Prognostic Characteristics Of Patients Research Articles

Long-term prognostic characteristics of patients with clinical stage IA part-solid lung adenocarcinoma: a conditional survival analysis

Abstract OBJECTIVES Despite excellent 5-year survival, there is limited data on the long-term prognostic characteristics of clinical stage IA (cIA) part-solid lung adenocarcinoma (LUAD). The objective was to elucidate the dynamics of prognostic characteristics through conditional survival analysis. METHODS Consecutive patients who underwent complete resection for cIA part-solid LUAD between 2011 and 2015 were retrospectively reviewed. Conditional survival is defined as the probability of surviving further y years, conditional on the patient has already survived x years. The conditional recurrence-free survival (CRFS) and conditional overall survival (COS) were analysed to evaluate prognosis over time, with conditional Cox regression analysis performed to identify time-dependent prognostic factors. RESULTS A total of 1539 patients were included with a median follow-up duration of 98.4 months, and 80 (5.2%) patients experienced recurrence. Among them, 20 (1.3%) recurrence cases occurred after 5 years of follow-up with 100% intrathoracic recurrence. The 5-year CRFS increased from 95.8% to 97.4%, while the 5-year COS maintained stable. Multivariable Cox analysis revealed that histologic subtype was always an independent prognostic factor for CRFS even after 5 years of follow-up, while the independent prognostic value of consolidation-to-tumour ratio, visceral pleural invasion, and lymph node metastasis was observed only within 5 years. Besides, age, pathologic size and lymph node metastasis maintained independent predictive value for COS during long-term follow-up, while consolidation-to-tumour ratio was predictive for COS only within 5 years of follow-up. CONCLUSIONS The independent prognostic factors for cIA part-solid LUAD changed over time, along with gradually increasing 5-year CRFS and stable 5-year COS.

Single-nucleus sequencing unveils heterogeneity in renal cell carcinomas microenvironment: Insights into pathogenic origins and treatment-responsive cellular subgroups

BackgroundDifferent individuals with renal cell carcinoma (RCC) exhibit substantial heterogeneity in histomorphology, genetic alterations in the proteome, immune cell infiltration patterns, and clinical behavior. ObjectivesThis study aims to use single-nucleus sequencing on ten samples (four normal, three clear cell renal cell carcinoma (ccRCC), and three chromophobe renal cell carcinoma (chRCC)) to uncover pathogenic origins and prognostic characteristics in patients with RCC. MethodsBy using two algorithms, inferCNV and k-means, the study explores malignant cells and compares them with the normal group to reveal their origins. Furthermore, we explore the pathogenic factors at the gene level through Summary-data-based Mendelian Randomization and co-localization methods. Based on the relevant malignant markers, a total of 212 machine-learning combinations were compared to develop a prognostic signature with high precision and stability. Finally, the study correlates with clinical data to investigate which cell subtypes may impact patients’ prognosis. Results & conclusionTwo main origin tumor cells were identified: Proximal tubule cell B and Intercalated cell type A, which were highly differentiated in epithelial cells, and three gene loci were determined as potential pathogenic genes. The best malignant signature among the 212 prognostic models demonstrated high predictive power in ccRCC: (AUC: 0.920 (1-year), 0.920 (3-year) and 0.930 (5-year) in the training dataset; 0.756 (1-year), 0.828 (3-year), and 0.832 (5-year) in the testing dataset. In addition, we confirmed that LYVE1+ tissue-resident macrophage and TOX+ CD8 significantly impact the prognosis of ccRCC patients, while monocytes play a crucial role in the prognosis of chRCC patients.

Clinical, biological, prognostic characteristics of patients with immune-mediated thrombotic thrombocytopenic purpura and Sjögren’s disease

ObjectivesThe association between immune-mediated thrombotic thrombocytopenic purpura (iTTP) and Sjögren disease (SjD) has been poorly investigated. This study presents the first retrospective cohort of iTTP-SjD aiming to identify risk factors...

