Predictive Factors In Patients Research Articles

651P - Obese and overweight is associated with better prognosis in metastatic colorectal cancer patients treated with bevacizumab

BackgroundPrevious studies showed that high and low body mass index (BMI) is associated with worse prognosis in early-stage colorectal cancer (CRC), and low BMI is associated with worse prognosis in metastatic CRC (mCRC). Whether BMI is a prognostic or predictive factor in patients with mCRC is unclear. The aim of the study was to assess the efficacy outcomes according to BMI range in patients with mCRC treated with bevacizumab plus FOLFOX (oxaliplatin, 5-fluorouracyl, folinic acid) chemotherapy regimen. MethodsThe analysis included patients with mCRC receiving bevacizumab plus FOLFOX in the second line treatment. Patients were divided into three study groups according to BMI range: >30kg/m2 (obese patients), ≥ 25 - < 30kg/m2 (overweight patients), <25 (normal weight patients). The median PFS (progression-free survival) and OS (overall survival) of the treated patients was compared based on the BMI range. Analysis of Kaplan-Meier survival, univariate ANOVA, chi-squared tests for categorical variables were used. Analysis of variance (ANOVA) was used to determining the significance of impact on quantitative variables, while for qualitative variables chi-squared tests were used to compare patient from different BMI groups. ResultsThe study included 237 patients with mCRC. The median age of the patients was 65 years (range 34–82). The study group included 54% of males. The median OS and PFS in the study group was 14.6 and 8.8 months, respectively. The comparison of obese vs overweight vs normal BMI range patients revealed a significant difference in mOS (17.5 vs 14.3 vs 13.1 months, p=0.01) and mPFS (9.4 vs 9.1 vs 7.3 months, p=0.03). The regression analysis (Pearson’s linear correlation) also confirmed that there is a statistically significant relationship between the length of OS and PFS and the BMI value. Higher BMI was associated with a better prognosis. The location of the primary lesion on the left side of the colon, less than two metastatic sites and CEA within the normal range before start of the treatment was linked with statistically longer OS. ConclusionsObese and overweight patients presented longer OS and PFS compared with normal weight patients with mCRC cancer treated with bevacizumab plus FOLFOX chemotherapy regimen. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Incidencia, tasa de éxito, complicaciones y factores predictores de empleo de la vía femoral en procedimientos percutáneos de extracción de electrodos

IntroductionThe femoral route is used in electrode removal procedures when the upper route has failed. ObjectiveTo describe the incidence, success rate, complications and predictive factors for the use of the femoral route. MethodsAn analysis was performed on the incidence of use of the femoral route and the predictive factors in patients in whom electrode removal was carried out between November 2011 and November 2017. ResultsThe study included 85 patients with a mean age of 62.36±11.5 years. Pacemakers made up 38.9% of the devices. A total of 135 electrodes, 59.3% of passive fixation, were removed. The median time since the implant was 102 (60-174) months. The femoral route was used in 25.9% of the procedures. Clinical success was achieved in 92.9% of the patients. The removal was not successful in 22.7% of the procedures when the femoral route was used, compared to 1.6% when the upper route was used (P=.004). The removal was not completed in 36.4% of the procedures when the femoral route was used, compared to 9.5% with the upper route (P=.007).The factors that predicted the use of the femoral route were the presence of passive-fixation electrodes (OR=13.69: 95% CI; 3.06 – 62.5, P=.001), and the time since the electrodes were implanted (OR=1.04, 95% CI; 1.00 – 1.09, P=.044, for every 10 months). ConclusionsThe femoral route was employed in 25.9% of the procedures. It was not effective in 22.7% of the interventions. The factors that predicted its use were the presence of passive-fixation electrodes and the time since the electrode implant.

