Predictor Of Long-term Survival Research Articles

PBI34 IMPACTS OF LONG-TERM UNCERTAINTY AND FAMILY SPILLOVER EFFECTS ON THE COST-UTILITY OF APPROVED TREATMENTS FOR SMA TYPE I

In April 2019 the Institute for Clinical and Economic Review (ICER) released a report on nusinersen and onasemnogene abeparvovec-xioi (OA-xioi) compared to best supportive care (BSC) in infantile-onset spinal muscular atrophy (SMA I). ICER discussed family spillover effects for these treatments but did not implement them in the economic model. The objective of this analysis was to explore the impact of family spillover and curve fitting strategies for long-term survival prediction on the incremental cost per QALY gained from nusinersen and OA-xioi compared to BSC.

Metastatic colorectal cancer prior to expanded RAS assessment: evidence from long-term outcome analysis of a real-life cohort within a dedicated colorectal cancer unit

BackgroundMolecular assessment and treatment of metastatic colorectal cancer (mCRC) quickly evolved during the last decades, hampering longitudinal evaluation of prognostic markers. The aim of this study was to evaluate prognostic predictors of long-term survival in a retrospective series of mCRC, treated prior to the expanded RAS assessment era.MethodsmCRC cases treated at the Città della Salute e della Scienza University Hospital (Turin, Italy) between January 2004 and December 2012 were evaluated, including cases with ≥ 5-year follow-up only. Long-term survival was defined as an overall survival (OS) ≥ 4 years based on the observed OS interquartile range values. Univariate/multivariate Cox proportional hazards regression models were performed to assess the prognostic significance of the clinical/biological features, while binary logistic regression models were used to verify their associations with long-term survival.ResultsTwo hundred and forty-eight mCRC cases were included and analyzed. Sixty out of two hundred and forty-eight (24%) patients were long-term survivors. Univariate binary logistic regression analysis demonstrated a significant association between long-term survival and age at diagnosis < 65 (OR = 2.28, p = 0.007), single metastatic site (OR = 1.89, p = 0.039), surgical resection of metastases (OR = 5.30, p < 0.001), local non-surgical treatment of metastases (OR = 4.74, p < 0.001), and a bevacizumab-including first-line treatment schedule (OR = 2.19, p = 0.024). Multivariate binary logistic regression analysis confirmed the prognostic significance of surgical resection of metastases (OR = 3.96, p < 0.001), local non-surgical treatment of metastases (OR = 3.32, p = 0.001), and of bevacizumab-including first-line treatment schedule (OR = 2.49, p = 0.024).ConclusionLong-term survival could be achieved in a significant rate of patients with mCRC even in an era of limited molecular characterization. Local treatment of metastases proved to be a significant predictor of long-term survival.

Distant metastases from pathologically proven benign follicular nodules of the thyroid: clinicopathological features and predictors of long-term survival.

Distant metastases are rarely observed in patients with initial pathologically proven benign follicular nodules of the thyroid. This study aimed to evaluate the clinicopathological features and independent variables associated with survival in such patients with distant metastases. In total, 10,992 consecutive differentiated thyroid cancer (DTC) patients treated with 131I after total or near-total thyroidectomy from 2000 to 2018 were retrospectively reviewed. Thirty-nine patients with initial pathologically proven benign follicular nodules of the thyroid were enrolled. Among them, 26 were pathologically diagnosed as thyroid adenoma, 8 as benign nodular goiter, 4 as thyroid adenoma combined with benign nodular goiter, and 1 as normal thyroid tissue. Of 26 patients with the initial pathological slides obtained, eight cases were rediagnosed as minimally invasive thyroid carcinoma (MI-FTC), 10 as follicular tumor of uncertain malignant potential (FT-UMP), and five as well-differentiated tumor of UMP (WDT-UMP). Monitoring of thyroglobulin (Tg) changes after initial thyroidectomy and preablation-stimulated Tg (psTg) level were significantly associated with 5-year OS rate (P = 0.007 and P = 0.005, respectively). The presence of radioactive-refractory DTC (RR-DTC), monitoring of Tg changes after initial thyroidectomy, and psTg level had significant effects on 10-year OS rate (P = 0.002, P < 0.001, and P = 0.005, respectively). Lack of monitoring of Tg changes after initial thyroidectomy and RR-DTC were independent factors associated with poor prognosis (P = 0.003 and P = 0.008, respectively). MI-FTC, FT-UMP, and WDT-UMP tended to be ignored and/or misdiagnosed as benign follicular lesions. Lack of monitoring of Tg changes after initial thyroidectomy and the presence of RR-DTC were identified as independent factors associated with poor survival.