Risk Factors of COVID-19 associated mucormycosis in Iranian patients: a multicenter study

BackgroundTo evaluate the demographic, clinical, and prognostic characteristics of patients diagnosed with COVID-19-associated mucormycosis (CAM) in Iranian patients.MethodsThis prospective observational study was conducted in 8 tertiary referral ophthalmology centers in different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination and underwent standard accepted treatment strategy based on the disease stage.ResultsTwo hundred seventy-four CAM patients (most were males (150, 54.7%)) with a mean age of 56.8 ± 12.44 years were enrolled. Patients with a history of cigarette smoking (Adjusted Odds Ratio (AOR) = 4.36), Intensive Care Unit admission (ICU) (AOR = 16.26), higher stage of CAM (AOR = 2.72), and receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (AOR = 3.30) had higher odds of mortality. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (AOR = 0.16). Generalized Estimating Equations analysis showed that the visual acuity of deceased patients (LogMAR: 3.71, 95% CI: 3.04–4.38) was worse than that of patients who were discharged from the hospital (LogMAR: 2.42, 95% CI: 2.16–2.68) (P < 0.001).ConclusionsThis study highlights significant risk factors for mortality in patients with CAM, such as cigarette smoking, ICU admission, advanced CAM stages, receiving transcutaneous retrobulbar amphotericin B and worser visual acuity. Conversely, a history of systemic corticosteroid use during COVID-19 was linked to reduced mortality. These findings underscore the critical need for early identification and targeted interventions for high-risk CAM patients to improve clinical outcomes.

Diagnostic, therapeutic, and prognostic characteristics of patients with acromegaly according to tumor size at diagnosis.

To evaluate clinical, laboratory, radiological, therapeutic, and prognostic characteristics of patients with acromegaly according to the size of the growth hormone (GH)-secreting pituitary adenoma at diagnosis. Observational, retrospective, single-center study of patients with acromegaly followed at a tertiary center. Data were collected regarding clinical presentation, characteristics of the adenoma in the magnetic resonance imaging, GH and IGF-1 levels, and disease control after surgery or adjuvant treatment (normal IGF-1 levels). Patients were divided according to the adenoma size at diagnosis in: group I < 10mm; II 10-19mm; III 20-29mm; IV 30-39mm; and V ≥ 40mm. Comparisons were made between the groups, and correlations of tumor size with disease parameters, ROC curves, and logistic regression analyses were performed to investigate tumor size and confounding factors that could impact the outcomes. 117 patients were studied [59 women, age at diagnosis 43 ± 13 years; group I = 11 patients (9%); group II 54 (46%); group III 34 (29%); group IV 10 (9%); group V 8 (7%)]. Hypopituitarism, cavernous sinus invasion, GH levels, and use of somatostatin receptor ligands had their prevalence increased according to the adenoma size. Age showed a negative correlation with tumor size. A tumor diameter around 20mm was the best predictor for the presence of hypopituitarism, invasiveness, need of adjuvant therapies, and poorer disease control. Adenomas < 20mm showed lower morbidity and better therapeutic response in acromegaly, while those ≥ 20mm had similar clinical, therapeutic, and prognostic behavior.

Assessment of automated TICI scoring during endovascular treatment in patients with an ischemic stroke

BackgroundThe extended Thrombolysis in Cerebral Infarction (eTICI) score is used in digital subtraction angiography (DSA) to quantify reperfusion grade in patients with an ischemic stroke who undergo endovascular thrombectomy (EVT)....

Right ventricular dysfunction in chronic heart failure: clinical laboratory and echocardiographic characteristics. (the RIVED-CHF registry).