Abstract 1828: Genetic profiling of breast cancer confirms a pivotal role of EGFR pathway in the development of acquired resistance to tamoxifen

Abstract Background: Metastatic breast cancer (MBC) represents a major health problem in Egypt and worldwide. Prognostic and predictive factors for patients with MBC are highly needed, for better management and improved survival. The aim of this study was to assess the prognostic and predictive value(s) of CYP2D6 polymorphisms in MBC patients on Tamoxifen and to determine the genetic profile(s) of Tamoxifen responders and non-responders. Methods: We assessed 157 females with hormone receptor positive, locally recurrent inoperable and/or metastatic breast cancer (MBC) patients from Egypt for 1) CYP2D6 polymorphisms and 2) genetic aberrations in the EGFR pathway (92 genes). All patients received Tamoxifen and according to their response they were divided into Tamoxifen-responders and refractory. RNA was extracted from tumor and normal tissue samples and used to assess the genetic profiles of the patients using the SABioscience array (Qiagen) with four house-keeping genes. Results: 92(58.6%) patients were ER and PR positive, 51 (32.5%) were ER positive and 14 (8.9%) were PR positive. CYP2D6 *3/*4 was significantly prevalent in the refractory group (86.6%).Variants *10/*10 and *10/*3 were more common in the responders (85.5%) compared to refractory (P=0.027). CYP2D6 polymorphism associated significantly with Her-2 amplification (P&amp;lt;0.001), and reduced overall survival rate of patients in both refractory and responder groups (P&amp;lt; 0.001). Fifty-six genes were differentially over-expressed in the refractory group compared to responders, of which only JAK1, COL1A1, GAB1, FN1and MKNK1 showed a significant difference. In the refractory group 34 genes were differentially reduced compared to responders; none of them showed significant difference. Response to Tamoxifen associated significantly with disease site since patients with bone only disease showed better response than those with visceral metastases (P&amp;lt;0.005). Conclusion: A panel of 5 genes in EGFR pathway (MJAK1, COL1A1, GAB1, FN1 and MKNK1) together with CYP2D6 polymorphism scan predict response to Tamoxifen in metastatic BC patients though this has to be verified in an extended study including larger sample. Citation Format: Abeer A. Bahnnasy, Ibrahim Malash, Nasr Al-Lahlouby, Osman Mansour, Sabry Shaarawy, Mona S. Abdellateif, Hend Yousef, Mai M. Lotfy, Rabab Gaafar, Mohamed. elsesy, Abdel-Rahman N. Zekri. Genetic profiling of breast cancer confirms a pivotal role of EGFR pathway in the development of acquired resistance to tamoxifen [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1828.

Abstract 3304: CNS metastases in prostate cancer: an analysis of SEER database

Abstract Metastases to central nervous system (CNS) from various solid tumors, such as lung cancer (40-50%), breast cancer (15-25%) and melanoma (5-20%), are relatively common and confer a poor prognosis. CNS metastases from prostate cancer are uncommon. Due to the rarity of this disease and lack of studies, little is known about the clinical and pathological characteristics as well as outcome of these patients. CNS metastases also have therapeutic implications in terms of targeting hypothalamic-pituitary axis for androgen deprivation as well as CNS penetration of systemic chemotherapy agents. The objective of this study is to analyze clinicopathologic features and outcome of prostate cancer patients with CNS metastases in Survival, Epidemiology, and End Result (SEER) database. Between 2010 and 2015, a total of 23,776 patients with metastatic prostate were identified. Among them, 23,468 cases were adenocarcinoma and 308 cases were prostate cancer with neuroendocrine differentiation. A number of variables, including age, race, prostate-specific antigen (PSA) level, Gleason score, and prior radiotherapy, site of metastases were extracted. Primary outcome were overall survival (OS) and disease specific survival (DSS). CNS metastases were identified in 208 (0.89%) and 11 (3.57%) patients with adenocarcinoma and neuroendocrine tumor, respectively. Majority of patients (56.2%) were 65 years or older. Median OS and DSS were 13 months and 14 months, respectively. In comparison to patients with lymph nodes metastases only (n=8,103), the median OS and DSS were 40 months and 58 months, respectively. In patients with bone dominant metastasis (n=14,407), the median OS and DSS were 27 months and 34 months, respectively. Multivariate analysis identified age was an adverse predictive factor in patients with CNS metastasis. Race, high Gleason score (≥9), high PSA level (≥98ng/ml) and prior radiotherapy were not associated with OS and DSS. In conclusion, CNS metastases are more common in neuroendocrine tumor than in adenocarcinoma of prostate, and it confers poor survival outcome irrespective of histological subtypes. OS and DSS were worse in patients with prostate cancer and CNS metastases compared to those with lymph node metastases only or bone-dominant metastases. Note: This abstract was not presented at the meeting. Citation Format: Lin Mei, Taha Al-Juhaishi, Andrew Poklepovic, Asit Paul. CNS metastases in prostate cancer: an analysis of SEER database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3304.

