Predictive Factors In Patients Research Articles

Level IIb lymph node metastasis characteristics and predictive factors for patients with cN1b papillary thyroid carcinoma

BackgroundThe aim of the present study was to examine the frequency, characteristics, and risk factors of level IIb lymph node metastases in papillary thyroid carcinoma. MethodsWe reviewed and collected clinical and pathological records for 954 papillary thyroid carcinoma patients with clinically positive lateral neck node metastasis. Univariate and multivariate analyses were performed to detect risk factors for level IIb lymph node metastasis; a predictive model was built based on multivariate analysis and tested in a validation group. ResultsLevel IIb lymph node metastasis was observed in 137 of 954 patients (14.4%). Univariate and multivariate analyses using the training group indicated that gross extrathyroidal extension of the primary tumor, tumor location in the upper pole, and preoperative distant metastasis were 3 independent risk factors for level IIb lymph node metastasis. This model was built and tested in a validation group, and the area under the curve was 0.840 (P < .001). The cutoff of the IIb score was 12, which was tested in the validation group; the sensitivity was 82.1% and the specificity was 95.6%. ConclusionLevel IIb dissection should be performed in select patients with IIb scores ≥12.

Decreased Nek9 expression correlates with aggressive behaviour and predicts unfavourable prognosis in breast cancer

As a new member of Neks family, Nek9 regulates spindle assembly and controls chromosome alignment and centrosome separation. In the current study we aimed to investigate the expression of Nek9 in breast cancer and its clinical significance. We evaluated the expression of Nek9 in invasive ductal carcinoma (IDC, n=316), ductal carcinoma in situ (DCIS), usual ductal hyperplasia, atypical ductal hyperplasia, fibroadenoma and normal breast tissues using immunohistochemistry. The results revealed significantly reduced Nek9 in IDCs (41.8%) compared to benign breast lesions. Moreover, gradually reduced Nek9 was found from DCIS to invasive carcinoma and metastatic tumour within the same tumours. The decrease in Nek9 expression was associated with larger tumour size (p=0.0087), high grade (p<0.0001) and high Ki-67 index (p<0.0020). TCGA and GEO datasets analysis revealed low level of Nek9 mRNA was more frequent in triple negative breast cancers, and associated with poor overall survival and distant metastasis-free survival. These findings suggest an important role of Nek9 in the progression of breast cancer, and aberrantly expressed Nek9 correlates with more aggressive clinicopathological variables and predicts poor clinical prognosis. Nek9 may serve as a potential predictive factor for patients with breast cancer.

Nomogram for Individualized Prediction of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis on Conservative Treatment.

Background Portal vein tumor thrombosis (PVTT) is one of the major predictive factors for patients with hepatocellular carcinoma (HCC). The objective of this study was to establish a prognostic nomogram for identifying individual survival outcomes in patients with HCC and PVTT on conservative treatment based on specific factors. Methods Two hundred and ten patients with HCC and PVTT on conservative treatment in Beijing Ditan Hospital between June 2008 and May 2017 were studied retrospectively as a derivation cohort. We built a nomogram based on independent risk factors for survival prediction. The concordance index (c-index) and a calibration curve were used to evaluate the predictive accuracy. During the study, 102 patients were included at the Putuo Hospital and Third People's Hospital of Changzhou as a validation cohort. Results In the derivation cohort, the independent factors for overall survival were identified by multivariate analysis, namely, aspartate aminotransferase ≥119 IU/L, gamma-glutamyl transferase ≥115 IU/L, Child–Pugh class C liver function, creatinine ≥91 μmoI/L, α-fetoprotein ≥400 ng/ml, and largest tumor diameter ≥5 cm. The nomogram had a c-index of 0.737 (95% confidence interval, 0.692–0.782) and the calibration curves fitted well. The median survival time was 4.2 months in the derivation cohort, with an MST of 5 months for BCLC C stage and 1.8 months for BCLC D stage patients. Kaplan–Meier analysis showed significant statistical differences in the 6-month overall survival rates of the primary and validation cohorts after the total scores were divided into three quartiles (low risk: 0–85; intermediate risk: 86–210; high risk: ≥211; p < 0.0001 in both cohorts). Conclusions The nomogram can be a more accurate and individualized prediction for 6-month overall survival of patients with HCC and PVTT on conservative treatment, and it is possible to consider further active interventions for patients in the low-risk group (0–85 scores) to achieve the aim of prolonging survival.