Right ventricular dysfunction (RVD) and pulmonary hypertension have been recognized as two important prognostic features in patients with left side heart failure. Current literature does not distinguish between right heart failure (RHF) and RVD, and the two terms are used indiscriminately to describe pulmonary hypertension and RVD as well as clinical sign of RHF. Therefore, the right ventricle (RV) adaptation across the whole spectrum of left ventricular ejection fraction (LVEF) values has been poorly investigated. This is a multicenter observational prospective study endorsed by the Italian Society of Cardiology aiming to analyze the concordance between the signs and symptoms of RHF and echocardiographic features of RVD. The protocol will assess patients affected by chronic heart failure in stable condition regardless of the LVEF threshold by clinical, laboratory, and detailed echocardiographic study. During the follow-up period, patients will be observed by direct check-up visit and/or virtual visits every 6 months for a mean period of 3 years. All clinical laboratory and echocardiographic data will be recorded in a web platform system accessible for all centers included in the study. The main study goals are: to investigate the concordance and discordance between clinical signs of RHF and RVD measured by ultrasonographic examination; to evaluate prognostic impact (in terms of cardiovascular mortality and heart failure hospitalization) of RVD and RHF during a mean follow-up period of 3 years; to investigate the prevalence of different right ventricular maladaptation (isolated right ventricular dilatation, isolated pulmonary hypertension, combined pattern) and the related prognostic impact. With this protocol, we would investigate the three main RVD patterns according to heart failure types and stages; we would clarify different RVD and pulmonary hypertension severity according to the heart failure types. Additionally, by a serial multiparametric analysis of RV, we would provide a better definition of RVD stage and how much is it related with clinical signs of RHF (ClinicalTrials.gov Identifier: NCT06002321).

Extramedullary infiltration in pediatric acute myeloid leukemia: Results from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) initiative.

The outcome of extramedullary infiltration (EMI) in pediatric acute myeloid leukemia (AML) is controversial, and little is known about the implications of stem cell transplantation (SCT) and gemtuzumab ozogamicin (GO) treatment on patients with EMI. We retrieved the clinical data of 713 pediatric patients with AML from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) dataset, and analyzed the clinical and prognostic characteristics of patients with EMI at diagnosis and relapse. A total of 123 patients were identified to have EMI at diagnosis and 64 presented with EMI at relapse. The presence of EMI was associated with age ≤2years, M5 morphology, abnormal karyotype, and KMT2A rearrangements. Hyperleukocytosis and complex karyotype were more prevalent in patients with EMI at relapse. Additionally, patients with EMI at diagnosis had a reduced incidence of FLT3 ITD-/NPM1+, whereas those with EMI at relapse displayed a lower frequency of FLT3 ITD+. Patients with EMI at diagnosis exhibited a lower complete remission (CR) rate at the end of Induction Course 1 and higher relapse incidence. Importantly, EMI at diagnosis independently predicted both shorter event-free survival (EFS) and overall survival (OS). Regarding relapse patients, the occurrence of EMI at relapse showed no impact on OS. However, relapse patients with myeloid sarcoma (MS)/no central nervous system (CNS) exhibited poorer OS compared to those with CNS/no MS. Furthermore, regarding patients with EMI at diagnosis, SCT failed to improve the survival, whereas GO treatment potentially enhanced OS. EMI at diagnosis is an independent adverse prognostic risk factor for pediatric AML, and GO treatment potentially improves survival for patients with EMI at diagnosis.

249P Analysis of clinical and prognostic characteristics of patients with lung cancer and solid organ transplantation

249P Analysis of clinical and prognostic characteristics of patients with lung cancer and solid organ transplantation

Clinicopathological features, psychological status, and prognosis of 33 patients with occult breast cancer.

