Outcomes In Young Patients Research Articles

Clinical characteristics and outcomes of young patients with acute myocardial infarction: YAMI registry.

Despite its low prevalence, premature myocardial infarction (MI) bears serious social consequences and shares different pathophysiology. The aim of the study was to evaluate young MI patients in terms of clinical characteristics and long-term outcomes. This study is an observational research covering 221 patients <45 years old [16.7% women, age 38.4(4.8) years], hospitalized due to acute MI between January 2017 and April 2023. Data was extracted from Academic Repository of Clinical Cases of Medical University of Silesia. Young MI patients were compared to representative MI cohort >45 years old (n=2256). The mean follow-up time was 648.7(178.7) days. The primary end-point was all-cause mortality. Patients with MI ≤45 years were predominantly male (83.3%), had lower mortality (7.2%vs.15.0%,log-rank P=0.01), shorter hospitalization time [4.0(3.0; 6.0)vs. 5.0(3.0; 6.0) days, P=0.03] and less pronounced cardiovascular risk factors than patients >45 years old. Cox regression in MI patients ≤45 years indicated that peri-MI sudden cardiac arrest, Q waves presence, higher volume of contrast and lack of qualification to cardiac rehabilitation (CR) were independent predictors of mortality. In young cohort, 15.8% of patients had MI unrelated to ruptured atheroma and more often had non-ST-elevation acute MI, were female and younger, had lower prevalence of hyperlipidemia and hypertension, less often were referred for PCI and CR, and more often for optical coherence tomography and cardiac magnetic resonance (CMR). Young MI patients have favorable prognosis and frequently have atypical MI pathophysiology. Cardiac rehabilitation is of utmost importance in mortality reduction regardless of age.

Clinical Profile and Complications in Patients with ST-Elevation Myocardial Infarction-A Systematic Review

ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality. Our study shows that AWMI predominates as the initial symptom of acute coronary syndrome (ACS), leading to a significant delay in first medical contact. Complications such as cardiogenic shock and arrhythmia are frequently observed. This study was conducted with the aim of understanding the clinical profile of ACS in people attending our institute. A total of 20 articles were identified during the year 2003 to 2023 in PubMed, Embase, and Google Scholar. Search. The mean age of the subjects was 55.75 ± 12.5 years, and the majority were male (75%). The differential diagnosis of ST-segment elevation includes four main processes: ST-elevation myocardial infarction (STEMI), premature repolarization, pericarditis, and QRS complex abnormalities (left bundle branch block, left ventricular hypertrophy). ST-segment elevation secondary to, or pre-excitation). Other processes that may be associated with ST segment elevation include hyperkalemia, pulmonary embolism, and Brugada syndrome. The biggest barrier to consistent STEMI care in developing countries is the lack of community care systems, which needs improvement. All patients received routine anti-ischemic therapy, followed by initial PCI or revascularization with thrombolytic therapy, and routine post-MI treatment. Complications and outcomes were evaluated by electrocardiogram, echocardiography, and other examinations, if necessary. ST-segment elevation myocardial infarction has a good outcome in young patients. Smoking and dyslipidemia are the main risk factors for STEMI in young people. The majority of young patients with dyslipidemia were unaware of their previous disease. Our results recommend the implementation of community adaptation and screening programs for dyslipidemia in young people, and the strengthening of smoking prevention programs.

Coronary Artery Bypass Grafting in Young Adults.

To evaluate the risk factors for early onset of coronary artery disease (CAD) and assess the preoperative presentation, perioperative course, survival, and short-term complications after coronary artery bypass graft (CABG) in patients aged 45 years or younger undergoing CABG. Observational study. Place and Duration of the Study: Department of Cardiothoracic Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from December 2020 to January 2021. All patients aged 45 years or younger who were undergoing CABG were included in the study. Patients with incomplete medical records were excluded. Study variables included preoperative demographic information, intraoperative variables including the number and type of conduits used, and postoperative morbidity and mortality. Descriptive analysis was reported for all variables. The study population cohort included 134 patients, of whom 120 (89.6%) were male, with a mean age of 38.6 ± 5.1 years (range: 30-45 years). The indication for surgery was 3-vessel CAD in 56 (41.7%) patients. A total of 421 grafts were constructed, with a mean of 3.14 grafts per patient. One patient died in the hospital with an overall operative mortality of 1.5%. The most common risk factors were found to be family history, the presence of diabetes mellitus, hypertension, and smoking. The risk factors and outcomes in younger patients (less than 45 years) undergoing CABG are not markedly different from those in older patients and are comparable to the existing literature. Coronary artery disease, Coronary artery bypass graft, Young adults, Risk factors, Three vessel disease.