Short term prognosis of heart failure after first hospital admission

BackgroundDeath and unexpected readmission are frequent among heart failure patients. We aimed to assess 30-day readmission and mortality rate as well as to identify predictive factors for patients discharged from a first HF related hospital admission. Methods and resultsRetrospective, single-center, cohort study, using administrative data from a tertiary care hospital in Barcelona, Spain. Patients discharged alive from a first HF related admission from 2010 to 2014 were assessed for 30-day death, readmission and adverse outcome rate. A Linear Logistic Regression Model was fitted for each outcome.The set accounted for 3642 patients; 50.1% female and 49.9% male. Mean age was 76 years (SD=12). 30-Days rates were 9.2% for readmission, 5.6% for death and 13.8% for adverse outcome. Admission to an ED within 30 days was strongly linked to readmission (OR=6.97), death (OR=2.31) and adverse outcome (OR=8.55), as well as chronic kidney disease (OR=1.44/1.61/2.86 respectively). Discharge to a Long Stay Care (LSC) facility was linked to lower readmission and adverse event rates (OR=.57 and OR=.15). ConclusionPre and post-index discharge use of health care resources is related to adverse outcome rates. Our findings point out the potential benefit for a more tailored approach in the management of HF patients.

An analysis of symptom burden and its predictive factors in patients with prostate cancer

Objective To assess the symptom burden and its predictive factors in patients with prostate cancer. Methods A cross-sectional study of 370 men with prostate cancer were conducted in the department of urology, Fudan University Shanghai Cancer Center. The questionnaire included a general questionnaire, Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) and Hospital Anxiety and Depression Scale (HADS). Results The average score of EPIC-26 in patients with prostate cancer was 25.32±12.00. The sexual function (15.59±7.38) and endocrine disorder (4.09±3.70) scored higher in five domains. There were significant differences in symptom burden scores among different treatment methods (P < 0.01). Multiple linear regression showed that endocrine therapy, anxiety, prostate specific antigen (PSA) and income were the influencing factors of symptom burden in this population, which could explain 49.3% of symptom burden. Conclusions The symptom burden of patients with prostate cancer is heavy, especially during endocrine therapy. Health care provider should focus on assessing the psychology of them. What′s more, it is important to develop the symptom management and psychological support, especially for patients with lower income and advanced patients. Key words: Prostate neoplasm; Symptom burden; Predictive factors

Early Postoperative Complications in Meningioma: Predictive Factors and Impact on Outcome

Craniotomies carry inherent risks of postoperative complications that may have a negative impact on patients' status. Recognizing and preventing surgical complications is of paramount importance, especially in meningioma surgery, where most of these tumors are benign and current management protocols are effective in terms of disease control and maintenance of higher quality of life. The objective of this study was to describe the early complications after surgery and their predictive factors in patients undergoing resection of intracranial meningiomas. A partly retrospective, partly prospective review was conducted in a Norwegian population-based cohort of 1469 consecutive cases of meningioma surgery treated at the university hospitals of Oslo, totaling 11,414 patient-years of follow-up. 2.6% of patients had a postoperative hematoma, 2.7% a postoperative infection, 3.9% a postoperative worsening of neurologic status; 5.4% of patients died during a 30-day period after surgery. Predictive factors of increased risk of postoperative complications were patient's age for the hematoma, a non-skull base meningioma for infection, and postoperative hematoma for the risk of neurologic worsening or 30-day mortality. Early postoperative complications in meningioma surgery have a negative impact on patient survival and postoperative neurologic status, in a disease where survival is usually not limited by the meningioma itself. In this study, we identified risk factors for early postoperative complications, the identification of at-risk populations may help to prevent the occurrence of these risk factors.

P012: Mortality rate of cancer patients by type presenting to the intensive care unit with sepsis.