Occult breast cancer (OBC) has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer. Due to the small number of cases and limited clinical ex-perience, treatments vary greatly around the world and no standardized treat-ment has yet been established. To investigate the clinicopathological features, psychological status and prog-nostic features of patients with OBC. The clinicopathological data of 33 OBC patients diagnosed and treated in the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from November 2015 to November 2022 were retrospectively analyzed. The psychological status of OBC patients was evaluated by the Self-rating Anxiety Scale and Self-rating Depression Scale. Patients' emotions, stress perception and psychological resilience were evaluated by the Positive and Negative Affect Schedule, the Chinese Perceived Stress Scale, and the Connor-Davidson Resilience Scale (CD-RISC), respectively. Patient survival was calculated using the Kaplan-Meier method, and survival curves were plotted for analysis with the log-rank test. Univariate and multivariate survival analyses were performed using the Cox regression model. The 33 OBC patients included 32 females and 1 male. Of the 33 patients, 30 (91%) had axillary tumors, 3 (9%) had a neck mass as the primary symptom; 18 (54.5%) had estrogen receptor-positive tumors, 17 (51.5%) had progesterone receptor-positive tumors, and 18 (54.5%) had Her-2-positive tumors; 24 (72.7%) received surgical treatment, including 18 patients who underwent modified radical mastectomy, 1 patient who underwent breast-conserving surgery plus axillary lymph node dissection (ALND), and 5 patients who underwent ALND alone; 12 patients received preoperative neoadjuvant therapy. All 30 patients developed anxiety and depression, with low positive affect scores and high negative affect scores, accompanied by a high stress level and poor psychological resilience. There were no differences in the psychological status of patients according to age, body mass index, or menopausal status. The overall survival and disease-free survival (DFS) of all the patients were 83.3% and 55.7%, respectively. Univariate analysis demonstrated that the initial tumor site (P = 0.021) and node stage (P = 0.020) were factors that may affect patient prognosis. The 5-year DFS rate of OBC patients who received radiotherapy was greater (P < 0.001), while the use of different surgical methods (P = 0.687) had no statistically significant effect on patient outcomes. Multivariate analysis revealed that radiotherapy (P = 0.031) was an independent prognostic factor. Receiving radiotherapy had a significant effect on the CD-RISC score (P = 0.02). OBC is a rare breast disease whose diagnosis and treatment are currently controversial. There was no significant difference in the efficacy of other less invasive surgical procedures compared to those of modified radical mastectomy. In addition, radiotherapy can significantly improve patient outcomes. We should pay attention to the psychological state of patients while they receive antitumor therapy.

Real-world effectiveness of aromatase inhibitors and fulvestrant in HR+/HER2- advanced breast cancer: a snapshot of the last two years before conventional use of CDK 4/6 inhibitors in a Portuguese institution.

Monotherapy with aromatase inhibitors and fulvestrant were the standard-of-care for hormone receptor-positive (HR+)/human epidermal growth factor receptor-type2 negative (HER2-) advanced breast cancer, before integration of cyclin-dependent kinase 4/6 inhibitors. Effectiveness data is essential for regulatory action, but little is known about real-world use of aromatase inhibitors and fulvestrant. A retrospective cohort study was conducted resorting to data from a cancer registry to identify adult women with HR+/HER- advanced breast cancer exposed to aromatase inhibitors or fulvestrant (31 May 2017-31 March 2019) at the main oncology hospital in Portugal. Cases were updated with follow-up until death or cut-off (31 March 2021) and pseudoanonymized data extracted. Primary outcome was overall survival (OS) and secondary time to treatment failure (TTF), estimated using survival analysis and compared with published trials. 192 patients were distributed by subgroups according to the medicine. Letrozole: OS 30.8 (95% confidence interval (CI) 20.6-41.4); TTF 11.2 (95%CI 8.7-13.7). Exemestane: OS 22.1 (95%CI 9.7-34.6); TTF 6.0 (95%CI 4.1-7.8). Fulvestrant: OS 21.6 (95%CI 16.5-26.7); TTF 5.6 (95%CI 4.5-6.6). Estimated effectiveness (OS) of letrozole and fulvestrant was, respectively, 3.2-3.5 months lower than reported. The clinical meaning seems uncertain and may be explained a higher proportion of worse prognostic characteristics in patients treated in the real-world.