Predictors of long-term survival after surgical mitral valve repair in patients with heart failure.

Predictors of long-term survival after surgical mitral valve repair in patients with heart failure.

Long-Term Survival Outcomes after Coronary Artery Revascularization Surgery of Bangladeshi Population: A Single Centre Study

Background &amp; objective : Coronary artery bypass graft (CABG) surgery has given symptomatic and structural release of coronary atherosclerotic heart disease. CABG has been performed frequently for more than 30 years in Bangladesh. But there are no nationwide studies on the rate of survival in Bangladesh. The present study was undertaken to find the post CABG surgery survival outcomes and association between risk factors and survival over long time span.&#x0D; Methods: We studied 650 consecutive patients’ post-operative clinical data retrospectively and survival outcome data were collected prospectively who had CABG surgery from 2010 to 2015 in Ibrahim Cardiac Hospital &amp; Research Institute. Of the 650 patients, 84(12.9%) died after a median follow up of 4.9 years. Demographic, clinical, operative and postoperative characteristics were then compared between survived and died patients to find the factors associated with survival.&#x0D; Result: Analysis revealed that younger patients were more likely to survive [RR = 1.1(95% CI = 1.0-1.2)] longer than those who have had their CABG at or &gt; 55 years (p = 0.001). Males generally had a higher likelihood of survival [RR = 1.1(RR = 1.1(95% CI = 0.9-1.2)] than their female counterparts (p = 0.038). Non-diabetics tend to have a better survival [RR = 2.3(95% CI = 1.3-3.9)] than diabetics (p = 0.001). Non-smokers also have a higher chance of longer survival [RR = 1.5(95% CI = 0.9-2.2)] than the smokers. CABG patients without CKD enjoyed longer survival [RR = 1.4(95% CI = 0.9-2.2)] than CABG patients with CKD (p = 0.006). None of the operative and postoperative factors but hospital stay was associated with longer survival. The survived patients had a shorter mean hospital stay than the patients who died (p = 0.001). Analyses of the causes of death revealed heart disease to be the predominant cause (38%) followed by stroke (12%), CKD (8%) and other causes like cancer, liver disease etc. (42%).&#x0D; Conclusion: Younger, male, non-smoker, non-diabetic patients may enjoy long-term survival following CABG surgery. Prediction of long-term survival can be used to determine the most appropriate post-discharge care strategies. This would undoubtedly help both patients and doctors to implement behavioral and therapeutic modifications to optimize benefit from surgery.&#x0D; Ibrahim Card Med J 2019; 9 (1&amp;2): 8-15

Geriatric assessment in the prediction of delirium and long-term survival after transcatheter aortic valve implantation

ObjectivesTranscatheter aortic valve implantation (TAVI) has emerged as the preferred management strategy for elderly patients with severe symptomatic aortic valve stenosis. These patients are often at high risk of postoperative delirium (POD), which is associated with morbidity and mortality. Since POD may be prevented in a considerable part of these patients, identification of patients at risk is essential. The aim of current study was to identify geriatric assessment tools associated with delirium after TAVI, and long-term mortality. MethodsConsecutive patients were preoperatively assessed by a geriatrician between 2012 and 2017. Geriatric assessment tools consisted of cognitive, functional, mobility, and nutritional tests. POD was prospectively assessed during hospitalization after TAVI. Mortality tracking was performed by consulting municipal registries. ResultsA total of 511 patients were included. Median age was 80 [76-84] years, 44.8% (n = 229) were male, and 14.1% (n = 72) had a history of POD. Delirium was observed in 66 (12.9%) patients. Impaired mobility was the strongest geriatric assessment tool associated with POD (adjusted odds ratio, 2.1 [1.1-4.2], P = .028) and 2-year mortality (adjusted hazard ratio, 2.5 [1.4-4.5], P = .003). Two-year survival was reduced with more than 10% in patients with impaired mobility before TAVI (79.4% vs 91.4%, P = .013). ConclusionsThis study shows that impaired mobility is currently the best single predictor for POD and 2-year mortality in high-risk patients undergoing TAVI. Prospective multicenter studies are needed to optimize and to further explore the facilitation of routine use of POD predictors in TAVI pathways of care, and subsequent preventive interventions.