Introduction: Sepsis in cancer patients is associated with higher mortality rates than non-cancer patients. As a whole, hematological or solid tumor cancers have not demonstrated a prognostic link to sepsis survival rates in intensive care units (ICU), however poor-prognosis solid tumours (less than 25% 5-year survival) have not been investigated. This study examined ICU mortality rate and its predictive factors of patients with sepsis and poor-prognosis solid tumors in comparison to patients with higher prognosis solid tumours. Methods: A 6-year retrospective chart review of 79 patients with sepsis and solid tumour cancers and/or metastatic cancers admitted to the ICU was conducted. Information regarding mortality rate within 14 days, length of ICU stay, incidence of intubation, and other primary reasons for ICU admission was collected. Data was analysed using logistic regression. Results: Logistic regression results showed intubation as the only significant factor contributing to patient mortality (p &amp;lt; .001), with the odds of mortality being 12.3 times higher for intubated than non-intubated patients. Five-year cancer survival rate was the second best predictor (p = .082), while age, sex, and metastasis were also not significant predictive factors for survival. Intubated patients with poor prognosis cancers had the lowest survival chance as further indicated by the 16 patients who met this criterion, of which 14 died within two weeks of ICU admission. Conclusion: The fact that poor prognosis cancers in sepsis were not significantly predictive of ICU mortality supports current literature regarding solid tumors in general, while intubation being a significant predictor for mortality in patients with sepsis and cancer regardless of type builds on previous research. A limitation of this study is the relative low number of included cases with poor-prognosis cancer types. Further evaluation is needed to understand the implications of our results for end-of-life care and ICU admission for patients with these characteristics.

Identifying Survival Predictive Factors in Patients with Breast Cancer: A 16-Year Cohort Study Using Cox Maximum Penalized Likelihood Method

Background: Cancer is the second leading cause of death globally, and it was responsible for almost 9.6 million deaths in 2018. Breast cancer (BC) is the most common cancer among women with almost two million new cases worldwide in 2018. Thus, it is necessary to study new methods to estimate the survival predictive factors in BC patients. Objectives: This cohort study aimed to fit a Cox model to BC data using partial likelihood (PL) and new maximum penalized likelihood (MPL) methods in order to determine the predictive factors of survival time and compare the accuracy of these two methods. Methods: This prospective cohort study used the data of 356 women with BC registered at the Cancer Research Center of Shahid Beheshti University of Medical Sciences in Tehran, Iran. The patients were identified from 1999 to 2015. The Cox model by new MPL and PL methods was used with variables such as the stage of cancer, tumor grade, estrogen receptor, and several other variables for univariate and multiple analyses. Results: The mean age ± standard deviation (SD) of patients at diagnosis was about 48 ± 11.27 years ranging from 24 to 84 years. Using the new MPL method, in addition to lymphovascular invasion and recurrence variables, estrogen receptor (P = 0.045) also had a statistically significant relationship with survival. The standard errors of most variables were smaller when using the MLP method than the PL method. The overall one-year, two-year, five-year, and 10-year survival rates based on the baseline hazard estimate were 96%, 92%, 70%, and 51%, respectively. Conclusions: In the analysis of BC data, new MPL method can help identify the factors that affect the survival of patients more accurately than usual methods do. This method decreases the standard error of most variables and can be applied for identifying predictive factors more accurately than previous methods.

Predictive factors for patients receiving intravitreal anti-vascular endothelial growth factor for the treatment of diabetic macular edema