The prognostic value of echocardiographic right ventricular global longitudinal strain in heart failure: A systematic review and meta-analysis

Abstract Background Right ventricular (RV) dysfunction is a well-recognized adverse prognostic feature in patients with heart failure (HF). However, accurate RV functional assessment remains challenging in clinical practice. Recently, many studies have demonstrated that RV global longitudinal strain (RV GLS) assessed using speckle tracking echocardiography might be a powerful prognosticator in HF. Aim To systematically appraise and quantitatively synthesize the prognostic evidence of RV GLS derived by echocardiography, across the entire spectrum of left ventricular ejection function (LVEF) in HF. Methods A systemic literature review was conducted in MEDLINE, Scopus and Cochrane databases to identify every study reporting the predictive role of RV GLS in HF subjects irrespective of LVEF. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios [(a)HRs] for all-cause-mortality and the composite outcome of all-cause mortality or any HF-related hospitalization per each unit of increase in RV GLS. Subgroup analysis was feasible for patients with LVEF&amp;lt;45%. Results Thirteen studies were deemed eligible for inclusion in the systematic review. Of them, 8 provided appropriate quantitative data for the meta-analysis, encompassing a total of 3,736 patients. When adjusted for pre-specified clinically-relevant parameters, it was shown that each unit of increase in RV GLS conferred increased risk of all-cause mortality (pooled aHR=1.08 [1.03-1.13]; p&amp;lt;0.01; I²=76%) and the composite outcome (pooled aHR= 1.10 [1.06-1.15]; p&amp;lt;0.01; I²=0%) for patients with HF (Abstract Picture 1 and 2). Subgroup analysis for HF patients with LVEF&amp;lt;45% yielded similar results, with each increase of 1% in RV GLS being independently associated with increased risk of all-cause mortality (pooled aHR=1.10 [1.06-1.13]; p&amp;lt;0.01; I²=0) and the composite end-point (pooled aHR= 1.13 [1.07-1.20]; p&amp;lt;0.01; I²=0%) (Abstract Picture 1 and 2). Conclusion RV GLS assessed by speckle-tracking echocardiography is a novel echocardiographic biomarker that can further add in patient prognostication across a wide range of HF populations regardless of LVEF.RV GLS and all-cause mortalityRV GLS and the composite outcome

Phenotype and outcome correlates of high dose loop diuretics in type 1 pulmonary hypertension

Abstract Background Use of higher dose of loop diuretics has been associated with worse survival in acute and chronic heart failure. The use of loop diuretics in type 1 pulmonary hypertension (PAH) is generally less frequent compared to heart failure and required doses may be lower. the clinical and prognostic characteristics of patients requiring high dose of loop diuretics in PAH remain unexplored. Purpose We studied the characteristics of patients requiring different doses of loop diuretic and their association with survival in PAH. Methods Patients with a diagnosis of PAH according to 2015 European guidelines criteria enrolled from 2001 and 2021 at seven European centers for the management of PAH and with available information on loop diuretic use were retrospectively included in the study. High dose diuretic use was defined according to the median dose of furosemide in the overall cohort and patients were then divided into two subgroups: no/low dose and high dose diuretic use. Primary outcome was 5-year survival. Predictors of high dose diuretic use were assessed by multivariable logistic regression analysis. Multivariable Cox regression analysis was performed to test the association between high dose diuretic use and 5-year survival. Results Among the 402 patients included (median age 61 years, IQR 49-74; 67% females), 231 (57%) were treated with loop diuretics. Median furosemide dose was 25 mg (IQR 0-40 mg) and accordingly patients were divided in no/low dose (n. 260, 65%, median dose 0 mg, IQR 0-20) vs high dose (n. 142, 35%, median dose 40, 50-100) diuretic ones. Patients in the high dose group were older, had more comorbidities, including impaired renal function (Figure 1) and the characteristics of a more severe disease (41% vs 27% at intermediate-high risk and 42% vs 22% at high risk based on COMPERA 2.0 classification, p&amp;lt;0.001). Predictors of high dose loop diuretic use were obesity (OR 2.04, 95%CI 1.06-3.91, p=0.032), COMPERA 2.0 risk class (OR 1.66, 95%CI 1.19-2.31, p=0.003) and right atrial pressure risk class (OR 2.23, 95%CI 1.42-3.51, p=0.001). Rates of monotherapy, dual and triple combination therapy were similar in patients at no/low vs high dose. Crude 5-year survival was significantly lower in patients in the high dose group (log-rank p=0.002). However, after adjustment for age, sex and main risk factors (i.e. COMPERA 2.0 score, TAPSE/PASP, right atrial pressure and cardiac index), high loop diuretic dose was not significantly associated with higher 5-year mortality risk. Conclusions Use of high dose of loop diuretics in PAH characterizes patients with higher burden of comorbidities, more severe disease and worse survival. However, in PAH the need of high loop diuretic dose represents a marker of disease severity rather than an independent prognostic factor.Figure 1Figure 2.