NCOG-03. DESCRIPTIVE ANALYSIS AND OUTCOME COMPARISON BETWEEN PATIENTS WITH GLIOBLASTOMA MULTIFORME WHO RECEIVE 15 VERSUS 30 FRACTIONS OF RADIOTHERAPY: A RETROSPECTIVE CHART REVIEW

Abstract The morbidity and efficacy of abbreviated radiotherapy (RT) courses for Glioblastoma (GB) in patients over 60 years have been studied, however, outcomes in younger patients are not yet well-described. This study aims to characterize the outcomes of patients receiving either a standard versus abbreviated RT course. A retrospective chart review at Kingston Health Sciences Centre from June 2014 to March 2021 included patients with GB receiving either 40Gy in 15 fractions (Fr) or 60Gy in 30Fr. Data on age, ECOG score, and concurrent chemotherapy (Temozolomide, TMZ) were collected. Outcomes compared were treatment completion, hospital admission during treatment, progression-free survival (PFS), and overall survival (OS). Records of 156 patients (median age 61 years, range 25-87 years) were reviewed. Of these, 89 received 30Fr and 67 received 15Fr (p=0.51). MGMT methylation was recorded in 54 (35%) patients; of these, 27 received 15Fr and 27 received 30Fr. Median follow-up was 12 months. While PFS did not significantly differ between 15Fr vs. 30Fr (6 vs. 11 months, respectively; p=0.08), OS was significantly different (8 vs. 16 months, respectively; p&amp;lt;0.001). Patients receiving 15Fr vs 30F tended to have higher ECOG scores (p&amp;lt;0.001) and were older (median: 71 [range 45-87] vs. 57 [range 25-69] years; p&amp;lt;0.001). Individuals receiving TMZ were more likely to receive 30Fr (67.5% vs. 32.5% for 15Fr; p&amp;lt;0.001). Completion rates were higher for 30Fr (94.3%) than 15Fr (83.6%; p=0.03). Hospital admission rates did not differ (p=0.51). In summary, patients receiving 15Fr (40Gy) typically have poorer functional status, are less likely to receive chemotherapy, and less likely to complete treatment compared to those receiving 30Fr. Hospital admission rates during treatment are low (13%) and similar for both groups. OS, but not PFS, is better for patients receiving 30Fr compared to 15Fr.

Comparative analysis of risk factors and clinical outcomes in young patients with acute ischemic and hemorrhagic stroke

BackgroundStroke is a leading cause of death and disability worldwide and has significant socioeconomic impacts, particularly among young adults. This study focused on young adults (18–55 years) who experienced acute ischemic (AIS) or hemorrhagic stroke (HS) in Zanjan, Iran.MethodsA retrospective registry-based analysis was conducted using data from the Vali-e-Asr Hospital Stroke Center. A total of 5345 stroke patients were recorded between March 2016 and June 2023, and 616 young stroke survivors were included. Baseline demographic data, stroke risk factor data, functional status (modified Rankin scale (mRS) score, stroke severity (NIHSS score), treatment history, and mortality were analyzed. The statistical analyses included chi-square tests, independent t tests, and logistic regression.ResultsThe cohort comprised 525 AIS (85.23%) and 91 HS (14.77%) patients. Significant differences were observed between groups in terms of atrial fibrillation incidence, antiplatelet treatment history, hypertension, previous smoking, and recent stroke history. HS patients had a higher baseline NIHSS score (12.90 ± 6.04 vs. 7.69 ± 8.56, p < 0.05). In-hospital and three-month mortality rates were significantly greater in the HS group. Factors significantly associated with in-hospital mortality included hemorrhagic stroke, female sex, higher NIHSS score, and current smoking status. Lower odds of achieving excellent functional outcomes and functional independence at three months were noted for HS patients, influenced by NIHSS scores and prior health conditions.ConclusionYoung stroke patients, particularly those with hemorrhagic stroke, have higher mortality and poorer outcomes. The key risk factors included stroke type, NIHSS score, smoking status, and sex. Identifying and managing these factors could improve patient outcomes.