To determine whether anemia and other demographic or laboratory "risk factors" impact anti-vascular endothelial growth factor treatment in diabetic macular edema patients. This is a retrospective, time-varying cohort study using a medical claims database to identify new diabetic macular edema patients who had received at least one intravitreal injection of anti-vascular endothelial growth factor. Exclusion occurred for having <2 years in the plan prior to diabetic macular edema diagnosis, any history of proliferative retinopathy or any treatment that is used for diabetic macular edema. Covariates of interest were demographic characteristics, laboratory values, and clinical factors such as previous anti-vascular endothelial growth factor used, number of involved eyes, year of treatment, and time since last injection. Those variables that changed with time were assessed and updated at each visit. The main outcome measure was the odds of receiving treatment at any visit. In total, 189 new diabetic macular edema patients with follow-up were analyzed, covering 729 visits with 543 (74.5%) receiving treatment. Univariate analysis showed that male gender (odds ratio: 0.54, 95% confidence interval: 0.32-0.91, p = 0.03), every week since last injection (odds ratio: 0.94, 95% confidence interval: 0.91-0.97, p = 0.001), and having two eyes affected (odds ratio: 2.09, 95% confidence interval: 1.10-3.97, p = 0.02) were associated with getting an injection. After multivariate analysis, only time since previous injection with every week that passed reduced the odds on having an injection at the next visit (odds ratio: 0.95, 95% confidence interval: 0.92-0.97, p < 0.001). Anemia was not associated with receiving an injection (odds ratio: 1.05, 95% confidence interval: 0.61-1.80, p = 0.86). This study used time-varying methodology to better identify which patients will likely need an injection at any one visit. While anemia was not found to impact injections, our results can aid future endeavors that may incorporate clinical visit information in developing a full prediction model to help make diabetic macular edema care more efficient.

Predictive Roles of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Calcific Aortic Valve Disease.

The neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) are emerging indirect blood markers to roughly reflect the inflammation level in our body while some pathological changes occurring in aortic valve tissue. Few recent studies demonstrated that NLR is related to calcific aortic valve disease (CAVD). However, the extent of the relationship between them and the impact of CRP on CAVD are not clear. This study aimed to investigate the diagnostic influence and surgical predictive effect of NLR and CRP on CAVD.A total of 278 consecutive patients with CAVD (123 patients with bicuspid aortic valve and others with tricuspid aortic valve) and 108 healthy individuals who were included in the control group were enrolled in the study. The NLR was calculated from the complete blood count, and the CRP was measured from peripheral blood samples. Echocardiography was used to evaluate the severity of aortic stenosis. Intraoperation/postoperation indicators were collected in 166 patients from the total consecutive patients who underwent aortic valve replacement (AVR) alone.Significantly higher NLR was measured in both the BAV group (1.96 ± 0.78 versus 0.97 ± 0.15, P < 0.001) and the TAV group (2.51 ± 2.03 versus 0.97 ± 0.15, P < 0.001) compared with the control group. Moreover, the NLR level was significantly higher (P < 0.001) and the CRP level was significantly lower (P = 0.007) of the TAV group than that of the BAV group; a significant positive correlation between the NLR and the maximum gradient of aortic valve was detected. Furthermore, there was a moderate correlation between the NLR and the postoperative mechanical ventilation time.Our results indicated that the NLR and CRP were novel and useful predictive factors in patients with CAVD, and these two potential factors have guiding significance for the prediction of different pathological typing (BAV or TAV). Higher NLR level will not extend the cardiopulmonary bypass time (CPB); however, it will prolong the operation time and the postoperative mechanical ventilation time.

Dyslipidemia and Rate of Under-Target Low-Density Lipoprotein-Cholesterol in Patients with Coronary Artery Disease in Korea.

ObjectiveThe aim of this study was to evaluate under target rates of low-density lipoprotein-cholesterol (LDL-C) in Korean patients with stable coronary artery disease (CAD) or an acute coronary syndrome (ACS) in real world practice.MethodsDyslipidemia International Study II was an international observational study of patients with stable CAD or an ACS. Lipid profiles and use of lipid-lowering therapy (LLT) were documented at enrollment, and for the ACS cohort, 4 months follow-up was recommended. Rates of under target LDL-C as per European guidelines, were evaluated, and multivariate regression was performed to identify predictive factors of patients presenting under the target.ResultsA total of 808 patients were enrolled in Korea, 500 with stable CAD and 308 with ACS. Of these, 90.6% and 52.6% were being treated with LLT, respectively. In the stable CAD group, 40.0% were under target LDL-C, while in ACS group, the rate was 23.7%. A higher statin dose was independently associated with under target LDL-C in both groups (OR, 1.03; p=0.046 [stable CAD] and OR, 1.05; p=0.01 [ACS]). The mean statin dosage (atorvastatin equivalent) was 17 mg/day. In the 79 ACS patients who underwent the follow-up examination, the LDL-C under target rate rose to 59.5%.ConclusionOnly a minority of patients with stable CAD or ACS were under their target LDL-C level at enrollment. The statin dose was not sufficient in the majority of patients. These results indicate a considerable LLT gap in Korean patients with established CAD.