Abstract P3-07-09: The preoperative systemic inflammatory response as a strong prognostic factor in breast cancer patients

Abstract Background: Recent reports show that the preoperative systemic inflammatory response status correlate with the survival rate in cancer patients. The Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) score are used as screening tools for immunonutritional status and reported to be a predictor of postoperative recurrence in patients with various gastrointestinal cancers. However, the clinical importance of these scoring in breast cancer has not been fully elucidated. The aim of this study is to investigate the clinical impact of preoperative systemic inflammatory response on long-term survival of breast cancer patients. Patients and Methods: We retrospectively analyzed 653 consecutive stage I-III breast cancer patients who were treated from January 2002 to December 2013. The PNI score was calculated as 10 x serum albumin (g/dl) + 0.005 x total lymphocyte count (per mm3). The CONUT score is calculated from three parameters, serum albumin, cholesterol, and total lymphocytes count. The patients were divided into two groups according to each value. The uni- and multivariate Cox regression analyses were performed to evaluate the prognositic value of the systemic inflammatory response in breast cancer. Results: The malnutritional or high SIR status was observed in 170 (26%),131 (20%), 119 (18%) and 226 (35%) patients as low-PNI, high-CONUT, elevated NLR and PLR, respectively. The relapse-free survival (RFS) and overall survival (OS) rates were significantly lower in the low-PNI group (RFS: p&amp;lt;0.0001, OS: p&amp;lt;0.0001) and high-CONUT group (RFS: p=0.0009, OS: p=0.0018). No significant association was found between NLR, PLR and prognosis. In the multivariate analysis, low-PNI was the independent prognostic factors for OS (HR4.71, p=0.0023). In the subset analysis, the low-PNI group showed poor prognosis especially in the postmenopausal, hormone receptor negative patients. The low-PNI also had poorer prognosis in post-recurrence survival. Conclusions: The preoperative systemic inflammatory response, especially PNI, is a strong independent predictor of long-term survival among breast cancer patients. Citation Format: Nami Yamashita, Sayuri Akiyoshi, Eiki Sano, Tomoko Shigechi, Yuichi Hisamatsu, Eriko Tokunaga, Eiji Oki, Masaki Mori. The preoperative systemic inflammatory response as a strong prognostic factor in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-09.

The Prognostic Impact of Circulating Regulatory T Lymphocytes on Mortality in Patients with Ischemic Heart Failure with Reduced Ejection Fraction.

Background Heart failure with reduced ejection fraction (HFrEF) constitutes a global health issue. While proinflammatory cytokines proved to have a pivotal role in the development and progression of HFrEF, less attention has been paid to the cellular immunity. Regulatory T lymphocytes (Tregs) seem to have an important role in the induction and maintenance of immune homeostasis. Therefore, we aimed to investigate the impact of Tregs on the outcome in HFrEF. Methods We prospectively enrolled 112 patients with HFrEF and performed flow cytometry for cell phenotyping. Individuals were stratified in ischemic (iHFrEF, n = 57) and nonischemic etiology (niHFrEF, n = 57) and nonischemic etiology (niHFrEF, Results Comparing patients with iHFrEF to niHFrEF, we found a significantly lower fraction of Tregs within lymphocytes in the ischemic subgroup (0.42% vs. 0.56%; p = 0.009). After a mean follow-up time of 4.5 years, 32 (28.6%) patients died due to cardiovascular causes. We found that Tregs were significantly associated with cardiovascular survival in the entire study cohort with an adjusted HR per one standard deviation (1-SD) of 0.60 (95% CI: 0.39-0.92; p = 0.009). After a mean follow-up time of 4.5 years, 32 (28.6%) patients died due to cardiovascular causes. We found that Tregs were significantly associated with cardiovascular survival in the entire study cohort with an adjusted HR per one standard deviation (1-SD) of 0.60 (95% CI: 0.39-0.92; p = 0.009). After a mean follow-up time of 4.5 years, 32 (28.6%) patients died due to cardiovascular causes. We found that Tregs were significantly associated with cardiovascular survival in the entire study cohort with an adjusted HR per one standard deviation (1-SD) of 0.60 (95% CI: 0.39-0.92; p = 0.009). After a mean follow-up time of 4.5 years, 32 (28.6%) patients died due to cardiovascular causes. We found that Tregs were significantly associated with cardiovascular survival in the entire study cohort with an adjusted HR per one standard deviation (1-SD) of 0.60 (95% CI: 0.39-0.92; Conclusion Our results indicate a potential influence of Tregs in the pathogenesis and progression of iHFrEF, fostering the implication of cellular immunity in iHFrEF pathophysiology and proving Tregs as a predictor for long-term survival among iHFrEF patients. A preview of this study has been presented at a meeting of the European Society of Cardiology earlier this year.

Prognostic Nomogram for Resected Pancreatic Adenocarcinoma: A TRIPOD-Compliant Retrospective Long-Term Survival Analysis.