Prevalence, Clinical Features, and Outcomes of Young Patients with Idiopathic Pulmonary Fibrosis

Plain Language SummaryThis study examined the clinical features and outcomes of younger patients with idiopathic pulmonary fibrosis (IPF). Results showed that young patients with IPF exhibit lower risks of mortality and lung transplantation but are more often treated with steroids and less frequently with pirfenidone, potentially increasing these risks. These findings highlight the need for a strategic shift toward treatment approaches tailored for younger patients to avoid harmful treatments.

Age-Related Differences in Clinical Characteristics and Outcomes of Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study of 657 Patients

Aneurysmal subarachnoid hemorrhage (aSAH) has an incidence of 6-7 per 100,000 person-years. Despite advancements in treatment, 26% of patients die, and 19% remain dependent post-hemorrhage. Long-term neuropsychological sequelae affect about half of the survivors, significantly impacting their quality of life. This study aims to assess aSAH characteristics and identify predictive factors of clinical outcomes in young patients. A retrospective study analyzed 657 aSAH patients treated at two South Korean medical centers from January 2011 to December 2023. Data on demographics, comorbidities, smoking history, clinical grades, aneurysm size and location, and outcomes were collected. Outcomes were classified using the modified Rankin Scale (mRS), with scores ≤2 indicating good outcomes. The cohort included 233 men and 424 women (male-to-female ratio 1:1.8). Most patients were middle-aged (74.4%), followed by young (16.7%) and old (8.8%) groups. Young patients exhibited male predominance (56.8%), lower hypertension (12.7%) and diabetes (1.8%) rates, and higher smoking rates (39.6%). Older patients had higher hypertension (44.6%) and diabetes (23.3%) rates, and were predominantly female (69.1%). Aneurysms in young patients were smaller (p=0.04). Multivariate analysis identified poor Hunt-Hess grade, permanent cerebral infarction, and aneurysmal recurrence or rebleeding as predictors of poor outcomes in young patients. Middle-aged patients had additional predictors, including diabetes and hydrocephalus. In older patients, only poor Hunt-Hess grade was significant. Young aSAH patients exhibit distinct characteristics and prognostic factors compared to older patients. Despite higher post-operative complications, young patients generally have better outcomes, emphasizing the need for age-specific management strategies in aSAH.

Abstract 382: Racial and ethnic differences in risk factors, etiologies and outcomes in young patients with intracerebral hemorrhage

Abstract 382: Racial and ethnic differences in risk factors, etiologies and outcomes in young patients with intracerebral hemorrhage

Predicting 3-month poor functional outcomes of acute ischemic stroke in young patients using machine learning

BackgroundPrediction of short-term outcomes in young patients with acute ischemic stroke (AIS) may assist in making therapy decisions. Machine learning (ML) is increasingly used in healthcare due to its high accuracy. This study aims to use a ML-based predictive model for poor 3-month functional outcomes in young AIS patients and to compare the predictive performance of ML models with the logistic regression model.MethodsWe enrolled AIS patients aged between 18 and 50 years from the Third Chinese National Stroke Registry (CNSR-III), collected between 2015 and 2018. A modified Rankin Scale (mRS) ≥ 3 was a poor functional outcome at 3 months. Four ML tree models were developed: The extreme Gradient Boosting (XGBoost), Light Gradient Boosted Machine (lightGBM), Random Forest (RF), and The Gradient Boosting Decision Trees (GBDT), compared with logistic regression. We assess the model performance based on both discrimination and calibration.ResultsA total of 2268 young patients with a mean age of 44.3 ± 5.5 years were included. Among them, (9%) had poor functional outcomes. The mRS at admission, living alone conditions, and high National Institutes of Health Stroke Scale (NIHSS) at discharge remained independent predictors of poor 3-month outcomes. The best AUC in the test group was XGBoost (AUC = 0.801), followed by GBDT, RF, and lightGBM (AUCs of 0.795, 0, 794, and 0.792, respectively). The XGBoost, RF, and lightGBM models were significantly better than logistic regression (P < 0.05).ConclusionsML outperformed logistic regression, where XGBoost the boost was the best model for predicting poor functional outcomes in young AIS patients. It is important to consider living alone conditions with high severity scores to improve stroke prognosis.