Evaluation and predictive factors analyses for patient-self-reported depression, anxiety and quality of life in patients with metastatic renal cell carcinoma underwent interferon-α treatment: a prospective cohort study

Background: This study aimed to investigate the patient-self-reported depression, anxiety and quality of life (QoL) as well as their predictive factors in patients with metastatic renal cell carcinoma (mRCC) underwent interferon-alpha (IFN-α) treatment. Methods: A total of 127 patients with mRCC underwent IFN-α treatment were consecutively enrolled in this prospective cohort study. Anxiety, depression and QoL were assessed at week 0 (W0), W4, W8 and W12 by Hospital Anxiety and Depression Scale (HADS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 Scale), respectively. Results: The percentages of anxiety and depression both increased at W12 compared with W0. The EORTC QLQ-C30 Scale-Global health status score, EORTC QLQ-C30 Scale-Function and EORTC QLQ-C30 Scale-Symptoms scores did not deteriorate at W4, W8 or W12 compared with W0. Multivariate logistic regression analyses revealed that older age and elevated level of highest education independently predict reduced risk of HADS-Anxiety score elevation at W12, while hypertension was an independent predictive factor for increased risk. Older age also independently associated with less risk of elevated HADS-Depression score. Smoke, hypertension, diabetes and higher ECOG performance were independent predicting factors for escalated risk of EORTC QLQ-C30 Scale-Global health status score elevation at W12, and higher ECOG performance was an independent predicting factor for increased risk of elevated EORTC QLQ-C30 Scale-Function score at W12. Conclusions: In conclusion, anxiety and depression increased while QoL did not deteriorate in mRCC patients during IFN-α treatment, and age, highest education, hypertension, smoke, diabetes as well as higher ECOG performance status correlated with their aggravation.

Impact of primary tumor location as a predictive factor in patients suffering from colorectal cancer treated with cytotoxic anticancer agents based on the collagen gel droplet-embedded drug sensitivity test.

In recent studies, better clinical outcomes for patients with left-sided colon cancer (CC) compared with right-sided CC have been reported; however, in such investigations, the chemotherapy regimens included molecular-targeting agents. To the best of our knowledge, the impact of primary tumor location as a predictive factor in patients suffering from CC treated with cytotoxic anticancer agents alone has not been investigated. The aim of the present study was to determine the impact of the primary tumor location as a predictive factor of patients undergoing the following cytotoxic anticancer agent regimens: Leucovorin and fluorouracil + oxaliplatin (FOLFOX) or Leucovorin and fluorouracil + irinotecan (FOLFIRI), using the collagen gel droplet-embedded drug sensitivity test (CD-DST). Between March 2008 and April 2017, tumor specimens were obtained from 133 patients suffering from colorectal cancer (CRC) who had not received preoperative chemotherapy. CD-DST was performed and the growth inhibition rate (IR) was determined in FOLFOX and FOLFIRI regimens. The associations between tumor location and IR values for each condition were evaluated. In the present study, the prognosis of patients receiving palliative chemotherapy as well as treatment with molecularly-targeted agents was also investigated. There were no significant differences in the IRs (%) of the two regimens using CD-DST for right-sided tumors compared with left-sided tumors, including or excluding the rectum. The median survival times of patients with right CC and left CC who had received palliative chemotherapy and treatment with molecularly-targeted agents were 960 and 1,348 days, respectively. Primary tumor location did not represent a predictive factor for the efficacy of treatment with cytotoxic anticancer agent regimens using CD-DST. However, patients suffering from left-sided CC were revealed to exhibit better clinical outcomes compared with patients suffering from right-sided CC when molecularly-targeted agent regimens were administered. Therefore, the results of the present study suggested that molecularly-targeted agents rather than cytotoxic anticancer agents may result in improved clinical outcomes for patients with CRC suffering from left-sided tumors.

Predictive factors of patients' general quality of life after nasal septoplasty.