Clinical characteristics and prognosis of pneumonia-related bloodstream infections in the intensive care unit: a single-center retrospective study.

Bloodstream infections (BSI) are one of the most severe healthcare-associated infections in intensive care units (ICU). However, there are few studies on pneumonia-related BSI (PRBSI) in the ICU. This study aimed to investigate the clinical and prognostic characteristics of patients with PRBSI in the ICU and to provide a clinical basis for early clinical identification. We retrospectively collected data from patients with bacterial BSI in a single-center ICU between January 1, 2017, and August 31, 2020. Clinical diagnosis combined with whole-genome sequencing (WGS) was used to clarify the diagnosis of PRBSI, and patients with PRBSI and non-PRBSI were analyzed for clinical features, prognosis, imaging presentation, and distribution of pathogenic microorganisms. Of the 2,240 patients admitted to the MICU, 120 with bacterial BSI were included in this study. Thirty-two (26.7%) patients were identified as having PRBSI based on the clinical diagnosis combined with WGS. Compared to patients without PRBSI, those with PRBSI had higher 28-day mortality (81.3 vs.51.1%, p = 0.003), a higher total mortality rate (93.8 vs. 64.8%, p = 0.002), longer duration of invasive mechanical ventilation (median 16 vs. 6 days, p = 0.037), and prolonged duration of ICU stay (median 21 vs. 10 days, p = 0.004). There were no differences in other baseline data between the two groups, but patients with PRBSI had extensive consolidation on chest radiographs and significantly higher Radiographic Assessment of Lung Edema scores (mean 35 vs. 24, p < 0.001). The most common causative organisms isolated in the PRBSI group were gram-negative bacteria (n = 31, 96.9%), with carbapenem-resistant gram-negative bacteria accounting for 68.8% (n = 22) and multidrug-resistant bacteria accounting for 81.3% (n = 26). Pneumonia-related BSI is an important component of ICU-BSI and has a poor prognosis. Compared to non-PRBSI, patients with PRBSI do not have typical clinical features but have more severe lung consolidation lesions, and should be alerted to the possibility of their occurrence when combined with pulmonary gram-negative bacterial infections, especially carbapenem-resistant bacteria. Further multicenter, large-sample studies are needed to identify the risk factors for the development of PRBSI and prevention and treatment strategies.

The clinical-histological and prognostic characteristics in patients with second primary non-small cell lung cancer after lobectomy.

This study aimed to investigate whether operation can bring survival benefits to patients with second primary non-small cell lung cancer (NSCLC) after lobectomy for first primary NSCLC and analyze the characteristics affecting the survival of those patients. We performed survival analysis of patients with the second primary NSCLC based on the Surveillance, Epidemiology, and End Results program and used propensity-score matching (PSM) method to reduce the potential bias and analyze the data. Besides, the primary observational endpoint was overall survival (OS), and the secondary observational endpoint was histology migration. The data from 944 patients was used to perform the main analysis. 36.2% of patients experienced a shift in tumor histological type between two diagnoses of primary NSCLC, and this shift significantly effected on OS (p = 0.0065). The median survival time in patients with surgical resection and those without operation was 52.0 months vs. 33.0 months, respectively. Patients with surgical resection at secondary diagnosis had better survival than cases without surgery (5-year OS rate: 48.0% vs. 34.0%, p < 0.001). Besides, compared with pneumonectomy and sublobar resection, lobectomy was the optimal surgical procedure for patients diagnosed with second primary NSCLC after adjusting for other confounders (adjusted hazard ratio: 0.68, p < 0.01). However, in the subgroup analysis, lobar and sublobar resection could provide similar survival benefits for patients with tumor size ≤20mm (p = 0.5). The surgery, especially lobectomy, can prolong OS in patients with the second primary NSCLC. Besides, sublobar resection can be performed in selected patients with tumor size ≤20mm. Moreover, histology migration may impact the survival of those patients with a secondary primary NSCLC.