Prognostic implications of tumor sidedness in colorectal cancer patients in South Dakota, 2006-2015.

46 Background: Tumor “sidedness” is emerging as an important prognostic and predictive factor in patients with metastatic colorectal cancer (CRC), with right sided colon cancer (RC) associated with poorer overall survival (OS) than left sided colon cancer (LC). This distinction has been noted in clinical trials and large databases, where American Indian (AI) populations are generally underrepresented. This project aims to investigate the prognostic implications of CRC sidedness in the state of South Dakota, focusing on the AI population. Methods: Data from patients diagnosed with CRC in the South Dakota cancer registry from January 1, 2006 to December 31, 2015 were analyzed for demographic and presenting features as well as survival outcomes. A total of 3,637 cases were included in the analysis, of which 191 (5%) were AI. Tumors arising from the cecum, ascending colon, hepatic flexure and transverse colon were considered RC while those arising from the splenic flexure, descending colon, sigmoid colon and rectum were considered LC. Results: In all patients, 47.1% of cases were RC; Caucasians (C) were significantly more likely to have RC, as 47.7% of cases in Caucasians were RC, whereas in the AI population, 35.6% cases were RC (p=0.005). Patients with RC were more likely to be female and older and less likely to present with metastatic disease than LC. Tumor sidedness was not associated with OS when analyzing all patients regardless of stage or in patients with non-metastatic disease. In patients with metastatic disease, RC was associated with inferior OS compared to LC [Median OS (mo): 9.9 v. 23.6, p&lt;0.001]. When analyzed by race, RC was associated with inferior OS in C [Median OS (mo): 9.6 v. 23.6, p=0.002] but not in AI [Median OS (mo): 10.2 v. 10.4, p=0.082]. Conclusions: Although limited by small sample size, this analysis is hypothesis generating, as AI patients with CRC were more likely to have LC than Caucasians and the well described prognostic implications of RC were not noted in the AI population. Larger population studies and further investigation as to potential explanations for this finding are recommended.

Medication adherence and predictive factors in patients with cardiovascular disease: A cross-sectional study.

Adherence to cardiac medications makes a significant contribution to avoidance of morbidity and premature mortality in patients with cardiovascular disease. This quantitative study used cross-sectional survey design to evaluate medication adherence and contributing factors among patients with cardiovascular disease, comparing patients who were admitted to a cardiac ward (n = 89) and those attending outpatient cardiac rehabilitation (n = 31) in Australia. Data collection was completed between October 2016 and December 2017. Descriptive and regression analyses were conducted to identify medication adherence and determine factors independently predictive of medication adherence. Participants from cardiac rehabilitation had significantly lower adherence to cardiac medications than those recruited from the cardiac ward (58.1 vs 64.0%, respectively). Self-efficacy was significantly associated with participants' medication adherence in both groups. The ability to refill medications and beliefs about cardiac medications were independently significantly predictive of cardiac medication adherence. These findings indicate areas where clinical nurses could expand their role to improve cardiac patients' medication self-management.

Initial Prostate Biopsy of Grade Group One

Purpose: The aim of our study was to analyze the outcomes and predictive factors in patients with an initial biopsy grade group 1 (GG1) prostate cancer (PCa) at risk of GG upgrading. Materials and Methods: We performed a retrospective review of patients who had GG1 PCa at biopsy and were managed with robotic-assisted laparoscopic radical prostatectomy (RaLRP) from January 2012 to December 2018 and collected their clinical characteristics and pathological data. The primary outcomes were GG upgrading at RaLRP and biochemical recurrence-free survival (BCRFS) in these patients. The secondary outcome was to analyze the risk factors of pathological upgrades. Results: Among the 159 patients with initial prostate biopsy of GG1, 122 patients (76.7%) had GG upgrading based on the final pathology at RaLRP. Multivariable analysis showed that transrectal ultrasound (TRUS)-measured prostate volume &lt;30 mL (odds ratio [OR] 4.727, P = 0.011), prostate-specific antigen density [PSAD] ≥0.2 ng/mL2 (OR 3.201, P = 0.019), magnetic resonance imaging (MRI)-measured prostate volume &lt;30 mL (OR 3.892, P = 0.007), and PSAD ≥ 0.2 ng/mL2 (OR 2.65, P = 0.019) were independent predictive factors of GG upgrading. During 5 years of follow-up, patients who upgraded to GG3-5 had a significantly shorter time to biochemical recurrence than those who remained as GG1 (P = 0.001) or upgraded to GG2 (P = 0.008). Conclusion: The final pathology grading was underestimated in 76.7% of initial biopsy GG1 and may influence the BCRFS after RaLRP. Prostate volume &lt;30 mL and PSAD ≥0.2 ng/mL2, measured by either MRI or TRUS, were significant predictive factors of biopsy GG1 upgrading.

