplant was 3 in 2020 and 4 in 2021(refer Table 2). When assessing the Disease Risk Index, overall, more patients with higher disease risk were transplanted in 2021 compared to 2020 (refer Table 3). 16 patients (12 in 2021 and 4 in 2020) underwent transplant for diseases that are not included in the DRI assessment tool. Of these, 8 patients in 2021 underwent allo-HCT. These included aplastic anemia (AA), inherited bone marrow failure syndromes (BMF), solid tumors, primary CNS lymphomas, mycosis fungoides and hemophagocytic lymphohistiocytosis (HLH). Conclusion: The HCT-CI and the DRI are both tools used in transplant centers to risk stratify patients pre-transplant. The use of both tools can give a good sense of post-transplant outcomes, combining both individual patient characteristics as well as diseases specific variations. These data are also important for monitoring outcomes at transplant centers. In this study, patients who had an HCT-CI &amp;gt;/3 were similar in both years. The DRI however could not be ascertained in 16 patients, as these diseases are not currently included in the DRI. This makes outcome prediction for these particular patients suboptimal especially if they do not have as many comorbidities but still higher risk diseases. Furthermore, this precludes effective outcome monitoring in and amongst transplant centers. The combination of both the HCT-CI and the DRI would perform better if the DRI tool is revised to become more comprehensive or by creating a DRI that is specific for non-malignant disorders like AA, HLA and BMF. We intend to propose this to CIBMTR for further consideration.

The Prognosis of Advanced Non-Small Cell Lung Cancer Patients with Precision-Targeted Therapy Guided by NGS Testing or Routine Testing.

We aim to observe the potential survival benefits of driver gene-guided targeted therapy in advanced non-small cell lung cancer (NSCLC) patients compared to non-targeted therapy. Additionally, the study aims to assess whether Next-generation sequencing technology (NGS)-guided targeted therapy can provide survival advantages for advanced NSCLC patients compared to conventional Epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) gene detection. Clinical data, genetic testing results, and treatment information of 1663 advanced lung cancer patients diagnosed by pathology from January 2013 to June 2019 in Jiangsu University Affiliated Lianyungang Hospital were collected. Propensity score matching survival analysis was used to evaluate the differences in overall survival(OS) between groups. In the unadjusted survival curve, targeted therapy patients had significantly longer median OS than non-targeted therapy patients (28.3 months vs 15.4 months, Hazard ratio (HR) = 0.5426, 95% confidence interval (CI) 0.4768-0.6176, P < 0.0001); the conclusion was the same after propensity score matching analysis, with targeted therapy group patients having significantly prolonged OS median (27.5 months vs 14.8 months, HR = 0.5572, 95% CI 0.4796-0.6474, P < 0.0001). In the unadjusted survival curve, the NGS group had a significantly prolonged median OS compared to the conventional gene detection group (23.4 months vs 21.2 months, HR = 1.243, 95% CI = 1.017-1.519, P = 0.0495). However, after propensity score matching analysis, no statistically significant difference existed in the median OS between the two patient groups (23.1 months vs 21.5 months, HR = 1.288, 95% CI = 0.9557-1.735, P = 0.0926). Further analysis demonstrated no advantage in the five-, three-, and two-year survival rates of the NGS group compared to conventional gene detection group patients. However, the one-year survival rate of the NGS group was significantly increased (83.2% vs 68.1%, HR = 0.4890, 95% CI = 0.3170-0.7544, P = 0.0015). Driver gene-guided targeted precision therapy significantly prolonged the median OS of advanced NSCLC patients compared to non-targeted therapy. NGS detection did not improve the median OS of advanced NSCLC patients compared to conventional EGFR/ALK gene detection but increased the one-year survival rate of patients.

