Prognostic Estimates Research Articles

Real-world analysis of the correlation between overall survival and progression-free survival in advanced pancreatic cancer: Results of NAPOLEON-1 and 2 studies.

Fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) improve overall survival (OS) and progression-free survival (PFS) in patients with pancreatic cancer, compared with gemcitabine (GEM). However, whether PFS is a surrogate marker of OS in pancreatic cancer chemotherapy focusing on FOLFIRINOX or GEM plus nab-paclitaxel remains unknown. We aimed to verify whether PFS can be a surrogate marker of OS in prognosis prediction. This was an integrated analysis of the NAPOLEON study and retrospective cohort of the NAPOLEON-2 study-a multicenter observational study conducted in Japan, using real-world data. The primary and secondary endpoints were OS and PFS, respectively. The correlation between OS and PFS in first- and second-line treatments was assessed using Method of Moments estimation. An analysis was performed in patients with confirmed OS at the end of follow-up. The NAPOLEON-2 cohort included only patients who received 5-fluorouracil, leucovorin, and nanoliposomal irinotecan (NFF) as second-line treatment. Among 479 patients, the correlation between PFS and OS from first- and second-line chemotherapies was calculated in 310 and 225 patients, respectively. The R-squared values for the correlation between PFS and OS from first- and second-line chemotherapies were 0.74 and 0.76, respectively. There was no statistically significant difference in first-line treatment between the FOLFIRINOX and gemcitabine plus nab-paclitaxel groups (P=0.92). Therefore, the FOLFIRINOX group may not have shown a stronger correlation than the NFF group. PFS can be a surrogate marker of OS in first- and second-line therapies. Appropriate prognostic estimation might contribute to proper treatment selection.

Consensus palliative care referral criteria for people with chronic obstructive pulmonary disease

ObjectivePeople with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral.We conducted a Delphi study of...

The impact of a web-based prognostic calculator on prognostic confidence in outpatient palliative care.

Clinicians are often uncertain about their prognostic estimates, which may impede prognostic communication and clinical decision-making. We assessed the impact of a web-based prognostic calculator on physicians' prognostic confidence. In this prospective study, palliative care physicians estimated the prognosis of patients with advanced cancer in an outpatient clinic using the temporal, surprise, and probabilistic approaches for 6m, 3m, 2m, 1m, 2 w, 1 w, and 3 d. They then reviewed information from www.predictsurvival.com , which calculated survival estimates from seven validated prognostic scores,including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance Status, and again provided their prognostic estimates after calculator use. The primary outcome was prognostic confidence in temporal CPS (0-10 numeric rating scale, 0 = not confident, 10 = most confident). Twenty palliative care physicians estimated prognoses for 217 patients. The mean (standard deviation) prognostic confidence significantly increased from 5.59 (1.68) before to 6.94 (1.39) after calculator use (p < 0.001). A significantly greater proportion of physicians reported feeling confident enough in their prognosis to share it with patients (44% vs. 74%, p < 0.001) and formulate care recommendations (80% vs. 94%, p < 0.001) after calculator use. Prognostic accuracy did not differ significantly before or after calculator use, ranging from 55-100%, 29-98%, and 48-100% for the temporal, surprise, and probabilistic approaches, respectively. This web-based prognostic calculator was associated with increased prognostic confidence and willingness to discuss prognosis. Further research is needed to examine how prognostic tools may augment prognostic discussions and clinical decision-making.

Predicting the development of optic nerve atrophy in children with cerebral palsy