The metastasis patterns and their prognostic features in patients with de novo metastatic breast cancer of different ages.

The prognostic outcomes of metastasis patterns in patients with de novo metastatic breast cancer (dnMBC) of different ages are unknown. Our study used a large-scale data to investigate the metastasis patterns and prognostic features in dnMBC of different ages. Total 24,698 women with dnMBC in the Surveillance, Epidemiology and End Results database (2010-2018) were divided into three groups by age. Chi-squared test was used to compare metastasis patterns and logistic regression was performed to investigate the risk of age and specific organ metastases. Kaplan-Meier survival curves were used to compare the overall survival. In three groups, young group had the largest proportion of liver metastases (35.2% vs. 28.2% vs. 21.1%, p < 0.001), and elderly group had the largest proportion of lung metastases (22.6% vs. 30.0% vs. 35.0%, p < 0.001) and the lowest proportion of bone metastases (65.7% vs. 67.6% vs. 64.4%, p < 0.001). In young group, patients with liver metastases had better prognosis than patients with lung metastases (MST: 34 months vs. 29 months, p = 0.041), but in middle-aged and elderly groups, the prognosis of lung metastases was better than that of liver metastases (MST in middle-aged group: 24 months vs. 20 months, p = 0.002; MST in elderly group: 12 months vs. 6 months, p < 0.001). DnMBC patients at different age have distinct metastasis patterns and prognostic features. The findings lend support to consideration of tailored management and surveillance strategies for different age patients.

Long-term survival in patients with brain metastases-clinical characterization of arare scenario.

This study aimed to assess clinical, treatment, and prognostic features in patients with brain metastases (BM) from solid tumors achieving long-term survival (LTS). Further, the accuracy of diagnosis-specific Graded Prognostic Assessment scores (ds-GPA) to predict LTS was evaluated. Patients admitted for radiotherapy of BM between 2010 and 2020 at alarge tertiary cancer center with survival of at least 3years from diagnosis of BM were included. Patient, tumor, treatment characteristics and ds-GPA were compiled retrospectively. From atotal of 1248patients with BM, 61 (4.9%) survived ≥ 3years. In 40patients, detailed patient charts were available. Among LTS patients, median survival time from diagnosis of BM was 51.5months. Most frequent primary tumors were lung cancer (45%), melanoma (20%), and breast cancer (17.5%). At the time of diagnosis of BM, 11/40patients (27.5%) had oligometastatic disease. Estimated mean survival time based on ds-GPA was 19.7months (in 8cases estimated survival < 12months). Resection followed by focal or whole-brain radiotherapy (WBRT) was often applied (60%), followed by primary stereotactic radiotherapy (SRT) (20%) or WBRT (20%). 80% of patients received systemic treatment, appearing particularly active in specifically altered non-small lung cancer (NSCLC), melanoma, and HER2-positive breast cancer. Karnofsky performance score (KPS) and the presence of oligometastatic disease at BM diagnosis were persisting prognostic factors in LTS patients. In this monocentric setting reflecting daily pattern of care, LTS with BM is heterogeneous and difficult to predict. Effective local treatment and modern systemic therapies often appear crucial for LTS. The impact of concomitant diseases and frailty is not clear.

Uveitis in with Juvenile Idiopathic Arthritis

Uveitis is a serious complication of Juvenile Idiopathic Arthritis (JIA) that can lead to significant visual impairment or even blindness. It is the most common cause of uveitis in children and differs from uveitis associated with spondyloarthropathies by the paucity of its functional signs, resulting in diagnostic and therapeutic delays and affecting visual prognosis. The aim of our study was to identify the epidemiological, diagnostic and prognostic features of patients with uveitis associated with Juvenile Idiopathic Arthritis (JIA), as well as to discuss the complications and best therapeutic alternatives and prognostic data on these cases, shedding light on the challenges of managing this complex condition.