Survival Rate Estimation in Patients with Colorectal Cancer by applying Fuzzy Product Limit Estimator

Background: Survival rates are important to show the progress of the disease and the effect of treatments. The estimation of survival probabilities especially in presence of highly censored data is challenging. In this study, Fuzzy Product Limit Estimator (FPLE) is introduced to mitigate the challenge.&#x0D; Methods: In a longitudinal study, data of 173 CRC patients were analyzed. To estimate survival probabilities, mean and median survival time, Fuzzy Product Limit Estimator (FPLE), a data-driven method, was applied to the data. It provides a smooth survival probability curve and the continuation of the survival curve is not a concern in the case while the largest observed time is censored.&#x0D; Results: One-year survival rate for CRC patients was estimated to be 83% using FPLE and KM methods. The five-year survival rate was estimated to be 37% and 52% by the FPLE and KM methods, respectively. The largest observed time in data (71.96 months) was censored, so the survival rate after 71.96 months was not estimable by the KM method. But 10-year and 20-year survival rates were estimated by FPLE as 0.21 and 0.09. The mean (median) survival time was estimated 45.97 (65) and 82.69 (41.70) months by KM and FPLE methods, respectively. &#x0D; Conclusion: In presence of highly censored survival data, the FPLE method provides acceptable estimates of CRC patients' survival rate. Also, the continuation of the survival curve was estimated after the largest observed time. The smaller estimates by the FPLE at 5-year could be considered as warning that the actual survival rate is lower than that reported by the KM method.

The state of cancer care in Russia: breast cancer. Epidemiology and survival of patients. The impact of the SARS-CoV-2-beta-coronavirus epidemic (clinical and population study)

Background. Breast cancer is the main cause of morbidity and mortality of the female population among economically developed countries, including in Russia. Despite the continued increase in morbidity, mortality is decreasing, which is confirmed by a decrease in the index of accuracy (the ratio of the number of deaths to the sick). Calculations of survival at the population level (the most important criterion for evaluating the activities of the oncological service) in Russia are carried out only on the basis of databases of the population cancer registry of the North-Western Federal District. The accumulated 1.5 million primary cases of malignant tumors allowed for the in-depth development of data on rare tumor localities, including breast cancer among the male population.Aim. To study the impact of the coronavirus pandemic on the dynamics of the process of detection, mortality and survival of breast cancer patients in Russia and in the North-Western Federal District of the Russian Federation.Materials and methods. The material of the study is the reference books of the P. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia, and the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia, and the database of the population cancer registry of the North-Western Federal District, clinical materials of the surgical department of breast tumors of theN.N. Petrov National Medical Research Oncology Center. More than 110 thousand primary cases of breast cancer were selected. Data processing was carried out by standard methods of oncology statistics recommended by the International Association of Cancer Registries (Eurocare program).Results. A significant impact of the coronavirus pandemic on the primary registration of breast cancer in Russia from 2019 to 2020 has been established, with some weakening of its impact in the subsequent period. The pandemic has had a significant impact on the quality of primary registration of patients. The value of the index of accuracy has been set back five years, but there is a sign of its improvement in 2021. The positive dynamics of one-year and five-year survival of patients with breast cancer is shown. The quality of registration of patients with breast cancer by detailed localization and histological structures of breast cancer was investigated. A significant decrease in the mortality of patients was noted when studying the patterns of dynamics in annual mortality over three follow-up periods.Conclusion. A steady increase in the incidence of breast cancer among women has been established, and the negative impact of the coronavirus pandemic has been noted. The mortality rate of the Russian population from breast cancer continues to decrease. The localization and histological structure of the incidence of breast cancer in women remains unchanged. The one-year and five-year survival rate of breast cancer patients continues to grow.

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study

The aim of this study was to evaluate the association between types of ventilator and the one-year survival rate of patients with acute respiratory distress syndrome (ARDS) due to SARS‑CoV-2 infection. This multi-center, retrospective observational study was conducted on 1078 adult patients admitted to five university-affiliated hospitals in Iran who underwent mechanical ventilator (MV) due to ARDS. Of the 1078 patients, 781 (72.4%) were managed with ICU ventilators and 297 (27.6%) with transport ventilators. Overall mortality was significantly higher in patients supported with transport ventilator compared to patients supported with ICU ventilator (16.5% vs. 9.3% P = 0.001). Regression analysis revealed that the expected hazard overall increased with age (HR: 1.525, 95% CI 1.112–1.938, P = 0.001), opacity score (HR: 1.448, 95% CI 1.122–2.074, P = 0.001) and transport ventilator versus ICU ventilator (HR: 1.511, 95% CI 1.143–2.187, P = 0.029). The Kaplan–Meier curves of survival analysis showed that patients supported with ICU ventilator had a significantly higher 1-year survival rate (P = 0.001). In MV patients with ARDS due to COVID-19, management with non-ICU sophisticated ventilators was associated with a higher mortality rate compared to standard ICU ventilators. However, more studies are needed to determine the exact effect of ventilator types on the outcome of critically ill patients.