The contemporary management and coronary angioplasty outcomes in young patients with ST-Elevation myocardial infarction (STEMI) age < 40 years old: the insight from nationwide Thai PCI registry

BackgroundCardiovascular disease (CVD) remains one of the major causes of death around the world in which ST elevation MI (STEMI) is in the lead. Although the mortality rate from STEMI seems to decline, this result might not be demonstrated in young adults who basically have different baseline characteristics and outcomes compared with older patients.MethodsData of the STEMI patients aged 18 years or older who underwent PCI during May 2018 to August 2019 from Thai PCI Registry, a prospective, multi-center, nationwide study, was included and aimed to investigate the predisposing factors and short-term outcomes of patients aged < 40 years compared with age 41–60, and > 61 years.ResultsData of 5,479 STEMI patients were collected. The patients’ mean age was 62.6 (SD = 12.6) years, and 73.6% were males. There were 204, 2,154, and 3,121 patients in the youngest, middle, and oldest groups. The young patients were mainly male gender (89.2% vs. 82.4% and 66.6%; p < 0.001), were current smokers (70.6%, 57.7%, 34.1%; p < 0.001), had BMI ≥ 25 kg/m2 more frequently (60.8%, 44.1%, 26.1%; p < 0.001), and had greater family history of premature CAD (6.9%, 7.2%, 2.9%; p < 0.001). The diseased vessel in the young STEMI patients was more often single vessel disease with the highest percentage of proximal LAD stenosis involvement. Interestingly, there were trends of higher events of procedural failure (2.9%, 2.1%, 3.3%; p = 0.028) and procedural complications (8.8%, 5.8%, 9.4%; p < 0.001) in both youngest and oldest groups compared to the middle-aged group. In-hospital death was found in 3.4% in the youngest group compared to 3.3% in the middle-aged patients and 9.2% in the older patients (p < 0.001).ConclusionsDespite experiencing higher rates of procedural failure and complications during treatment compared to middle-aged and older patients, young STEMI individuals demonstrate a significantly lower risk of death during hospitalization and within one year of the event. Younger patients might have a more robust physiological reserve or benefit from more aggressive post-procedure management. However, the higher prevalence of modifiable risk factors like smoking and obesity in younger individuals underscores the need for preventative measures. Encouraging smoking cessation and weight control in this demographic is crucial not only to prevent STEMI but also to potentially improve their long-term survival prospects.

Trends in Cartilage Repair Techniques for Chondral Defects in the Hip in Germany: An Epidemiological Analysis from 2006 to 2022.

Cartilage repair techniques for chondral defects in the hip are crucial for treating conditions like femoroacetabular impingement, developmental dysplasia, and osteonecrosis, especially in young patients to delay the progression of osteoarthritis. This study aims to present age and sex distributions and trends in hip-preserving surgeries in Germany from 2006 to 2022, analyzing 116,179 procedures using the German OPS coding system. The procedures were categorized into three groups: debridement, refixation, and regeneration. Arthroscopy was more common than arthrotomy (98,916 vs. 17,263). Males underwent more procedures than females (63,771 vs. 52,408). Debridement had a monomodal age distribution peaking at 43.42 years, while refixation and regeneration exhibited bimodal patterns. Regenerative procedures were primarily performed on younger patients (average 27.73 years). A Joinpoint analysis showed an initial increase in procedures, peaking around 2013, followed by a decline. Arthroscopic procedures peaked at approximately 9000 in 2013, whereas arthrotomies peaked at around 1200 after 2014. The decline in procedures post-2013 may reflect refined surgical indications and a shift towards outpatient settings. These findings underscore the trend towards minimally invasive, scaffold-based treatments, with regenerative techniques showing promising outcomes in younger patients. Future research should focus on prospective comparative studies and cost-benefit analyses to guide clinical decision-making.