Introduction. Optic nerve atrophy (ONA) holds a leading position in the nosological structure of ophthalmopathology. In children with cerebral palsy (CP), the presence of concomitant pathology such as ONA significantly worsens their health and quality of life. The combination of ONA and CP, as well as the interrelationship of these diseases, represents a relevant subject for research, particulary in studying the clinical and epidemiological features of ONA in children with CP to find optimal clinical solutions and prognostic approaches. Purpose: to investigate the prevalence of optic nerve atrophy in children with cerebral palsy to determine the prognosis for the development of this pathology in the study group. Materials and methods. A retrospective analysis of medical records of 640 patients diagnosed with cerebral palsy who were hospitalized in the clinic from 2015 to 2020 was conducted. The analysis included data from children with early-onset cerebral palsy (up to 3 years old) who were hospitalized for the first time. MS EXCEL software was used to calculate the main indicators of linear regression. Results. The study revealed that optic nerve atrophy in young children develops more frequently in boys (1.5 times more often than in girls), in rural areas, and in those with spastic cerebral palsy (36.3 %). The second most common form was ataxic cerebral palsy (69 children, 21.6 %), followed by infantile hemiplegia (61 children, 19%). Based on the dynamics of the prevalence of optic nerve atrophy in children with cerebral palsy, a mid-term forecast was made using the main indicators of linear regression. The prevalence of optic nerve atrophy in children with cerebral palsy is increasing, with prognostic estimates indicating further growth (14.9% in 2015, 15.4% in 2020, and 16.2% in 2024). Conclusion. The results of the study showed that cerebral palsy in children is often associated with optic nerve atrophy. ONA in young children is more frequently developed in cases of spastic cerebral palsy. As a result of calculating, an increase in the prevalence of optic nerve atrophy in children with cerebral palsy was observed over time, based on the correlation calculated using Spearman’s non-parametric correlation analysis Prognostic estimates indicate a significant increase in the near future.

Physical and numerical simulation of heat and mass transfer in the furnace of a thermogravimetric analyzer

A numerical study of the processes of heat and mass transfer in the furnace of a thermogravimetric analyzer was carried out, aimed at improving the accuracy of determining the kinetic characteristics of samples during their thermal transformations in different media. Validation of the model and prognostic estimates were carried out in relation to specially conducted thermogravimetric studies of the conversion of fossil and renewable carbon-containing raw materials in successive processes of decarbonization (combustion) and carbonation (mineralization of ash residue). The application of the study results allows to calculate the actual concentrations of the reagent over the sample uncontrolled by the device during pulsed switching of media and the actual temperatures of the sample during its thermochemical transformations.

Criteria and prognostic models for patients with hepatocellular carcinoma undergoing liver transplantation.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated death globally. Liver transplantation (LT) has emerged as a key treatment for patients with HCC, and the Milan criteria have been adopted as the cornerstone of the selection policy. To allow more patients to benefit from LT, a number of expanded criteria have been proposed, many of which use radiologic morphological characteristics with larger and more tumors as surrogates to predict outcomes. Other groups developed indices incorporating biological variables and dynamic markers of response to locoregional treatment. These expanded selection criteria achieved satisfactory results with limited liver supplies. In addition, a number of prognostic models have been developed using clinicopathological characteristics, imaging radiomics features, genetic data, and advanced techniques such as artificial intelligence. These models could improve prognostic estimation, establish surveillance strategies, and bolster long-term outcomes in patients with HCC. In this study, we reviewed the latest findings and achievements regarding the selection criteria and post-transplant prognostic models for LT in patients with HCC.

Prognostic role of late gadolinium-enhanced MRI in confirmed and suspected cardiac sarcoidosis: meta-analysis.

The prognostic implications of late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) in the context of cardiac sarcoidosis (CS) have attracted considerable attention. Nevertheless, a subset of studies has undistinguished confirmed and suspected CS cases, thereby engendering interpretative ambiguities. In this meta-analysis, we evaluated the differences in cardiac MRI findings and their prognostic utility between confirmed and suspected CS. A literature search was conducted using PubMed, Web of Science, and Cochrane libraries to compare the findings of cardiac MRI and its prognostic value in CS and suspected CS. A meta-analysis was performed to compare the prevalence of LGE MRI, odds ratios, and hazard ratios for predicting cardiac events in both groups. A total of 21 studies encompassing 24 different populations were included in the meta-analysis (CS: 393 cases, suspected CS: 2151 cases). CS had a higher frequency of LGE of the left ventricle (87.2% vs. 36.4%, p < 0.0001) and right ventricle (62.1% vs. 23.8%, p = 0.04) than suspected CS. In patients with suspected CS, the presence of left ventricular LGE was associated with higher all-cause mortality [odds ratio: 5.70 (95%CI: 2.51-12.93), p < 0.0001, I2 = 8%, p for heterogeneity = 0.37] and ventricular arrhythmia [odds ratio: 15.51 (95%CI: 5.65-42.55), p < 0.0001, I2 = 0, p for heterogeneity = 0.94]. In contrast, in CS, not the presence but extent of left ventricular LGE was a significant predictor of outcome (hazard ratio = 1.83 per 10% increase of %LGE (95%CI: 1.43-2.34, p < 0.001, I2 = 15, p for heterogeneity = 0.31). The presence of left ventricular LGE was a strong prognostic factor in suspected sarcoidosis. However, the extremely high prevalence of left ventricular LGE in confirmed CS suggests that the quantitative assessment of LGE is useful for prognostic estimation.