Early conversion to belatacept-based immunosuppression regimen promotes improved long-term renal graft function in kidney transplant recipients

BackgroundBelatacept has been demonstrated as an effective alternative immunosuppressant in kidney transplant recipients. This study focuses on outcomes of early and late conversion to Belatacept-based immunosuppression after kidney transplant. Materials and methodsThis retrospective analysis of a prospectively collected database included all adult kidney transplants patients at SUNY Upstate Medical Hospital from 1 January 2014 to 30 December 2022. Early conversion was defined as all conversions done at <6 months after kidney transplantation, and late conversion to belatacept was defined as conversion at >6 months after kidney transplantation. ResultsOut of 61 patients included in this study, 33 patients (54%) were in the early conversion group, and 28 patients (46%) were in the late conversion group. The mean eGFR in the early conversion group was 26.73 ± 16.26 ml/min/1.73 m2 before conversion to belatacept, which improved to 45.3 ± 21.01 ml/min/1.73 m2 at one-year post-conversion (p = 0.0006). Furthermore, eGFR changes in the late conversion group were insignificant, with 46.30 ± 15.65 ml/min/1.73 m2 before conversion to belatacept, and 44.76 ± 22.91 ml/min/1.73 m2 after one year of follow-up (p = 0.72). All four biopsy-proven allograft rejections in the early conversion group were acute T-cell-mediated rejections (ATMR). In the late conversion group, out of three biopsy-proven rejections, one was chronic antibody-mediated rejection (CAMR), one was ATMR, and one was mixed ATMR/CAMR. All four patients with ATMR rejection received mycophenolic acid (MPA) as part of their immunosuppressive regimen, and none received tacrolimus. The one-year post-conversion allograft survival rate in early and late conversion groups was 100%. However, the one-year post-conversion patient survival rate was 90.9% in the early conversion group and 100% in the late conversion group (P = 0.11). ConclusionsEarly post-transplant conversion to belatacept can improve the eGFR more meaningful when compared to late conversion. Patients who receive belatacept and MPA rather than tacrolimus may have increased rates of T-cell-mediated rejection.

Utilization of Segmental Grafts Is Associated With Higher Transplant Rates in Pediatric Patients

IntroductionIn July 2017, a policy to increase the use of segmental grafts (SGs) was implemented at our institution. The aim was to compare changes in waitlist activity after implementation of this policy. MethodsA single-center, retrospective study. Pediatric patients on the liver waiting list between January 2015 and December 2019 were screened. Patients were classified as receiving a liver transplant (LT) before (Period 1) or after (Period 2) policy changes. Primary end points were transplant rates and time to transplant. ResultsSixty five first LT performed on 65 patients were included. Twenty nine LT were performed during Period 1 and 36 during Period 2. More than half (55%) of LT in Period 2 were SG, compared to 10.3% in Period 1 (P < 0.001). Forty nine and 56 pediatric candidates on the waiting list accounted for 38.78 and 24.48 person-years during Period 1 and Period 2, respectively. Transplant rates per 100 person-years on the waiting list increased from 85.09 during Period 1 to 187.87 in Period 2 (Rate ratio: 2.20; P < 0.001). Median time to receive a LT decreased from 229 d in Period 1 to 75 d during Period 2 (P = 0.013). One-year patient survival rates were 96.6% in Period 1 and 95.7% in Period 2. One-year graft survival rates were 89.7% and 88% in Period 1 and Period 2, respectively. ConclusionsA policy to increase the use of SG was associated with significantly higher transplant rates and lower waiting times. Implementation of this policy can be done successfully with no observed negative impact on patient and graft survival.