Clinical Characteristics and Outcomes of Young Patients with Thrombotic Microangiopathy at Ain Shams University Children’s Hospital

Abstract Introduction Thrombotic microangiopathies (TMA) is a life-threatening condition that requires urgent management. Survival of patients has improved greatly over the past two decades with improved supportive care and other therapeutic options. Objectives: to describe the clinical features and outcomes of patients with TMA at Ain Shams University Children’s Hospital. Methods In a retro-prospective study, we included patients diagnosed with TMA in the Pediatric Hematology and Pediatric Nephrology Units at Ain Shams University Children’s Hospital from 2009 through 2023. Results Thirty-three patients were enrolled, they were 15 females and 18 males with age ranges from 0.31 to 13.9 years and median (IQR) of 4.3 (1.4 – 9.0) years. Almost half of our patients had infection related hemolytic uremic syndrome (HUS) (51.5%), 30.3% had atypical HUS (aHUS), 9.1% had congenital thrombotic thrombocytopenic purpura (cTTP), while 9.1% were diagnosed with immune-mediated TTP (iTTP). Renal manifestations were the most common presenting symptoms (90.9%), hematological manifestations were present in (66.7%), while neurological manifestation were evident in (36.4%) of patients. Conservative management was the most commonly used approach (87.9%),while (75.8%) received plasma infusion and (69.7%) needed renal replacement therapy. On studying the outcome of our TMA cases, 33.3% had residual hematological manifestations, meanwhile 60.6% left with chronic kidney disease. Mortality was reported in 18.2% during the whole follow-up period. Conclusion infection-related HUS was the most common type of TMA in our cohort, and most patients were managed conservatively with disease resolution at 3 and 6 months follow up.

The Society of Thoracic Surgeons Intermacs 2024 Annual Report: Focus on Outcomes in Younger Patients

The 15th Annual Report from The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support includes 29,634 continuous-flow left ventricular assist devices from the 10-year period between 2014 and 2024. The outcomes reported here demonstrate continued improved survival in the current era of fully magnetically levitated devices, with a significantly higher 1-year (85.7% vs 78.4%) and 5-year (59.7% vs 43.7%) survival than those receiving non-magnetically levitated devices. Magnetically levitated device recipients are experiencing a lower incidence of adverse events, including freedom from gastrointestinal bleeding (72.6%), device malfunction (82.9%), and stroke (86.7%) at 5 years. Additionally, a focus on a subgroup of patients younger than 50 years of age has demonstrated both superior outcomes in survival (91.6% survival at 1 year and 72.6% survival at 5 years) and decreased incidence of adverse events compared with older recipients. This younger cohort also demonstrated more tolerance to the characteristics of sex, race, ethnicity, and psychosocial indicators that are associated with worse outcomes after heart transplantation. Based upon these data, a potential net prolongation of life may be realized by considering prolonged left ventricular assist device support prior to heart transplantation in this population. These analyses provide preliminary data that could positively influence adoption of left ventricular assist device technology in groups previously not seen as candidates for this therapy, while providing a more responsible donor allocation strategy for advanced heart failure patients.

Anterior Cruciate Ligament Reconstruction Utilizing Double Adjustable-Loop Suspensory Fixation Devices Provides Good Clinical Outcomes in Patients under the Age of 40 Years at Two-Year Follow-Up.