Quantitative PET Imaging and Clinical Parameters as Predictive Factors for Patients With Cervical Carcinoma: Implications of a Prediction Model Generated Using Multi-Objective Support Vector Machine Learning.

Purpose:Quantitative features from pre-treatment positron emission tomography (PET) have been used to predict treatment outcomes for patients with cervical carcinoma. The purpose of this study is to use quantitative PET imaging features and clinical parameters to construct a multi-objective machine learning predictive model.Materials/Methods:Seventy-five patients with stage IB2-IVA disease treated at our institution from 2009–2012 were analyzed. Models predicting locoregional and distant failure were generated using clinical parameters (age, race, stage, histology, tumor size, nodal status) and imaging features (12 textural, 9 intensity, 8 geometric features, 2 additional imaging features) from pre-treatment PET. Model features were selected based on a multi-objective evolutionary algorithm to maximize specificity given a fixed moderately high sensitivity using support vector machine learning methods. Model 1 used clinical parameters only (C), Model 2 used imaging features only (I), and Model 3 used clinical and imaging features (C+I). Sensitivity, specificity, area under a receiver-operating characteristic curve (AUC), and p-values were compared to assess ability to predict locoregional and distant failure.Results:C+I had the highest performance for both locoregional failure (AUC 0.84, p < 0.01; specificity: 0.86; sensitivity: 0.79) and distant failure (AUC 0.75, p < 0.01; specificity: 0.75; sensitivity: 0.75).Conclusions:Based on a moderately high fixed sensitivity and optimized for specificity, the model using both clinical parameters and imaging features (C+I) had the best performance in predicting both locoregional failure and distant failure.

Progression in cerebral microbleeds number after acute myocardial infarction: Harmful role of triple antithrombotic therapy

Cerebral microbleeds (CMB) is a predictive factor of intracerebral haemorrhage (ICH) and patients with CMB under antithrombotics are at higher risk of ICH. Thus, the impact of anticoagulants and/or antiplatelets on the occurrence of ICH and/or on new CMB development is a major issue. We aimed to evaluate the early progression at 3 months of CMB and their predictive factors in patients with acute myocardial infarction (AMI) treated with direct oral anticoagulant (DOA) or vitamin K antagonist (VKA). Prospective study from November 2016 to December 2018, including patients > 60 y hospitalized in intensive cardiac care unit for AMI. They underwent a first brain MRI (T2* gradient echo and SWI magnetic susceptibility image) < 72 hours after admission, and repeated 3 months after stenting. One hundred and eight patients (42 women and 66 men, mean age 77 years) were included. Among the patients with CMB (21%), 66 patients received a cerebral MRI at 3 months after AMI. An increase in CMB number was observed for 6% of patients. These patients were older than those without CMB progression (85 ± 5 vs. 75 ± 8 y, P = 0.016) and were more often treated by DOA or VKA at hospital discharge than patients with unchanged CMB number:OR = 15.6 [1.470–165.582]. In multivariate analysis, only discharge treatment with DOA or VKA was a predictive factor of CMB progression 3 M after AMI:OR = 13.8 [1.11–173.5]. No significant differences between the two groups with regard to CRUSADE and BLEEDING Risk haemorrhage scores were noted. Neither ICH nor ischemic stroke were observed. MRI-detected CMB was common and may even early increase after AMI. Our results highlight that the association of DOA or VKA with dual antiplatelet therapy at hospital discharge could be an independent risk factor of CMB progression. Larger population studies are needed to address antiplatelet therapy duration and dose of DOA as potential risk factors for CMB progression.