The state of cancer care in Russia: one-year survival rate of patients with malignant neoplasms and first-year mortality rate for cancer of any site. (Population study at the federal district level)

Наиболее объективным критерием оценки деятельности онкологической службы является показатель выживаемости, исчисленный по международным стандартам на базе данных тщательно выверенного Популяционного ракового регистра. Уровень стандартизованных показателей заболеваемости населения злокачественными новообразованиями (ЗНО) в России и Северо-Западном федеральном округе Российской Федерации (СЗФО РФ) различаются на 4,26% (в пределах статистической погрешности, что позволяет нам перевести итоги нашего исследования на всю Россию. Население СЗФО РФ в 2022 году составило 13,9 млн. человек, что соответствует населению Белоруссии, Латвии и Литвы вместе взятых. Впервые в России на материале базы данных популяционного регистра (БД ПРР) СЗФО РФ исчислены показатели однолетней и пятилетней выживаемости по всем трехзначным рубрикам МКБ-10 плюс 13 сгруппированным рубрикам, как это принято в отчетах (форма №7) для анализа динамики заболеваемости и смертности населения от ЗНО. Цель исследования: на обширном выверенном материале БД ПРР СЗФО РФ представить анализ деятельности онкологической службы региона на основе расчета динамики показателей наблюдаемой выживаемости больных 71 локализации опухолей. Материалы и методы. Материалом явилась БД ПРР СЗФО РФ объемом более 1 млн. 150 тыс. наблюдений, использована методология расчета показателей выживаемости по программе Eurocare. Полученные результаты. Проведенное сравнение уровней показателей однолетней выживаемости больных ЗНО за два периода наблюдения (1995-1999 и 2015-2019) выявило рост однолетней наблюдаемой выживаемости с 63,8 до 71,0, т.е. на 11,29%, соответственно снижение одногодичной летальности по региону составило с 36,2 до 29,0%. Наибольшие успехи достигнуты (прирост однолетней выживаемости более 25%) для ЗНО печени (С22), тонкого кишечника (С17), желчного пузыря (С23, 24), рото- и гортаноглотки (С10, 12, 13). Более 10% прирост однолетней выживаемости пришелся на ЗНО языка (С01, 02), пищевода (С15), предстательной железы (С61), плаценты (С58) и ободочной кишки (С18). При среднем показателе (С00-96) – 11,29%. По многим локализациям ЗНО, выявлены более скромные успехи. По ведущим локализациям опухолей прирост этого показателя составил для рака желудка +5,5; рака легкого +2,7; рака прямой кишки +4,7; меланомы кожи +3,8; рака шейки матки +2,5. Однолетняя выживаемость больных раком тела матки и раком поджелудочной железы остались без изменений, по ряду локализаций (С51, С81-96, С60, С07-08, С00 и С70-72) отмечено снижение показателя от -2 до -9%. Пятилетняя наблюдаемая выживаемость возросла с 42,9% в 1995-1999г. до 47,1% в 2010-2014 году или на 9,8%. Относительная однолетняя выживаемость была на 1-2% выше, пятилетняя кумулятивная относительная выживаемость на 5-7% выше. Прирост показателя пятилетней выживаемости больных ЗНО произошел по многим локализациям опухолей и системным новообразованиям лимфатической и кроветворной ткани, но в существенно меньших объемах по сравнению с однолетней выживаемостью. По 20 локализациям пятилетняя выживаемость больных ЗНО уменьшилась, в первую очередь по опухолям головного мозга, поджелудочной железы, пищевода, желудка, легких и некоторых других. Заключение и выводы. Проведенное популяционное исследование показало улучшение проводимых мероприятий противораковой борьбы, существенный рост показателя однолетней выживаемости и рост показателя пятилетней выживаемости. К проценту прироста-убыли показателя надо относиться критически с учетом её реальной величины на исходном уровне. По ряду локализаций уже ранее были достигнуты высокие уровни выживаемости больных, в связи с чем величина прироста показателя может быть скромной. Это в первую очередь относится к новообразованиям щитовидной железы, мочевого пузыря, яичка, меланомы кожи, глаза, тела матки, губы, системных новообразований лимфатической кроветворной ткани.