Prognostic prediction had been widely used in various cancer entities, from early screening to end-stage patient caring. Currently, there is hardly any well-validated nomogram which exists for long-term survival prediction in pancreatic adenocarcinoma (PC) patients in a post-surgery setting. Our objectives are to identify possible prognostic factors in PC patients following radical resection and to develop a prognostic nomogram based on independent survival predictors. From 2009 to 2014, a total of 432 PC patients who underwent curative intended surgeries with complete follow-up data were included in this current retrospective long-term survival analysis. Clinicopathological data were extracted from medical records, and all missing values (percentage 0.9-8.3%) were imputed five times with the "PMM" method. Cox proportional hazards models were utilized. A nomogram was formulated based on results from the multivariate regression model so as to predict OS at 1-, 2- and 3-year as well as median OS. Validations, including discrimination and calibration, were carried out with 1000 bootstrap resamples. External validation was conducted in order to verify the accuracy of our nomogram at 1 and 2years by utilizing the clinicopathological data of 122 PC patients who underwent curative intended surgeries in 2015 in our centre. Age, abdominal pain, back pain, tumour location, preoperative neutrophil-lymphocyte ratio, preoperative CA19-9, tumour differentiation, microscopic nerve invasion, microscopic vascular invasion, T stage, lymph node ratio, M stage and adjuvant chemotherapy were all assembled into nomogram. The concordance index (C-index) of internal and external validation was 0.702 and 0.688, respectively. The C-index of the TNM staging system was 0.572 (P < 0.001 vs. nomogram). Our prognostic nomogram based on clinicopathological parameters shows good performance in long-term survival prediction in PC patients following radical surgery and could play a role in further clinical utilization.

Leiomyosarcoma of Prostate: A Case Report and Literature Review

Prostate leiomyosarcoma is an extremely rare and very aggressive neoplasm that represents less than 0.1% of primary malignant tumors of the prostate. We present a patient with primary leiomyosarcoma of prostate and examine the cases reported in the literature to discuss the clinical, diagnostic and therapeutic aspects of this rare tumor. Median survival was estimated at 17 months (95% CI 20.7–43.7 months) and the actuarial survival rates at 1, 3 and 5 years were 68%, 34% and 26%, respectively. The only predictors of long-term survival were negative surgical margins and the absence of metastatic disease at presentation. A multidisciplinary approach is necessary for the proper management of this terrible entity.&#x0D; Surgery with or without chemotherapy seems to be the main therapeutic method for operable leimyosarcomas, but in general there is no consensus on the best therapeutic approach. Most cases are diagnosed at an advanced stage of the disease. A global multicenter trial is needed to find therapies that would improve the prognosis.

Value of Sarcopenia defined by the new EWGSOP2 consensus for the prediction of Postoperative Complications and Long-term Survival after Radical Gastrectomy for Gastric Cancer: A comparison with four common nutritional screening tools.

Background: Nutritional risk and sarcopenia are both associated with increased postoperative morbidity and mortality following elective surgery. This study aimed to investigate whether sarcopenia has additional predictive value for postoperative complications and long-term survival besides nutritional screening tools.Methods: Clinical data of patients underwent radical gastrectomy for gastric cancer was prospectively collected. Sarcopenia was diagnosed by grip strength plus muscle quanlity/quality based on preoperative abdominal CT scans. Nutritional screening was performed using 4 common nutritional screening tools, including Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS)-2002, Malnutrition Screening Tool (MST), and Short Nutritional Assessment Questionnaire (SNAQ).Results: A total of 880 patients were analyzed, in which 167 (18.98%) were diagnosed with sarcopenia. The incidence of nutritional risk identified by the 4 tools were 44.66% (MUST ≥1), 35.23% (NRS-2002 ≥3), 29.89% (MST ≥2), and 20.34% (SNAQ ≥2). Multivariate analyses showed that nutritional risk identified by the 4 nutritional screening tools were not independently associated with postoperative complications, overall survival (OS) or disease-free survival (DFS), except for NRS-2002 ≥3 as an independent risk factor of OS. Sarcopenia was always an independent risk factor for postoperative complications, OS, and DFS after adjusting for nutritional risk and the other covariates in the multivariate analyses.Conclusions: MUST, NRS-2002, MST, and SNAQ had low predictive power for postoperative complications and long-term survival in patients underwent radical gastrectomy for gastric cancer. Sarcopenia had additional predictive value for postoperative complications and long-term survival besides these nutritional screening tools and should be implemented in the preoperative assessments.

Impact of One-Year Serum Creatinine on Long-term Renal Graft Survival in a Living-Related Renal Transplant Program.