Although septoplasty is considered to be the definitive treatment of septal deviation and is associated with an increase of nasal patency, patients are not always satisfied with the surgical outcome as assessed by its effect on their general Quality of Life (QOL).The aim of this study was to identify the predictive factors that influence the patients' QOL after surgery. 60 patients with nasal obstruction and septal deviation were enrolled in this prospective study, and they all completed the follow-up survey of 6 postoperative months. Symptom severity (Nasal Obstruction Symptom Evaluation-NOSE, Sino nasal outcome test 22-SNOT-22), sleep quality (Epworth Sleepiness Scale-ESS), olfactory function (Threshold Discrimination Identification-TDI score), voice quality (Nasalance score and Voice Handicap Index-VHI), stress (SQ test) and emotional status (Beck Depression Index-BDI) were evaluated as predictive factors of patients' QOL (Glasgow Benefit Inventory-GBI) postoperatively. We also analyzed age, gender, smoking, socioeconomic status, type of septal deviation and changes of nasal patency (with the use of rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow). From all the analyzed parameters, the nasal obstruction symptom severity, the sleep quality, and stress levels were only significantly associated with patients' overall QOL (p < 0.05; univariate analysis). However, on multiple regression, positive changes in NOSE score (OR 15.09, 95% CI 1.47-22.64, p < 0.05) and SQ test (OR 4, 95% CI 1.12-14.3, p < 0.05) were only related with higher likelihood of participants' QOL improvement after surgery. Thorough preoperative evaluation of the symptom severity and stress levels is critical as these two factors are predictive of patient's satisfaction after septoplasty.

The role of disorganization of inner retinal layers as predictive factor in patients with epiretinal membrane

The role of disorganization of inner retinal layers as predictive factor in patients with epiretinal membrane

Lymphocytic Count and Ratio as Predictive Factors for Pathological Response after Neoadjuvant Therapy in Patients with Rectal Cancer

AbstractBackground: To evaluate results of pre-operative Complete Blood Count (CBC), with special emphasis on lymphocytic count and ratio as predictive factors for rectal cancer response to neoadjuvant chemoradiotherapy and prediction of complete pathological response.The Aim of the Study: Is to evaluate results of pre-operative complete blood count, with special emphasis on lymphocytic count and lymphocyte ratio as predictive factors of rectal cancer response to neoadjuvant chemoradiotherapy.Patients and Methods: This research studied the associa-tion between CBC results of patients with stage II or III Locally Advanced Rectal Cancer (LARC) before neoadjuvant therapy and the pathological response found in the specimen after standard surgical management. Patients were divided into two groups; Group I included patients with complete pathological response and Group II included patients with no or partial pathological response to study the predictive factors for complete pathological response.Results: A total of 36 patients (20 females and 16 males) were included. Mean age was 56.40±11.18 years. 19 patients (52.7%) underwent low anterior resections and 17 patients (47.2%) underwent abdomino-perineal resections. Lymphocytic count and ratio were significant predictive factors for the pathological response of the tumor to neoadjuvant therapy (p=0.011 and 0.048, respectively). Comparison between Group I and Group II showed that lymphocytic count and ratio were significant predictive factors for patients in Group I compared to Group II (p=0.001 and p=0.049, respectively).Conclusions: Lymphocytic count and ratio can play an important role as predictive factors for pathological response to neoadjuvant therapy in patients with LARC and also as predictive factors for complete pathological response. Further multicenter studies with larger number of patients are needed.

Image Guided Brachytherapy for Cancer of the Nasal Vestibule: Local Control and Cosmesis