The Addition of Hypomethylating Agents to Low-Intensity Induction Chemotherapy Does Not Improve Outcomes in Elderly Acute Myeloid Leukemia Patients: A Single-Center Retrospective Study

Background and Objectives: This study aimed to evaluate whether the addition of hypomethylating agents (HMA) to low-intensity chemotherapy can enhance the clinical efficacy of induction treatment for elderly acute myeloid leukemia (AML) patients who are unsuitable for standard induction therapy. Materials and Methods: This study retrospectively analyzed 117 patients over 60 years old who were initially diagnosed with AML and received low-intensity induction treatment in the Department of Hematology in Anhui provincial hospital from January 2015 to December 2020. Twenty-three patients were excluded, and the remaining 94 patients were divided into two groups according to the selection of induction regimens. Results: Forty-four patients received HMA combined with low-intensity chemotherapy, and the other 50 patients received only low-intensity induction chemotherapy. Forty-three patients (45.7%) obtained complete remission (CR) after the initial induction treatment. The CR rate in the HMA plus low-intensity chemotherapy group was 34.1% (15/44), and in the single low-intensity chemotherapy group was 56.0% (28/50) (p = 0.04). The 30 days cumulative early death rates were 9.1% (95% CI: 3.5-22.4%) in the HMA plus low-intensity chemotherapy group and 6.0% (95% CI: 2.0-17.5%) in the single low-intensity chemotherapy group, respectively (p = 0.59), and the one-year cumulative relapse rates were 21.1% (95% Cl: 9.8-41.9%) and 33.3% (95% Cl: 20.3-51.5%), respectively (p = 0.80). The one-year overall survival (OS) rates for patients in the HMA plus low-intensity chemotherapy group and the single low-intensity chemotherapy group were 37.3% (95% Cl: 23.1-51.5%) and 55.4% (95% Cl: 40.5-67.9%), respectively (p = 0.098), and the one-year event-free survival (EFS) rates were 8.5% (95% Cl: 2.2-20.6%) and 20.6% (95% Cl: 9.1-35.3%), respectively (p = 0.058). Conclusions: This study showed that the addition of HMA to low-intensity induction chemotherapy does not improve prognosis in elderly AML patients who are unsuitable for standard induction chemotherapy.

Current morbimortality and one-year survival after pneumonectomy for infectious diseases

ObjectiveIdentify the one-year survival rate and major complications in patients submitted to pneumonectomy for infectious disease. MethodsRetrospective data from all cases of infectious disease pneumonectomy over the past 10 years were collected from two reference centers. The authors analyzed: patient demographics, etiology, laterality, bronchial stump treatment, presence of previous pulmonary resection, postoperative complications in the first 30 days, the treatment used in pleural complications, and one-year survival rate. Results56 procedures were performed. The average age was 44 years, with female predominance (55%). 29 cases were operated on the left side (51%) and the most frequent etiology was post-tuberculosis (51.8%). The overall incidence of complications was 28.6% and the most common was empyema (19.2%). Among empyema cases, 36.3% required pleurostomy, 27.3% required pleuroscopy and 36.3% underwent thoracoplasty for treatment. Bronchial stump fistula was observed in 10.7% of cases. From all cases, 16.1% were completion pneumonectomies and 62.5% of these had some complication, a significantly higher incidence than patients without previous surgery (p = 0.0187). 30-day in-hospital mortality was (7.1%) with 52 cases (92.9%) and 1-year survival. The causes of death were massive postoperative bleeding (1 case) and sepsis (3 cases). ConclusionsPneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. While morbidity is often significant, once the perioperative risk has passed, the one-year survival rate can be very satisfying in selected patients with benign disease.