This study was carried out to determine the impact of one-year posttransplant serum creatinine (SCr) levels on the long-term outcomes of living-related donor kidney transplants. A retrospective cohort study included 773 adult living-related renal transplant recipients from 2010 to 2012, with a minimum follow-up period of five years. Demographics and posttransplantation follow-up data including immunosuppression regimens, rejection episodes, and survival rates were evaluated. Patients were divided into four cohorts (G1, G2, G3, and G4 based on SCr at the end of the 1st year: G1, SCr <88.4 μ mol/L; G2, 88.5≤ SCr ≤ 132.6 μmol/L; G3, 132.7≤ SCr ≤176.8 mol/L; and G4, SCr ≥176.9 μ mol/L). Comparisons between the groups used the Chi-square test for qualitative parameters and analysis of variance for continuous variables. Five-year graft survival for G1 was 98% as compared to 76% in G4 (P <0.001). Recipients of G4 encountered more acute rejection episodes in 21% of the cases as compared to 7.3% in G1 (P = 0.001). Donors were older in G4 (42.07 ± 10.4 years) as compared to G1 (30.1 ± 8.5 years) (P = 0.001). A third of the donors in G1 were HLA identical as compared to 7% in G4. Prediction of long-term graft survival is possible by the SCr level at one year post transplant. This can be of great importance, especially to identify those patients who require close monitoring in follow-up. Donor age, HLA, and acute rejection impact SCr at one year and hence graft outcome.

Metabolic Tumor Volume Change Predicts Long-term Survival and Histological Response to Preoperative Chemotherapy in Locally Advanced Esophageal Cancer.

Here, we assess the ability of metabolic tumor volume (MTV) as measured by F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-FDG PET/CT) to evaluate neoadjuvant chemotherapy response for patients with locally advanced esophageal cancer (EC). Optimal methods to evaluate treatment response for EC patients have not yet been established. Although previous studies have reported the value of standardized uptake value (SUV), the accuracy of predicting histological response or long-term survival in EC is limited. In all, 102 EC patients without distant metastasis who underwent F-FDG PET/CT both before and after the preoperative chemotherapy series were analyzed. The median primary tumor MTV values before and after preoperative chemotherapy were 22.55 (range 0.4-183.1) and 2.75 (0-52.9), respectively, and the median MVT reduction rate was 86.5%. We found the most significant difference in survival between PET responders and nonresponders with a cut-off value of 60% MTV reduction, using a 10% stepwise cut-off analysis [2-year progression-free survival (PFS): 79.2 vs 44.4%; hazard ratio (HR) 3.397; P < 0.0001). With this cut-off value, histological response (P = 0.0091), tumor location (P = 0.0102), pT (P = 0.0011), and pN (P = 0.0110) were significantly associated with PET response. Univariate analysis of PFS indicated a correlation between PFS and tumor size, cT, decrease of primary lesion by CT, SUVmax reduction rate, MTV reduction rate, pT, pN, and pM. Multivariate analysis further identified pM (HR 3.063; P = 0.0279) and MTV reduction rate (HR 2.471; P = 0.0263) to be independent prognostic predictors, but not decrease of primary lesion by CT or SUVmax reduction rate. MTV change is clinically useful in predicting both long-term survival and histological response to preoperative chemotherapy in EC patients, after determining the optimal cut-off value based on survival analysis.

Abstract GMM-057: A FUNCTIONAL HOMOLOGOUS RECOMBINATION ASSAY PREDICTS PRIMARY CHEMOTHERAPY RESPONSE AND LONG-TERM SURVIVAL IN OVARIAN CANCER PATIENTS