Idiopathic Sudden Sensorineural Hearing Loss: Should Otoacoustic Emissions Be Added to the Monitoring Protocol? A Systematic Review

Idiopathic sudden sensorineural hearing loss (ISSNHL) refers to a loss of hearing, most commonly unilateral, that occurs suddenly (≤72 h) with no identifiable cause or etiology. To date, there is no standard protocol to predict prognosis (hearing recovery) for patients with ISSNHL. However, studies have shown that changes in otoacoustic emissions (OAEs) often occur prior to changes in audiometric hearing thresholds. OAEs originate from the electrochemical motility of the outer hair cells (OHC) and reflect the integrity of the inner ear, specifically the cochlear amplifier. Therefore, OAEs may be useful as a prognostic predictive factor in patients with ISSNHL from the initial onset of symptoms through recovery. A systematic review of the literature was undertaken to assess the relationship between pure tone thresholds, OAEs, and subjective hearing improvement and/or recovery. Fourteen studies were identified for inclusion, and they overwhelmingly support the inclusion of OAEs in the protocol to monitor ISSNHL recovery. This finding supports the development of a standard diagnostic protocol that includes OAEs to predict patient hearing outcomes.

Investigation of Predictive Factors for Patients with Nondiagnostic or Insufficient FNAB Results Who Underwent Thyroidectomy

Investigation of Predictive Factors for Patients with Nondiagnostic or Insufficient FNAB Results Who Underwent Thyroidectomy

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.

Increased Expression of Gankyrin and Stemness Factor Oct-4 are Associated with Unfavorable Clinical Outcomes and Poor Benefit of Tamoxifen in Breast Carcinoma Patients.

Tamoxifen is the most important treatment component in estrogen receptor positive (ER+) breast carcinoma patients. Tamoxifen resistance incidence presents an important obstacle in clinical treatment. Mechanisms underlying tamoxifen refractory are not completely understood. Although elevated expression of Gankyrin (P28GANK) and stem cell markers Nanog, Oct-4 and Sox-2 have been reported in breast carcinoma, their role in tamoxifen resistance progression has not been explored. In the present study, P28GANK and stem cell markers Nanog, Oct-4 and Sox-2 expression were evaluated using quantitative RT-PCR and immunohistochemical technology in 72 breast carcinoma patients who received tamoxifen as adjuvant anti-hormone treatment. Expression data were correlated with the clinical outcome and survival of patients. Data analysis showed that P28GANK, Oct-4 and Sox-2 transcripts were significantly overexpressed in tamoxifen resistance patients. Immunohistochemical staining indicated that protein expression of P28GANK and Oct-4 were also significantly higher in tamoxifen resistance patients. We have shown a positive correlation between mRNA and protein expression of P28GANK, Oct-4 and Sox-2. Multivariate logistic regression analysis indicated that P28GANK (P = 0.002) and Oct-4 (P = 0.013) overexpression could be negative independent factors of disease outcome. Additionally, in the whole study group, multivariate Cox regression analysis revealed that high expression of P28GANK and Oct-4 remained significant and unfavorable predictive factors for patients' survival. These findings suggest that Gankyrin and Oct-4 overexpression could promote tamoxifen refractory in breast cancer patients. More studies are warranted to clarify the predictive role of these potential biomarkers for patients who don't benefit from tamoxifen treatment and their possible application as prognostic markers in ER+ tamoxifen-treated breast carcinoma patients.