Cardiopulmonary Exercise Test Could Predict Mortality in Patients with Interstitial Lung Disease

<h3>Research Objectives</h3> To identify the mortality predictors from cardiopulmonary exercise test in a group of Asian patients with interstitial lung disease. <h3>Design</h3> A prospective observational study followed up for 32 months. <h3>Setting</h3> A referral medical center. <h3>Participants</h3> A total of 106 patients with definite diagnosis of interstitial lung disease confirmed by high-resolution computed tomography were enrolled in our study. <h3>Interventions</h3> This is a prospective observational study without any special intervention. All participants received the cardiopulmonary exercise test. <h3>Main Outcome Measures</h3> Mortality. <h3>Results</h3> Six variables from cardiopulmonary exercise test, namely peak oxygen consumption, oxygen pulse, peak end-tidal partial pressure of carbon dioxide, heart rate recovery 1 minute after cardiopulmonary exercise test, minute ventilation to carbon dioxide output slope and functional aerobic impairment, were identified to be significant predictors of mortality. We created a summed score, representing the number of variables beyond the cutoff values. The one-year survival rate of patients scored 6 in this summed score were only 25%, in contrast to 97.96% for patients scored 0-5. <h3>Conclusions</h3> If a cardiopulmonary exercise test is available for patients with interstitial lung disease, the summed score created in this study can provide a useful tool to screen these patients for their prognosis. Additional study recruiting more participants is required before the results to be used in clinical settings. <h3>Author(s) Disclosures</h3> All authors of this study declares no conflicts of interest.

The state of cancer care in Russia: cancer of the small intestine (C17). Survival of patients, median survival, survival of patients according to tumor localization, histological pattern and stage of the disease (Population study at the federal district level). Part II

Background. Small intestine cancer is extremely rare cancer worldwide with an incidence of less than 1.0 per 100,000 population. In 2020, 1,711 cases of small intestine cancer were recorded in Russia, including 781 cases among the male population, and 930 among the female population. It should be noted that in Russia, despite the decrease in the total number of new cancer cases associated with the coronavirus epidemic, the number of patients with small intestine cancer increased by 4.14 % from 2019 to 2020. In the Northwestern Federal district of the Russian Federation, 216 patients with newly diagnosed small intestine cancer were registered in 2020, (29 more patients than in the previous year). The purpose of the study was to analyze the efficiency of small intestine cancer care provision based on of the database of the population cancer Registry (db pcr) of the Northwestern Federal district of the Russian Federation, with an assessment of one- and five-year survival rates. Material and methods. To calculate the survival rates for patients with small intestine cancer, we selected 1922 patients from the database of the pcr of the Northwestern Federal district of the Russian Federation, for the period from 2000 to 2018. Standard methods for calculating survival rates according to the eurocare program were used. Results. The one-year survival rate of small intestine cancer patients increased from 50.0 % to 61.1 % from 2000 to 2018, and the five-year survival rate remained almost unchanged. The relative one-year survival rate of patients was 2.0 % higher. The five-year survival rate for five-year cohorts indicates defects in staging of small intestine cancer rather than an improvement in patient care; although this rate increased from 31.5 to 32.9 %. The histological detail of small intestine cancer according to the icd-10 was investigated. Conclusion. The study confirmed the high mortality rates and modest survival benefits in survival rates in patients with small intestine cancer. Defects in the distribution of patients by disease stages were revealed. The most common histological types of small intestine cancer with calculations of patient survival were identified.

Short-term outcome of kidney transplantation from deceased donors with nephrolithiasis.