Abstract PURPOSE: Homologous recombination deficiency (HRD) correlates with platinum sensitivity in ovarian cancer patients, which clinically is the most useful predictor of sensitivity to PARPi. For this reason, there is clearly a critical need to identify homologous recombination deficiency (HRD) as early as possible. Currently, HRD is mostly diagnosed by genetic testing, which however fails to identify a large proportion of HR-deficient tumors and predict a patient's response to chemotherapy, thus we aimed to develop an ex vivo functional HRD detection test that could predict both platinum-sensitivity and patient eligibility to targeted drug treatments. METHODS: We obtained a functional HR score by quantifying homologous recombination (HR) repair after ionizing radiation-induced DNA damage in primary ovarian cancer samples (n=32). Samples clustered in 3 categories: HR-deficient, HR-low and HR-proficient. We analysed the HR score association with platinum sensitivity and treatment response, platinum-free interval (PFI) and overall survival (OS), and compared it with other clinical parameters. In parallel, we performed whole-genome sequencing and targeted DNA-sequencing of HR genes to assess if functional HRD can be predicted by currently offered genetic screening. RESULTS: Low HR scores predicted primary platinum sensitivity with high statistical significance (p=0.0103), associated with longer PFI (HR-deficient vs HR-proficient: 531 vs 53 days), and significantly correlated with improved OS (HR score &amp;lt;35 vs ≥35, hazard ratio=0.08, p=0.0116). At the genomic level, we identified a few unclear mutations in HR genes and the mutational signature associated with HRD, but, overall, genetic screening failed to predict functional HRD. CONCLUSIONS: We developed an ex vivo assay that detects tumor functional HRD and an HR score able to predict platinum sensitivity, which holds the clinically relevant potential to become the routine companion diagnostic in the management of ovarian cancer patients. Citation Format: Manuela Tumiati, Sakari Hietanen, Johanna Hynninen, Elina Pietilä, Anniina Färkkilä, Amjad Alkodsi, Yilin Li, Rainer Lehtonen, Erdogan Pekcan Erkan, Minna M. Tuominen, Kaisa Lehti, Sampsa K. Hautaniemi, Anna Vähärautio, Seija Grénman, Olli Carpén, and Liisa Kauppi. A FUNCTIONAL HOMOLOGOUS RECOMBINATION ASSAY PREDICTS PRIMARY CHEMOTHERAPY RESPONSE AND LONG-TERM SURVIVAL IN OVARIAN CANCER PATIENTS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr GMM-057.

Abstract DP-004: DESCRIBING THE ODDS OF LONG-TERM SURVIVAL AMONG WOMEN DIAGNOSED WITH HIGH-GRADE SEROUS OVARIAN CANCER USING ELECTRONIC MEDICAL RECORDS

Abstract Relatively little is known about factors associated with long-term survival (LTS) following a diagnosis of ovarian cancer. We conducted a retrospective observational study of high-grade serous ovarian cancer (HGSOC) to explore predictors of LTS, defined as &amp;gt;= 7 years of survivorship, using data from five participating health plans in the Cancer Research Network (CRN, http:\\crn.cancer.gov). Our primary data source was the Virtual Data Warehouse (VDW), a common data model which includes standardized, individual-level data extracted from the electronic data systems of each study site. We included 642 women with incident HGSOC diagnosed between 2000 and 2008 to allow for at least 7 years of follow-up. We conducted a multivariable logistic regression analysis to compare characteristics of women who survived &amp;gt;=7 years after diagnosis (n=148) to those who died within 7 years of diagnosis (n=494). In addition to stage and grade, predictors considered for the model included age, race, smoking status at time of diagnosis, body mass index (BMI) within the year prior to diagnosis, and CA-125 level prior to cancer treatment. We examined estrogen and hormonal contraceptive use, as well as the prevalence of comorbidities in the year prior to diagnosis of ovarian cancer. We also included variables for receipt of surgery, radiation, and chemotherapy. We used forward selection to include variables, and retained them in the final model if they had a p-value of &amp;lt;= 0.3. Our final model included CRN study site, age, stage at diagnosis, CA-125 (categorized as &amp;lt;35 or &amp;gt;=35 units/ml), Charlson comorbidity score, receipt of chemotherapy, BMI, and five separate comorbid conditions: weight loss, hypothyroidism, liver disease, chronic pulmonary disease and hypertension. Of these, only younger age, lower stage, and receipt of chemotherapy were statistically significantly associated with LTS. The OR for LTS was 2.9 (95% CI: 1.2-6.3) for ages 18-49 years at diagnosis compared to &amp;gt;=70 years of age. Those who were diagnosed at stage IV had statistically significantly lower odds of surviving &amp;gt;=7 years than any other stage of disease. The OR for LTS for stage I vs. stage IV was 46.6 (95% CI: 46.7 – 15.9), stage II vs. stage IV was 14.1 (95% CI: 5.3-37.0) and stage III vs. stage IV was 5.3 (95% CI: 2.7-10.4). The OR was 2.9 (95% CI: 1.0-8.4) for receipt of chemotherapy versus no chemotherapy after adjusting for all other covariates. Our analysis of data from electronic medical records did not identify any new characteristics that may be associated with ovarian cancer LTS. Citation Format: Christina L. Clarke, Lawrence H. Kushi, Jessica Chubak, Pamala A. Pawloski, Joanna E. Bulkley, Mara M. Epstein, Andrea N. Burnett-Hartman, Bethan Powell, C. Leigh Pearce, Heather Spencer Feigelson. DESCRIBING THE ODDS OF LONG-TERM SURVIVAL AMONG WOMEN DIAGNOSED WITH HIGH-GRADE SEROUS OVARIAN CANCER USING ELECTRONIC MEDICAL RECORDS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr DP-004.