Detection of circulating tumour cells in the breast cancer using CytoTrack system

Summary Introduction: Plants are a rich source of healing substances. Cancer is a leading cause of death worldwide while breast cancer is the most common cancer among women. Circulating tumour cells (CTCs) are potential founder cells for metastasis. Therefore, their assessment may be used for monitoring of treatment as well as detecting cancer metastatis. Hence, it is suggested that the number of CTCs may be a valuable tumour biomarker during therapy. Objective: The purpose of this study was to detect CTCs in breast cancer and to validate the method of assessment of CTC count using CytoTrack CT11 technology. Methods: MCF-7 cells were sorted by a FACSARIA flow cytometer from blood samples derived from patients who have not been diagnosed with cancer. Identification and quantitative assessment of MCF-7 cells in blood samples were determined by flow sorting. Then, blood samples containing MCF-7 cells or without MCF-7 were scanned with the use of an automated fluorescence scanning microscope. Results: In in vitro model analysing the glass CytoDisc™ with stained MCF-7 cells, we noted the correlation between the amount of observed tumour cells and expected number of tumour cells. Moreover, coefficient of variation in case of the recovery rate of the assumed number of MCF-7 cells was 30%, 17%, 18% and 15%, respectively. Conclusion: Our study suggest that CTCs could be predictive factor in patients with metastatic cancer especially in breast cancer.

Incidence of the initiation of comfort care immediately following emergent neurosurgical and endovascular procedures.

It is unknown what proportion of patients who undergo emergent neurosurgical procedures initiate comfort care (CC) measures shortly after the operation. The purpose of the present study was to analyze the proportion and predictive factors of patients who initiated CC measures within the same hospital admission after undergoing emergent neurosurgery. This retrospective cohort study included all adult patients who underwent emergent neurosurgical and endovascular procedures at a single center between 2009 and 2014. Primary and secondary outcomes were initiation of CC measures during the initial hospitalization and determination of predictive factors, respectively. Of the 1295 operations, comfort care was initiated in 111 (8.6%) during the initial admission. On average, CC was initiated 9.3 ± 10.0 days postoperatively. One-third of the patients switched to CC within 3 days. In multivariate analysis, patients > 70 years of age were significantly more likely to undergo CC than those < 50 years (70-79 years, p = 0.004; > 80 years, p = 0.0001). Two-thirds of CC patients had been admitted with a cerebrovascular pathology (p < 0.001). Admission diagnosis of cerebrovascular pathology was a significant predictor of initiating CC (p < 0.0001). A high Hunt and Hess grade of IV or V in patients with subarachnoid hemorrhage was significantly associated with initiation of CC compared to a low grade (27.1% vs 2.9%, p < 0.001). Surgery starting between 15:01 and 06:59 hours had a 1.70 times greater odds of initiating CC compared to surgery between 07:00 and 15:00. Initiation of CC after emergent neurosurgical and endovascular procedures is relatively common, particularly when an elderly patient presents with a cerebrovascular pathology after typical operating hours.

Предикторы циторедукции: лапароскопическая диагностика для выбора тактики лечения у пациенток с распространенными формами серозного рака яичников

Ovarian cancer (OC) holds the first place in a structure of mortality among oncogynecology diseases all over the world. Complex approach in treatment of advanced forms of serous ovarian cancer (SOC) (stages III-IV by FIGO) – suggests a combination of surgery and chemotherapy methods – as the world standard. Nowadays, use of operative intervention at the preliminary stage of treatment (primary cytoreduction) is regarded as preferred and contributes to remote therapy results in women, if compared to those patients whose treatment started with the courses of neoajuvant chemotherapy. Nevertheless, just volume of residual tumor belongs to the most important predictive factors in patients with SOC, therefore, depth of cytoreductive surgery completion is considered to be a mainstay in treatment of such women. Macroscopic absence of residual tumor – its full cytoreduction is referred to as the «gold standard» in surgery treatment of OC. At present, there are no efficient methods which would allow to predict a full extent of cytoreduction and, as a result, to identify the group of patients with justified neoajuvant chemotherapy and the next cytoreduction in intervals, as well as women who will benefit from performing primary cytoreduction. Diagnostic laparoscopy for assessment of tumor process spreading and predicting the volume of cytoreduction was first time conducted in 1998. Until presently, only 1 randomized study (the Netherlands, 2016) had been carried out with participation of 201 women to evaluate effectiveness of diagnostic laparoscopy as a predictive factor of cytoreduction. The other studies were conducted as non-randomized pro– and retrospective. Review of literature proposed in the article allows introducing the data and all results of such studies. Use of laparoscopy as the predictor of cytoreduction in combination with radiology diagnostic methods allows making much personalized approaches in therapy of women with advanced forms of SOC and therefore, will contribute to better remote results of treatment. Key words: serous ovarian cancer, diagnostic laparoscopy, cytoreductive surgery.