Prognoses Associated With Palliative Performance Scale Scores in Modern Palliative Care Practice

The Palliative Performance Scale (PPS) is one of the most widely used prognostic tools for patients with serious illness. However, current prognostic estimates associated with PPS scores are based on data that are over a decade old. To generate updated prognostic estimates by PPS score, care setting, and illness category, and examine how well PPS predicts short- and longer-term survival. This prognostic study was conducted at a large academic medical center with robust inpatient and outpatient palliative care practices using electronic health record data linked with data from California Vital Records. Eligible participants included patients who received a palliative care consultation between January 1, 2018, and December 31, 2020. Data analysis was conducted from November 2022 to February 2024. Palliative care consultation with a PPS score documented. The primary outcomes were predicted 1-, 6-, and 12-month mortality and median survival of patients by PPS score in the inpatient and outpatient settings, and performance of the PPS across a range of survival times. In subgroup analyses, mortality risk by PPS score was estimated in patients with cancer vs noncancer illnesses and those seen in-person vs by video telemedicine in the outpatient setting. Overall, 4779 patients (mean [SD] age, 63.5 [14.8] years; 2437 female [51.0%] and 2342 male [49.0%]) had a palliative care consultation with a PPS score documented. Of these patients, 2276 were seen in the inpatient setting and 3080 were seen in the outpatient setting. In both the inpatient and outpatient settings, 1-, 6-, and 12-month mortality were higher and median survival was shorter for patients with lower PPS scores. Prognostic estimates associated with PPS scores were substantially longer (2.3- to 11.7-fold) than previous estimates commonly used by clinicians. The PPS had good ability to discriminate between patients who lived and those who died in the inpatient setting (integrated time-dependent area under the curve [iAUC], 0.74) but its discriminative ability was lower in the outpatient setting (iAUC, 0.67). The PPS better predicted 1-month survival than longer-term survival. Mortality rates were higher for patients with cancer than other serious illnesses at most PPS levels. In this prognostic study, prognostic estimates associated with PPS scores were substantially longer than previous estimates commonly used by clinicians. Based on these findings, an online calculator was updated to assist clinicians in reaching prognostic estimates that are more consistent with modern palliative care practice and specific to the patient's setting and diagnosis group.

Combination immunohistochemistry for CK5/6, p63, GATA6, and HNF4a predicts clinical outcome in treatment-naïve pancreatic ductal adenocarcinoma

Although sequence-based studies show that basal-like features lead to worse prognosis and chemotherapy-resistance compared to the classical subtype in advanced pancreatic ductal adenocarcinoma (PDAC), a surrogate biomarker distinguishing between these subtypes in routine diagnostic practice remains to be identified. We aimed to evaluate the utility of immunohistochemistry (IHC) expression subtypes generated by unsupervised hierarchical clustering based on staining scores of four markers (CK5/6, p63, GATA6, HNF4a) applied to endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) materials. EUS-FNAB materials taken from 190 treatment-naïve advanced PDAC patients were analyzed, and three IHC patterns were established (Classical, Transitional, and Basal-like pattern). Basal-like pattern (high co-expression of CK5/6 and p63 with low expression of GATA6 and HNF4a) was significantly associated with squamous differentiation histology (p < 0.001) and demonstrated the worst overall survival among our cohort (p = 0.004). IHC expression subtype (Transitional, Basal vs Classical) was an independent poor prognosticator in multivariate analysis [HR 1.58 (95% CI 1.01–2.38), p = 0.047]. Furthermore, CK5/6 expression was an independent poor prognostic factor in histological glandular type PDAC [HR 2.82 (95% CI 1.31–6.08), p = 0.008]. Our results suggest that IHC expression patterns successfully predict molecular features indicative of the Basal-like subgroup in advanced PDAC. These results provide the basis for appropriate stratification for therapeutic selection and prognostic estimation of advanced PDAC in a simplified manner.