Nomograms for pre- and postoperative prediction of long-term survival among proximal gastric cancer patients: A large-scale, single-center retrospective study.

BACKGROUNDThe incidence of proximal gastric cancer (GC) is increasing, and methods for the prediction of the long-term survival of proximal GC patients have not been well established.AIMTo develop nomograms for the prediction of long-term survival among proximal GC patients.METHODSBetween January 2007 and June 2013, we prospectively collected and retrospectively analyzed the medical records of 746 patients with proximal GC, who were divided into a training set (n = 560, 75%) and a validation set (n = 186, 25%). A Cox regression analysis was used to identify the preoperative and postoperative risk factors for overall survival (OS).RESULTSAmong the 746 patients examined, the 3- and 5-year OS rates were 66.1% and 58.4%, respectively. In the training set, preoperative T stage (cT), N stage (cN), CA19-9, tumor size, ASA core, and 3- to 6-mo weight loss were incorporated into the preoperative nomogram to predict the OS. In addition to these variables, lymphatic vascular infiltration (LVI), postoperative tumor size, T stage, N stage, blood transfusions, and complications were incorporated into the postoperative nomogram. All calibration curves used to determine the OS probability fit well. In the training set, the preoperative nomogram achieved a C-index of 0.751 [95% confidence interval (CI): 0.732-0.770] in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 86.8%, 73.0%, 43.72%, and 20.9%, P < 0.001). The postoperative nomogram had a C-index of 0.758 in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 82.6%, 74.3%, 45.9%, and 18.9%, P < 0.001).CONCLUSIONThe nomograms accurately predicted the pre- and postoperative long-term survival of proximal GC patients.

PCN20 ACCURATE PREDICTIONS OF LIFE YEAR GAINS FOR IMMUNO-ONCOLOGY THERAPIES IN THE LONG TERM? AN ANALYSIS BASED ON PUBLISHED CHECKMATE 057 NIVOLUMAB DATA

Immuno-oncology (I-O) therapies are associated with complex hazard functions due to delayed treatment effects and long-term survivors. Therefore, using best statistical fit to determine the extrapolation of short-term trial data at the time of an HTA submission may lead to inaccurate predictions of long-term survival. This research aimed to retrospectively analyse the accuracy of different extrapolations performed at early data cuts in predicting realised long-term life years (LYs) based on the CheckMate 057 study of nivolumab (NCT01673867). Over a 51.8-month time horizon (corresponding to the longest available duration of observed Kaplan-Meier [KM] data), cumulative LYs were estimated for standard parametric models and spline models (1–4 knots) fitted to digitised published overall survival data for nivolumab from successive interim data cuts of the CheckMate 057 trial in advanced non-squamous non-small-cell lung cancer (minimum follow-ups of 13.2, 18.0 and 24.2 months). Estimated LYs at each interim data cut were compared to LYs calculated from published long-term KM data observed over 51.8 months to determine which interim models provided the most accurate predictions. Estimates from the spline 1 knot (13.2 months minimum follow-up) and the log-logistic model (18.0 and 24.2 months minimum follow-ups) most accurately predicted the LYs accumulated over 51.8 months from observed KM data. Notably, these contrast with the best statistically fitting models at the interim data cuts. This study provides empirical evidence that the model of best statistical fit for short-term survival data may not provide the most accurate estimates of LYs for I-O therapies over the long-term, which may lead to inaccurate cost-effectiveness estimates of treatments. Further research is required to determine whether there are learnings that are generalisable across I-O therapies and indications to support the use of particular model choices, which allow for long-term survivors, at early data cuts.

P4687Relevance of TAPSE and FAC, and their relationship to PASP as echo-derived measures for RV-PA coupling in heart failure: a comparative analysis with invasive RV-pressure volume loop data