Background: Anterior cruciate ligament reconstruction (ACLR) using double adjustable fixation gained popularity in the last decade due to its minimally invasive technique. However, suspensory fixation devices could be related to recurrent instability, poor clinical outcomes, and patient dissatisfaction. The present study aims to evaluate the clinical outcomes following ACLR using double adjustable-loop suspensory fixation devices in the demanding population of young patients. Methods: Between 2019 and 2022, 95 patients with knee post-traumatic anterior cruciate ligament insufficiency were treated with primary ACLR using semitendinosus quadrupled graft and double adjustable-loop suspensory fixation devices and followed for at least two years. Concomitant lesions were also treated at the same surgical time. The knee examination form of the International Knee Documentation Committee (IKDC) was used to assess clinical evaluation, and the return to physical activities using the Tegner Activity Scale was recorded. Patient-reported objective measures (PROMs) were also evaluated, including the IKDC subjective and Lysholm scores. Results: Sixty-six males and twenty-nine females with a mean age of 23.8 (range 18-37) and a mean BMI of 24.9 (SD ± 2.42) kg/m2 were included in this study. All patients were evaluated clinically as normal or nearly normal at the final follow-up. PROMs also significantly improved postoperatively (p < 0.05) compared to the preoperative values. The Tegner Activity Scale increased from 2 to 7, the IKDC mean score improved from 43.9 (±8.9) to 93.3 (±12.3), and the modified Lysholm from 47.3 (±11.1) to 92.9 (±16.6). No complications or adverse events were recorded. Conclusions: Anterior cruciate ligament reconstruction utilizing double adjustable-loop suspensory fixation devices provides good clinical and functional outcomes in young patients at a two-year follow-up.

Beat-AML 2024 ELN–refined risk stratification for older adults with newly diagnosed AML given lower-intensity therapy

AbstractAlthough the 2022 European LeukemiaNet (ELN) acute myeloid leukemia (AML) risk classification reliably predicts outcomes in younger patients treated with intensive chemotherapy, it is unclear whether it applies to adults ≥60 years treated with lower-intensity treatment (LIT). We aimed to test the prognostic impact of ELN risk in patients with newly diagnosed (ND) AML aged ≥60 years given LIT and to further refine risk stratification for these patients. A total of 595 patients were included: 11% had favorable-, 11% intermediate-, and 78% had adverse-risk AML. ELN risk was prognostic for overall survival (OS) (P < .001) but did not stratify favorable- from intermediate-risk (P = .71). Within adverse-risk AML, the impact of additional molecular abnormalities was further evaluated. Multivariable analysis was performed on a training set (n = 316) and identified IDH2 mutation as an independent favorable prognostic factor, and KRAS, MLL2, and TP53 mutations as unfavorable (P < .05). A “mutation score” was calculated for each combination of these mutations, assigning adverse-risk patients to 2 risk groups: −1 to 0 points (“Beat-AML intermediate”) vs 1+ points (“Beat-AML adverse”). In the final refined risk classification, ELN favorable- and intermediate-risk were combined into a newly defined “Beat-AML favorable-risk” group, in addition to mutation scoring within the ELN adverse-risk group. This approach redefines risk for older patients with ND AML and proposes refined Beat-AML risk groups with improved discrimination for OS (2-year OS, 48% vs 33% vs 11%, respectively; P < .001), providing patients and providers additional information for treatment decision-making.

Clinical Presentation and Long-Term Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention: Results From a State-wide Registry

Clinical Presentation and Long-Term Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention: Results From a State-wide Registry

Cardiac Rehabilitation Outcomes in Young Patients With CABG and STEMI

Cardiac Rehabilitation Outcomes in Young Patients With CABG and STEMI

Coronary Lesion Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction and No Standard Modifiable Risk Factors: analysis of Data From Across the Asia Pacific Region

Coronary Lesion Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction and No Standard Modifiable Risk Factors: analysis of Data From Across the Asia Pacific Region

Real-world safety and efficacy of biologics in elderly patients with psoriasis: A multicenter observational study.