The predicting value of the 8th edition of American Joint Committee on Cancer staging manual in mucinous breast cancer

Objective: The current study aimed to evaluate the predictive performances of anatomic staging system (AS) and prognostic staging system (PS) proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual in patients with pure mucinous breast cancer (PMBC). Methods: Clinicopathologic features and follow-up information were collected from a total of 3628 patients with PMBC. Breast cancer-specific survival (BCSS) were compared among patients in different stage groups. Likelihood ratio (LR) χ(2), Akaike information criterion (AIC) and Harrell's concordance index (C-index) were used to evaluate the predictive performances of AS and PS in PMBC. Results: In PMBC, BCSS was associated with tumor size (P=0.002), lymph node status (P=0.002), grade(P=0.003), PR status(P=0.017)and the receipt of radiation. Compared to AS, 1326 patients (37.54%) underwent stage change after applying PS, with 6.50% upstaged and 37.04% downstaged. There were significant differences in BCSS among patients of different stages under the AS and PS (P<0.001). However, PS was not superior to AS in predicting prognosis (AS vs PS, LR χ(2): 16.41 vs 17.5; AIC: 357.44 vs 358.35; C-index, 0.72 vs 0.73, P=0.667). Conclusions: Both of AS and PS proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual were predictive factors in patients with PMBC. Compared with AS, the PS did not show superiority in prognosis prediction among patients with PMBC.

A predictive factor for patients with acute respiratory distress syndrome: CT lung volumetry of the well-aerated region as an automated method

PurposeAcute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury that frequently shows fatal outcomes. As radiographic predictive factors, some reports have focused on the region of ill-aerated lung, but none have focused on well-aerated lung. Our objective was to evaluate the relationship between computed tomography (CT) volume of the well-aerated lung region and prognosis in patients with ARDS. MethodThis retrospective observational study of a single intensive care unit (ICU) included patients with ARDS treated between April 2011 and May 2013. We identified 42 patients with ARDS for whom adequate helical CT scans were available. CT images were analyzed for 3-dimensional reconstruction, and lung region volumes were measured using automated volumetry methods. Lung regions were identified by CT attenuation in Hounsfield units (HU). ResultsOf the 42 patients, 35 (83.3 %) survived 28 days and 32 (76.2 %) survived to ICU discharge. CT lung volumetry was performed within 144.5 ± 76.6 s, and inter-rater reliability of CT lung volumetry for lung regions below −500 HU (well-aerated lung region) were near-perfect. Well-aerated lung region showed a positive correlation with 28-day survival (P = 0.020), and lung volumes below −900 HU correlated positively with 28-day survival and ICU survival, respectively (P = 0.028, 0.017). Survival outcome was better for percentage of well-aerated lung region/predicted total lung capacity ≥40 % than for <40 % (P = 0.039). ConclusionsCT lung volumetry of the well-aerated lung region using an automated method allows fast, reliable quantitative CT analysis and potentially prediction of the clinical course in patients with ARDS.

Associated factors with delayed ambulation after abdominal surgery.

After abdominal surgery, ambulatory status is an important indicator of postoperative recovery. This study investigated the inability to ambulate on postoperative day 1 and identified associated predictive factors in patients undergoing abdominal surgery, focusing on preoperative hematologic markers such as the neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index. Adult patients undergoing abdominal surgery from May 2018 to October 2018 were investigated consecutively. Only patients with duration of surgery ≥ 3h were included for observation. Data on patient characteristics were collected from medical charts and laboratory results. Univariate analysis and multivariate logistic regression were used to determine associations with inability to ambulate without human assistance on postoperative day 1 and postoperative length of stay. Of 416 eligible patients, 217 patients were included in the analysis. Sixty-nine patients (31.7%) were not able to ambulate on postoperative day 1. The NLR (odds ratio, 1.11; 95% confidence interval, 1.01-1.23), duration of surgery (odds ratio per 1h, 1.27; 95% confidence interval, 1.06-1.43), and American Society of Anesthesiologists physical status of 3 (odds ratio, 4.99; 95% confidence interval, 1.15-21.5) were independently associated with the inability to ambulate without assistance on postoperative day 1, which was also associated with longer hospital stays (13 [11, 22] vs 21 [15, 39] days, P < 0.001). The NLR, surgical duration, and American Society of Anesthesiologists physical status were significantly associated with the inability to ambulate without human assistance on postoperative day 1 and prolonged hospitalization.