Flow cytometric profiles with CD7 and CADM1 in CD4+ T cells are promising indicators for prognosis of aggressive ATL

AbstractAdult T-cell leukemia/lymphoma (ATL) is a poor prognosis hematological malignancy originating from human T-cell leukemia virus 1 (HTLV-1)–infected CD4+ T cells. Flow cytometric plots of CADM1 and CD7 in CD4+ T cells are useful for separating HTLV-1–uninfected T cells and ATL cells. They are indicators of clonal evolution of HTLV-1–infected cells and disease progression of asymptomatic carriers or indolent ATL. However, the impacts of the plots on the clinical course or prognosis of ATL, especially in aggressive ATL, remain unclear. We focused on the N fraction (CD4+ CADM1+ CD7–) reflecting ATL cells and analyzed the flow cytometric profiles and clinical course of 497 samples from 92 HTLV-1–infected patients who were mainly aggressive ATL. The parameters based on N fractions showed significant correlations with known indicators of ATL disease status (soluble interleukin-2 receptor, lactate dehydrogenase, abnormal lymphocytes, etc.) and sensitively reflected the treatment response of aggressive ATL. The parameters based on N fractions significantly stratified the prognosis of aggressive ATL at 4 different time points: before treatment, after 1 course of chemotherapy, at the best response after chemotherapy, and before allogeneic hematopoietic cell transplantation. Even after mogamulizumab administration, which shows potent effects for peripheral blood lesions, the N fraction was still a useful indicator for prognostic estimation. In summary, this report shows that CADM1 vs CD7 plots in CD4+ T cells are useful indicators of the clinical course and prognosis of aggressive ATL. Therefore, this CADM1 and CD7 profile is suggested to be a useful prognostic indicator consistently from HTLV-1 carriers to aggressive ATL.

Subventricular zone-associated classification in isocitrate dehydrogenase-wildtype glioblastomas: improved prognostic value through integration of FLAIR with contrast-enhanced imaging.

Controversy surrounds the prognostic value of contrast-enhanced T1-weighted (T1CE) imaging-based subventricular zone (SVZ) classification in isocitrate dehydrogenase (IDH)-wildtype glioblastomas (GBMs). In this study, the authors aimed to assess the potential of incorporating FLAIR imaging into T1CE imaging-based classification for improving prognostic accuracy. A retrospective analysis was conducted on 281 patients with IDH-wildtype GBM. T1CE imaging-based classification was performed, and T2-weighted/FLAIR imaging was integrated to evaluate its prognostic estimation ability. Based on the relationship between the tumors and SVZ, patients were categorized into SVZ+ and SVZ- cohorts based on T1CE and T2-weighted/FLAIR imaging findings. Kaplan-Meier and Cox proportional hazards regression analyses were used to assess progression-free survival (PFS) and overall survival (OS), respectively. Patients were then categorized into three subgroups based on their combined classifications: group 1 (SVZ+ on T1CE and T2-weighted/FLAIR imaging), group 2 (SVZ- on T1CE but SVZ+ on T2-weighted/FLAIR imaging), and group 3 (SVZ- on T1CE and T2-weighted/FLAIR imaging). Subgroup analysis was used to evaluate differences in clinical and molecular factors as well as in prognoses. The T1CE imaging-based classification failed to stratify OS between SVZ+ and SVZ- cohorts (16.0 vs 20.0 months, p = 0.36). Survival analysis revealed similar prognoses for patients in groups 1 and 2, and patients in group 2 exhibited worse OS compared with those in group 3 (19.0 vs 23.5 months, p = 0.024). Logistic regression identified lower Karnofsky Performance Status (KPS) (p = 0.011), tumor diameter (p = 0.002), and telomerase reverse transcriptase (TERT) promoter mutation (p = 0.003) to be associated with a higher incidence of group 2 GBMs. Additionally, T2-weighted/FLAIR imaging-based classification provided significant prognostic value (17.0 vs 23.5 months p = 0.021) and was found to be an independent prognostic factor in the Cox multivariate analysis (HR 1.79, 95% CI 1.08-2.96; p = 0.024). This study underscores the limitations of T1CE imaging-based SVZ-associated classification in predicting prognosis for IDH-wildtype GBMs. The authors therefore propose an integrated approach that involves T2-weighted/FLAIR imaging that can provide improved prognostic ability. Notably, the presence of TERT promoter mutation was identified as a critical factor in nonenhancing tumor infiltration into the SVZ. Further validation through extensive cohort studies is recommended to confirm these findings.