Abstract Background Right ventricular (RV) to pulmonary artery (PA) coupling (C), quantified by pressure volume (PV) loop analysis, predicts RV function, and is independently associated with long term survival in systolic heart failure (HFrEF). However, the PV loop technique is invasive and complex to carry out, especially when used to do RV functional analyses. Different echo-surrogate parameters are proposed to measure RV-PA-C, such as the tricuspid annular plane systolic excursion, TAPSE/PAsystolic pressure (SP) and FAC (fractional area change)/PASP as the most promising parameters. However, up to now, no validation of these non-invasive coupling indices with the invasive gold standard method of RV-PV-loops has been done. Methods In 111 patients with advanced HFrEF (Post-hoc analysis of Magdeburger CRT Responder Trial, DRKS00011133), echo-derived TAPSE and FAC, and their relationship to PASP were related to the RV PV-loop-derived parameters of intrinsic RV contractility (Ees), pulmonary load (Ea), and the RV-PA-C efficiency (Ees/Ea) by linear regression analysis. Within a MRI substudy (n=49 patients) we examined the relationship of pure longitudinal contraction (MRI-TAPSE) and radial free wall to septum contraction (area change of 5 RV segments from tricuspid valve to apex in the short axis view) to the invasive RV-PA-C. Results The MRI analysis demonstrated that radial RV contraction (R2=0.77, p&lt;0.001) correlated better to invasive RV-PA-C than pure longitudinal shortening (R2=0.37, p&lt;0.001) (radial vs. longitudinal: p&lt;0.00). Echo data for the entire patient cohort confirmed the MRI data. The FAC (R2=0.8, p&lt;0.001) was significantly better associated with RV-PA-C than TAPSE (R2=0.57, p&lt;0.001) (TAPSE vs FAC, p&lt;0.001). Placing TAPSE or FAC into a quotient with PASP did not at all (TAPSE vs. TAPSE/PASP, p=0.1) or significantly attenuated (FAC vs. FAC/PASP R2=0.8 vs 0.58, p&lt;0.001) their association to RV-PA-C. However, FAC/PASP and TAPSE/PASP correlated significantly better with global afterload (Eea), PA compliance, and pressure volume area (PVA), (p&lt;0.001). In ROC analysis for all-cause mortality, all 4 tested parameters were prognostic relevant, however, with higher AUC values for FAC/PASP (AUC=0.74, p&lt;0.001) and TAPSE/PASP (AUC=0.74, p&lt;0.001) than for single TAPSE (AUC= 0.71, p=0.001) or FAC (AUC=0.7, p=0.001). Within a multivariate Cox regression analysis, only the FAC/PASP remained an independent predictor for long term survival. Conclusion FAC, an echo parameter that includes a predominant radial with a smaller part of longitudinal contraction, correlated significantly better to the invasively derived RV-PA-C-ratio than pure longitudinal RV shortening (TAPSE). Combining FAC or TAPSE with PASP did not improve the non-invasive RV-PA coupling information. However, it provided more comprehensive information on pulmonary vascular load and RV oxygen consumption, which seems to be translated into a higher prognostic power. Acknowledgement/Funding scientific grant from Boston Scientific

P1956Geriatric nutritional risk index as predictor for long-term survival and cardiovascular or limb events in peripheral arterial disease patients

Abstract Background The geriatric nutritional risk index (GNRI) is a simple tool to assess the nutritional risk and associated with mortality. However, there are no reports focusing GNRI in peripheral artery disease (PAD) patients. Purpose The purpose of this study was to examine the effects of GNRI for long-term survival, cardiovascular and limb events in PAD patients. Methods A prospective cohort study was performed in 1219 PAD patients. Baseline GNRI was calculated from serum albumin level and body-mass-index. The patients were divided into four groups by GNRI level (G1: &gt;98; G2: 92–98; G3: 82–91; G4: &lt;82). The endpoints were overall survival (OS) and freedom from major adverse cardiovascular and limb events (MACE and MACLE). Results The median follow-up was 73 months. There were 626 deaths (51.4%) during follow-up. The rate of cardiovascular death among dead was 51.3%. The OS rates markedly depended on GNRI level (p&lt;0.01). The 5-year OS rates were G1: 80.8%, G2: 62.0%, G3: 40.0%, G4: 23.3%, respectively. In multivariate analyses, GNRI, age, low ankle brachial pressure index (ABI), low estimated glomerular filtration rate (eGFR), and high C-reactive protein (CRP) levels were independent factors associated with OS (&lt;0.05). GNRI, age, low ABI, diabetes mellitus, coronary artery disease, lower eGFR and higher CRP levels were associated with MACE and MACLE (p&lt;0.05, respectively). Besides, statins improved OS, MACE, and MACLE (&lt;0.01, respectively). Conclusions GNRI was an independent predictor for OS, MACE, and MACLE in PAD patients. Furthermore,statins improved OS, MACE and MACLE in patients with PAD.

Improvement of Early Mortality and Long-Term Survival in Patients With Multiple Myeloma Between 1970 and 2015

Multiple myeloma (MM) is the second most frequent hematologic malignant disease. The estimated 5-year overall survival (OS) is around 50%. The prognosis has steadily increased over the last decades. Nevertheless, many studies do not reflect properly the true real-world population. The aims of the study were to analyze the survival improvements and determine the incidence and causes of early mortality (EM) and predictors of long-term survival over the last 45 years in MM patients treated at a single institution.