To evaluate the efficacy of modern image guided brachytherapy for squamous cell carcinoma of the nasal vestibule, to explore tumor volume as a prognostic factor for local and regional recurrence, and to assess patient satisfaction with nasal function and appearance after treatment. In a retrospective analysis, we reviewed the medical records of 102 patients with Wang T1-T2 nasal vestibule cancer treated at a single institution with brachytherapy as the sole treatment. Median follow-up time was 42months (range, 3-210months). A patient satisfaction study using the validated Nasal Appearance and Function Evaluation Questionnaire was conducted among 42 patients more than 1year after treatment. A statistically significant cutoff point for tumor volume as a prognostic factor of local control was established using Youden's index method. Seventy-seven of 102 patients were treated with interstitial implants, and 25 patients were treated by an intracavitary mould technique. The 5-year control rates were 95%, 91%, and 83% for local, regional, and locoregional control, respectively. Tumor volume ≥2.3cm3 resulted in worse 3-year regional control compared to tumor volume <2.3cm3 (62% vs 96%; P=.01). Ultimate regional control after salvage treatment was 96%, with no significant difference observed between subgroups by tumor volume (92% for ≥2.3cm3 vs 96% for <2.3cm3; P=.57). Three patients with regional failure developed distant metastases. Five-year disease-specific survival and overall survival were 94% and 74%, respectively. Patient-assessed cosmetic and functional satisfaction were both rated high (mean 3.7 and 4.0 of 5, respectively). We report the largest cohort to date treated with brachytherapy as the sole treatment for nasal vestibule carcinoma. Brachytherapy offers excellent local control for Wang T1-T2 tumors with high patient satisfaction. Tumor volume is an adequate predictive factor for patients at risk of regional recurrence, but ultimate control rates after salvage treatment are high. Therefore, we do not recommend elective treatment of the neck.

Which Patient-Related Factors Determine Optimal Bowel Preparation?

Adequate bowel cleansing before colonoscopy is a simple concept but the high rate of inadequate or incomplete bowel cleanliness and its consequences have been the subject of many studies, guidelines, and meta-analysis. The complexity resides in all the factors surrounding preparation intake such as type and regimen of bowel preparation, diets, compliance, and also patient-related factors that all influence quality of the bowel preparation. The purpose of this review is to focus specifically on patient-related factors and their challenges. Patients with lower GI bleeding are excluded from this review. Patient factors that may be associated with a poor bowel preparation were searched for in the literature. With regard to patient's characteristics, higher age, male gender, and socio-economic status (lower income, Medicaid, and lower education) were all associated with higher rates of inadequate bowel preparation. Comorbidities such as inflammatory bowel disease (IBD), in-patients, body mass index (BMI), cirrhosis, constipation, and neurological condition as well as some pharmacotherapy were also associated with inadequate bowel preparation. Studies identifying predictive patient factors as well as those studying these patients in particular showed variability in the strength of the patient factor associations. Patients taking tricyclic antidepressant, narcotics, and those with neurological conditions were identified to have a stronger association with worse bowel cleanliness. Those can be implemented with the current recommendations of split-dosing. Identifying individual factors that can impact the quality of bowel cleanliness can be challenging. Some have been well-studied in the literature such as age, in-patient status, or constipation and others such as male gender or higher BMI have required more studies to clearly conclude on any possible association. In many studies, simple recommendations like walking 30min during the preparation, and additional instructions or support have also been added to instructions to improve motility and compliance.

Increased serum levels of Galectin-9 in patients with chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults. Despite improvements in treatment, CLL is still considered an incurable disease. The aim of the present study was to evaluate galectin-1, −3 and −9 (Gal-1, −3 and −9) and Gal-3 binding protein (Gal-3BP) as prognostic and predictive factors in patients with CLL. Serum concentrations of Gal-1, −3 and −9 and Gal-3BP were measured in 48 patients with CLL and 30 control patients, using multiplex bead arrays. In patients with CLL, galectin concentrations were assessed prior to, during and following treatment. In patients with CLL who were untreated, galectin concentrations were measured twice with a 6-month interval. The serum level of Gal-9 was significantly increased (P<0.0001) in patients with CLL compared with the control group, and was associated with the clinical stage according to Binet classification, as well as poor cytogenetic and serum CLL prognostic factors. In addition, patients with CLL, who exhibited treatment failure, exhibited higher concentrations of Gal-9 (P=0.06) and Gal-3BP (P=0.009) at the end of the treatment when compared with patients under complete remission or stabilization of the disease. The serum level of Gal-3 was significantly decreased (P=0.012) in patients with CLL compared with the control group. These results suggest that Gal-9 is a potential prognostic factor in patients with CLL. The predictive value of Gal-9 requires further study in larger cohorts of patients.