Clinical trials of biologics have frequently excluded elderly patients, resulting in inadequate data on their safety and efficacy. Additionally, evidence of their safety and efficacy remains limited, despite some real-world studies. To assess the safety and efficacy of biologics in elderly patients with psoriasis, we compared these outcomes in younger patients using data from the West Japan Psoriasis Registry (WJPR). The WJPR consists of approximately 30 facilities in Western Japan, including various healthcare settings. This study enrolled 1395 patients who participated in the 2022 follow-up survey of the WJPR and were either using or had used biologics during the survey. These included 456 patients in the elderly group (≥65 years) and 939 patients in the younger group (<65 years). Treatment-ending adverse events (TEAEs) occurred in 15.8% and 11.3% of elderly and younger patients, respectively. The incidence rate per 1000 patient-years (PY) for TEAEs was significantly higher in elderly patients than in younger patients (32.9 vs 23.2, p = 0.0234). Infectious diseases were more prevalent in the elderly group than the younger group; however, no significant difference in the frequency of infectious diseases was found between the two groups (p = 0.0807). Malignant neoplasms occurred significantly more frequently in the elderly group than in the younger group (p = 0.0169). Our results indicate a few concerns about infection when prescribing biologics to elderly patients. Biologics were effective for both elderly and younger patients. We found no significant differences in the proportion of patients with a body surface area score ≤3%, Physician's Global Assessment score 0/1, or Patient's Global Assessment score 0/1, as well as in the mean Dermatology Life Quality Index and the Itch Numerical Rating Scale between the younger and the elderly groups. Overall, our results confirm the appropriateness of using biologics in elderly patients with regard to safety and efficacy.

Impact of hormone receptor status and tumor subtypes on clinical behavior and outcomes of breast cancer in young BRCA carriers.

504 Background: Hormone receptor expression is a known positive prognostic and predictive factor in breast cancer (BC). Among young patients harboring germline BRCA1or BRCA2 (BRCA) pathogenic variants (PVs), most of the tumors arising in BRCA2carriers express hormone receptors, while most BC cases in BRCA1 carriers do not; however, limited evidence exists on the impact of hormone receptor status on clinical behavior and outcomes in young patients harboring BRCA PVs. Methods: This is an international, multicenter, hospital-based, retrospective cohort study including young patients (≤40 years) diagnosed with invasive BC between January 2000 and December 2020, harboring germline PVs in BRCA genes. Our analysis investigates the impact of hormone receptor status on clinical behavior and outcomes of BC. The type and pattern of recurrence and survival outcomes (disease-free survival [DFS], BC specific survival [BCSS] and overall survival [OS]) were first investigated according to hormone receptors expression (positive vs. negative), and then according to BC subtype (luminal A-like vs. luminal B-like vs. triple-negative vs. HER2-positive BC). Results: From 78 centers worldwide, 4,709 BRCA carriers were included in this analysis, of whom 2,143 (45.5%) had hormone receptor-positive and 2,566 (54.5%) hormone receptor-negative BC. Patients with hormone receptor-positive BC were more likely to harbor BRCA2 PVs while less frequently had grade 3 tumors and nodal involvement. Median follow-up was 7.88 (IQR 4.47-12.61) years. The rate of distant recurrences was higher in patients with hormone receptor-positive BC (13.1% vs. 9.6%, p&lt;.001), while the rate of second primary BC was lower (9.1% vs. 14.7%, p&lt;.001) when compared to patients with hormone receptor-negative disease. The 8-years DFS was 65.8% in patients with hormone receptor-positive and 63.4% in those with hormone receptor-negative BC. No differences in terms of OS nor BCSS were observed. The hazard ratio of hormone receptor-positive vs. negative disease changed over time for DFS, BCSS, and OS (p&lt;.05 for interactions of hormone receptor status and survival time). Among the 4,363 patients eligible for subtypes analysis, 612 had luminal A-like, 1,038 luminal B-like, 2,373 triple-negative and 340 HER2-positive BC. Patients with Luminal A-like BC had the worst long-term prognosis in terms of DFS compared to all the other subgroups (8-years DFS: 60.8% in luminal A-like vs. 63.5% in triple-negative vs. 65.5% in HER2-positive and 69.7% in luminal B-like subtype). Conclusions: In young BRCAPVs carriers with early BC, hormone receptor status did not appear to be a positive prognostic factor. The differences in pattern of recurrence and second primary BC among hormone receptor-positive vs. negative disease warrants consideration in counseling patients on treatment, follow-up strategies and indication for risk-reducing surgery.