What influences provision of information about recovery on stroke units? A focused ethnographic case study

ObjectivePatients and carers frequently report dissatisfaction with post-stroke information provision. This study aimed to develop an in-depth understanding of the factors influencing provision of information about recovery in stroke units. MethodsFocused ethnographic case-studies in two UK stroke units, including non-participant observations and semi-structured interviews with professionals, patients and carers, and documentary analysis. A Framework approach to analysis was undertaken. ResultsTwenty patients, 17 carers and 47 professionals participated. The unpredictable recovery trajectory led professionals to present prognostic estimates as uncertain possibilities. The need to maintain patients’ motivation limited sharing of negative predictions, and generic information over-emphasised the importance of therapy in recovery. A structured multidisciplinary team approach to delivering information improved consistency. Complex clinical reasoning was required to identify and meet patients’ needs. Hospital environments and routines restricted opportunities for dialogue, particularly with carers. ConclusionsThe process of providing information about post-stroke recovery is complex, requiring enhanced clinical reasoning and communication. The challenges faced by professionals are numerous and if not addressed can result in suboptimal provision.Practice implications: Professionals should develop a co-ordinated multidisciplinary approach to information provision; and engage in dialogue to ensure a tailored approach to identifying and meeting patients’ and carers’ information needs.

Abstract PO5-01-11: Breast Cancer Index and comparative analysis of late distant recurrence risk with results from the TEAM trial

Abstract Background: Individualized risk assessment of distant recurrence (DR) is critical for early-stage HR+ breast cancer patients, as prolonged risk of recurrence continues even after completing 5 years of adjuvant endocrine therapy. The Breast Cancer Index (BCI) is a guideline-endorsed, validated gene expression assay that provides an individualized risk of overall (0-10y) and late (5-10y) DR and predicts the likelihood of benefit from extended endocrine therapy. The current BCI assay reports prognostic risk estimates based on tamoxifen-treated patients from the Stockholm (STO-3) cohort for node-negative (N0) patients, enrolled between 1976 through 1990 and a retrospective cohort from Massachusetts General Hospital (MGH) for patients with 1 to 3 positive nodes (N1), diagnosed between 1993 and 2007, of which approximately 50% were tamoxifen-treated. More recently, additional validation was completed in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial, in which patients were enrolled between 2001 and 2006. Here, individualized DR risk estimates from the TEAM trial were compared with those from Stockholm and MGH cohorts. Methods: For the TEAM translational study, BCI testing was performed blinded to clinical outcome and BCI and BCIN+ risk scores were calculated as previously described. A total of 2910 postmenopausal patients with HR+ breast cancer, including 1285 N0 and 1625 N1 patients, who remained DR-free for five years were analyzed to determine the risk of late DR. Cox proportional hazard models using Breslow estimates were used to calculate the risk of late DR as a function of continuous BCI risk scores. Results: Late DR risk estimates from both the TEAM trial and the Stockholm/MGH cohorts are summarized in the table below. In N0 patients, comparison of 5-10y risk estimates of late DR observed in TEAM patients were higher than those in the Stockholm cohort for BCI scores less than 8.0, but reduced for BCI scores greater than 8.0. Risk estimates differed by 1.5% for a BCI score of 0 and -4.3% for a BCI score of 10. A similar pattern was observed for N1 patients between the TEAM and MGH cohorts, with risk estimates from TEAM trial being higher for BCI scores less than 8.0 but reduced for BCI scores greater than 8.0 compared to those from the MGH cohort. Conclusions: BCI prognostic validation in the TEAM trial enabled the characterization of DR risk that is more compatible with the current standard of care in the US, as postmenopausal patients were all treated with at least 2-3 years or 5 years of primary adjuvant endocrine therapy with an aromatase inhibitor. Results from the TEAM study provide a more representative assessment of late DR risk to guide individualized treatment decision-making for HR+ early-stage breast cancer patients. Table. Citation Format: John MS Bartlett, Yi Zhang, Gregory Pond, Jenna Wong, Keying Xu, Melanie Spears, Elizabeth Mallon, Karen Taylor, Annette Hasenburg, Christos Markopoulos, Luc Dirix, Caroline Seynaeve, Cornelis J.H. van de Velde, Daniel Rea, Adam Brufsky, Olle Stål, Dennis Sgroi, Catherine Schnabel, Kai Treuner, Jane Bayani. Breast Cancer Index and comparative analysis of late distant recurrence risk with results from the TEAM trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-01-11.