Right ventricular global longitudinal strain and short-term prognosis in patients with first acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular (RV) dysfunction is recognized as an adverse prognostic feature in patients with Acute Coronary Syndromes (ACS). However, conventional echocardiographic indices for the evaluation of RV function have considerable limitations. Right Ventricular Global Longitudinal Strain (RV GLS) is a novel speckle-tracking echocardiographic index that assesses the overall intramyocardial function of the RV free wall and interventricular septum. Purpose The present study aimed to investigate the short-term prognostic value of RV GLS in patients with first ACS. Methods A total of 300 consecutive patients with first ACS (mean age 61.2±11.8 years, 74% males) were prospectively studied. A comprehensive transthoracic echocardiographic assessment was undertaken within 24 hours after revascularization and in-hospital mortality was assessed. Multiple multivariable Cox Regression analysis models were constructed to compare the predictive value of RV function indices for in-hospital mortality. Only significant variables (P&amp;lt;0.05) in the univariate analysis were included in the models. Due to the limited number of events, all multivariable models were constructed including a maximum of 3 variables. To further assess the prognostic value of RV GLS over a baseline model the change in χ2 was assessed using the likelihood ratio test. The absolute value of strain parameters was used for all analysis. Results Patients with anterior-STEMI had significantly more impaired RV GLS (anterior-STEMI 14.52±5.23 vs. inferior-STEMI 17.41±5.06 vs. lateral-STEMI 19.50±4.17 vs. Non-STEMI 20.61±3.69%, P&amp;lt;0.001). A total of 23 (7.7%) patients died in-hospital after revascularization. In univariate analysis RV GLS was significantly associated with in-hospital mortality (HR=0.717, 95% CI=0.642–0.801, P&amp;lt;0.001). After adjustment for Global Registry of Acute Coronary Event (GRACE) risk score and Left Ventricular Ejection Fraction (LVEF), RV function indices that retained independent association with in-hospital mortality were RV GLS, Fractional Area Change, and Tricuspid Annular Plane Systolic Excursion (Table). The model that included RV GLS demonstrated the highest overall χ2 value (Table). To prove the incremental value of RV GLS on in-hospital mortality prognosis, a baseline model including the GRACE risk score was created, and then LVEF was added. The further addition of RV GLS significantly increased the prognostic value the model (Figure). Conclusions RV GLS measured by transthoracic echocardiography within 24 hours after revascularization in patients with first ACS showed the strongest association with in-hospital mortality outperforming other RV function indices. RV GLS provides additine prognostic information over GRACE risk score and LVEF to predict in-hospital mortality.

Treatment Outcome of Early-stage Laryngeal Carcinoma Treated with Radical Radiotherapy Using Different Techniques: A Retrospective Study

Aim: The aim was to evaluate the treatment outcomes and prognostic characteristics of patients with early-stage glottic laryngeal carcinoma who underwent radical radiotherapy (RT) with different techniques.Materials and Methods: Radiotherapy was applied using the 2D conventional technique, 3DCRT (three dimensional conformal radiotherapy and IMRT (intensity modulated radiation therapy). Clinical T stages were 12 (48%) for T1a, 5 (20%) for T1b and 8 (32%) for T2. Stage and anterior commissure involvement were analyzed as prognostic factors. Results: There were 12 (48%) patients with T1a, 5 (20%) patients with T1b and 8 (32%) patients with T2 cancer. 5 years of overall survival and diseases free survival for T1a, T1b, T2 were found to be 91%, 80%, 62% and 91%, 80%, 62% respectively. 5 year survival for patients without and with involvement of anterior commissure was 92% and 67% respectively. Hence, showing poor survival in patients with T2 lesion or T1 lesion with involvement of anterior commissure. Conclusion: In early-stage laryngeal carcinomas, radical RT is a function sparing and effective treatment modality with excellent survival rates, regardless of treatment techniques.