1515P - Impact of visceral fat area as independent predictive factor in patients with advanced non-small cell lung cancer treated with nivolumab

BackgroundA better identification of patients who are more likely to benefit from immune checkpoint inhibitors is warranted in advanced non-small cell lung cancer (NSCLC). In resent preclinical study, obesity was associated with increased efficacy of PD-1/PD-L1 blockage. Herein, we conducted a retrospective study to investigate the prognostic accuracy of body mass index (BMI) and computed tomography-defined fat area in patients with advanced NSCLC treated with nivolumab. MethodsWe retrospectively analyzed patients with advanced NSCLC who received nivolumab at our institute between January 2016 and January 2019. Clinical data including BMI, visceral fat area (VFA) and subcutaneous fat area (SFA), and progression free survival (PFS) were collected. Treatment outcome of nivolumab was assessed according to the Response Evaluation Criteria in Solid Tumors, version 1.1. ResultsIn total, 126 patients were included in this study. High VFA (≥100cm2) were significantly associated with longer PFS, whereas high SFA (≥100cm2) and high BMI (≥25) were not. The objective response rates were higher in patients with high VFA than in those with low VFA (39% versus 19%; [P=0.027], respectively). In multivariate analysis, high VSA (hazard ratio: 0.61, 95% confidence interval: 0.40–0.93; [P=0.022]) and better PS (hazard ratio:0.35, 95% confidence interval: 0.19–0.68; [P=0.003]) were identified as an independent predictor of longer PFS in patients treated with nivolumab. ConclusionsIn patients with advanced NSCLC who received nivolumab, high VFA were independent predictors of nivolumab efficacy. Legal entity responsible for the studyKobe City Medical Center General Hospital. FundingHas not received any funding. DisclosureY. Sato: Speaker Bureau / Expert testimony: Ono Pharmaceutical Co., Ltd. D. Fujimoto: Speaker Bureau / Expert testimony: Ono Pharmaceutical Co., Ltd. K. Hosoya: Speaker Bureau / Expert testimony: Ono Pharmaceutical Co., Ltd. All other authors have declared no conflicts of interest.

1012 Impact of Treatment With Direct Anti Viral Agents on Health Related Quality of Life Using Chronic Liver Disease Questionnaire in Chronic Hepatitis C Patients

INTRODUCTION: Health related quality of life (HRQOL) is important for the physical and psychosocial wellbeing of patients with chronic illnesses. The Chronic Liver Disease Questionnaire (CLDQ) is validated to assess HRQOL. We aim to determine the effect on HRQOL and associated predictive factors in patients treated with direct antiviral agent for Hepatitis C. METHODS: Patients receiving sofosbuvir, daclatasvir and ribavirin combination for 12 weeks for Hepatitis C eradication were enrolled. CLDQ consisted of 29 questions assessed on a seven point Likert scale, consisting of 6 domains; Abdomen symptoms, Fatigue, Systemic symptoms, Activity, Emotional function and Worry. Higher score was indicative of minimum symptoms. RESULTS: In 168 patients, majority were females (53 %) with mean age of 45.6 ± 10.8 yrs. Most of study population were uneducated (47 %) and had a low socioeconomic status (60.1%). End of treatment response was achieved in all participants. Mean CLDQ score before and after HCV treatment was 3.8 ± 1.0 and 5.2 ± 1.7, respectively (P = 0.00). Median Child score before and after treatment was 10 and 9, respectively. (P = 0.00) Similarly, MELD score improved from 13 to 10 after treatment. (P = 0.00) Statistical significant improvement in all domain of CLDQ score was also observed after treatment. (P = 0.00) On multiple regression analysis pretreatment systemic and activity score showed statistical significant association with post treatment CLDQ score. CONCLUSION: We report positive impact of HRQOL in hepatitis C patients treated with direct antiviral agents. Pre-treatment Systemic and Activity scores are statistically significant predictors of improvements in HRQOL.