Otalgia as a Predictor of Cholesteatoma Formation in Chronic Suppurative Otitis Media

With its locally invasive nature, cholesteatoma has the potential to cause fatal complications. However, many remain undetected until advanced stages. Otalgia is suggested as the indicator of impending intratemporal or intracranial complication and is commonly presented before episodes of characteristic foul-smelling purulent discharge. As an earlier diagnosis of this condition is needed, this study aims to find whether the presence of otalgia has a prognostic value of cholesteatoma formation in adult patients with chronic suppurative otitis media. Literature searching using Pubmed, Cochrane, and ScienceDirect was done from the 12th to 16th of March 2022. Two articles were selected and appraised using the Center of Evidence-Based Medicine Oxford tool for prognostic study. Both studies retrospectively found no statistically significant patient characteristics or clinical presentation findings including otalgia that might guide the distinction between chronic suppurative otitis media on first hospital admission with and without cholesteatoma. Even though all studies have good validity, applicability, and precise prognostic estimates owing to their narrow 95%CI, considerable discrepancies between the two studies exist, therefore clinical interpretation remains questionable. Otalgia does not have a significant prognostic role in cholesteatoma formation in patients with chronic suppurative otitis media.

Abstract PO4-18-01: International Validation of a Staging Model for de novo Metastatic Breast Cancer

Abstract Background Given the heterogeneity in outcomes for de novo metastatic breast cancer (dnMBC), a staging system was recently developed that refines prognostic estimates for patients presenting with distant metastases (JCO 2023;10:2546). This staging model was developed using the National Cancer Database and stratified patients into 4 subgroups, termed IVA, IVB, IVC, and IVD based on 3-year overall survival (OS): IVA &amp;gt;70%, IVB 50-70%, IVC 25-&amp;lt; 50%, and IVD &amp;lt; 25%; the primary factors affecting higher stage grouping were negative for ER, PR, and HER2 expression and a higher number of involved organ sites. Here, we aim to validate this model using an international data set. Methods Data for dnMBC patients were obtained from the Netherlands Cancer Registry (NCR, hosted by IKNL), Epidemiological Strategy and Medical Economics (ESME) by Unicancer, British Columbia Cancer (BCCan), Instituto Nacional de Cancerología, México (INCan), and Grupo Español de Investigación en Cáncer de Mama (GEICAM); the diagnosis years included varied by organization (range 2002-2021). Stage groups were assigned based on previously published criteria, defined by T-category, grade, ER, PR, HER2, histology, organ system site of metastases (bone-only, brain-only, visceral), and number of organ systems involved. For each cohort, followup time and OS were estimated using the reverse Kapan-Meier and Kaplan-Meier method, respectively. Median rates were estimated across all cohorts by weighting on cohort sample size or number at risk. Cox proportional hazards models were used to estimate the association of stage with OS after adjustment for age at diagnosis (treatment data not available for all cohorts). For the ESME cohort, a subgroup multivariable analysis was used to estimate the association of stage with OS after adjustment for age, local (surgery or radiotherapy) and first line systemic treatments. Results The final validation cohort was comprised of N=11,199 patients from 5 international organizations: n=5063 (45.2%, IKNL), n=4139 (37.0%, ESME), n=774 (6.9%, BCCan), n=757 (6.8%, INCan), and n=466 (4.2% GEICAM). Median followup across all cohorts was 77.5 months (95% CI 74.3-80.2). Median followup (in months) for the IKNL, ESME, BCCan, INCan, and GEICAM cohorts was 45.3 (95% CI 43.6-47.1), 77.5 (95% CI 74.3-80.2), 105.0 (95% CI 95.9-106.5), 93.0 (95% CI 86.5-102.1), and 49.5 (95% CI 46.5-53.4), respectively. Patients were stratified into stage groups: IVA, n=603 (5.4%); IVB, n=5704 (50.9%); IVC, n=3356 (30.0%); IVD, n=1536 (13.7%). For all cohorts combined, the weighted average OS rates consistently decreased with increasing stage group; similar findings were noted for individual cohorts (all p&amp;lt; 0.001; Table). On multivariable subgroup analysis including age at diagnosis, stage group was significantly associated with OS, and the risk of death increased with increasing stage (all p&amp;lt; 0.001; Table). On multivariable subgroup analysis for n=4139 patients (ESME cohort), stage group remained significantly associated with OS [IVA: reference; IVB: HR 1.51 (95% CI 1.17-1.93); IVC: HR 2.11 (95% CI 1.64-2.72); IVD: HR 3.60 (95% CI 2.75-4.70)] after adjusting for age and treatment. Conclusions These findings provide external validation of the previously published staging guidelines for dnMBC. This may guide future revisions of the AJCC staging guidelines for patients with dnMBC and provide patients and providers valuable information in planning therapy and goals of care as they approach the end-of-life. Table. Citation Format: Jennifer Plichta, Samantha Thomas, Sabine Siesling, Linda de Munck, Amélie Lusque, Thomas Grinda, Lovedeep Gondara, Stephen Chia, Paula Cabrera-Galeana, Nancy Reynoso-Noverón, Sara López-Tarruella, Isabel Álvarez López, Stephen Edge, Gabriel Hortobagyi. International Validation of a Staging Model for de novo Metastatic Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-18-01.