Shortage of kidney allografts is a major barrier to end-stage renal disease patients receiving kidney transplantation, and it is necessary to enlarge the donor pool and find better ways of using available allografts. The global incidence of nephrolithiasis is increasing, nephrolithiasis affects approximately 10% of adults worldwide, and it also affects the kidney donors. However, there is little information about the use of cadaveric kidney allografts with nephrolithiasis. This study aims to evaluate the safety and outcome of kidney transplantation with allografts from the deceased donors with nephrolithiasis. A total of 520 deceased donors who was at least 10 years old, and 945 adult recipients with single kidney transplantation at the Department of Kidney Transplantation, the Second Xiangya Hospital from 2016 to 2020 were included in this study. The donors were divided into 2 groups according to nephrolithiasis diagnoses: The donors with nephrolithiasis (D + ) and the donors without nephrolithiasis (D - ). The recipients were assigned into 3 groups according to their donors and the allografts they received: The allografts from donors without nephrolithiasis (D - K - ), the allografts without nephrolithiasis from donors with nephrolithiasis (D + K - ), and the allografts with nephrolithiasis (D + K + ). The demographic and clinical data of enrolled subjects were retrospectively analyzed. The allograft discard ratio between different donors were analyzed. The one-year survival of allografts and recipients, as well as the allograft function and the complications of kidney transplantation were compared. Fifty out of 520 donors had nephrolithiasis, and the nephrolithiasis incidence was 9.6%. We recovered 1 040 kidneys, and total discard rate was 4.4% (46/1 040). The D + group had a rate of 7% discard. The donors with kidney discard accounted for 12% in the D + group, and this was higher than that of donors in the D - group (5.1%, P <0.05). The total incidence of delayed graft function (DGF) was 7.5%, and there were no significant differences in the incidence of DGF in recipients among the D - K - , D + K - , and D + K + group (7.5% vs 6.5% vs 8.2%, P> 0.05). During the one-year follow-up, 8 allografts lost function and 19 recipients died with a functional allograft. Recipients in the D - K - , D + K - ,and D + K + groups also had no significant difference between a one-year allograft and patient survival rate ( P >0.05). However, recipients in the D + K + group had a higher level of serum creatinine [(139.2±62.46) μmol/L vs (117.19±51.22) μmol/L, P <0.05] and lower estimated glomerular filtration rate [eGFR; (56.67±23.31) mL/(min·1.73 m -2 ) vs (66.86±21.90) mL/(min·1.73 m -2 ), P <0.05] compared with recipients in the D - K - group at 12 months after transplantation. During the first year after transplantation, 4 recipients developed urolithiasis, and recipients who received allografts from the D + group donors had a higher incidence of urolithiasis than those who received allografts from the D - group donors (2.2% vs 0.2%, P <0.05). There were no significant differences in the incidence of urinary tract infections and ureteral strictures at 1 year between recipients of D + and D - donors (both P >0.05). The cadaveric kidney allografts with nephrolithiasis could be safely used for transplantation, and the short-term outcome is acceptable. However, nephrolithiasis in donors may increase the rate of kidney discard, disturb the short-term function of allografts, and increase the risk of urolithiasis in recipients. Further research with a long-term study is needed to verify the long-term outcome of kidney transplantation using cadaveric kidney allografts with nephrolithiasis.

The role of post-operative glutamine serum level and one-year survival rate of stage III of colorectal cancer patients: a single center study

Introduction: Colorectal cancer (CRC) occurs, accounting for 11.5% of all patients with cancer in Indonesia. The less the spread of cancer, the higher the life expectancy of patients with cancer. Glutamine is involved in tumor cell proliferation and growth. This study aims to verify the correlation of serum glutamine levels with the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia. Method: A quantitative analytic-observational longitudinal study (Cohort) was conducted from May 1st, 2020, to September 30th, 2021. Inclusion criteria were the CRC patients with stage III and could be followed up for one year. Exclusion criteria were the CRC patients who had other systemic problems. The patient’s blood glutamine levels were taken three months postoperatively measured by Glutamine Assay kit (Colorimetric) ab197011 and evaluated clinically for one year. Glutamine levels in the blood are low if they are less than 52 ng/µL. The parameters assessed were glutamine serum level and survival rate of colorectal cancer patients. Statistical analysis using the Chi-square test and the Kaplan Meier method was employed to obtain the survival curve. Analysis to compare survival rate with glutamine levels used the Cox regression model. Results: A one-year survival rate in patients with stadium III colorectal cancer was 95.5% at post-operative glutamine levels of ≥ 52 ng/µL and 65.4% at post-operative glutamine levels of &lt; 52 ng/µL. The mean progressive free survival rate was 11.818 months (95%CI=11.470-12.166) at post-operative glutamine levels of ≥ 52 ng/µL and 10.038 months (95%CI=8.913-11.164) at post-operative glutamine levels of &lt; 52 ng/µL. The overall free survival rate was 11.955 months (95%CI=11.868-12.042) at post-operative glutamine levels of ≥ 52 ng/µL and 10.885 months (95% CI=10.128-11.641) at post-operative glutamine levels of &lt; 52 ng/µL. Patients with glutamine levels of &lt;52 ng/µL were 8.959 times more probable to die than patients with post-operative glutamine levels of ≥ 52 ng/µL. Conclusion: This study shows a significant relationship between serum glutamine levels and the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.