Time estimates in prognostic discussions: A conversation analytic study of hospice multidisciplinary team meetings

Background: Recommendations state that multidisciplinary team expertise should be utilised for more accurate survival predictions. How the multidisciplinary team discusses prognoses during meetings and how they reference time, is yet to be explored. Aim: To explore how temporality is conveyed in relation to patients’ prognoses during hospice multidisciplinary team meetings. Design: Video-recordings of 24 hospice multidisciplinary team meetings were transcribed and analysed using Conversation Analysis. Setting/participants: A total of 65 staff participating in multidisciplinary team meetings in a UK hospice from May to December 2021. Results: Team members conveyed temporality in three different ways. (i) Staff stated that a patient was dying as part of the patient’s current health status. These formulations did not include a time reference per se but described the patient’s current situation (as dying) instead. (ii) Staff used specific time period references where another specific reference had been provided previously that somehow constrained the timeframe. In these cases, the prognosis would conflict with other proposed care plans. (iii) Staff members used unspecific time period references where the reference appeared vague and there was greater uncertainty about when the patient was expected to die. Conclusions: Unspecific time period references are sufficient for achieving meaningful prognostic talk in multidisciplinary teams. In-depth discussion and accurate prediction of patient prognoses are not deemed a priority nor a necessity of these meetings. Providing precise predictions may be too difficult due to uncertainty and accountability. The lack of staff pursuing more specific time references implies shared knowledge between staff and a context-specific use of prognostic estimates.

Candidate selection for lung transplantation - considerations beyond the medical evidence.

The scarcity of organs available for lung transplantation makes it necessary to develop consistent practices for candidate selection and organ allocation. Such policies are mainly built on prognostic estimations, which are again built on medical evidence. In addition, however, other factors also guide these practices. These factors are not always explicit. The purpose of this review is to discuss some of these factors. While one candidate may be considered to be in need of a transplant, the extent to which this need is weighed up against other patients at need varies, depending on how societal responsibility is conceived at the transplant center. Individual survival benefit may be in conflict with the concept of a just distribution of life years ('fair innings'). Furthermore, the need to expand medical knowledge, and the perceived patient autonomy and right to choose may affect the selection and allocation practices. Finally, financial considerations and nationality may have great influence. Although well trained in medical judgment, the clinicians' candidate selection for lung transplantation is often influenced by factors beyond the medical evidence. These factors should be discussed just as transparently and accountably as the medical judgments.

Predicting the complexity and mortality of polytrauma patients with machine learning models

We aim to develop machine learning (ML) models for predicting the complexity and mortality of polytrauma patients using clinical features, including physician diagnoses and physiological data. We conducted a retrospective analysis of a cohort comprising 756 polytrauma patients admitted to the intensive care unit (ICU) at Pizhou People’s Hospital Trauma Center, Jiangsu, China between 2020 and 2022. Clinical parameters encompassed demographics, vital signs, laboratory values, clinical scores and physician diagnoses. The two primary outcomes considered were mortality and complexity. We developed ML models to predict polytrauma mortality or complexity using four ML algorithms, including Support Vector Machine (SVM), Random Forest (RF), Artificial Neural Network (ANN) and eXtreme Gradient Boosting (XGBoost). We assessed the models’ performance and compared the optimal ML model against three existing trauma evaluation scores, including Injury Severity Score (ISS), Trauma Index (TI) and Glasgow Coma Scale (GCS). In addition, we identified several important clinical predictors that made contributions to the prognostic models. The XGBoost-based polytrauma mortality prediction model demonstrated a predictive ability with an accuracy of 90% and an F-score of 88%, outperforming SVM, RF and ANN models. In comparison to conventional scoring systems, the XGBoost model had substantial improvements in predicting the mortality of polytrauma patients. External validation yielded strong stability and generalization with an accuracy of up to 91% and an AUC of 82%. To predict polytrauma complexity, the XGBoost model maintained its performance over other models and scoring systems with good calibration and discrimination abilities. Feature importance analysis highlighted several clinical predictors of polytrauma complexity and mortality, such as Intracranial hematoma (ICH). Leveraging ML algorithms in polytrauma care can enhance the prognostic estimation of polytrauma patients. This approach may have potential value in the management of polytrauma patients.

Identification of fibronectin type III domain containing 3B as a potential prognostic and therapeutic target for pancreatic cancer: a preliminary analysis

BackgroundFibronectin type III domain containing 3B (FNDC3B), a member of the fibronectin type III domain-containing protein family, has been indicated in various malignancies. However, the precise role of FNDC3B in the progression of pancreatic cancer (PC) still remains to be elucidated.MethodsIn this study, we integrated data from the National Center for Biotechnology Information, the Cancer Genome Atlas, Genotype-Tissue Expression database, and Gene Expression Omnibus datasets to analyze FNDC3B expression and its association with various clinicopathological parameters. Subsequently, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes, along with Gene Set Enrichment Analysis (GSEA), single sample Gene Set Enrichment Analysis (ssGSEA) and estimate analysis were recruited to delve into the biological function and immune infiltration based on FNDC3B expression. Additionally, the prognostic estimation was conducted using Cox analysis and Kaplan–Meier analysis. Subsequently, a nomogram was constructed according to the result of Cox analysis to enhance the prognostic ability of FNDC3B. Finally, the preliminary biological function of FNDC3B in PC cells was explored.ResultsThe study demonstrated a significantly higher expression of FNDC3B in tumor tissues compared to normal pancreatic tissues, and this expression was significantly associated with various clinicopathological parameters. GSEA revealed the involvement of FNDC3B in biological processes and signaling pathways related to integrin signaling pathway and cell adhesion. Additionally, ssGSEA analysis indicated a positive correlation between FNDC3B expression and infiltration of Th2 cells and neutrophils, while showing a negative correlation with plasmacytoid dendritic cells and Th17 cells infiltration. Kaplan–Meier analysis further supported that high FNDC3B expression in PC patients was linked to shorter overall survival, disease-specific survival, and progression-free interval. However, although univariate analysis demonstrated a significant correlation between FNDC3B expression and prognosis in PC patients, this association did not hold true in multivariate analysis. Finally, our findings highlight the crucial role of FNDC3B expression in regulating proliferation, migration, and invasion abilities of PC cells.ConclusionDespite limitations, the findings of this study underscored the potential of FNDC3B as a prognostic biomarker and its pivotal role in driving the progression of PC, particularly in orchestrating immune responses.

(1099) - Predictive Models Refine Physician Prognostication: A Secondary Analysis Evaluating Integrated Model and Physician Prognostic Estimates in Heart Failure Patients with Reduced Left Ventricular Ejection Fraction

(1099) - Predictive Models Refine Physician Prognostication: A Secondary Analysis Evaluating Integrated Model and Physician Prognostic Estimates in Heart Failure Patients with Reduced Left Ventricular Ejection Fraction